31A-224 (6) 50 HARRISON AVE BP-2017-0812
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3 IA-224 CITY OF NORTHAMPTON
Lot: -OW PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2017-0812
Project# JS-2017-001361
Est. Cost: $98500.00
Fee: $643.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: SACKREY CONSTRUCTION 079384
Lot Size(sq. ft.): 9365.40 Owner: WEINSIER LAUREN B&STEVEN T
Zoning: URB(I00)/ Applicant: SACKREY CONSTRUCTION
AT: 50 HARRISON AVE
Applicant Address: Phone: Insurance:
83 SOUTH MAIN ST (413) 665-9995 O Workers
Compensation
SUNDERLANDMA01375 ISSUED ON::1/4/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL 2 BATHROOMS AND 2 BEDROOMS,
REPLACE 5 WINDOWS
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 1/4/2017 0:00:00 $643.50
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0812
APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION
ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLAND (413)665-9995 0
PROPERTY LOCATION 50 HARRISON AVE
MAP 3IA PARCEL 224 001 ZONE URB(100)1
THIS SECTION FOR OFFICIAL USE ONLY:
RERMIFAEELIC ON CHECKLIST
E CLOSED REQUIRED DATE
ZONING FORM FILLED O &, [3 o[
Fee Paid `�
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL 2 BATHROOMS AND 2 BEDROOMS.REPLACE 5 WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 079384
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 Permit DPW Storm Water Management
oie
der
r;se-- /""r V7
Signa r e g 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 Office of
Planning&Development for more information.
I
- -—- Department use only
_ City of Northampton �.� Sta of Permit:
Building Department A../ rb C. Driveway Permit
Lir L 2 212 Main Street i Zvi' - -r/Se. IC Availability
Room 100 AVell , ailability
- - Northampton, M' 110 `C'� .. of Structural Plans
__. hnn6 413-587-1240 Fax •13- 87-1 2 r ite Plans
1 her Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,"REN VA OR)DEMOLIISSHH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION //�T A` 7 �` /1:2:1/.1 8P_! 7- 7/L
O 2 Pi' ,fid G
1.1 Property Address:4t frn n This section to be completed by office
So SOiF-t 1\-V IL Map Lot Unit
Mpp_rit4n0-4.10-C41-01 iia A Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: .,I -
�( 5'k.1 e vi W 2 l vi 5 t e r 5-6r�-2
a oria- tc o.-P A-v i7. Wal- G,P
tl Name(Print Current Mailing Address:
- _z `tl3 - S9 &- 9YZo
Telephone
Signature
2.2 Authorized Agent: c
4s-, !4 - SA-C- 51 8-5 5. wu,ul.L S-t. Su1-oilerta,-LD
Name(Print) Current Mailing Address: O l 37 S
`I(3- 5. 473- c31
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 4olio (a)Building Permit Fee
6 512. Electrical -15w (b)Estimated Total Cost of
QS Ca Construction from(6)
3. Plumbing1 L �SDO ao Building Permit Fee
0-6 y3.so
4. Mechanical(HVAC)
oo
5. Fire Protection t 2. I 62Sa
6. Total=(1 +2+3+4+5) S 1 S r ,5-er0 Check Number it 150Z-
This
306This Section For Official Use Only
Building Permit Number: ep/q/i / 7 - fl//_ Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
t
Section 4. ZONING Alt Information Must Be Completed. Permit Can ore Denied Due To Incomplete Information
Existing .._
Requiredura to Zoning
This column to be filled in by
NI {,y BaiWine Depannamt
Lot Size NI P
FIN
Frontage
Setbacks Front
Side
Rear
Building Height 111111111.1.11
Bldg.Square Footage alliallIMINI
Open Space Footage
(Wr area minus M114&paved
11111111.11.1111111
ft of Parkin_S.aces _
.1
-�
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document H
B. Does the site contain a brook, body of water or wetlands? NO ot DONT KNOW (0 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 elle
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 lam/
IF YES, describe size, type and Location:
E, Will the construction activity disturb(clearing,grading, x vation,or lilting)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check ell aoolicable)
New House ❑ Addition ❑ Replacement Wi>iows Alterations) Roofing o
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O) Decks [D Siding(01 Other[CA
Brief Description of Proposed �}
Work: RiU-MOW Cz) ibplu,tckwt$ A t-W z) Sc D4ca% S - ttpLAc2 ( 5) wtI-s.4 Q5
Alteration of existing bedroom 01 Yes No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes ‘../- No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing. complete the following:
a, Use of building:One Family 1.7 Two Family Other
b. Number of rooms in each family unit: l Number of Bathrooms i
c. Is there a garage attached? 440
d. Proposed Square footage of new construction. Pe Dimensions
e. Number of stones? 3 , c
f. Method of heating?_.(EAS (-o? ... .... Fireplaces or Woodstoves FLS Number of each t
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction UAi F
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 (0
k. Will building conform to the Building and Zoning regulations? ✓ YesNo.
I. Septic Tank City Sewer ,,,_✓ Private well City water Supply 1/
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS�A^GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
J
Property TILItL WEL% 4S R14— ,as Owner of the subject
property { ``yy C
hereby authorize --10vrl-i P' r SA-
to
act on m h tf in all matters relative to work authorized by t is building permit application.
t 110
Signature of Owrfer-- Date
4 o L1-L-A 4� r Az_G sas Owner/Authorized
Agent hereby declare that the statements and informon on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
`•}4ikr4 k }t-C-(WR tt)
Print Name
Signature of O
t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of license Helder: 3a ._ CS - 011 38Y
License Number
`5,) 5, Vim/+-(, , t-4/)h2 i—I I o 1 I g
Addre OI 37 Expiration ate
Signature Telephone
9.Registered Home Improvement Contractor. Not Applicable 0
cAd),i GP-WI C.43a LLL 1!e-t 481
Company Name I Registration Number
73 5. U -Boit 5
Address Cy 137}/ Expiration Dat
[�
_ ..._—Telephone 7/356$-b 639
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,f 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building,permit.
Signed Affidavit Attached Yes ® No ❑
11. - home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 1883.$.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 at 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 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 Stale 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: 50 44 rt.t(S.,-P Avh, gatt e-AWf Cow, VA-d1/4-
The
&The debris will be transported by: IA)lc-Ica-1,S ttp-cjc_14,144
(s
The debris will be received by: )p L L , Rr2,G1r.0 Cr
Building permit number:
Name of Permit Applicant SA-e-Ai—Av, CART,- `-0 -
Date Signature of Perm' Applicant
•
The Commonwealth of Massachusetts
I :— Department of Industrial Accidents
=rel_t Office of Investigations
- h-_ z, 1 Congress Street, Suite 100
t WSW .c'
Boston, MA 02114-2017
51
.= www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): S Ac_p 1-f2.2„` Cy„SS(. Cps , UL( ,
Address: ca3 5 . M-A-144/ St. Se
City/State/Zip: , .3,.. z i-.t ) 14- O( ,7 s Phone#: 415 -i6 3 - (C, 3 9
Are you an employer? Check the appropriate box: Type of project(required):
L L`1 I am a employer with Jo 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. El New construction
listed on the attached sheet. 7. [Remodeling
2.❑ lam 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 comp. insurance.
9. ❑ Building addition
❑ We are a corporation 5. 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.] ' c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 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.
Contractors 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 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. ,,�1
Insurance Company Name: A , 1, 1 •/s ,
Policy#or Self-ins. Lia #: w!^�/�7i/t2 1- OLts. kket L— Expiration Date: ( 21 4I [ -7
Job Site Address: SO UUf- 14.5#1h(Svt-9 P'iii City/State/Zip: t'LS+�T tiG.O W-4-
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 c fy under t e pains and penalties of perjury that the information provided above is true and correct.
Simature: Date: .1 Z '1-1 11 [o
Phone#: 4t 5 e S '2 ` Ir C.`/ 1
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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
4 Other
Contact Person: Phone#: