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38A-144 (5) 9 LAUREL ST BP-2017-0830 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38A- 144 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2017-0830 Proiect# JS-2017-001387 Est.Cost: $10200.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KUEL MCQUAID 051394 Lot size(sa. ft.): 12545.28 Owner: PAIK MEGAN Zoning: Applicant: KUEL MCQUAID AT: 9 LAUREL ST Applicant Address: Phone: Insurance: 131 FERRY ST (413) 537-5063 O EASTHAMPTONMA01027 ISSUED ON:1/5/2017 0:00:00 TO PERFORM THE FOLLOWING WORK FINISHING WITH WALLS AND SHEETROCK PART OF BASEMENT 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 1/5/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck -Building Commissioner File#BP-2017-0830 APPLICANT/CONTACT PERSON KUEL MCQUAID ADDRESS/PHONE 131 FERRY ST EASTHAMPTON (413)537-5063 0 PROPERTY LOCATION 9 LAUREL ST MAP 38A PARCEL 144 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out '7 (pp) Fee Paid Typeof Construction: FINISHIN WTIH WALLS AND SHEETROCK PART OF BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 051394 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN OR ION PRESENTED: pproved 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 9-/ 7 Sign. ire of Buildi g 'al l 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. -»e u City of Northampton C-1En.tr14,ti - _ 4 JAN Building Department 212 Main Street ti,_; 1 r17.4gtttikj -- �_.. Room 100 k?R?r.1 t�ttL � Pu{ '^s Northampton, MA 01060pX` ^�) phone 13-587-1240 Fax 413-587-1272 � 1 P tiaa�.a4a '+ 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 pic 9 LAU Rt s 1 _ Map. Lot Una. ht ' t - 010,6 Zone Overlay District V Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT may/ 2.1 Owner of Record: � -' Ne4apt PI k `( l4-) c4 Jr- ,(6 M/1 Name(Pri ) Current Mailmg Address: -yl(ph2A,t ��q (t 4 ? Z(4 6 ti Lt< J Telephone Signature ,c /: QYIket(fl7�717CcjI-1N�,coal 2.2 Authorized Agent: /we.( l�4(_ Qua;o l3 ( tc raj Sk- E-R-s akken Ai-1 Name(Print)/> `/� �` Current Mailing Address 0 2 j 4-13-S37- Co Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building -4o D (a)Building Permit Fee 2. Electrical L Il c O (b) Estimated Total Cost of _l Construction from(6) 3. Plumbing Building Permit Fee 7/ lr 4. Mechanical(HVAC) O✓ 5 Fire Protection eye 6. Total=(1 +2+3+4+5) /(Jr k, -- Check NumberaeR , ! This Section For Official Use Only Building Permit Number: Date �� Issued: Signature: ///� /— Sl ingCommissioner/Inspector of Buildings Date 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 1 _I f__ ._-_... f .. ! Frontage _._1 I I __ _. _ Setbacks Front —" --'"—I Side L::_ I R:l I L:L— i R:[-1 f Rear I 1 1 1 -- — Building Height '1 1 _ Bldg.Square Footage % Open Space Footage oe _ — - (Lot area minus bldg&pved i J ......_._.I parking) .. _ #of Parking Spaces I- I [—id I j Fill: (volume&Location) — i _ A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO O DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O Pager1 �1 and/or Document#L IF YES: enter Book � L B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW l:/ YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O , Date Issued: I 1 C. Do any signs exist on the property? YES O NO ele 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 e IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exc tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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) pre Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [0] Other[0] Brief Description of Proposed v w'` t L f bt t Work: r 1.4-.4% a- ettLel S Yco3c, fa-drO't Alteration of existing bedroom Yes No Adding new bedroom Yes /' No Attached Narrative Renovating unfinished basement v/ Yes No Plans Attached Roll -Sheet 5a: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 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 CONTRACTORpAPPUES FOR BUILDING PERMIT Pit I, tt C64A IIS- as Owner of the subject property // , I hereby authorize /\✓� (V` C (Qt.,:to act on my behalf, in all matters relativetto work authorized by this building permit application. -W /111/1 �GLUk- Signature of Owner Date //�� /l�e- !;Q t `L Q✓a t as Owner/Authorized Agent hereby declare 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 of perjury. Ki/L-( C QULt :G4 Print Name A 2/?// 7 Signature of Owner/Agent Oat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Superv[sor: Not Applicable ❑ Name of License Holder fyv e- `k L a'✓ C-'2 — o 31 License Number L ( cerci Ea_9A,+katLA\p4-00, Al 1 / 2otR Addrej� , q �,' Q(oar Expirati n Date Signature Teiephone litiG a��=6tt)Ct®y;,�A,t. .mar'/- CC UA S:Rep/Shred Home improvement Contractpr. ,_ Not Applicable 0 Y,ue_t lei C 4ue,t\t� 1 ob7oo Company Name Registration Number re 4 gmac-t-katt,t�P�aL7 Al A 7 J Z I2ta1A Address ..-- ofoZ. 7 Expir tion Oat Telephone 1113-S37-hoe 3 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 building permit. ,,r Signed Affidavit Attached Yes....... ❑ No CSY 11. - Home-Owner'Exemotion 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 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 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 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 Iaws 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 rte State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Taws 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: 9 La✓ca S-- A c ri A The debris will be transported by: KJ AAc cua The debris will be received by: o,kLi 12ec2c� e Building permit number: G Name of Permit Applicant {Cve.-( c a € (/ //3)'7 4 &e.1/ Date Signature of Permit Applicant The Commonwealth of Massachusetts �p Department of Industrial Accidents 1, Office of Investigations Ai1Congress Street,Suite 100 iit Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j� ,t MPlease Print Legibly Name (Business/Organization/Individual): {Uve_( 1 M. C _ Address: )3 ) rt.c s r7 s'1`t tek-- • City/State/Lir: A O 1O z- Phone#: (3 - 5 3 ? - <-O C Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I femployees(MI and/or part-time).* have hired the sub-contractors 6. ❑N w construction 2. +[� I am a sole proprietor or partner- listed on the attached sheet. 7. ErRemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance. required] 5. ❑ We are a corporation and its 100 Electrical repairs or additions officers have exercised their 11.0Plumbing❑ 1 em a homeowner doing all work re a p us or additions myself. [No workers' comp. right of exemption per MGL 12.10 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 checks box NI 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. tContmetors 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 he sub-contractors have employees,they must provide thea workers'comp.policy number. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and,job site information. Insurance Company Name: Policy if or Self-ins Lie.d: 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 cert under a pa'.. and penalties of perjury that the information provided above is true and correct Signature: do /'/7- /_.... Date; i/ 3 _i ! Phone#: 413 7 .?- 3 7 - o 3 i 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#: „---7„2,-(,-7. /_17. 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