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12C-036 (3)
48 STERLING RD BP-2017-1067 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I2C-036 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1067 Project# JS-2017-001829 Est.Cost: $7950.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: NEWMAN'S CONSTRUCTION 64690 Lot Size(sa.ft.): 14331.24 Owner: DAHLQUIST KENDRA Zoning: RI(l00)/URA(I001/W$P(100)1 Applicant: NEWMAN'S CONSTRUCTION AT: 48 STERLING RD Applicant Address: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 NORTHAMPTONMA01060 ISSUED ON:3/28/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:ST RI P & SHINGLE ROOF 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: OB: 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 3/28/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �Department use anty City of Northampton Status-u Pe1P1 - Building Department curb Cut/Dnveway,Permit ` /- ,� ; 212 Main Street SeWedSept IAvac iatluty �� ,net Room 100 .W eiel/Welh(1.vallabiuty — C*2-% Northampton, MA 01060 Tvio Sets of$tructural Plans `\ phone 413-587-1240 Fax 413-587-1272 PJot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR//DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION BP- /7-/Co7 1.1 Property Address This section to be completed by office J l xt 4 1 O 4 r feNtURa Map Lot Unit Zone Overlay District FICnet-t„« Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (� I�iY. p (iA COA1nk CR 1♦R 5T112Jin l -A Name(Print) Current Mailing Address: rfr/�-- FLoy>_f?ACC 111‘,42 o106a x / e G er( Telephone L�44 Signature ,C, ie./ : ,3 // — ✓ / ) 5- 2.2 Authorized Agent: e/ fV f.,.ltM h-n-i ,dY7 I rt;n e �� i L 4 Name(Pk) Current Mailing Address — A 586 - ) .�3 Signal re Telephone SECTIO -ESTIMATED CONSTRUCTION COSTS jr?9 50. `a Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee �) \ 4. Mechanical (HVAC) 6'v Vv 5. Fire Protection pp 6. Total= (1 +2+3+4+5) Check Number ppp 6y 7 Oi C/16- This Section For Official Use Only Date Building Permit Number. i 7 -d: Signature: ► // ,/G / 3'-b / / Building Commissioner/Inspector of Buildings Date Section 4. ZONING Alt 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 __.._. —. L __..— __ . . _ L__ Frontage _. --i L. -- — Setbacks Front -- Side L - R:--- L R: Rear I_—_ 1_ _ Building Height h Bldg. Square Footage c cJ / — I Open Space Footage _ % - (Lot area minus bldg&level _� parking) #of Parking Spaces --.— Fill: (volume&Location) — — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O 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 1. PagelF '. and/or Document #! B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © 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 © NO fa 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 O IF YES, describe size, type and location: 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 X Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding[❑] Other[CO Brief Description of Proposed 1 . r 1 l Work: ✓t: a, 4 S h] S _ \ UJ L Va Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing. complete the 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 FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date A/p t I, C ��.t)-I �7-y�/ JE2 w✓P//Wsn✓r 5 /'. as Owner/Authorized Agent herebyleclare that the statements and information on the foregoing applicatio are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CV AIg„Nr, AN,/ Print Namt abe s A8 Signature of Owt gent Date SECTION 8-CONSTRUCTION SERVICES " -BA-Licensed Construction-Supervisor ---=--- -_— _____ Not Applicable_❑ - . -- . Name of Hcense Holder: eC -. .. 41/ /p License Number 697 : 12. . / . �4 : adna �j� / 7 Address /ll1 Expiral n to r 584-/0 1 3 Sign- Telephone a p.Recistered Home Improvement Contractor. - Not Applicable ❑ /I7--,7490 7 Com an y NN ee „/,/ y Registration Number N�4/X�.�1LrS .. f 4,c we/ 6�'� Addres IVV•�”' Expirafion tG5 e rk H - A. .h J„�/}to Telephone SY6 'f��/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT{M.O.L.c. 152,§25C(8)1 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"homeavners"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-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form aocertable 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 he required from time to time,duringand 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 percents) you hire to perform cork for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with de 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 byMGL c 111 , S 150A. Address of the work: 99 ,Sfrnn /4. /-, ��/. 1 frre%* et The debris will be transported by: _ 417 ' e,>z ©.e,c The debris will be received by: 1/ f c c/e n IIII Building permit number: Name of Permit Applicant on_S ( . y� /Vir /_-�^� Date Sign of Permit Applicant . \ The Commonwealth of Massachusetts 3 Department of Industrial Accidents tOffice of Investigations ' twos 1 Congress Street, Suite 100 .7 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): A44§. 4/}y(/f �n54u�f1a:4) Address: 6 7 Iti. .0 ti 'Pat City/State/Zip: lLLOtpA41 Phone#: <y/ - St‘ -/07 Are you an employer? Checil the appropriate box: Type of project(required): I.El I am a employer with 4, ❑ I am a general contractor and I �..,-///employees(full and/or part-thee)." have hired the sub-contractors 6. ❑New construction2.Qy I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling / `ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9LI Building addition [No workers' comp. insurance comp.insurance t 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 11.5 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL l-.clRoof repairs insurance required.] t c. 152, §1(4),and we have no 12X employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box SI 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. 1Contractors 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. 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 k or Self-ins. Lie. 4: _ 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 foe 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided abov is true and correct. Si•nature: _ //. Date: .' 17/7 Phone4: ' (Tx --/as-1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License K Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone h: Proposal Page No. of Pages NEWMAN'S CONSTRUCTION697 Bre Rd. q Northampton MA 01060 121 17 413.586.1093 PROPOSAL SUBMITTED TO ,-- PHONE +- DATE y SET j 2 ' c\ u15�'. ..,/ -3 /`7 /fig / 7 J08 DAME -5'? ,4rc/, ri k K.- i2� UL. CITY STATE and DP CODE JOB LOCATION ,�_G_ei',"2 AC, � � 0/66 :j1 �et9£.._ APG SECT / DATE OF Pi ANS JOB PRONE We hereby submit specifications and estimates or 5ta,p 20 st-, Ili .,,_s i7tis5 0t7 RtiOi, -7 i / at; =a:rz: V-21.9?,s rflaw/- S.fa/1 --11-Lam,”uw0,4n` ).?... ..:r Gi c, -2,--`uJi#/': Orr :'rA/e25# Aepig_s \1 /cri& S r /i.. .,GA tdf1 9 pc,; .,.)s C1) SC: t 014-1. a 9,U'tail_a ,4-r z'A,u .s 4 /41zoJ•T ,. CLI r'r"..l'1'a'.r•{ 4`t t, e' <?IL`Ck X &if kit SeCh �s I&// 1/t 5 i4 . � S I J �,454tc' / A-a(1041i rwLI _65f smtz_frto 77 ,,.„) e iqn - z-S _ .. fai/._../ALuo-it/ °>7c"/ -5r2�,7 / 1J/tL-'L ,=L/?S ir.,, �/•+-S. _its O D. ... ns /21/ A)1C-1I.I.- C .( cif Slrtn tis 0.0 frit 1't /26-Ji= Prie.&X et,lot ed bf. 4_k..054110 ke Fc I MS.£'/,) JOnhrrtrM/L/c'.... S?N. < £S .. ''..-77-45'ail dam i4i1 f f3T 2. ; c'd C zoZ [_ t/114' /CAH ;s'//f CFS F, rkie,.$ . l-Iced tat CV'C.:,<(C. the propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum oh �<it .ii- —4(ns 1-74.,„,7 1,, rv• ,` i!_r, dollars($ '7` . cc. _). Payment to be Madel tollows: 1 r - 7 I - p/ 51/,/91,. (di 1C )--) IIWvt '� �d i1el,i All material Is guar steed to be as specified. All work to be completed in a wo*nianiike /`i ccording to standard prances.Any alteration or deviation from above specifications Authorized e manner aSignature evolving extra costs will be executed only upon orders, and will become an extra -' charge over and above the estimate. All agreementse, contingent upnaccidents w delays beyond our coned.Owner to carry @e,tornado and other necessary Insurance, Note:This pro.•.zit may be ,��/ \%)�Ow workers ate luny cohered by Workman's Compensation losumx%. withdrawn by us it not of ept d within f days. ;�000p}8[tQQutProposal —The above prices,specifications l/.PJicia_'50� Y " \ and conditions are satisfactory and are hereby accepted. line are authoriued Signature /t CCC/// to do the work as specified, Payment wilt be made as outlined above. ?VI Acceptance eI /7 Signature..... ..j Date ctlA rice: t