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23C-070
73 WILLOW ST BP-2017-1056 GIS It: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C-070 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2017-1056 Project# JS-2017-001812 Est.Cost: $7000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Ciask: Contractor: License: Use Group: KIM RESCIA 022464 Lot Size(su. It.): 22999.68 Owner: SPICER CHRISTOPHER V Zoning: URA{10011WSP(1(101/ Applicant: KIM RESCIA AT: 73 WILLOW ST Applicant Address: Phone: Insurance: 311 Locust St (413)320-1831 O FLORENCEMA01062 ISSUED ON:3/22/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE SHOWER SURROUND 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 it Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: OH: 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: FeeTvpe: Date Paid: Amount: Building 3/22/20170:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2017-1056 APPLICANT/CONTACT PERSON KIM RESCIA ADDRESS/PHONE 311 Locust St FLORENCE (413)320-1831 O PROPERTY LOCATION 73 WILLOW ST MAP 23C PARCEL 070 001 ZONE URA(I00)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paidtit 1� Building Permit Filled out `4 Fee Paid Typeof Construction: REPLACE SHOWER SURROUND New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 022464 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: jp9 pproved 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 Demolition Delay lle L . 3- 27-/'7 Signat Pill7 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. ;,,e,,/du-11--Sr,-F s aLfrfe 1 d --.Ll° 'dr,-.... 2,-.7.,,,r r- City of Northampton ' uL ii3�.- r�- - "'� Building Department eoYi_ r�.+Ln. IR'(.n.+.1E.a.�uerYt. s 2 0 20}( 212 Main Street `x41;1 ,)i „y-tl„7+Ua ,,,, ,_„,, _ ' Room 100 t�.`C�1fM1�A �tltYEr „., r� Northampton, MA 01060 r"4b1'" 21144, ?,{,(, ,.� r" phone 413-587-1240 Fax 413-587-1272 1�5r9t{ ,7Urt M' 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 73 L3tI Ioto i Map Lot Unit -7areu Q �I � o M3bd Zone 1Overlay District 11 , Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ CAA t_tc li1F D) 1Ce — .17, w,11� �r rt�e�c� Name(Print) - Current Mailing Addres i u t �1 - �{l4 -JJS _:'7SS l ) l -"0( �-� Telephone Ut l .I Signature J /-TryCji 'Ic-�'1 'Sfu Ql'K'.'�� ICe�'u e� +tT.l .C 2.2 Authorized Anent: killM res�lc� .7 3 ) I hcuA� Sit c--10 (t(QI Name(Print) / ' Current Mailing Address: l/�/ F �l'll `//3-3zD / Sf3 / Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 000,0 ' CO (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing D. O Building Permit Fee A 4. Mechanical(HVAC) 5. Fire Protection �) �'{{ 6. Total =(1 +2+3+q+5) b000 , tO Check Number 467,4 This Section For Official Use Only Budding Permit Number: Issued:ate Is Signature: Date Building Commissioner/Inspector of Buildings Section 4. ZONING All 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-_- --.-- I F - _.._ 1 L -.-__ __..__I Frontage _.J L__- Setbacks Front - Side L:L Ill R:Li LEI] Rt.__1 I Rear J L__J I -1 Building Height 1 L__ Bldg. Square Footage I_J r I / r I r _1 I Open Space Footage _ f (Lot area minus bldg&raved L_-I i.___. I = ---.J parking) #of Parking Spaces r i I L___1 Fill: .— J II L (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW O YES O IF YES, date issued:( 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book _ l Pagel 1 and/or Document# l B. Does the site contain a brook, body of water or wetlands? NO 'Q DON'T KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: f C. Do any signs exist on the property? YES © 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 O 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 © N6-0 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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors ❑ Accessory Bldg, ❑ Demolition ❑ New Signs [0] Docks [0 Siding [O] Other(f Brief Description of Proposed Work: i s 'r . `Atte _ . . ,t1, A. Alteration of existing bedroom Yes" No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes \ No Plans Attached Roll -Sheet at If:New hoose and.oridd@ionto existtnq housing;cotnp]'eteftje toliowinp: 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 r\ekrim.st,.., € LD (Cep as Owner of the subject property hereby authorize <1n-, IULSC'�cL toact on my b , m all m tiers relative to work authorized by this building permit application. c (, > AMA__ 3'9-0 ' 17 � Signature of Otis Date r .e S G ,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 penalties of perjury. Print Name 7/7 L)(1(.4 3/?O// 7 Signature of.wit. Age ( Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable D Name of License Holder: I c ICP SC 1 q r S o az_yd, Y License Number 31 I HeSI—X, � T - (o RIO 0106Q , 0////� Address Expira on Dare /7/I (i",--Z.Va y/D 32c / g3 / Signal Telephone Emar 9. Registe're/d Homed rovement Contractor: ; . . _ .. ,. . . ElNot Applicable I`IIlM escicc• / Y`/Yo2 Company Name Registration Number 3 " hete s-1 'J / r-2 V/r Address Expiratio Date Telephone 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 ofthe building permit. Signed Affidavit Attached Yes\QUI No 0 11. - 1oine<Ownertxemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 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 facility, as defined by MGL c 111 , S 150A. Address of the work: 73 IADI ( l ou,O S+ The debris will be transported by: ;,eS C. The debris will be received by: . i.. / _ Building permit number: 41 Name of Permit Applicant VIN- ��eSII Q ay /7 al/k c I Date /Signature of Permit Applicant The Commonwealth of Massachusetts l $_ Department of Industrial Accidents Office of Investigations SNOW I Congress Street,Suite 100 .14 Boston,MA 02114-2017 4w- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Legibly K Name (Business/Organization/Individual): � lM Ps( I (A Address: 3 1 ( f oGLLn J City/State/Zip: o , . O\C)FR Phone#: l(/ 3 zn / ETJ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8- El Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance? 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their I1.❑Plumbing repairs or additions myself [No workers' right of exemption per MGL Y comp. 12.❑Roof repairs insurance required.] t c. 152, §I(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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors 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#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 cover.• verification. i I do hereby certify unde fa ,,ins anps„iii hies of perjury that the information provided a ove is fr e and correct. Signature:, i (//( /��/t' Date: 3 Zo / i Phone#: % C f t3 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#: