32C-183 (4) File# BP-2017-0243
APPLICANT/CONTACT PERSON STEPHEN CAMP ( e
ADDRESS/PHONE 46 EAST ST (413)527-7124 O /7 °2-`-'--
PROPERTY LOCATION 386 PLEASANT ST 'l ( 1-
MAP 32C PARCEL 183 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvpeof Construction: Rebuild rear porches and egress stairs for four apartments
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 082531
3 sets of Plans/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
Signature of Building Official 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 the Office of
Planning&Development for more information.
City of Northampton 5€ai s f Rermti r�„'e'" -, s� a "c�3V
a rivs+5' as taa1,Y Tay Cr
Z Building Department Wib qo v�Pernfiit-r "h ilia-lie;AUG 2 ��F 2di Main Street p pert ggalratitty -� a4as. t y
ewer
Room 100 —11 :Wete`r/ feYlvuvaila'fnllry "" -, x Na xP
IPi
P is yr t a -� >�trr{ ir.
DEPT
i Northampton, MA 01060 Tw' .Sets" ts1ruaa atP ues tv ro'- t xf i1 4 - `_
phone 413-567-1240 Fax 413-567-1272 PIotISIti Plans ib qtr '"r ,
APPLICATION TO CONSTRUCT,ALTER,REPAIR
SECTION 1 -SITE INFORMATION - -
1.1 Property Add ss: hdaxn�a d � isseygrLmattabrRm
3DD waip L nt} s`lI e"fed°Liby O
ff
iUcr
en
5N�/44‘....7crr�ha + msw, . � ii � yOimL��
1.overl�Y strr� . �
Le/i
c .
Elm^�5! District 1 Y ':r CgOmtnct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ph7X cry 7p/CGu//4z- ire /N.✓,.," ii /%d#W,4tY
Name(Print) Current Mailing Addre
zra- 7y7
Telephone
Signature
2.2 Authorized Agent:
CAV
1/4 1411-"Xl7r/e74-- 1,41547aJ a44--
Name(Pant) ,{/ // CurrenttMMailing Address:
Signature Telephone
SECTION 3—ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building -200- en (a) Building Permit Fee
2. Electrical (b)Estimated Total post of
Construction from(6)
3. Plumbing Building Permit Fee /C6.
4. Mechanical(HVAC)
5. Fire Protection J /�7 /
6. Total=(1 +2+3+4+5) 4-r2at • Check Number ,jdp '/T
• This Section For Official Use Only 'j>3
Building Permit Number: `"6/,7 i-Q 'g,l f3, • Dale
9slued:
Signature: - --
Building Commissioner/Inspector of Buildings Date
l�e4MPIM— qlo ti Ai/v9, Ce ,/
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
Lot Size i_ H 1 r— 1
Frontage L__._._J L_________ I L. ________J
Setbacks Front = 1 1---7
Side L: Rd 1 L:L I 111-1 I
Reat I ] I j
Building Height 1 —1 L__i
Bldg.Square Footage r-7 j 7 i -7 i
Open Space Footage
(Wt area minus bldg&payed L__--I [—I L__J = I J
parking) _
#of Parking Spaces 1 _ ii
Fill: .—
(volume&Location) !!
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO QJ DONT KNOW 0 YES Q
IF YES, date issued:)
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q -
IF YES: enter Book � j Page 1 and/or Document N� _I
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q . Obtained Q ,
Date Issued: 1 —!
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: ' '
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location: j 1
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 Q NO 0
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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E
�r�II Or Doors D Accessory Bldg ❑ Demolition Iqi New Signs [01 Decks Siding[01 Other[01
Brief Description of Proposed !'
Work: /fi fkre /x )511hry slot r°' - t
Alteration of existing bedroom Yes YK No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
5a IINew house and or addition t0 exi5tlnq 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
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
,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 Date
54-4-11w/ G ,as Ow prize.
Agent hereby decl that the statements and information on the foregoing application are true and accurate,to the best o - .^e.ge
and belief.
Signed under the pains and penalties of perjury.
Sir Name _.
SignaWre of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
§.1 Licensed Construction Supervisor: Not Applicable E�y(y9
Name of License Holder: las Or . .J w/ •
License Number
G/G Z1-4-31- ,5'1 -i.. 1Ay,/ r //-J3 — /7
Address Expiation Date
? r"i7-7/0y
S'r :ore Telephone
S.,Registered Hofne'lniprowarnent Contractor: in _ ,. , _ Not Applicable E
Seri
i / ,. aikii-25Y'w✓ 275-20 y
Company N1me Registration Number
Z/6 £V17rr24~- x.:4144,14 Abt, 3-/I- /7
Address Expiration Date
Telephoned-17'57/ 2
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25g6))
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.A. £
11rib:fame t3wnerEiemption
The current exemption for"homeowners"was extended to include Owner-occgp(ed 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 acct
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 he,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 beconsidereda homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
respgnsible for aft such work performed under the building permit.
As acting Construction Superrisoc 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. _
'`'. The Commonwealth of Massachusetts
.
-- Department of Industrial Accidents
2. to .'
s-�
.. g' Office of Investigations
1 -( N. 600 Washington Street
•
q� , Boston, MA 02111
"~ ^'# www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): (.+r
ss` W
Address: ` 6��77 gf1 S.7t'/�tn'�- Y -7
City/State/Zip: J_ ' S, 11., O 002 Phone#: 52-7 - € ? ,7____.
Are ou an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I=a general contractor and I 6. ❑New construction
employees(full and/or part-time).` have hired the sub-contactors
2,❑ I am a sole proprietor orpartner- listed on the attached sheet 7. 'Remodeling
ship and have no employees These-sub-contactors have g. Demolition
workingfor me in anycapacity. employees and have workers'
P ty. 9. ❑Building addition
[No workers' comp. insurance - comp. a corporation 5. El We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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.❑ Other
. comp. insurance required.)
"Any applicant that checks box#1 rust 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 anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the nam of the sub-contractors and state whether or not those entities have
employees. If the sub-contactors have employes,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 nn,,rr �J
Insurance Company Name: /`l(.{ /Y/1`l enC w./ r4�%f• CV, /l 7
Policy#or Self-ins.Lie..#: ( 'r 2 L/ '� 5:89617 Z Expiration Date:A/% �/— //
Job Site Address: _??-67- l/€4,.(4.,....-/--- 371C; City/State/Zip: /[/6/7"k✓I/ /44. O/OG 2'
Attach a copy of the workers' compensation policy declaration page(showing the policy number an 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 f this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under eh pains a penalties of perjury that the information provided above is true and correct
Signature: (� Date: �//6//d
Phone#: J A 7 -7/ 7
Official use only. Do not write in this area, to be completed by city or town official
Cstot 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#:
Versionl.7 Commercial Building Pentad May 15,2000
•
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required • Yes (,) No 0
SECTION 11 OWNER AUTHORIZATION-TOBE COMPLETED WHEN ''I
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, c _ as 0 er of the subject property
.hereby authorize—_____________
act on my behalf, ' alters relative to work authorized by this building permit application.
I
Signature ofDate
f owner " �
I _,_„.�1 �,.y�• r - ,as Owner/ nzed n
Agent hereby declare that the statements and informationortthi-foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the and penalties of perjury.
P nt Na
'acre of Owner/Agent
rr
SECTION 12 CONSTRUCTION SE- ICES
/
10.1 Licensed Construction Sup. ison. _. _--- • • •• --- -
t _. !
Name cif License Holder:1.�_. - '��-�_ / !i--- --- !._L 7(. -
License Nu ber
-- i 4 r 571 f ' 0 /2-+A- I l 2,7 l7
Address Date
�. e Ex! sL 7 J/ Zy
Signature _ - elephone
SECTION 13-WORKERS'COMPENSATION INSURANCEAF IDAVIT(MAL.c.152,§-25C(6))
Workers Compensation Insurance affidavit must be completeH and submitted with this application. Fa ure to provide this affidavit will result
in the denial of the issuance of the uilding permit. (�
Signed Affidavit Attached Yes No a
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To : Felix Grygorcewicz Phone- 250-8743
Address : 388 Pleasant street Date- 7-17-2016
Northampton, Ma 01060
We hereby submit this estimate for-Porch Re-build
To start I will support the roof and demo the porch.
I will pour concrete in sauna tubes as needed.
The new porch will be built with all new pressure treated lumber.
I will build new stairs and new railings at code required heights.
Building permit and trash removal is included in my price.
Price= $4200.00 Each
Inte .r water damage-
The b. hroom ceiling will be stripped an. ew sheet rock
Will be ' . led,taped ready for pai
The floor wi . stripped and .: - plywood will be installed along with linoleum to
Be glued down.
T will install new b. =.oard to finish the job.
Price= $ C+0.00
Con .• or Supervisors License num.= 082531
. . e Improvement contractor Registratio • ber 135204
I propose to supply materials and labor-in accordance with above specific.ions.
This proposal may be withdrawn /A /
By us if not accepted within 30 days Authorized Signature SS .j
Acceptance of proposal Signature i + _ `r�
5c` x z ! f0 /1 A- 9e4.)0N,c✓ zco- o?.yei
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Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
I request that you grant a modification to waive the requirements for control construction
for the porch re-build at 388 pleasant street in Northampton because the work is of a
minor nature, will not affect health, accessibility, life and fire safety,or structural
requirements and is impractical in that the cost of control construction is considerable
when compared to the cost of the proposed work.
Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an
exclusion from control construction for this project"
Respectfully, Stephen Camp
Stephen Camp Construction
46 East Street Easthampton, Ma 01027