38B-216 (4) File# BP-2417-0203 -}{g
APPLICANT/CONTACT PERSON BRANCH DIANNE E Rs(1^,M5 p E2,.
firt
ADDRESS/PHONE 161 northampton st apt f EASTHAMPI'ON01027 (413)313-2685 Q Y
PROPERTY LOCATION 54 FORT ST
MAP 388 PARCEL 216001 ZONE URB(851/SC(16)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT,...A PPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
FeeZONINGai51
FORM FILLED OUT
Fee 06 ./1�
Paid (,�
Building Permit Filled out
Fee Pajd
Typeof Construction DEMO SFH
New Construction
Non Structu0+l interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PROENTED:
Approved t,4(dditional 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 Pemits 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 frmn ElmStreet Commission Permit DPW StormWater Management
/Demolition Demolition Delay ) tlism c_, co MM. USITJ
ejj;
Sig . ure of Buil rig Offcial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all 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,
Depanmentuse only i�
RECEIVED ChNNc mpton stousofPerm,
Eur Ina D ✓J2 ,megl Curb Cu Driveway Permit -
AUG
6 2010 2 2 Main Sreet See e,5 pticAvai1abmy
IW L
Room 100 Water/W ll Availability
�pr�•srth p0 MA 01080 Two Sem of Strucrural Plans
cevroceuunyira�c+lo'd-`•r 12-,v Fax 413587-1272 PlotlSle Plans -
NO F BLIT
Other s--
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
SY RT St Map of =
INbQTW+tow trit\ Zone 'CverlayDrstrc¢
EIm St Gstr c: - 'CB ostrct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
h(AhME 13RAh -1 o' • ti :.a stt t t o •
Ne e(Prinr) (� Currant Moping yddress. A.L_O • q
6y 4l? —113 —?••685 '�'�C T
IN
•• 41..t C,1�_ Telephone
Cnature
2.2 Authorized Agent'
KRISTEN QRRv141 93 West st ter 2,�lstRitimpron •
Name(Print)
Current Marling Address: O(CT.¢
Goath„13 -324-9Y91
Sig N�A
� Talephon5
SECTION 3 -ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost(Dollars)to be Offlraal Use Only
completed by permit applicant
1. Building (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
--
j 6. Total=(1 +2 +3 ,A+5) 01660 , Check Number / , 7 '/4
This Section For Official Use Only
Building Permit Number Date
saved'
gnature:
Building CommissionedInspestcr of Buildings Date
ma 1 _bQanc�$ diol b • c4wt.
Section A ZONING AR Information Must Be Completed. Fermis Can Be Denied Due To Incomplete Information
Existing I Proposed Required by Zoning
This column to he filled m by
auilding Derailment
Lot S¢e
Frontage
Setbacks Front ___ f_—
Side L _ R L R.__ -
Rear __. _._ - ---
Building Height
Bldg Square Footage — - % r -
Open Space Footage _
(Lot area mous bldg Se i __
part ng) _ —
p of Parking Spaces - ^-
• _.
(volume&Location) I f--- _
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
• 'ND Q. ..DON'.KhOW,'Q. .. . . l'ES' 0
IF YES, date issued:'
•
IF YES: Was the permit recorded at the Registry of Deeds? _
NO 10 DONT KNOW O YES F'�\_J
IF YES: enter Book I
l Pagel ! and/or Document#
L
B. Does the site contain a brook, body of water or wettands? NO 0DONT KNOW 0 YES Q w __
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued.
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: I..
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location '
E. Will the construction activity disturb(claaring, grading, excavaton. or filling)over I acre or is It part of a common plan
that will disturb over i acre? YES 0 NO 0
DYES, then a Northampton Storm Water Management Permit from the DPW is required.
o
SECTVOM 5-DESCRIPTION OF PROPOSED WORK(check all avpllcable)
New House Audition Repiacement Windows Alferayicn(s) l Pooling
Or Doors C
Accessory Bidg. ❑ Demolitdon n New Signs_ In] Decks [fl Siding[OI Other[p]
Brief Description of Proposed
Work D t'nb'1 al ZahSo 5,A, fkwciLy STeuavRs
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rall -Sheet
6a If NiW house end or addition to oms6i'¢1q hoq=i:iq;-cocnDVetethe 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
e. Number of stories?
f_ Method of heating? Fireplaces or Woodsteves Number of each
y. Energy Canson/at/on Compliance. Masscheck Energy Compliance form attached,
h. Type of construction
i. Is construction within 100 fl_of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
Depth of basement or cellar floor below finished grade
k. tali budding 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, P bitut E 11)12410(1.4 ,as Owner of the subject
property '/,,//��
hereby authorize KF\S1 e i
t act on my behalf,in all matte Iative t authorized by this budding permit application.
�� 2/i3�/
gnature of Owner e�y, p ry� Dat
.fir.' /,p'.,atjId'"gffipp°.�`�`✓,�.latltntln5tl` dF7s in?
KAos cv Roan+ as Owner/Authorized
Agent hereby declare that the statements and information bh tnaforegoing application are trr eyqd eswrate,to the best of my knowledge
and belief
Signed under the pains and penalties of perjury.
KIEStea. g anntA
Print Na e /J
��
(/}/�
9/1_04
Sig t e of 0 nerlAyFjy/ Date
I SSECTION 8-COPNSTRUCTION SERVICES
8.i Licensed Construction Supervisor. No:Applicable £
Name or Ucanse Holder
License Number
A(ttress 6pYadrn Owe
Signature Telephone
_ ..__ - ..
9. Registered Home Imuravement Contractor . Not Applicable £
Company Name Reaistral"ron Number
Address m --- Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.V„c.152,§25C(6)) I_
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 Ven £
-Th
l.
dcd
3&."= €boa e �9%%viler Exesab➢tios ii
The current exemption for"homeowners"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,wag±d that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.3.
Definition of Homeovv,ien: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
uj actur¢s.A person who constructs more than one home in a two-year period shall not be considereda ho neownpe .,
Such"homeowner shall submit to the Building Official,on afonn acceptable to the Building OfPeial.tharie/die shall be -
responsible for all such work performed under the building vermin r
As acting Construction Supervisor your presence on the job site will be required fromtirue to time,daring and upon
completion of the work for which this permit is issued,
Also be advised that with reference to Chapter 152(Yfirkers:Compmnsationj and Chapter 153 (,Liability of Employers to •
.
Employees for Eniuries not resulting in Death/of the Massachusetts General Caws Arh&tated,vou may be Hable fur�o $i. ` -
you hire to perform work for you under this permit
The undersigned"homeowner"certifes and assumes respofor compliance with the State Building Code,City of
Northampton Ordinance State and f veal out I,- nd fMassachusetts General Laws Annotated.
Homeowner Sigvatuute A aa.O*p,,;�s
l .e Commonwealth ofl'� ag'.`,'f1t. k5,fi15
.w ` ' De,.mat s/e ofThil: rWI,Accidents
�- ii r7'
ilk 1��1 - Office of Inv�esl -2 ons
Fy
iliimm xi)
619.9 Was3craad;.nm Stimme
1,1i
M1 _'r'` Boston, MA 02111 www.Elireg's.psv;`ith
'Workers' Compensation In:marmm eirmictNit: lE'Midens/Cohums'sou'e/EVectriciians/PiuunuC ere
Applicant Information Ck,ese Print Leteibly
Name (ptsinesstOromittatiom`Ln victual):
Address:
City/State/Zip: Phone M
Are you an employer? Check the appropriate box: Type of piproject(required):
1.7 I am a employer with 4. l_ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors
F. New construction
2.1 Z as a sole proprietor or pounce- listed on the attached sheet. 7. �{Remodeling
ship and have no employees These sub-contractors have 4. U Demolition
world,'n for me M.anycapacity. employees and have workers'
g9. Building addition
[No workers' comp. insurance temp. insurance.[
fequirectj 5. L We are a corporation and its I O,( Electrical repairs or additions
3 I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself No workers' comp. right of exemption per MGL 12. Roof repairs
insurance required.] [ c. 152, §1(4), and we have no
employees. [No workers' 1.3. Other_.. _.
comp.insurance required]
*Any applicant that checks box#1 muse also fill out the section below showing their workers'compensation policy information_
'Ho meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box roust attached an additional sheet showing the canna of the sub-contractors and state whether or not those entities have
employees if the sub-contactors have employees,they must provide their workers'comp.policy number.
—I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policymumber.and**piratiidh 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 agaunsr the violator. Be advised that a copy of this statement may be forwarded to the Office of .
Investigation'of the DIA for insurance coverage verification_
1 do herebyunderpains and ena 'es ofer'ua that the information proyideed above is true and correct
fY ��"J 7 Y 1
i mature. ._, Waaw_ 4 Date. V M;
Phone ll! 113 - 313-WIC- .
Official use only. Do not write in this area, to be completed by city or town official
City or Town: _ Permit/License It
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. C_it'y/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other ,
Contact Person: Phone#:
City of Northampton.
Ml Chll ',J,""15(air;
S a
fyVI ���4 C -3 'r'NT C Bz LDti3 t C 7fN.S S �1 :�
Fv ",„4FI 42 Harr st t M 'c..p 1 i13?_5 J rr r
Northampton, ua 0:060f-afgah y O
INSPECTOR
Louis Nesbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HONE OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780C14PF 108.3..4 to act as his/her
construction supervisor. The state defines "Homeowner"as, "Person(s) who owns a parte(on which
he/she resides or intends 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 shah not be considered a home owner."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that he building department be called to inspect work at various stages, which include
foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these insnections can result in failure to obtain a certificate of occupancy until the work can be
inspected. F
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as requir-.-n DELAY the project until such time as the proper permits
and .nspections are made
• . _ .._. - understand the above.
�f (Home.miner/resident's signature requesting exemption)
I ill call to schedule all required building inspections necessary for the building permit issued to me.
Date 9//311
4
Address of work location 5 y .R44 Si
•
ilorkht.vekon I MA
—. ._ 0(OfeD
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
acfivity 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: 5-9 .SRT 5-r
The debris will be transported by: Awahva$T 110..e4 G.-
The debris will be received by: Mut gal 4it-
Building permit number: 1
Name of Permit Applicant Kg- rep l—it cm.
P /3
. I �I
Date Signature of Permit Applicant
8:12:2018 Prim
Subject: Fwd: Fwd: 54 Fort St- Sewer Pipe Cap
From: David Veleta (dveleta@northamptonma-gov)
To: branchstudio@yahoo.com;
Date: Friday, July 8, 2016 1:01 PM
Forwarded Message
Subject:Fwd: 54 Fort St- Sewer Pipe Cap
Date:Thu, 30 Jun 2016 15:32:41 -0400
From:David Veleta <dvcleta n northanlptonma _or>
To:Louis Hasbrouck <Ihaabrouc kuorthamptonma_sov
CC:Charles Miller<c miller northaniptrmnmsor>. Rich Parasiliti <rp;irasili.ii « ❑onhnngnonnm.,_oe>,
61:mchstnd10 a vahoo.coni
Louis.
Please see the email and photo below and attached photo. the sewer department was not on site to inspect the
cap shown below but verified the stake in the field today and discussed the future connection with the contractor
as noted below. Based on the information provided, the DPW confirms that the sewer was capped off on
6/29/2016.
David
David Veleta, P.E.
Department of Public Works
125 Locust Street
Northampton, MA 01060
T: 413-587-1570 ext.4310
C: 413-320-0198
F: 413-587-1576
E: dveleta2 nor champtonma.gay
W: wv”.northarptonma.gov/dpw
Forwarded Message
Subject:54 Fort St - Sewer Pipe Cap
Date:Thu, 30 Jun 2016 14:49:25 +0000 (UPC)
From:kristen branch <branchstudio:a vahoo.coni>
Reply-To:kristen branch <branchsuulio:« y ahoo.com>
To:dceletaiv nolthanlptonma.sov <dVCletat•, nonhampionma_rov>
Hi,
Attached please find photo taken yesterday by Matt Gilmore, excavation contractor As you can see it is staked and this
stake is now about 18" out of the dirt, it was covered after capping. Chuck Miller in the bid. dept. is requesting a letter from
anon Nisi 19
/ 1(1 ;Al `.
A NiSource Company
995 Belmont Street
Brockton. MA 02301
August 4, 2016
To Whom It May Concern:
Our records indicate that the address below does not have gas
service from Columbia Gas of Massachusetts.
54 Fort St
Northampton, MA 01060
Thank you,
Heather Meunier
(508)580-0100 Ext 1342
Integration Center
Columbia Gas of Massachusetts
40 Sylvan Road.
Waltham MA 02451
5/23/2016
54 Fort St.
Northampton,MA 01060
RE: Service Removal for Building Demolition.
To Whom It May Concern,
this letter is to confirm that, per your request National Grid has confirmed
electrical service has been removed from 54 Fort St. Northampton, MA 01060.
If you have any questions or need further assistance, please feel free to contact
me at (50S)357-4778.
Sincerely,
C ,( )(zk_�u� 11 , e e-c )0 —,
Elisabeth Coleman
Customer Order Fulfillment
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