24D-192 (9) 4 WARFIELD PL BP-2017-0971
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 192 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2017-0971
Project JS-2017-001674
Est.Cost: $21252.00
Fee: $138.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SERENA TORRY 078904
Lot Size(sq.ft.): 4617.36 Owner: YOUNG KATHRYNE
ZoninE: URC(IOOV Applicant: SERENA TORRY
AT: 4 WARFIELD PL
Applicant Address: Phone: Insurance:
158 PLEASANT ST (413) 634-8088
P LA I N F I E L D MA0107 0 ISSUED ON:2/24/20I7 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD/ADJUST 2 CLOSETS, NEW TOILET &
FLOORING IN BATHROOM
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 Or Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OI: 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 2/24/2017 0:00:00 $138.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File 4 BP-2017-0971
APPLICANT/CONTACT PERSON SERENA TORRY
ADDRESS/PHONE 158 PLEASANT ST PLAINFIELD (413)634-8088
PROPERTY LOCATION 4 WARFIELD PL
MAP 24D PARCEL 192 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
61. 4
Building Permit Filled outFee PaidTvpeofConstruction: ADD/ADJUST 2 CL , EW TOILET&FLOORING IN BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 078904
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO$MATION PRESENTED:
Pi-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
__ �- olifrn Delay
e'Y
S eo Buil.ing il'ficial 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.
...t..%. .f. tot use ly3
City of Northampton Sfary- _• - Ta „1"
Building Department UHDmewayPermrt
Y
212 Main Street Sewer/Se I bully
Room 100 W I. tE •lity '
Northampton, MA 01060 1'wB< by e ,.�`
phone 413-587-1240 Fax 413-587-1272
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
N t.,/u c.--(l e I d Map Lot Unit
Aro rThon pro rtA Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
' 2.1 Owner of Record: � � 1
�-I a li Vv�r�•7 PLnl�r- i-„1-, �r , /AA 0 (040
Na. p CurrentM ling Address'
L c"\ bo g6z 5r9 l
/ Telephone
Sign re
2.2 Authorized Agent:
Name(Prim, Current Mailing Address:
Signature \ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /1 .� 5 .a (a)Building Permit Fee
2. Electrical 3. 00O (b)Estimated Total Cost of
Construction from(6)
3. Plumbing a 000 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection71( 2
6. Total=(1 +2+ 3+4 +5) ] II ?-5J- Check Number / 339 ./i
This Section For Official Use Only
Building Permit Number: Date
Issued.
Signature'Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING AU Information Must Be Completed.-Pe ed Due To Incomplete Information
ExisNa� . Proposed I Required by Zoning
ATh column to be filled n by
(1/17b
/ Building toDepartment
Lot Size -.. - --- --
Frontage _.. _..... _. _.
Setbacks Front
Side L: R: L: R.
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved j_ l
parking)
#of Parking Spaces
Fl:
(volume&Location)
-- — ---- ---
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO G. DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO c DONT KNOW O YES
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 O NO
IF YES, describe size, type and Location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 4
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION¢.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
6r Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs IDI Decks ID Siding(Dl Other[fl
•
Brief Description of Proposed
Work. Qdd/acc,,,r ac/ost Ys n ew '7b:/e7- a -/caika ci
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes X,No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housings complete the following:
a. Use of budding:One Family Two Family Other
b. Number of roams 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 CONTRACTOR APPLIES FOR BUILDING PERMIT
-
i, ���r r1�v `� Vve ! o '"� as Owner of the subject
it property
hereby authorize SC r'2 v`Z`II `
to act on my beh If, in all matters relative to work authorized by this building permit application.
(z(4 117
Signal e of Owner ,♦ ��
eta_
`' Or r`y ,as Owne A// uthorized
Agent hereby declare that the statements and information on the foregoing application are hue and aerate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Se( eree.Y
Print Name
Signature of Own Agent) Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: -/,_ Not Applicable
Name of License Holder: SE r'C ter- I �r retj CS-L779 foy
License Number
( ze "-.t P/a,tn ECe/J , /i4 01 070 3 —3! _ 2-017
Address Expiration Date
>c-Th
Lti 3 6ys -goss
Signature Telephone
9.Retdstered Home Improvement Contractor: Not Applicable ❑
I o rrey Gere -t ( 1 7$040
Company Name Registration Number
1551 P1 ed>e,,-1- St M/a, hSci ✓ 4 oto.7e 3_ ( _ �0l $
Address Expiration Date
TelephoneY/7-645 doss
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 Jg No 0
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 homeown to engage an individual for hire who does not possess a license,provided that the owner acts
as sue ervisor.CMR 780 Sixt Edition Section 108.3.5.1.
Definition of Homeowner:Person - 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 fa- dwelling,attached or detached structures accessory to such use and/or farm
structures.A •erson who constructs more •an one home i o- ear Period shall not be considered a homeowner.
Such"homeowner"shall submit to the Buildin_ - ,on a form acceptable to the Building Official that he/she shall be
res•onsible for all such work •erformed 41It buildin_ •ermit.
As acting Construction Supervisor • presence on --ob site will be required from time to time,during and upon
completion of the work for whi is permit is issued.
Also be advised that with •1-rence to Chapter 152(Workers' ••mpensation) and Chapter 153(Liability of Employers to
Employees for injuri- of resulting in Death)of the Massachusen 'encral Laws Annotated,von may be liable for person(s)
you him to pert• work for you under this permit.
The unders.• ed"homeowner"certifies and assumes responsibility for co •liancc with the State Building Code,City of
North.• -•ton 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: Li l.ra"F''t Id
The debris will be transported by: Cr: c .1a
The debris will be received by: Aro r`n^a 1-1)r Ow "p'
Building permit number:
Name of Permit Applicant SC rein. ch) many
2 �� ti
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
_ � Department of Industrial Accidents
g G Office of Investigations
�
—••. _ 1 Congress Street, Suite 100
'•��'�= 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): Se r e .rc. T rrtt/
Address: ] SS ele&so.,1 H
City/State/Zip: i(4 t fi '6-€(d , ill 4 010 7 o Phone #: 14 t 7 '6 9 5--go S-5-
Are
SAre you an employer? Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑Remodeling
2. 1 am 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' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.111 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 12.111 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 h I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
t(ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut 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.
Insurance Company Name:
Policy#or Self-ins. Lic. #: 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 certify under the pains and penalties of perjury that the information provided above is true and correct.
nature: ----C---1-->4'=" Date: a —�1/411 —1 7
Phone#: K (3 - 655--- SoSs
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#:
trOad Q S 444 -ay-l y
4,9 � it Northampton
ung Department
'ian Review
'Main Street
••neon, MA 01060
r“.. ..••••••••••
4 c W-, r eld
1 Wr Rotate toilet
F ' 1! New tub/shower, toilet, vanity sink
I ' Extend deep closet
Create bedroom closet
Add fan/light
1 Plumbing and electrical to code
l Remove 112 wall segment
1 7Th`
Re-make built-in unit near toilet
Raced Pa1e1 Owner provides wall shelves
/ 1 FT Owner responsible for flooring changes
�f Add 114 in
drywall to upstairs office
Skim coat and sand walls, 2 rooms
10'-7 b Patch drywall in bathroom as needed
T
LEING AREA
76sgft