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38B-195 (8) 50 MANHAN ST BP-2017-0873 GIST: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B- 195 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2017-0873 Project# JS-2017-001472 Est.Cost: $60000.00 Fee:$120.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GOUGEON BUILDERS 075029 Lot Size(sq.fl.): 7448.76 Owner: ALBRO-FISHER BENJAMIN& BETHANN ALBRO-FISHER Zoning: URB(I 00)/ Applicant: GOUGEON BUILDERS AT: 50 MANHAN ST Applicant Address: Phone: Insurance: 126] HAWLEY RD (413) 625-9337 WC ASH FI ELDMA01330 ISSUED ON:1/20/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD 6'X14' ENTRANCE AND 12'X13' SCREEN PORCH 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 1/20/2017 0:00:00 $120.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner cc File#BP-2017-0873 �O r APPLICANT/CONTACT PERSON GOUGEON BUILDERS O ,>�/'" ADDRESS/PHONE 1261 HAWLEY RD ASHFIELD (413)625-9337 J� PROPERTY LOCATION 50 MANHAN ST MAP 38B PARCEL 195 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �("1 Fee Paid \V' Building Permit Filled out �V Fee Paid Typeof Construction: ADD 6'3(14'ENTRANC 12N13'SCREEN PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 075029 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 Permit DPW Storm Water Management Dem. tion Delay 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 Office of Planning&Development for more information. Department use only / 4 - City of Northampton Status of Permit: Building Department Curb CutlDriveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterAVell Availability / Ill. Northampton, MA 01060 Two Sets of Structural Plans C•-...„.. 'l- phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans --,,' / Other Specify PPk{CATION 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 SO Inraturet 54. Map Lot Unit Nuf Oat. Widir Zone Overlay District 0 lobo Elm St.District GB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S fbAft.I r•-.3I-1—c3,/L o—�STHe'rz— M. +Mt --r—t rs�.-ivl P'mc.1 aep (Fringe; Current Mailing 90tlress: grt�1 L{l'3 -'5%ca —C2C Telephone Si ature 2.2 Authorized Agent: �j dI /� II .,y� e• - t L�Sev• (.,yV /e- C/ davACI 2a k'1G el , /d 0I2TO Name(Pri. ) Current Mailing Atltlres Sign. Ifo Telephone SE TIO ' 3/ TIMATED •N TRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee ,r7000 2. Electrical (b)Estimated Total Cost of Construction from (6) • 3. PlumbingI a-00 Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total= (1 +2+3+4+5) bo,006 Check Number �a 71 /ag This Section For Official Use Only Building Permit Number: Date Issued: Signature:Signature: Building Commissioner/Inspector of Buildings Date 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 tilled to by Building Department kla Lot Size Frontage Setbacks Front Side L: R: L R: Rear Building Height ' Bldg.Square Footage io Open Space Footage (Lot area minus bldg&paved parki F) #of Parking Spaces Fill: (volume SZ Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW O 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 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and Location: E. Wiil the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre or is it pal of a common plan that will disturb over 1 acre? YES O NO e_ 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) n Roofing D Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [ISiding[0] Other[DI Brief Descri ion of Pro osed r A r x Work: . �� f X H EH{rt.�e c.. IBX (3 Sc real OOrp iel Alteration of existing bedroom Yes A No Adding new bedroom 1 Yes /- No Attached Narrative Renovating unfinished basement Yes A. No Plans Attached Roll -Sheet Sa.If New house and or addition to existing housing, complete the following: a. Use of building: One Family 4- Two Family Other b. Number of rooms in each family unit: ) Number of Bathrooms \NO G. Is there a garage attached? h O d. Proposed Square footage of new construction. 2HO Dimensions 6 x Arns f?-Xt3 e. Number of stories? I f. Method of heating? 110\-...Act" Fireplaces or Woodstoves A.d Number of each 1 g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction SI.wk i. Is construction within 100 ft. of wetlands? Yes "c No. Is construction within 100 yr. floodplain Yes X No j. Depth of basement or cellar floor below finished grade Al A. k. Will building conform to the Building and Zoning regulations? d Yes No. I. Septic Tank City Sewer .Y Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS� AGENT OR CON., W CONTRACTOR APPLIES( FOR BUILDING PERMIT I. 'l J V\f?NMI/J FCV'Y — T1t�Yc-2 ,as Owner of the subject property hereby authorize - rf-f L_C,�1 l�Csu Cr -cr� to on my alf, i matters relative to Work authorized by this building permit application. ( ( / lk(Z.m17 Signe ure of Owner (� Dale 111111.1.11 1, Sc 4-r- t o as Owner/Authorized Agent hereby declare that the statemen� -Lin-N._ 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. t a C90u ad.-, Print Ac 1/I Asa .. — (in/1 7 Sig ,: t. • er Agent Date/ SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: CJ3 Py u p es n C - 0 2 t3.). / r( / ,1 License Nu er a j 4ShZ IA /41A• 0133 Add - p Expirati Date .r1 t-Q�y S'R. ure / Telephoneephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 17413d�1 Company Name I II Registration_ Number a0 u)_.4 t�,a rde.f:S /� Address II r� Ex ratio Date la H / �4 w ./ IL I Telephone ul IS t(5 S et 7'1 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. 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 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 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 ;F�I� Office of Investigations 600 Washington Street >h�= Boston, MA 02111 tvww.ntass.gav/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Gougeon Builders Address: 1261 Hawley Rd City/State/Zip: Ashfield, MA 01330 Phone #: 413-519-9974 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction '.❑ I am a sole proprietor or partner- These on the attached sheet. 7. U Remodeling ship and have no employees These sub-contractors have 8. n Demolition workingforme in anycapacity. employees and have workers' p' y- 9. ❑ Building addition comp. insurance? [No workers' comp. insurance p IRE Electrical repairs or additions required.] 5. ❑ We area corporation and its officers have exorcised their I L❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL I2.❑ Roof repairs insurance required.] ` c. 152, §1(4), and we have no employees. [No workers' I.3. Other comp. insurance required.] *Any applicant that checks box Al must also fill out the section below showing their workers compensation policy Information. Homeowners who submit this affidavit indicating they are doing all work and then hire condi&contractors must suhnl a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not chose entities Laic 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: Associated Employers Insurance Co. Policy#or Self-ins. Lie.#: WCC-500-5014042015A Expiration Date: 11/25(111,- Job 1/25/1Job Site Address: CO 11Y1Cs ell wn IS Ne,tf\{tlwrsnt-Oh _-City,State/Zip: n I pfo 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 'u)))nder t pains and penalties of perjury that the information provided above is true and correct. Signature: Date: IA Al 7 Phone#: 13 $"'( 917y 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/Tovn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please he sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit:license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pennit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211 1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia 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: co Man L s Nor t�„f1- The debris will be transported by: 6ovir_un ZuS Idar S The debris will be received by: V' 4I y ?ccyclfs Building permit number: Name of Permit Applicant /i /1-7/i Date Date Signature of Permit Applicant The Commonwealth of Massachusetts Department af7ndustriatAccideats Office of Investigations I Congress Street, Suite 100 t Boston,MA 02114-2017 •testa i ..r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Pr' t Legibly Name (BusinessfOrgan zatirAndividual): Address: City/State/Zip: Phone#: Are you an employer? Check the ,ppropriate box: 'ype of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I t have hired the sub-contractors 6. ❑New construction 6 employees (fuand/orpaa-time}. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. D Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have worn rs' [No workers' comp.insurance comp. insurance. ❑ Building addition required.] 5. al We are a corporation and its 10.0 Electrical repairs or additions 3,❑ l am a homeowner doing all work officers have ex cised their I i.❑Plumbing repairs or additions myself [No workers' comp. right of exem ton per MIL y insurance required.] t 152, §1 , and we have no 12.111 Roof repairs c nploy„ s. [No workers' 13.n Other co p insurance required.] 'Any applicant that checks box 911 must also fill out the section bolo - .howing their workers'compensation policy information. tHomeownets who submit his affidavit indicating they are doing:11w rk and then hire outside contractors must submit a new affidavit indicating such. tContactorsthat check this box must attached an additional sh, t shone the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mu provide thei workers'comp-policy number. I am an employer that is providing workers'compensation i .urance 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 wo- ers'compensation policy declaration page(ski ing the policy number and expiration date). Failure to secure cover ge as required under Section 25A of MGI.c. 152 can Lad to the imposition of criminal penalties of a fine up to$1,500.00 nd/or one-year imprisonment, as well as civil penalties in to form of a STOP WORK ORDER and a fine of up to$250.00• day against the violator. Be advised that a copy of this stateme it may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct, Signature: ..Date: Phone et: 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 .. Plumbing Inspector 6.Other Contact Person: Phone#: s* tit *tab, . '*" f tifr r I I l� ' i .'ODIIIII /11/i/ilI k / I' / 1r 'Jill ' air` � ; Iiu > rii � l / - r City of Northampton 40,croud I. S 641,,,,vL -26-/7 Building Department Plan Review 212 Main Street �f Northampton, MA 01060 16,_9„ —___ 3 I 1 L \ 1 p U NEW i CLOSET " 0 i SCREEN PORCH 2. 6-61/2' , - MI II MM.. ��� T EW ENTRY, H �r -UP- p 3D68 T-11 W V I a DECK Q , if N��un1111111111111111111.-F- -, 61/76. 'L _ m- r r 1r iBb �. .... Diamond Piers I I j 0 Screen porch'. 2x6pt joists dbl 2xBpt girders. 4x4 posts spaced for screening. 2x10 rafters 16'0c with 5/8 sheathing iJf 1 011 3 F 4= �Pr It�� 1 k 1e. I I,''. New Entry li 11 i,. HI 111 J_L _ .-tf1 i_ 1 —� oVz P.7, l6 ac . L Roof: 2x6 rafters, 5/8 sheathing, with cellulose loft filled to miry-45 Wall:typ. 2x6 construction, %sheathing with dense pack cellulose. , Floor: 14" I-joist sealed below, %T&G sheathing. dense packed cellulose. Foundation: Diamond piers calculated for bearing. ort St N -. o 4 \ . I oil Driveway 1 _F00 E '1111111 \9 R I; 12.1 (`- ni1 iiik111 28'-8 3/16" tall] III ; ... „'._. II II II "' �� - --- - - - .� '' anhan Driveway - 0, m ,. �'' � ....„