25C-119 (2) 27 ELIZABETH ST BP-2017-1059
GIS#: ..._ COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C- 119 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 a BP-2017-1059
Project q JS-2017-001815
,Est.Cost: $1000.00
Fee:$4000 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group; JAMES FOLEY 065777
Lot She(sq. (1.): 3354.12 Owner: FOLEY JAMES V&COLLEEN B
Zoning:URB(100k Applicant: JAMES FOLEY
AT: 27 ELIZABETH ST
Applicant Address: Phone: Insurance:
10 FOREST GLEN DR (413) 584-6370
FLORENC EMA01602 ISSUED ON:3/24/2017 0:04:00
TO PERFORM THE FOLLOWING WORK:REMOVE AND REPLACE ROOF SHINGLES ON
GARAGE, REMOVE AND REPLACE SAGGING BEAM ABOVE GARAGE 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: 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 3/24/2017 0:00:00 $40.00
2 I 2 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck- Building Commissioner
Elle N BP-2017-1059
APPLICANT/CONTACT PERSON JAMES FOLEY
ADDRESS/PHONE 10 FOREST GLEN DR FLORENCE (413)584-6370
PROPERTY LOCATION 27 ELIZABETH ST
MAP 25C PARCEL, 119 001 ZONE URB(100 /
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee udn _l.
Building Permit Filled out I�
Fee Paid
TvpeofConstruction; REMOVE AND REPLACE ROOF SHINGLES ON GARAGE,REMOVE AND REPLACE
SAGGING BEAM ABOVE GARAGE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner!Statement or License 065777
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
I/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
D•oaf in Delay
dierro,e7 3 -2;
Signa ure of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with ail 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.
- - - a ae A+ 1re
City of Northampton ;i'r-(trrGl.rr„fir`
Building Department 33j}'r3nr) ra.Vegrx-rrnfl
C 2‘ \ 212 Main Street G'' ry j i t mf151Cu
Room 100 al aiLI -�iF ThIiii ,, _-_..�
\ Northampton, MA 01060
'�- -phone 413-587-1240 Fax 413-567-1272 a+e>iIr §,t i --a u”
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH/�A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 2'5 t(
1.1 Py Adtlre/sJs: This section to be completed by office
fjZZropert-2f 1E �.�(� (� ,5 r , Map Lot Unit
p//rt/71.4..“1270 iC/ /tiff(53 0(010 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e<k'Wes 1/ tZjegj ie) :ecIf eCW,Y ckc
Name(Print) Current Mailing Address
�}1-_,r/_ vCfSg 4710 62_
v ��✓ 2C 4-!Telephone //� QQyy��
Signature/ c.'ggf CY "� --G. �
2.2 A (orized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
jcompleted by permit applicant
1. Building (a)Building Permit Fee
/Oo,J. ea.
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
3(/0- oa
� 4. Mechanical(HVAC)
5. Fire Protection Cr
6. Total=(1 +2+3+4+5) Check Number /3
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning liky
This column to be filled in by
Building Department
Lot Size I ._ L _-_-_� r__ _--
Frontage i 1
Setbacks Front i I r I
Side L: R:1�� L:I-. R:I__I Ii-
Rear I I
Building Height LJ
Bldg.Square Footage r 1 [ 1 /o 7-1 I I _�
Open Space Footage
(Lot area minus bldg&raved I I [_ 1 I .I L—__ —1
parking) _ _
#of Parking Spaces 1 1 L 7 �-
Fill:
ol
L�
(volume
,
volume&LocafianZ
A. Has a�S-pfcecial Permit/Variance/Finding ever been issued for/on the site?
P.NO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book Pagel and/or Document AL•
B. Does the site contain a brook, body of water or wetlands? NO lY) 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 O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO '5
IF YES, describe size, type and location: l
7.
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 03)
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, ex vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O 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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [CH Decks [q Siding[0] Other[o]
Brief Description of Proposite�!NrvrY Q�`ce tea"' �� :lsrek 5/ A' tz,ye,�.
Work: .{'/K�LCC' Anzie /�7Ate. ymb, "set a GY/7v.cc gd'z llz�R �v✓�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
0, ina
. If'.New house and or addition to exi§ting hou§ing eompl'ete: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
, 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
11.111111111.11
,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.
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / ��77 Not Applicable U
Name of License Holder: N!> / r
(/ License Number
/D &ail 6"lic 44),--e -_ CS 06
Address Expiration Date
atce ii,,9Sx oioB2,
Signature •
Telephonq�� ' Y.-i2— 40/9`
9.Registered Home{morevemettt Cantrectpr ,,.,,,,� _,.,w,• = Not Applicable ❑
Company Name Registration Number
y &C1/ra pie ‘fed‘dfu;/r/5/7-1 r966 •M
Addr s •
/ro C/414 I / /].,, Expiration Date ,�/
/4j$ 666/ Akt,L ce Telephone5 4 -6f ' f/�(,/ao/"7-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Mal.c.152,§25C(9f
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 buildingdpermit.
Signed Affidavit Attached Yes....... [3- No ❑
11. -=13Om6OwnerEzeinption
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 208.3.5.1.
Definition of Homeowner:Person(a)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 he 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///t Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature ,J 1! 12-271 J
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 150k
%
Address of the work: 077 /1-74t 6j'% ,c1j12e/A,ftwett.
The debris will be transported by: ref
The debris will be received by: dielter (;. C4f.
U
Building permit number: mm
Name of Permit Applicant ;A weir i/ Li
ide-tx nu,
Date ,j/o'(0 ignature of Permit Applicant
"` N The Commonwealth of Massachusetts
—a Department of Industria[Accidents
� ' i OfftceofInvestigations
y 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): icidttt4 1/7'9OCr
Address:
�//,O12k (Fee!/ r'LtfeC?.
City/State/Zip: .-/' i t, fl( `5 r' 1062-Phone H: fi3) ;-;q -6 gz s_
Are you an employer? Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full andror part-time).
♦ have hired the subcontractors 6. El New construction
2.Uv I em a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P ty 9. E Building addition
[No workers' comp,insurance comp.insurance.;
equired] 5. I ( We are a corporation and its I0.❑Electrical repairs or additions
_er
3.M I am a homeowner doing all work officers have exercised their 11. P mbing repairs or additions
myself.m seworkers' comp. right of exemption per MGL
y [Nop 12. hoof repairs
insurance required.]t c. 152, §1(4),and we have no �+ ?/ c
employees. [No workers' 13.[-}`Gther,/q��/ J _
comp.insurance required.]
*Any applicant that checks box it 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 subcontractors have employees,they must provide their workers comp.policy number.
I am an employer that providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_
Policy#or Self-ins. Lie. in _ 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 e, 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 da hereby certify///*/under the pains and penalties of perjury that the information provided above�tis true andycorrect
Signature: rely 2 � Date: 0/20*T
Phone#: �/�j('{_411.1 (2\11 — (n .1 U'
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 6: