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16A-020 MULTIPLE CONDO ADDRESSES
FAIRWAY VLG BP-2017-1068 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-020 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TOTHEGUARANTY FUND (MGL c.142A) Cate!o : redacementwindows/sidin• BUILDING PERMIT Permit# BP-2017-1068 Project# JS-2017-001830 Est. Cost: $125000.00 Fee: $813.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: A & Z CONSTRUCTION LLC 070047 Lot Size(sq.ti): Owner: FAIRWAY VILLAGE CONDOMINIUM TRUST Zoning: URA(IO2)/WP(17)/WSP(l5)/ Applicant: A & Z CONSTRUCTION LLC AT: FAIRWAY VLG Applicant Address: Phone: Insurance: 359 BARDWELL ST (413) 250-8095 BELCHERTOWNMA01007 ISSUED ON:3/28/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WINDOW DORMERS & SIDING - UNITS - 201-204, 214-215, 401-404. 419-420, 501-502,503-506, 507-509, 510-511, 601-602,603-605,606-608,701-703, 704-708 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 3/28/2017 0:00:00 $813.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 4 t t V „/" Jw,, City of Northampton Cri , Building Department .9,4»srb>, ,;,am, „,, £ n 1% \ 212 Main Street , vaa1�t yt! ul?� t 011 Room 100 Yi 4 7 - - - Northampton, MA 01060 `',”rf , "� '''` `�' r s �\ d� 1 d �flk a phone 413-587-1240 Fax 413-587-1272 , (7f7 , -a APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION j 106- 1.1 Property Address: el 13" S f"c. —, 5T. This section to be completed'by office I--fue 16 :4-7,, .9 /05- 3 `Map.:. Lot r. Unit Ls.:T.i co/ let i d' i - 7.7- t 1 c1 e --/o 9 h c) -'CO? Zone Overlay District %/19- Y7-o Cie - ,11 /4 ' A r r jut -5-6;2, L a 1 - 4e; Elm St DistrictCB ChariotSECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT~ 1+e, " ‘ e'-) 7 G/.. 76+3 C.e k. - 4'061 764/ - 7v8 2.1 Owner of Record: �r41-u,2). ,'. �h Gan' 9 d�/1f� �a.v dm iUNt G '(o /UdmT�.f,,f,'rT�... .� l>JE'h / Name(Print) Current Mailing Marais, W 3 6 i - 9»�{ o Telephone ,04f +t G) se; t & Signature .-y' FYma,-it G (r�D' . (l7/Yf 22 Authorized Agent Pit (/f. /OA if44 ,,4; e fast/. 41�...de:.w7 f e, / 4I' ze,„4.477.),,Mr Memo(Pr-.) Current Mailing Address: a fp G / 4 '. - i /. _. . �� .._- . /3 n�*a4y70 4r a4fi ,e,r'o4d,, co.„ Signal = 1 1 Telephone SECTION 3-ESTIMATED C�T STRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Li- (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection yp ,(,_ '� B. Tatai_{1 +2+3+4+5} J f�LS pLi V LP Check Number SS r(!// �/�L} , 3 This Section For Official Use Only Date Building Permit Number: Issued: oBulking Commissioner/Inspector of Buildings Date ' 1 if • 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 1_____ _ I E. _— . . 1 __ ___.1 Frontage L J -- ------ Setbacks Front El---11 [I I 1_1 �.._ Side L:L—� RL.--.I L:..__-1 Ra_____. L..._I L—J Rear L_II L-.J L— Building Height 1 I L-7 Bldg. Square Footage ) I /o I L---.1 L._ Open Space Footage (Lot area minus bldg&paved L. LJ [ f I i parking) #of Parking Spaces _ L—J I--J L'-J Fill: I I (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on 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 DON'T KNOW © YES 0 4 IF YES: enter Book l Pagel. 1 and/or Document 1 B. Does the site contain a brook, body of water or wetlands? NO O DONT 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 © , Date Issued: C. Do any signs exist on the property? YES © NO 0 IF YES, describe size, type and location: L --i 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: r J E. Will the construction activity disturb(clearing,grading,excavation,or filling)overt acre or is it pad 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. gECTION 5-DESCRIPTION OF PROPOSED WORK[check all applicable) New House El Addition n Replaceme indent } Alteration(s) 0 Roofing Or Doors Accessory Bldg. 0 Demolition LI New Signs [0] Decks [O Siding n} Other[0] Brief Description of Proposed Work: iste p14- r 1/41 Airs lit (N , -u4 JJ04.4-/5 4- 5;...4f I^' Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet Ba If New house ani"or addition' to existing hous'inq,•Domplete 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 OWNERSn/ AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i, ei //lit Nr'Uyy; l iA'c-) as Owner of the subject properrttyy / hereby authorize Ca grn-uc7"/�eti 4-L e QA+`4-s/SOIL X 771 t / to act.,. my behalf,in all matt- relative to work authorized try this building permit application. tee . A 10 " i 7 - �3- /'J Sign.ure of Owner ��)��/ Date I, / -I dm?S /t,}?o51' 4 ('O.*cST <.T ^ +u - rwt as� er/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/annd penalties of perjury. 7441 Print Name ICC 3-23 Sign re of Owner/A ICC Date w SECTION 8 -CONSTRUCTION SERVICES _ 8.1 Licensed Constructions Supervisor: ! sk Not Applicable C7 Name of License Holder'. dm�fS J. Mitcrr (5 es7Od 97 West btA47e/y 744 License Number 3? LAu.Re T . rls�' D'/o 3 9 lo ---/ ?-- /8 Address J Expkatlot Pate tstwi il ACI— Wu?-.ea l _. yd9c_ Signa ire (((/// et9 Telephone� [ &m ,g ar f' R- i J 1S,-'1`.4lT t� t.v S j x-e r 9. Rp stored H/..pJple lmprovemmoUt��Contractor: _ `" Not Applicable ❑r^ -1110.41.1-5,/0/��e/x , Ate C'O.✓GTezc erten,'1 d.s.J LSC I v62<fd" Company Name Registration Number 35-9 .4,/4otnel/ 57. — `-f-e7-/7.. Addressr �/ Expiration Date tij/a0/r'r7J..v� �ul,✓f C iela i7 Telephone �d.250'itf 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 No Cl it Homeownei Ezempfion 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 su ervisor. CAW 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 form acceptable to the Building Official,that hetshe 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,duringand upon completion of the work for which this permit is issued. Also he 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 andState of Massachusetts General Laws Annotated, Homeowner Signature _ / I 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: 5f4 -7 fl z 02,15 A4.4 The debris will be transported by: Tl1u �& The debris will be received by: 14//-0)/ Pr cyc Building permit number: Name of Permit Applicant /I? 6 .,.7-- C C 714(t, 747,2) -acke X7%7 Date Signature of Permit Applicant The Commonwealth of Massachusetts p— Department of Industrial Accidents Office of Investigations ISO 1 Congress Street,Suite.100 lll � Boston,MA 02114-2017 .a•' r www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 41-i- , d i ,Tiii 1 tci L L- C Address: 3Y9 4. -.44.4.4).// Sr• C ,s CitylStatelZip:_ A *kijj rsg Tpw.++i e3/4/02 Phone #: 9t Z�d '"- O'419S Are you an employer? Check the appropriate box: 1. am I a employer with 4. [i 1 am a general contractor and 1 Type of ewprcon[(required): employees(full andtor part-time).* have hired the sub-contractors 6. New cnstructimt 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sob-contractors have g. 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.El I am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.1-1 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1354 Other Cu i � -coXe., , ,r,.�j comp.insurance required.] 4A-ed STGrt nv 'Any applicant that checks box et must also fill out the section below showing their workers'compensation?obey intbmsadon. Homeowners who submit this affidavit indicating they are doing all work and then hue 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.palmy number. I ane an employer that is providing workers'compensation insurancefor my employees. Below is the police 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 e. 152 can lead to the imposition of criminal penalties of a fate 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert(fy ande fie pains • d pen,hies of perjury that the information provided above is true and correct. r rte'--•.-.. Si•nature: _ ate' .� "` z3—I j Phone#: if -- 2$ted' tl D 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#: