Loading...
22B-034 16 CORTICELLI ST BP-2017-0741 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:228-034 CITY OF NORTHAMPTON Lot:-00] PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Siding BUILDING PERMIT Permit s BP-2017-0741 Project JS-2017-001234 En.Cost: 57000.00 Fee:$60.00 PERMISSION IS HEREBY GRANTED TO: cost.Class: Contractor: License: Use Group: BENJAMIN GREENE 96066 Lot Size(sq. RI: 10193.04 Owner ROSENFELD EMILY A Zoning:URB(100NWP(44)/ Applicant: BENJAMIN GREENE AT: 16 CORTICELLI ST Applicant Address: Phone: Insurance: 47 Chapin Street (413)374-9826 () EASTHAMPTONMA01027 ISSUED ON:121212016 0:00:00 TO PERFORM THE FOLLOWING WORK:REAR ENTRY TRIM & SIDING APPROX 250SQ FT CEDAR CLAPBOARD 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: House 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 12/2/2016 0:00:00 560.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner - "An -.�� „? City of Northampton ev.,. Budding Department LF` ifigm7:r• s. p- ,>v� 212 Main Street � a a 4'° rs,k Room 100 Sl :%q � F ,x-� �'4,a "s"1 , .' '" Northampton, MA 01060 st Y __ phone413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATEORR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION (6P- r/ - 74/ 1.1 Property Address: This section to be completed by office lb Col had; s/ Map Lot Unit Rua nu. ✓n* pypa Z Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: vc; . ll (0r/ca/L•• C t Name(Print) Current Mailing Address' y/7 - 2j0 -4' 37- Telephone Signature 2.2 Authorized Agent: i 6 etc y C6cgP�4 $tEaS144H+ri4y44l9- 0104 Name(Pnn Current Mailing Adohhess'. y13- f-t -992' Sign:Lire r Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building poo .- (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 1]( p 6. Total=(1 +2+3+4+5) j/ 000 — Check Number , 4±,C.� /�' This Section For Official Use Only / Building Permit Number: Date Issued: /J / Signature:, s���� - Building Commissioner/Inspector of Buildings Date Y Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled In by Building Department J Lot Size r ___ _.. .1 r I _... ____..__ Frontage __ _ I L__ 1 F ._._ Setbacks Front I- F 1 I._ I Side L:1____1 R:I_ _ ] L:_— _.I RFT] L_ I Rear L_1 . Building Height L_I Bldg. Square Footage r_. , L .] ° C r_...._I r_ ._.] Open Space Footage % (Lot area minus bldg&paved t H r' I_ ] r I [1-_____I parking) #of Parking Spaces Fill: (volume&Location) — — I1 —fJ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 1Q YES IF YES, date issued: _ H IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 YES O IF YES: enter Book 1 Page l and/or Document#L B. Does the site contain a brook, body of water or wetlands? NO 7Cx DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: f D. Are there any proposed changes to or additions of signs intended for the property? YES O NO iQ IF YES, describe size, type and location: I I E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 7(d"!� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors C Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Il Siding O) Other[o) Brief Desorption of Proposed Work: Ma/ WA./ 4- Cik4417 ffie 2t0 Sy iCee-f a6141C4ithare67 Alteration of existing bedroom Yes NC No Adding new bedroom Yes A No Attached Narrative Renovating unfinished basement Yes K No Plans Attached Roll -Sheet 6a If New house and•or addition':to existing housing,tornptete thefollowinq: a. Use of building : One Family X 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 e. 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 I. CL An. Sc y. 1-f- ,as Owner of the subject property �,7_ hereby authorize / 4 41 u?in 'eP'`f'e to act on my behalf, in all matt rs relative to work authorized by this building permit application. rr i2 • / • / c Signature of Owner Date 1, y���/77 CN C1*In 0-es N e— ,as Owner/Authorized Agent hereby ddclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties/_alof perjury. gjeNe gPin h &a..c Print Name Signature of Owner/Agent Date 2-// SECTION 8•CONSTRUCTION SERVICES 8,1 Licensed Construction$#ervisor Not Applicable ❑ Mil asks b7M4z 6-a 6 66 Name M License Holder: / ,6rt n .c ? c� license Number v c!,'_ 4tinf itSf- Eastksvi1fon 'MIL oto07-- 9-aftpg Address 11,7 - 77et—/I1Gt? Expiration Date Signature Telephone email ' 6(eeM a Iestarfion ' •✓011. Owl • 9.Resister d Homelmorovement Contractor; .. i Not Applicable 0 We-i G/ea e. (SS" :l3 Company Name ,�^^ Registration Number bteeElC- 6.410 an 6R?t,. lryy'' 5// 7' Address? i ( ¢1u�, y Expiration Date L/ 0(gp/d S! �SHMO.'1 001- Telephone yf3(xl /FGa 117-01§, O/0 1- SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(61) 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 building permit. Signed Affidavit Attached Yes No 0 11: -tfometOwner Exemption The current exemption for"homeavners"was extended to include Owner-occupied Dwellings of one(1) 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 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is 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 acne¢table to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will he required from time to time,duringand upon completion of the work for which thispennit 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 Nay be liable for persons) you hire to perfonn work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with tie 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: /a (0/Re4' sF The debris will be transported by: Odietc -or The debris will be received by: Vtii11 14-‘16b47 Building permit number: Name of Permit Applicant F¢..t 6/tewe- 121211 b Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I l Office of Investigations _' v 1 Congress Street, Suite 100 1�= Boston,MA 02114-2017 � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly bit Name (Business/Organization/Individual): (rf�croft/1 lite l4R-- Address: 41* tCkte-" Ol0 City/State/Zip: I Ahgin' S .i pa� Phone #: 37196 Areou an employer?Check thearopriate box: YP• Type of project(required): I.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.[X am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. II] Building addition [No workers' comp. insurance comp.insumnee.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.11I Plumbing repairs or additions [No workers myself. ' comp. right of exemption per MGL yt c. 152,§I(4),and we have no 12.0 Roof repairs / insurance required.] Oth.7. er25� 64 Si417 employees. [No workers' 13 � / comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t 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 hose 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: Policy I/or Self-ins. Lic. 4: Expiration Date: Job Site Address: City/State/Zip: 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 MOL 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 to pains and penalties of perjury that the information provided above is true and correct Si.nature: . Date: Z Phone N: W3 3-*7 feu Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License P 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 It: