29-579 167 OVERLOOK DR BP-2017-0944
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-579 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 4 BP-2017-0944
Project ft JS-2017-001622
Est. Cost: $38000.00
Fee: $247.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CHRISTOPHER O'CONNELL108508
Lot Size(sq. ft.): 20429.64 Owner GIBSON PAUL E&ELLEN T HEFFERNAN
Zoning: Applicant: CHRISTOPHER O'CONNELL
AT: 167 OVERLOOK DR
Applicant Address: Phone: Insurance:
P O BOX 176 (413) 539-1521
HUNTINGTONMA01050 ISSUED ON.:2/13/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL 1/2 BATH TO 3/4 BATH, REMODEL
UPSTAIRS TUB/SHOWER. REMODEL KITCHEN
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: House4 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 2/13/2017 0:00:00 $247.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0944
APPLICANT/CONTACT PERSON CHRISTOPHER O'CONNELL
ADDRESS/PHONE P O BOX 176 HUNTINGTON (413)539-1521
PROPERTY LOCATION 167 OVERLOOK DR
MAP 29 PARCEL 579 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT / n
Fee Paid 'K /
Building Permit Filled out /
Fee Paid
Typeof Construction: REMODEL 1/2 BATH T ATH. REMODEL UPSTAIRS TUB/SHOWER.
REMODEL KITCHEN GG.j,nI .¢5
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 108508
3 sets of s/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION 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
oli 'on�>.y
Lure 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.
DowIn du.ody
F,
City of Northampton a
Noampton BRIM
Building Deportment Cut CLIChte+T Porn*
13 i 212 Mein Street 8se3.deATRYMRry
Room 100 WsJWr AMORE
Northampton, MA 01060 Too Bob a$INmnd Pru
1.10!I 413-587-1240 Fax 413.587-1272 Pbuer Rom
DNR SPEY-
APPLICATON TO CONSTRUCT,ALTRI,REPAM.RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEWNG
SECTION I•SITE INFORMATION
w
1.1 a+�; TY� clbn to be CanPVMd EY Office
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SECI=2-PROPERTY OWNERMIPOWTNORRED AGENT
Li MESS org:
• 1. - .r .r. /- 414.12., a7 O/44 4 0/, iA,T1,./,.,./ MVI1
term Cat bag Adds:
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Irian
zi Amens Meat
Cklltfb,L4 0:4 li v <'"" fi Lac om rem) ra
0•11111 leg Adds:
Tarim
IffiagithilaaniaSEMEMOSAMMI
Rom Eatn1.d Cod(Darn)b Os OISSW Ur Only
om�bba Mpdmjx -
1. Otaia a Solo Wedding PumaFes
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2. OWNS g ATO �(b)EatIpd Total Cast a Ca
1 Cmrtruylbn from(S)
3. daft ciao° aitdfr9 Pond Foo
4. M.daSS pNAC)
a Fie ROWER'
a Talst•(1+2+3+4+51 faitOa) Chid rat - 2 - �t7
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&Sq Pan*Member baud
Sam Condo lN.bdpdvaelrp o.r
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
10/ `730Z.F? i✓�Fl
Frontage ny' N/A
Setbacks Front )o
Side L: / R: /.) L: I s R: I r
Rear
Building Height q, z/A
Bldg. Square Footage /671— a /o
Open Space Footage %
(Lot area minus bldg&paved N/n ink'
parking)
#of Parking Spaces
Fill: "tit' F✓ 1
(volume&Location) r/ 7"
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW r-.1 YES 0
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 (3 DONT KNOW ij7) 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 fl
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
IF YES, describe size, type and location:
E. Will the construction activity disturb(deanng,grading,excavation,or filling)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 a•DEeCMPfON of PROPoeeo WORN Wm*all egdisl
New Nouse 0 Addition ❑ a Doors O dowa Abragonte) ❑ Roofing ❑
Aooreery Bldg. 0 Demoeeon ❑ Mn Mgns ICU Decks CI aiding PI Other SA
:el 01 ^..,,y/ i4,•5 r. 344+4 /l....4r %nrh.r 44,11”... T✓S/fAaJot
Work *neo �T-t 4.
Moen of MOWS basun Yee X No Mdra me bedroorn_Tits K No
Mstlud hlenegn Renaming V watered Cement _Vee 2c. No
Plans Mated Reg •abe.t
fie NNaha b-L_ end. . addrtlon to a Iden N NSg Iw ONta Lha fOIIOM Ifl'
a. Use of beading:One Fenny '1S Tao Family Other
b. Number of rooms In etch temb unit: Number of Betwoonn
C. Is there a gangs attached?
d. Pnpw*d Snare footage of new a n ebucdon. Dimension*
I. Number of diode?
f. Method of tundra? Fireplaces or Woodrow Number of each
g Energy Conservation Compliance. MowUeck Energy Compilence form attached?
h. Type of contortion
L Is construction within 1001E of wetlands?_Yee _No. Is conainwt on within 100 yr. floodplain Yee_No
J. Depth of buamra or cellar Boor blow gn'ehad grade
k. WE building conform to the Building and Zoning regulations? Yee No.
I. Septld Tank_ City Sow_ Pante well City waist Supply
SECTION 711•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT
T�OR(CONTRACTOR APPLIES FOR BUILDING PERMrT
Ti[tot fi ( n as Owner of the subject
pr0-y •
Selby o✓„r// v a-'n /I Orli/rc 1 LLL.
to ed on u.^7 :f''�matte -.,: • to work authorized by gds building omit application.
k _a.al On Date
a,,,..:11,00/a L. , V ( D•1art I( asOemer:M:prized
gam No*own Mt the Manama and Infanlauon on the foregoing apPlicalion are true and amanita,to the best of my knoMed
td bele.
reds under the—and rates of penury.
f TIf Y'Rt! l • 0
/."n1I
�� DM *11
SECTION 8-CONSTRUCTION SERVICES
BA Licensed Construction Supervisor: �`J Not Applicable ❑
Name of License Holder: (7 Iu /-h JC. [/ ((y.e-it (t CS — OS 5o
License Number
fri p �)
Address Expiration Dat
14l3 - 531.— (5d-1
Sign ure Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
C�Yov'refl 6ct3kochian , LLL 184899
Company Name Registration Number
d4 elec.-54„0c- V•QJ Dr 314OnLP,
Address � �j Expiration Date
�(�4e(d t /ti1� 0UJ3V Telephone 4l35-011
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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(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 1083.5.1.
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
ended(QS /v 6TW ` �i 73 -! � of Northampton
,filing Department
z,,-
'Ian Review
a Main Street
flton. MA 01060
EXISTING
PROPOSED
4• r 4
906YN711l,? eCk
C i SHOWER
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POCKET DOOR �ss i 13 1 I
Mg i fricov
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: /6 7 (�1/4i/vok I it^r / F/eir/7er /4?} evoz -
The debris will be transported by: Oft../ -..// L L
The debris will be received by: V4/47 1. ez y n
Building permit number
Name of Permit Applicant D. (--�/i (-.,rGi-c C/`'Y"
;/?-/A-
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
i — l Department of Industrial Accidents
�p—„
e11=
Office of Investigations
-ie;_ 1, 1 Congress Street, Suite 100
ti Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): (J <e-,^'r/l (c' ;r,r.e+;w
Address: ZY /'/ fr ,rt /dew 0 ..,_
City/State/Zip: /14T*z'f (44 OM 5 Phone#: -1/F' `RIO '/l3 c7 2 , It 21
Are you an employer? Check the appropriate box:
Type of project(required):
1.la I am a employer with 3 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. .Remodeling
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.t 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑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.
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContactors 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. [f 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: /? x /'�•
Policy#or Self-ins. Lia #: 7"-PJ Li/3 - 0 6- / 9 6 3 } - 2 - Expiration Dale: ' F -
Job Site Address: / � I 6�(/t/i00/C t/' ' 4' //oIrp[r . /r�' /�6city/State/Zip: fietem c[/ ,^.C' 0/OG
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 cp4i[ytinder the pains and penalties of perjury that the information provided above is true and correct.
Signature: -)7 �r Date: 7 - /
Phone#: ///3 / ei
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#:
VDAC
TRAVELERS J� WORKERS COMPENSATION I
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (7PJUB-0G19637-2-1 6)
RENEWAL OF (7PJUB-0G19637-2-15)
INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
1 NCCI CO CODE: 13579
INSURED: PRODUCER:
OCONNELL CONSTRUCTION LLC BANAS & FICKERT INS AGCY
24 PLEASANT VIEW DRIVE 63 MAIN STREET
HATFIELD MA 01038 EASTHAMPTON MA 01027
Insured Is A LIMITED LIABILITY COMPANY
Other work places and Identification numbers are shown In the schedule(s) attached.
2. The policy period Is from 07-28-16 to 07-28-17 12:01 A.M. at the Insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Pail One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
s
tam
arm
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state Ilsted In
Item 3.A. The limits of our liability under Pan Two are:
Bodily Injury by Accident: $ 1000000 Each Accident
BodUy Injury by Disease: $ 1000000 Policy Limit
Bodily Injury by Disease: $ 1000000 Each Employee
arm
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, If any,listed.here:
assem COVERAGE REPLACED BY ENDORSEMENT WC 20 03 068 " GEIVE6
mor
s r SI 7UlG U '
D. This policy Includes these endorsements and schedules: ',a=ecA N1113 U
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE ?
0
4. The premium for this policy will be determined by our Manuals of Rules, ClassiflcatIOns,,h N�10 Rating
Plans. All required Information Is subject to verification and change by audit to be made ANNUALLY.
Ism
DATE OF ISSUE: 08-02-16 WC ST ASSIGN: MA
OFFICE: DIRECT ASSIGNMENT 701
PRODUCER: BANAS & FICKERT INS AGCY 75WYC
002234
VDAC
TRAVELERS J� WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (7P.JUB-OG1 9637-2-1 6)
CLASSIFICATION SCHEDULE:
PREMIUM BASIS
ESTIMATED RATES ESTIMATED
TOTAL ANNUAL PER $100 OF ANNUAL
CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM
SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S)
SIC-CODE: 1761 NAI CS: 2381 GO
STANDARD
TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 5377
PREMIUM DISCOUNT NONE
0900-20 EXPENSE CONSTANT 338
TERRORISM 20
TOTAL ESTIMATED PREMIUM 5735
TAXES AND SURCHARGES 295
DEPOSIT AMOUNT DUE 6030
A/R (WCIP) if
Minimum Premium: $ 500 EMPLOYERS LIABILITY MINIMUM: $75
ST ASSIGN: MA
DATE OF ISSUE: 08-02-16 WC
OFFICE: DIRECT ASSIGNMENT 701
PRODUCER: BANAS & FICKERT INS AGCY 75WYC
TRAVELERS J� WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A)
POLICY NUMBER: (7PJUB-0019637-2-16)
INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
13579-MA
INSURED'S NAME : OCONNELL CONSTRUCTION LLC
RATE BUREAU ID: 001037565
PREMIUM BASIS
ESTIMATED RATES ESTIMATED
TOTAL ANNUAL PER $100 DF ANNUAL
CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM
LOCATION 001 01
FEIN 473926348 ENTITY CD 001
OCOMJELL CONSTRUCTION LLC
24 PLEASANT VIEW DRIVE
HATFIELD, MA 01038
SIC CODE : 1761 NAICS: 238160
CARPENTRY NOC 5403 IF ANY 11 .00
ROOFING NOC & YARD EMPLOYEES,
. DRIVERS 5545 IF ANY 37.05
gigg CARPENTRY - DETACHED ONE OR
TWO FAMILY DWELLINGS 5645 65000 8.11 5272
0=
nS=
DATE OF ISSUE: 08-02-16 ,WC ST ASSIGN: MA SCHEDULE NO: I OFMORE
002235
TRAVELERS WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A)
POLICY NUMBER: (7PJUB-OG19637-2-16)
PREMIUM BASIS
ESTIMATED RATES ESTIMATED
TOTAL ANNUAL PER $100 OF ANNUAL
CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM
LOCATION 001 01 (CONT'D)
CARPENTRY - DWELLINGS -
THREE STORIES OR LESS 5651 IF ANY 8.11
2.00% EMPL. LIAB. INCREASED LIMI TS(9812) $ 105
MERIT RATING/EXPERIENCE MOD; NONE MODIFIED PREMIUM NONE
TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 5377
EXPENSE CONSTANT(0900) 338
0.0300 TERRORISM (9740) 20
5.60% MA WC SPECIAL FUND AND TRUST FUND 295
TOTAL ESTIMATED PREMIUM 6030
DEPOSIT AMOUNT DUE 6030
DATE OF ISSUE: 08-02-16 WC ST ASSIGN: MA SCHEDULE NO: 2 OF LAST