04-017 (6) 582 KENNEDY RD BP-2017-0834
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 04-017 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN&BATH RENO BUILDING PERMIT
Permit# BP-2017-0834
Project# JS-2017-001396
Est. Cost: $57800.00
Fee: $375.70 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
useGSTEPHEN D ROSS 079160
Lot Size(so. ft.): 327571.20 Owner: HINCKLEY C RICHARD&JOANN
Zoning:RR(1OO)/WSP(100)/ Applicant: STEPHEN D ROSS
AT: 582 KENNEDY RD
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584-1224 0 WC
N O RT H AM PTO N MA01060 ISSUED ON:1/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN & 3 BATROOMS REMODEL
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: O1: 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 1/6/2017 0:00:00 $375.70
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
---- 1 Department use only
City of Northampton Status of Permit,
III Building Department Curti Cut/Driveway Permit
c 212 Main Street Se%eilSepbe Avaeability
ry Room 100 Water/Well A>1labi ,
to Northampton, MA 01060 Two Sets of StnictuiatPler
y
I phone 413-587-1240 Fax 413-587.1272 Plb" 3ite Plans
AOther Spg6#f
. -ApPLIOATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
L .__SECTION 1-SITE INFORMATION 1114 drenerlc
This section to be completed by office
1.1 Property Address',
5a Z. / J (
Lee°+ j Map Lot Unit
e.� ol,4
Zone Overlay District
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: / t �t
3u,-4..w f� i r5 C 6Z (--tar 5 `FZ. /C.",......,-d la t) i7 /171-..
Na : t) I Current Mailing Address: / 4.-e,
,' i^+)I�n e_ic-7/ Telephone
Signal e :J/j-
2.2 A/1 thorized Agent:
vice Ji> Ro r 5" 36 5-<v-ti:t ( cry /-0,— rzc1
Name{PnjA i1..-c.r...f Current Maeng Address'
�c!�_ �) t/\- /14`, 4 4•-•"--1014-'‘ -4/4,-4. o7x661
5I atur Telephone C/7} -S-p re 17 Z4
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
Completed by permit applicant
1. Building 4 r".'9 GctU (a)Building Permit Fee
2. Electrical / /)
Y . � (b)Estimated Total Cost of
(J Construction from(6)
3. Plumbing g /wu C' ' Building Permit Fee
4. Mechanical(HVAC) /` y
5.Fire Protection j
6. Total=(1 +2+3+4+5) ,Y 7/ g&o. ✓✓ Check Number !i/� 375"— 70
This Section For Official Use Only
Date
Building Permit Number Issued
Signature
Y ": / ^ : / `b - /7
Building Commissioner/Inspector of Buildings Date
SIN —52111
oi':^CF Hul¢Ims INSMZIOna
NO fie.::prON,MA WWI
SECTION 8-CONSTRUCTION SERVICES
8.7 Licensed Construction Supervisor: A Not Applicable ❑
Name of License Holder: 54-c ---- T- 1?-0-5- 7' /4' 0
y / 42490 / License Nu r
Tit S-( rt), c / (e ( /fp /G4/f- V Z s /
Address Expiration Date
Telephone;
r• yl s / 2/ / etc(
8-its •' ,� _• Home Improvement Contractor: Not Applicable 0
,+-
211--e- r P. e75 a -- 2 Can Ae.724. -7✓' / f9 gV
Co any Name Registration Numrer
.j-ter✓;
36 -t - - GZ c( ,.41- f0>ti.�, .vi.(-- Si /
Address Expirat Sig
Telephone 5-9v— / Z 2`t
SECTION 70-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.
Signed Affidavit Attached Yes 0 No 0
11. —Home Owner Exemption
The current exemption for"homeowners"ries 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 108.3ST.
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 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
pECTION S-DESCRIPTION OF PROPOSED WORK tcheck all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [C] Siding ICI Other ICill
Brief Descdyphon f Pfsofpposed I(� //
work (fir �L/'I..C� 1����✓-GU -.W.•,s yk,`2/7„0 [,
Alteration of existing bedroom Yes ___ Adding new bedroom YesNo
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
Ga.If Newhouse 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. Propo -• quare footage of•:w construction. Dimensions
e. Number ofst• 'es?
f. Method of heahn f Fireplaces or Woodstoves Number of each
g. Energy Conserv. on Compliance- l' Masscheck Energy Compliance form attached?
h. Type •f con otion
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
Is 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
r1— /�
"tC-K
L j O n 1,4"--1,4"-- / ,as Owner of the subject
property ° //. �/,,,�
hereby author -v{- ""'1-"t"t '. - 5-5
to act on my beha f,in/alKKKnnnai��d atiive to work Mori d by this building permit application.
( '. �. �� 1 � 17C1/ 7
Signature of m `f P Date
I. K-{(,0 ••"'r`-I.. 'V'- R-0 S 5 ,as Owner/Authorized
Agent hereby(lettere that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the ains and penalties of perjury.
e�H..L--- > Re 5-4
Prin me
if gyp , — /if l7
attire ofOvner/Agent Date(
Section 4. ZONING All Int rmation Must Be Completed. Permit Can Be Denied Due To Incomplete Information
_®® ReThisqunttdpto ar be men1{ing
umitsd in by
Building
Department
(tepartment
®s®
Setbacks Fmnt
Side 11111111111111
Rear
Bldg.Squ
Open Space Footage -®®-_
Rot area minus bldg&paved
arkin_
A. Has a Special Permit/Variance/Finding er been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES,date issued:
IF YES: Was the permit recorded at theReg' ry 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 V DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 obtained Q , Date Issued:
C. Do any signs exist on the property? YES O NO
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 eV
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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: 5 uZ (,C, . � ..� Rc .
The debris will be transported by:: /1/7- `co t v'r `'•-` c (t <
The debris will be received by: Vat
1
7—
Building permit number:
Name of Permit Applicant 51-e-c172-0- 5
Date Signature of Permit Applicant