30B-065 (3) 284 RIVERSIDE DR BP-2017-0782
GIS g: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30B-065 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch RepE BUILDING PERMIT
Permit BP-2017-0782
Project# JS-2017-001298
Est.Cost:$6800.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot size(sq.ft.): 6011.28 Owner PASSALACQUA BRANDT
Zoning:URB(100)/ Applicant: STEPHEN CAMP
AT: 284 RIVERSIDE DR
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527-7124 0 WC
EAST H A M PTO N MA01027 ISSUED ON:12/12/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVAL OF EXISTING PORCH & REBUILD IN
SAME FOOT PRINT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House1 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 12/12/20160:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0782
APPLICANT/CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413)527-7124 Q
PROPERTY LOCATION 284 RIVERSIDE DR
MAP 30B PARCEL 065 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMITAPPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM Ell LED OUT
Fee Paid
Building.Permit Filled out
Fee Paid
T t.e ' lonstruction: REMOVA OF EXP. ING Par &REBUILD fN SAME FOOT PRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 082531
3 sets of Plans t Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with alt zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information
Department use only
GS) City of Northampton Status of Permit:
�1'%
Building Department curb Cut/Driveway Permit' �. 212 Main Street Sewertcaptic Availability
O�„
�i{, y ,—'° �.- Room 100 wateKrve9 A,reilabBty
S.,
Northampton, MA 01060Two SetsofSWUYurel Plans
'phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
PPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
t.t Prooetty Address-
25, ..
dtlress: This section to be completed by office
q . d I „,,,, $r 474- •Pl wL Map Lot Unit
Gd eienL & MIA, oI a6 a Zone Overlay District
Elm St.District _ CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: r
, ✓,0 et 4x9tia iAt . 2c'y g,vc-5 ,p e Pe-.4-1.-c,
Name(Print) Current Mailing Address
X11 373'" BYO/
Telephone
Signature
Z.2 Authorized Agent: /
S f cel/614).7"- G7 >'y .A
Name(Pool) 7 Current triaging Address:
r / r2 ?- 27 ay
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant _
1. Building / (/^Uv (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3, Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Are Protection y� (), r76. Total=(1 +2+3+4+5) Check Number
70 46
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature:
Budding Commissioner/Inspector of Bulk$ngs Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
ff'SL'II Or Doors 0
Accessory Bldg. ❑ Demolition yy New Signs [C] Decks [q Siding[0] Other[0)
Brief Description of Proposed �7
work: Rsf *-/ cc- ivelg 64 4-% y�- eC,10,,A2 in lst^t Fdr
Alteration of existing bedroom Yes A/ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Se.If New house and or addition to existing housing. complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
a Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,as Owner of the subject
Property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner
te / J //1,�,�/J Date
I. yeYI /vhat (7411 .as Own
Agent he y tare that the statem is and information on the foregoing application are true and accurate,to the best of my nowiedge
and belief.
Signed under the pains and penalties of perjury.
fir fry..- _ A
Print Name
/2/z /L
Signature of• :r/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:I '//� Not Applicable 0
Name of License Holder: 5)1%1 n/ (/l/ito 0/2 fJ/
V License Number
94fAc7` c+r 74— f4s L-/ ✓ / 23— / 7
Address Expiration Date
i� /' oe27- 7/ ZX
/
S nature / Telephone
9.RegisteredHomeImprovement Contractor: Not Applicable ❑
S4"'0' u i 6,403, G4i7U1s94,--(5-141ri..' /3 r 2° Y
Company Name Registration Number
yL £Msr f S7,4-N�1y7✓-r._/ .3 -i3 -icr
Address Expiration Date
Telephone 327' 7)y
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the buildingypermit.
Signed Affidavit Attached Yes /y No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,oris intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the bulldintpermit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: JXY /gived 0,e- 07✓-1-'4--
The debris will be transported by: f✓1)6-kC
The debris will be received by: l/ot/l-et ,Yce p Ch-7-
Building permit number
Name of Permit Applicant G-J/ti,cvt 194117
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
—.—_— Department of Industrial Accidents
t t
e_ Office of Investigations
' 1 Congress Street, Suite 100
. _''`l=i= Boston,MA 02114-2017
Vim.tal" www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Bu(Business/Organization/Individual): [.y:2A,v vt/ 6,,'pf/J
/
Address: S„4f V .J/ -t ) V
Ci /State/Zip: A /ate Alt r772 Phone#: 7 - 7/ 2
Are you an employer? Check he appropriate box: Type of project(required):
1.irI am a employer with 2- 4. 0 1 am a general contractor and I
employees (full and/or part-time).
• have hired the sub-contractors 6. 9 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.jz Remodeling
ship and have no employees These sub-contractors have 8. 10Demolition
working for me in any capacity. employees and have workers' 9 9 Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 9 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.9 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: /40e._/40e._ fi//I'2+t✓ Cw.✓r2 t/' ('O _
Policy#or Self-ins. Lic.#:6 (�(� 2U4 - r 7 f /D 9- 7 Z Expiration Date: -- /' / 2
Job Site Address: ) 9 /17; €1‘767 6 ii)/Ci-4 City/State/Zip: 1/5 d Pint G 'e/ „1/44
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the p ins an
penalties of petjury that the information provided above istrue
true and correct
Signature: ,f� i- Date: /2 ` 2 - l
Phone#: ) 27- 2/2/
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To ; Brandt Passalacqua Phone-917-374-8801
Address : 284 Riverside Drive Date- 12-01-2016
Florence,Ma 01062
We hereby submit this estimate for-Front Porch
The job is to build a new front porch.
I will start with the demo and I will supply a dumpster.
There will be new concrete poured in sauna tubes were needed.
I will build the floor with all pressure treated lumber.
Railings will be pressure treated.
I will build a new roof to cover the same area as existing,
Architectural shingles will be installed for roofing.
Building permit is included in my price.
$ 6800.00 50%to start/balance upon completion
Contractor Supervisors License number 082531
Home Improvement Contractor Registration number 135204
I propose to supply materials and labor-in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted within 30 days
Authorized Signature __
Acceptance of proposal Signature /moi 1�
r
.e/(
-----'-' City of Northampton
Building Department
�! ✓� (7 Ptan Review
( ! ate Peg 2 Matn Street
( i Northampton. MA 01060
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