17C-112 (9) 38 STILSON AVE BP-2017-1108
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 112 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Enclosure BUILDING PERMIT
Permit# BP-2017-1108
Project# JS-2017-001889
Est.Cost: $19650.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MICHAEL M POWELL 093015
Lot Size(sq. ft.): 11238.48 Owner: CHAMPOUX DAVID B
Zoning: URB(100)/ Applicant: MICHAEL M POWELL
AT: 38 STILSON AVE
Applicant Address: Phone: Insurance:
379 LINDEN ST (413) 374-0963
H O LY O K E MA01040 ISSUED ON:4/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ADDITION OF AN ENCLOSED PORCH IN PLACE
OF A LARGER EXISTING DECK
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:
FeeTvpe: Date Paid: Amount:
Building 4/6/2017 0:00:00 $75.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Ilasbrouck—Building Commissioner
0t, flaw'
File#BP-2017-1108 ��JJ
APPLICANT/CONTACT PERSON MICHAEL M POWELL
ADDRESS/PHONE 379 LINDEN ST HOLYOKE (413)374-0963
PROPERTY LOCATION 38 STILSON AVE
MAP 17C PARCEL 112 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 1\1 117
Building Permit Filled out
Fee Paid
Tyoeof Construction: ADDITION OF AN ENCLOSED P RCH M PLACE OF A LARGER EXISTING DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 093015
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 d/�/ Permit DPW Storm Water Management
Demolition Delay 7
ffii` �J e(-1
--- _
Signature of 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.
OeparInent use only
City of Northampton Status of Permit:
p9Q\\ Building Department Curb CrMDriveway Permit
• 212 Main Street
Swear/Septic Availability
\ \\ Room 100 Water/Well Availability
\�\ Northampton, MA 01060 Two Sets of Structural Plans
�.- phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 PrpDBfN Address: / This section to be completed by office
3 p 571 7 1 so t AAve. Map Lot Unit
101teelCQ/ AAA Zone Overlay District
O t 0 6 Elm St Dlablct CB Mattct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2T.1�Owner
/Iof Record:" /^� p- c1 O/6 C 2-
DaVid Ghamicsix/4my 64r I� Ci1& oct( .30 5AisoP, Auer F/Ott°.MR
Nam 1 // Current Mailing AOOress:
Signature qTelephone �3 _S 75_
-3y
2.2 Authorized Agent:
/1-,1; C a e I PO o f (/ / 4' /-30 4.4 E e y 6 a,,, c Altalus I-
Name(Print) Current Mailing Address: AAA 6/n a T
AAA — A I/ I (c// 3)379- x963
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pennn applicant
t. Building (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
6. Total=(1 +2+3+4+5) / 6 'j O Check Number3I'c3)
This Section For Official Use Only LG
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
1.orc 4 This column to be filled in by
Building Department
/5 i e 7S / 5'0
Lot Size ,oa �, f/ 1.so/ e6 (,1 ?co
Frontage ' , 7c
Setbacks Front / S ) S'
Side Id f S R: if L: 1 s R: / ri•
Rear 4H Dy
Building Height a61-
Bldg.Square Footage an 146 % �o'9y�, I o.i
Open Space Footage `R �[
(lot arta minus bldg&paved sr `f V 3Y1
parking)
#of Parking Spaces y
Fill:
(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:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 O , Date Issued:
C. Do any signs exist on the property? YES O NO It1/4111
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 CY
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,/gx�( ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO (YJ
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 Er Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs ® Decks ❑ Siding ml Other[p
Brief Descriptio of Proposal n �s[ ) / ,.Work: Mad/nu r^. Cr CM -- C 44.(Ori4l ®IGtGe o7 4 /cv,e- -e4I.5h"✓iq deCfc{�
-
Alteration of existing bedroom Yes V No Adding new bedroom Yes No \/
Attached Narrative Renovating unfinished basement Yes IV 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 '7
b. Number of rooms in each family unit: 7 Number of Bathrooms p( + roc'?it �jc($F.px2.tf t4 foo/tri
c Is there a garage attached? /do
I-
d. Proposed Square footage of new construction.41 .. Dimensions O /' c
e. Number of stories? l ] I, 60 /I f tie j,
or-
f Method of heating? NOM(pxsfi y.. rev- yloo se) Fireplaces or Woodstoves 0 Number of each
g. Energy Conservation Compliance. Masschedc Energy Compliance form attached?
h. Type of construction V c Ctl 'Tr cwµ
i. is construction within 100 ft. of wetlands? Yes I/ No Is construction within 100 yr floodplain Yes No
h
j. Depth of basement or cellar floor below finished grade 0 (a rntt `J- Qr0 U�c{, 6✓l 7aicie /�-/�,2.GS)
k. Will building conform to the Building and Zoning regulations? )t— Yes No-
I. Septic Tank City Sewer Private well City water Supply
SECTION la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /'
I, Pa v!] Oa Ott o uX t n sl L 0.4 *rs CAtt 0400 I/X as Owner of the subject
property //
hereby authorize /+'JICAge( poi-tie 1(
to act on behalf, in all rs relative to work authorized by this building permit application.
miiimil3/a7/ao / 7
Sign Owner Date
I, W1 f In A'( � 6l,li-e, 1,1 ,as Ovmer/Authorized
Agent herby declare that th4 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.
1icUgt I Pok-ve 1/
Prin ante
/en/la 7
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License/bider: ( 4ctz I Pn (,✓f l CS - oy3 07 5-
1 yQ P0MlC/11 y Cav '
i + , Ambi-.i $ , ,ten lc�- 'Z urease Number
0 -31 - 1 -7
Address Expiration Date
Y, 3 329 - 09o3
Signature Telephone
9.Reclstered Home Improvement Contractor: Not Applicable 0
/ A tit { Pdwel1 '7 /i/ S.
Company Name Registration Number
A- € j4g 060 z- a6 icK
Address Expiration 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 of the building permit.
Signed Affidavit Attached Yes J3 No 0
11. - Home Owner Exemption
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 10835.1.
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 he 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,lIas defined by MGL c 111, S 150A.
Address of the work: 3 5 h 1 S&o, nv-c-
The debris will be transported by: 4,,1 iv, 1 f %( vc:
The debris will be received by: A-yy, / Pry t // ve �
Building permit number:
Name of Permit Applicant Ali ( kat ( pl) w e 1 ( I bawtii Oremrx-vX
3a � n
AAA
Date Signature of Permit Applicant
Sia? tad /7
The Commonwealth of Es—,
•
s Department of Indus
trialAcci
de
nts
WOffice of Investigations
f n;g � I Congress Street,Suite 100
: rBoston,MA 02114-2017
*a-..f www.rnass govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information + t Please Print teeth's
m
Nae(Business/O/lrgativatloMttlividual : IC [ a'f. I P6 w 11
l ... _
Address:, pm-(l t fay �g� 7'Q-. q 3
City/State/Zip: ���t_'�',[,, J/IMO O i0('(� Phone#.: L) / 3 3'7 Y - U 7 6
Art you an employer?Check the appropriate box: Type of project(required):
0 I am a employer with 4. 0I am a general contractor and 1
p have hired the sub-contractors 6. 0 New construction
employees(full and/or part-time).'
2.®I am a sole proprietor or partner- listed on the attached sheet, 7. Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity. employees and have workers' q wilding addition
No workers' comp.insurance comp.insurance.:
required./ 5.0We are a corporation and its i 0.®Electrical repairs or additions
.3.0 I ant a homeowner doing all work officers have exercised their I 1.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL
12.0 hoof repairs
insurance required.] c. 152,41(4),and we have no
employees. No workers' 13.0 Other
comp.insurance required.]
"Any applicant that checks box k I must also till oat the section below showing their workers'compensation policy information.
Homeowners who submit tins affidavit indicating they are doing all work and thin hitt outside contraetnn must submit a newallidavit indicating such.
iContraciors that chock this box must attached an additional sheet showing the name of the snb-contreeton and state whether or not those entities have
employees_ If the xubmnttactors have employees,they must provide their workers'comp-polkv nwnber-
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 MOL 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 ofa STOP WORK ORDER and a fine
of up to S250.00 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.
l do hereby certify under the pains and pe perjury that the information provided above is true and correct.
Signature: /'v✓" ' V -� ._Date' 61.4v/ 1 201 7
Phone 4: 9/3 17 i- of 6 3 J
Official use only. Do, wt write in this area,to be completed by city or town official.
City or Town: Permit/License It ... .._._
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: ...._. Phone#:
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Notice 9 T ' S(Al Are
The information delivered through this on-line database!s provided in the spirt of open access to government information and is
intended as an enhanced service and convenience for citizens of Northampton, MA.
rhe providers of this database: CLT, Big Room Studios, and Northampton, NIA assume no liability for any error or omission in the
information provided here.
Currently All Values Are Finalized For Fiscal Yr 2017.
Comments regarding this service should be directed to:isarafn@nprthamom ends et sorus
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