32C-215 (9) 37 HOLYOKE ST-APT 2R BP-2017-1012
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-215 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 repo BUILDING PERMIT
Permit# BP-2017-1012
Project 4 JS-2017-001748
Est.Cost: $4200.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KUEL MCQUAID 051394
Lot Size(sq. ft.): 6490.44 Owner: WOLPIN ERIC
Zoning: CRC(I00)/ Applicant: KUEL MCQUAID
AT: 37 HOLYOKE ST -APT 2R
Applicant Address: Phone: Insurance:
131 FERRY ST (413) 537-5063 0
EASTHAMPTO NMA01027 ISSUED ON:3/10/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:BATHROOM 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: 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:
FeeTene: Date Paid: Amount:
Building 3/10/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1012
APPLICANT/CONTACT PERSON KUEL MCQUAID
ADDRESS/PHONE 131 FERRY ST EASTHAMPTON (413)537-5063 Q
PROPERTY LOCATION 37 HOLYOKE ST-APT 2R
MAP 32C PARCEL 215 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid `, /�
Building Permit Filled out T4
Fee Paid
Typeof Construction: BATHROOM REMODEL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051394
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIjMATION 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
P itton Dela r '
00IF
Si_ .-r re build g 4 mail 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.
• ,4L — 2 /5
De aktmen se-an1P ,�- .
City of Northampton i>•1ttp tax414t s s~ _
Building Department az;,PQAlvc(ua't :4-044;4.
r 212 Main Street
Room 100 rAF� „7 - C eT '511,x. 'r§
_ 9 2017 Northampton, MA 01060 � , u ; -"� x '"
phone 413-587-1240 Fax 413-587-1272 TIOVi t ` t sv .
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
37 HlalymKC Flet :1i' Map Lot Unit
fJO rvl...- .CT° ti .f"s 1°11 0 106 0 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Er',< . Uti) `7S.ts.44 P., ( t-\,iN,1.e•crtPO\ o eiri
Name(Print) Current Mailing Address:
Telephone �yI
Signature FYr1Gr'/ 2Ni7-t 1 (-e 1"'ttr ( �CCIY"%
2.2 Authorized Aaent:
Name(Print) 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 120 (a)Building Permit Fee
2. Electrical d (b)Estimated Total Cost of
Construction from (6)
3. Plumbing 3000 a PG Building Permit Fee
4. Mechanical(HVAC) .,/�
5. Fire Protection /7(/p.C.
6. Total= (1 +2+3+4 +5) I 1 4x00. 00 Check Number 5.1 . (.f'
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
•
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 F - _ 1 r _ -.-_ I [ _ _.I
Frontage — i __._—
Setbacks Front f I i I 1
Side LL _L R:L ] L:_____1 RI— 1 L I I
Rear
I L_J 1
Building Height ] l_i LT�
Bldg. Square Footage --
I 1 L__J r--1 117.11 1----;
Open Space Footager_L L-1 PHI
__ - -
(Lot area minus bldg&pavcd L-T1 ] I------1
parking)
#of Parking Spaces L. 1 I [-- "I
Fill. JL
(volume&Conation) -- ---"--
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book FPage and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O 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: I
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location: I I
E. WII 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 O NO O
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 n Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [I= Siding [O] Other IC]
Brief Description of Proposed; 'r
Work: i,VSA/0.�\ 1J'l\ikA'GU✓. LVV\Oetc-(
Alteration of existing bedroom . Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa If New house andier addition to existtnat housinq:.complete thee following:
a. Use of building : One Family Two Family Other SCVvw.�i�
b. Number of rooms 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
Ir c , ( j„,.)ot ,as Owner of the subject
property // '' / /� /�
hereby authorize 'Y'e-1 NL C (-l�✓4
to act on my behalf, in all matters relative to work authorized by this building permit application.
:(40Zif De
Signature of Own /'] 7J Date
kve( /l/L( aXieti \ ,as Owner/Authorized
Agent hereby declare that the statements and 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.
Kee( 1Llc Qua,
Print me
Si.nature of Owner/Agent ate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:r/ M
Q /� Not Applicable 0
Name of License Holder: K`/1%( L I o 0t 65 -051 3 ejlk
License Number
131 e (C2` 4Y E s 31 . M� Otov /a//( 2n (W
Address Expiration D e
j //z, ( / if/3—S 37-So E
Signature Telephone
Etna
9. Registered
////pHOme9mproV@ment Contractor .:i' Not Applicable 0
/v ./'t -/tet- co rA��ci. Gl:ov� ,-, 1.) 6700
Company Name _ Registration Number
(3j FaceN/' i� �a5�l aw �n %� Qlo'L7 7 / 2_4/Zo ( 8
Address L / j Expir lion Dat
Telephone 413-53?-So63
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 0 No..._. ❑
11. -7Ikomer-Owner Eiemation
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 tie State 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: 5 .4 i-ibtio c- 5 f lc h �� o bAP\
The debris will be transported by: k✓e( /1 k Oda
The debris will be received by: Uce( ✓��i
Building permit number:
Name of Permit Applicantli� Ave. Mc &vat72/
yg/t6 �L/%/ A (2 &
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department oflndustrialAccidents
a741]�._ Office of Investigations
_iiFitg_ 1 Congress Street, Suite 100
era='tl'9_ y` Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
,t t p Please Print Legibly
Name (Business/Organization/Individual): K✓ C))t Mt Q✓4 i [x
Address: /3 j27
City/State/Zip: r - M I Ola Phone #: 4/.3-s-37- 3063
Are you an employer? Check the appri priate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
_/employees(full and/or pert-time).`
have hired the sub-contractors 6. ❑yew construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. 1MRemodeling
ship and have no employees These sub-contractors have g
❑Demolition
working for me in any capacity. employees and have workers'
coo insurance? 9. ❑ Building addition
[No workers' comp. insurance P
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself [No workers' right of exemption per MGL
Y comp. 1.2.1D Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ 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
tContractors 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.
l am art 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 ofa
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a foe
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 cert�ifj'uu�nder heins and penalti of perjury that the information provided7aboveistrue and correct.
Signature: /�((��(�i%. 7.; Date: :7 25 ZO I7
Phone#: t/3--53 7- 306 3
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: