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24A-210 (3)
26 ADARE PL BP-2017-1023 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-210 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2017-1023 Project# JS-2017-001764 Est.Cost:$10000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICH HEINEMAN HOME IMPROVEMENT 098560 Lot Size(sq. ft.): 24219.36 Owner: ABRASHKIN WILLIAM H Zoning: URB(100)/ Applicant: RICH HEINEMAN HOME IMPROVEMENT AT: 26 ADARE PL Applicant Address: Phone: Insurance: 29 VICTORIA LANE (413) 949-1769 WI LBRAHAMMA01095 ISSUED ON:3/17/2017 0:00:00 TO PERFORM THE FOLLOWING WOR%CONSTRUCT A 4' EXTENSION ON VESTIBULE(ENTRYWAY) ROOF IN ORDER TO HAVE & CONSTRUCT A 4' COVERED LANDING UNDERNEATH AND ADD NEW STAIRS AND RAILINGS POST THIS CARD SO IT 1S VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House ft 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 3/17/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#13P-2017-1023 G\[/ APPLICANT/CONTACT PERSON RICH HEINEMAN HOME IMPROVEMENT ' 0 ADDRESS/PHONE 29 VICTORIA LANE WILBRAHAM (413)949-1769 PROPERTY LOCATION 26 ADARE PL MAP 24A PARCEL 210 001 ZQNE URB(I0l'i)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / Fee chid ik Fee Paid Permit Filled out o Fee Paid Typed Construction: CONSTRUCT A 4'EXTENSION ON VESTIBULE(ENTRYWAY)ROOF IN ORDER TO HAVE&CONSTRUCT A 4'COVERED LANDING UNDERNEATH AND ADD NEW STAIRS AND RAILINGS New Construction Non Structural interior renpvations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 098560 3 sets of Plans/Plot Plan T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IRMATION 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 • rein „. / 37/7 Signature of;nilding Official Date *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning& Development for more information, hyla I') szAM 'fit City of Northampton t: [94(.4uL , " Buiidins Department Ir: vz � �12017 x r 1 212 Main Street Room 1OO '°1 � null r+'11r17IlG s-w I Northampton, MA 01060 -- _- phone 413-587-1240 Fax 413-587-1272 -ri ri xti ' .&t�` ..� APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: 'J This section to be completed by office ad 1*InRe P/19 CC Map Lot Unit N7h1 ©, /t/11 pTo&1 y 1 A Zone Overlay District 0/060 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /`/.//i//in f /9,/e,q$hkA/ o26/td4ReP/Are Nog7An7ylo& /,2A0/04o Name(,Print) Current Mailing Address: \#(.(131/L4-- i ' / ac-, �Q . Telephone Signature ,cmlj, /: W«rou+, 04✓.rof 4K ,n C° Q YRa,I• rLa'M 2.2 Authorized Agent::,e /O /y IChAd Ca / /n e ��/7142. p 17? / l�ic�G?if�4wC /r//Je , , t M rint) Current Mailing Address: Q 095— _ ( yii) %S/9 — /7i9 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee /o1 coact, 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee CS( 06 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) /00000, Co Check Number ly0-5 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AR 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 I . _.._ .._1 -...-i Frontage ( 7 I- - II Setbacks Front p'— F'T Side L:_„__I_R: L:1 I R:1 i i i Rear � I I -- L • Building Height i i__ Bldg.. Square Footage i"1 L . J % `_i L 1 i_-___i Open Space Footage o _ (Lot area minus bld I g&paved I ] 1 L. I C parking) #of Parking Spaces 1. I i t , Fill: f - — — (volume Pe Location) A. Has a Special Permit/Variance/Finding ever been issued forton the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book Pagel ' andtor Document 14— L_ B. Does the site contain a brook, body of water or wetlands? NO a DON'T 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 , Date Issued: i C. Do any signs exist on the property? YES Q NO Ot IF YES, describe size, type and location: 1! D. Are there any proposed changes to or additions of signs intended for the property? YES O NO l.S/ IF YES, describe size, type and location: E. Win 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 © NO 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 Ti Addition [ Replacement Windows Alteration(s) n Roofing Ti Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [DJ Decks [p Siding[C] Other[Cl] Brief Description /Moe-Fa of Proposed Work: /N Cao'cTO rT!rR.�r'r 9 z e/7 s/o.0 011-1 es ; . /e "'AA'TRs x.n '0„r c7Raef �C1 NSuC!/io '�/ „, Ny //AiJP IP rye NTL lJ//td 1'3 tF?a✓7CFP rak)*filftu�9 a y/ 4I/nips Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet $a'if hause'.ani�"ot adiitlon't'o ezi§tipsy housing, complete••wabe following: a. Use of building:One Family ✓ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms, c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction, i. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply` _ SECTION 7a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FORUBUILDING PERMIT t I, (4,/, i1""' t/. 4"3 ��'�--,:. t,.7flI/19('Y1 ft A be Ash ,as Owner of the subject property hereby authorize /2 i` 6 / -v" e., .'— to actpon /4'n my behalf,in all matterserrelative to work authorized by this building permit application. G✓ ^-,- ;4/, 4 Signature of Owner / '—T- Date I, /l /C./ Neivefp9N Alennegg, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed un/der the pains and penalties of perjury. /? pve J2 _ Print •,e Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction$uQJervisor:: /} / --�-- Not Applicable ❑U Name of License Holder:�r{1A!(?d Li(7E'/ nMIL .l.e -L`J C.-5-0784.76 0 License Number a`1 V,21o,e,n I 4C. Odieig%IP? /44 0/0 ?5.- O�/o/ 099/7 Address ( Expiration ate ,,ti 0)3) 7`f7-176 7 Signature Telephone t( Ern '/a, 7 'ofin n ' crag 6kirTee, Ne! Si Registered bloMe-Improvement G`ontraotor: ,, -, , „j ) Not Applicable ❑ C•mIan ame Registration/acQ 33.E umberr �/ a c e/,vrmf9,v t/bme.._ rupee ae,na.c-! __ e2a /Nf6/ `ao/p � p Address1 ( Expiration Date fX / d, /dig/07 kikue h2/�ir 4 4n//f,9 relephohY/3)757-1.?el 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. I oni O; ner-Exemphon The current exemption for"homeovners"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 108.3.5.1. Definition ofllomeowne.r: 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 acceltable to the Building Official,that hetshe shall hg responsible for all such work performed under the building permits 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 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�lfacility, as defined by MGL/ c 1/11, S 150A. Address of the work: 96 /9d#fe ?Akio /l/o,P75A4 r7P/otv The debris will be transported by: /Plc He/iLei4114K/ 44/eT✓hp. The debris will be received by: Building permit number: / / /� Name of Permit Applicant Pc /� / kik. ei'yn4rt/-t/k • 3—lD/7" Q02(CCk . 1 Date Signature of Permit Applicant • The Commonwealth of Massachusetts 3.'. ,,67"-M Department of IndustrialAceidents t Office of Investigations l % 1 Congress Street,Suite IPO =• '_ Boston,MA 02114-2017 wwn:mass.govidia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j..� Please Print Legibly Name(Business/Organization/Individual): Rich HeM4ni l< Uen .g) ( +O 12'kat, ecueeNT Address: 09 IJiclfe1N L.i44)e. (AL /beg, I,xi en City/State/Zip: G)i/Aie A.ir 4,9 OfO?flhone#:j/3 7'! 9 - 17,67 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [I]New construction 2.[' ^ 1 am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g_ 0 Demolition working for me in any capacity. employees and have workers' 90 Building addition [No workers' comp.insurance comp.insurance. required.] .5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. [No workers' comp. right of exemption per MGL - YP IZ. jRoofreepppairs tr-- insurance required.]t c. 152, §t(4},and the have❑0 13.j(�OthetC%y W 1 F o1 f1n.( employees. [No workers' �" " / e comp. insurance required.] 1.14 furl/x-q *My applicant that checks box#1 must also SH 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. tContractors that check this box must attached art 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'camp.policy number. I ant 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. 7 do hereby • tify under the pain'and pen,Ivies of perjury that the information provided above is true and correct. )into re: l �y/ i �j� /y / q Date: 2 —JO�7" Phoned: L/13.) f9 f — � 1D f -- Official use only. Do not write in this area,to be completed by city or town official City or Town:_ Permit'Lieense Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Cityftbwn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 0:_, MORTGAGE LOAN INSPECTION THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERIY SURVEY (9Io I ) n c1 257.25'± L=25.79'± -H f 0 H O 8.25'± n, End N I 170.73'± _! DECK 2 STY. I cc, .N W/F p o 42 HSE. ro 30 /�. 70.00'± �! ADARE PLACE THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WTH THE BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS. AGREEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. TO THE NORTHAMPTON COOPERATIVE BANK AND THE LAWYERS TITLE INSURANCE CORPORATION - ONLY _.... _. 4.' . " � ,' .'.. la' S. ft- - r 1141 1 fi . Mail Mr aia . Iii it ale allimhealili Illif 41.‘ ammo' Nie . . 1, „. I., I . , ........ , . I ..„,,, �IIIII �,' ' iiii. ,i,,,, a., Hm7 .-ii- ..„ 7 'NV a k i a p HOV$2 4 4/I- 7oSfre ;r w ,c. ' A , irFr a, .--","'• f,- .I, gi. Solid �Iwe - ?iii " /L/ imecsJ2icis " vaett // a.461 A/c:Fep QRo je:Ziowe ' froroJed 444:1104/ 3 /tit Rdton_ -t47ASSuM,ek r — ______L__ City of Northampton Building Department Plan Review 212 Main Street Northampton, MA01060 1> 9-d-46 oz B f'xe^-- cr ' 1 g. Nl 1 I S v -- °pe , SrdFs zj�'o u m -F , FRcerr 1 -1L i 'Zi r f h --7 t 'C 5 , R pc I, I ye( Gam( ikrys /" Stet✓ VLELt �eofoJ l 0hi.cnetICT/O t,,) o f A 7' se tew,Red Lewd/ivy w?li NC 4.4.) 5 T AiRs + Re9riINgs