18C-163 45 WARBURTON WAY BP-2017-0849
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 163 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2017-0849
Project# JS-2017-001420
Est.Cost: SI000.00
Fee: 565.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM PATENAUDE 97317
Lot Size(sq.ft.): 0.00 Owner: LEVINE SUSAN
Zoning: URB(100)/ Applicant: WILLIAM PATENAUDE
AT: 45 WARBURTON WAY
Applicant Address: Phone: Insurance:
32 TERRACE LANE (413) 348-8245
NORTHAMPTONMA01060 ISSUED ON:I/10/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE & REPLACE TILE, PAINT AND
REMOVE TEXTURE ON CEILING
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 1/10/2017 0:00:00 565.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
I 0 2011j I Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
-- Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PIoVSite Plans
Other Spedty
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
/49 Vill( u( ti\) fAX4A1
!, / Map Lot Unit
Noakcu i Py U�)/ MP - V 1DIOO Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) e-'Q-A±-1-4jCtrrnti Petitsg tdr
one-
ignature
2.2 Authorized Agent:
tsil1/i4-wt ?Ai e../•)w-0pg" 60Z 9krS` 44T-6e7SAAoeo4g
Name(Print) Current Mailing Address:
/� 1(i3-3L08a4 S
ignature J Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official 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 `/h/
4. Mechanical(HVAC) �-/
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number/(JOe
This Section For Official Use Only
Building Permit Numbe Date
iiilslued:
Signator‘ if / /t�Ad/ 7--/4 -/'
Bui sing Commissioner/Ins• star of Buildings Date
f0CW
Section 4. ZONING AU 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
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage Ye
Open Space Footage
(lit area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findi g ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Re istry of Deeds?
NO O DONT KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW eca 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 O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and Location:
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
pECTION$•DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) {3 Roofing n
Or Doors O
Accessory Bldg. D Demolition ❑ New Signs [C] Decks [q Siding[C] Other[Cl
Brief Descmrip^tio�^n_of,-Proposed ((}}��,, . -n IL pp QJ
Work: 1larialOW' 9roD /[Wfttl.Q (7 ieietseq abaci
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil -Sheet
sa.If New house and or addition to existing housing, complete the following:
a. Use of building: One Family Two Family Other Y°' V11t1ff�+92-"
b. Number of rooms in each family unit Number of Bathrooms i tt2
c. Is there a garage attached? I(J D
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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
S643 L.L'uhve. ,as Owner of the subject
t
property n_ l..
7 Ge-trop,hereby authorize Wli1iani p41b`kfra hn is "c6i',^.'..'r"i 41r� gc."`v0_.If pl LL"
to act m my behalf, in all matters relay- to work authorized by this building permit application.
4 4 It _ t, . �, ] /4t?
^ir" re of Ovmer Date
tr
I, a A 'Id tit1C e ♦ .as OwnelAuthorized
Agent hereby declare that he 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 of perjury.
is [(ia�i pone
Print Name
err. I. ( ilio i7
Signature a Owner/Ages Date
SECTION 8•CONSTRUCTION SERVICES
0.1 Licensed Construction Supervisor: {^y Not ApplicableQca0
se
Name of LicenMolder: �eit/Art QA-TfiJ _ + `'5
...__ '1
License Number
(p2 `DM . • ' .41 (Mkt . at38 /2_ke l t
Address expiration Date
r�
III 3YV88)tS
igna 1 Telephone
S.Registered Home Inlprevement Contractor, Not Applicable 0
Less i ' 114‘,
0:minim Name Registration Number
mz vegig w'r S'r-. 4A-reit I d rho .aro 38 01,31 t?
Address p Expiration Date
[�
Telephone 1133(1892(6
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,§25C(8))
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 X No O
11.- Home Owner Exemption
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,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 helshe 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 Chan one home in a two-year period sball 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 building permit.
As acting Construction Supervisor your presence on the job site wilt 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
The Commonwealth of Massachusetts
;� Department of Industrial Accidents
l -S
Office of Investigations
ciimI Congress Street, Suite 100
Boston, MA 02114-2017
-" www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly ``,,��
Name(Business/Organniizzation/Individual): JUIe-1.. S i(jp� Remodel phi Rekf� CYIIC
Address: ,Z /51An cr )'--
City/State/Zip: " • (' 414. 0/Q 38" Phone #: _ 13 3:1&82
Are you an employer? Check the appropriate box:
Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. f�Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity- employees and have workers'
[No workers' comp. insurance LL comp. insurance. 9. ❑ Building addition
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work III"' officers have exercised their I1.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.111 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
'I lomcowners 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 must attached an additional sheet showing the name oldie 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:
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 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
/1k- r r' d penalties of perjury that the information provided above is true and correct.
Stature: /!v •/ ( I� Date: I/Jo/n
Phone#: ti/3 3( p t V-/S
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):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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: VS GlitutiunThd GAY
The debris will be transported by: /194fS T?gyw.!77r4- f
The debris will be received by: alrerA4TIX CL/ Ai Cory,S
Building permit number:
Name of Permit Applicant C,-2111„ar-1 VPr cwde
[NM /A' Ar ` eil
Date Signature of ermit Applicant
A
- - Massachusetts -Department of Public Safety
j. Monl(el r'imi - 'Board of Building Regulations and Standards
12-C,,„,_...12-C,,„,_... IItV�4lat i Construttiml Supers iwr a
This isto certify that License: CS-097317
T ,
Will Patenwide
,.
WILLIAM PATE[j\ C.
has successfully completedf
WINTeO Silver Certification Trainingael X13
y; September 2011 6 i'ls=
SY.� - .5.2.,••Jl' n w es Expiration 1
bdad T( er ID87943 Commissioner 021% %
Atwater Assotates Pa yy,,��I'L�
140 Atw #mnae,9pnneRe1d.MA 01107 (4231-ranroearr.
This certifies that 214-'12c -m!!/cirti/(,. M./umdw
`
William Patenaude Olive of Consumer Affairs&B sins Regotadou
% NOME IMPROVEMENT CONTRACTOR
32 Terrace sane.Northampton, MA MA 01060 (= i.�legIstration:
IiReas Renovatssfunyor
Icnial fated - I2'. Expi 120172 Type:
Lead RPrrovarorP Inhial English a;.'��u Exairdtion: .&3/2017 OBA
Ps 40 OA Pal 745.115 """�
Certification tit: R-I-19835-10-00107 j WILL'S RESIDENTAL REPAIR&REMDELING
Come fm.;4/33R010
r.Egeati6r Dm 4/13/101S 2 WILLIAM PATENAUDE '
222 RIVER RD 4 • __`
= - . . WHATELY,MA 01373 '
Stott labor trate a.gron^ .Tran., , Undersecretary