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17A-290 (5) 68 HILLCREST DR BP-2017-1153 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:elock: 17A-290 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: Bath reno BUILDING PERMIT Permit BP-2017-1153 Project# JS-2017-001953 Est.Cost: $13800.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grouo: ROBERT WALKER 034783 Lot Size(sq.ft): 31929.48 Owner: SARRO LYDIA&JOSEPH F BARTOLOMEO Zonine: URA(100)/ Applicant: ROBERT WALKER AT: 68 HILLCREST DR Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:4/13/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL 1ST FLOOR BATH 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 4/13/2017 0:00:00 $90.00 212 Main Street.Phone(4 13)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1153 APPLICANT/CONTACT PERSON ROBERT WALKER ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 68 HILLCREST DR MAP 17A PARCEL 290 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid a /�r-(1 Building Permit Filled out /V/,JI Fee Paid Typeof Construction:_REMODEL 1ST FLOOR BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 034783 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 I lealth Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Air .IitionD ' ,A es Y/-5-77 if Signa reof 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. City of Northampton 'b /s" Building Department 212 Main Street Room 100 Northampton, MA 01060 . phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEt TION 1.1 Property Address: 4-1-atc L As ' • titi SECTION?•PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owper of Record: JA/620A ai ��, eo F..k /$loch i vr F/t rrace MA 0/e/) N e( riot) Current Mailing Address: SOb 2 773 1^"' Telephone Sign4ture 2.4/Authorized Agent: Pecs ar c- te- z 3L2 Sp'vuo 6e0-cati 10a a— Name(P t) Current Mailing Address: L,c l Sl Ll1�Q � "CZ 4 - \Z a 4 Signature _ Telephone SECT-WWI-=ESTI MATED CONSTRUCTIOCflT*• Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ` o l c\/ (a)Building Permit Fee 2. Electrical 6.75 (b)Estimated Total.Cost of Construction from(6) 3. Plumbing '2- Jot, Building Permit Fee 4. Mechanical(HVAC) y�•�, 5. Fire Protection /�` � � 6. Total (1 +2+3+4+5) 1 3 YOU. Check Number - This Section For Official Use Only BuddingP mitNUmr.heDate. 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 This column to be fill nby Building Depart Lot Size Frontage Setbacks Front Side L: R: L: � Rear \--) e, Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved parking) ttofParking S es (volume&Location) A. Has a Spe al Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 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 Pagel a d/or Document if B. Does the site contain a brook, body of water or wetlands? NO DONT 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 ,rl(_f'�// IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NOeV IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex tion,or filling)over 1 acre oris 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. • swims', PROPOSED.WORK(checkallapplicable) New House • ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ' ❑ New Signs [D] Decks [D Siding lot Other[I7] Brief Description of Proposed work: On4A€J- 1 s r tF to* §45.----4- Alteration ' -Alteration of existing bedroom Yes Adding new bedroom Yes 1------TIO Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 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. lYrtknsio,: e. Number of stories? V.� ICN f Method of heating? -.laces 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 - ands? Yes No. Is construction within 100 yr. floodplain Yes_No i. Depth of basement .- -liar floor below finished grade k. Will buil. •• conform to the Building and Zoning regulations? Yes No I. --ptic Tank City Sewer Private well City water Supply SECTd7a-,QWTWRAa €NI THORIZATI -WOO COMPLETED WHEN O, , B ,,GEIW OwtONTRAeTOR APPLIESFQR BOOMING REMIT I. " JS epk J k71-0/0me ,as Owner of the subject property hereb authorize -y P,C..2-4r L/vK .V--Ett to - •n my behalf,in all ers relativd to work authorized by this building permit applicationili . • a 51 ///7 their ure of• r er Date I, RJ E¢7-- ‘./00-l.,r FAC. , 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 Sig nn ed under the pains and penalties of perjury. rat,6 EA2.-T ' - tU .(L Print Name a - - ) I-9— Signature of Owner/Agent Date SEC1 t.CANSTRHODON SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holler: IZCAIS.Irr 3 WAL\GeV— CS - 0%4-783 License Number 3(0 S e'¢..ncc C¢.n+llt smarm AA4 III MI toll Address t Expiration Date Rs•Lestesk LwSJti Ori - 5-64 - tzz LL Signature Telephone Not Applicable 0 2.45sex' 3 woe tAJ£Il 1-1 2016 Company Name Registration Number 3(. ScLutcE Cgr-, t f zotB Address Expiration Date IDbttlnacy.wnsx1 Vt4A D10(.0 Telephone 584 -1224 SECflOISKPII ORKERS'COMPENSATION INSURANCE AFFIDAVIT MAL.c.152,§25C16)) 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 0 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 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 maybe 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 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge th a condition of the building permit all debris resulting from the constru activity governed by this Building Permit shall be disposed of in a pro' licensed solid waste disposal facility, as defined by MGL c 111, S 15C Address of the work: 1�g y / `/2j et,_ _ The debris will be transported by: Co '"`P-'C , The debris will be received by: li/n-A-K`-t C9Uuteau Building permit number Name of Permit Applicant__ 17ott&�P InC . , lt. Date e f �_3 /4O/,Signature of Permit Applicant Department of Industrial Accidents s Office of Investigations .._ - 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation InslranceAffidavit: Builders/Cuntracdors'Eleciridans/Rumbss Maltreat information Please Print Legibly Name (BatinesssOrganizationmaividual): ' • _ -, , wt. S rat _ Address: e2i Co feta V tCt C v.uvc-(Z City/State/Zip: ralr: f1l)P-' vvva- c "Phone #: l SB 1 L Z Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with IC 4. ❑ I am a general connector and I employees (full and/or pan-time).' have hired the sub-contractors 6. ❑ New construction listed on the attached sheet 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Drlition working for me in any capacity. employees and have workers' 9. ftnuilding addition [No workers' comp. insurance comp. insurance.' required.3 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work rrysslf. f No workers comp. right of exemption per MGL 12.n Roof repairs insurance required.] ' c. 152, §1(4),and we have no arployees [No workers' 13.0 Other comp. insurance required.] 'Any a•_picaa tba cheSisbox#1 must um fill as the ssti&i tela/Stowing thdr workers'comps eggierl policy infamaian. I Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional shoe showing the name of the sub-contractors and state whether or not those entities have employees. If the sub- ntraaorshaearytoyam they must praidetheir workers'comp.policy numb'. I am an employer that is provicing workers' eompets3tioninsurance tor rryanployeas Beiowisthe policy and job site information. Insurance Company Name: 7j!//77 $Uz Policy# or Self-ins.Lic. z: m 2 2CC) 2 6 (7O /Ld Expiration Date: 10/7-0,/7 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(shavingthepoi icy 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 S 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 5250.00 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 above is true and correct Signature: Date: Phone#: 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#: A ROC ROC De CERTIFICATE OF LIABILITY INSURANCE D4/13no V( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CN01NTAC7 Barbara Grynkiewicz Webber c Grinnell PNOXE (413)586-0111 EAR uvnse6 ue1 INC.NO.EXU. _ WC.Na B North Xing Street ;ORES$:bgrynkieries@Rrebberandgrinnell.corn __.. WSYRER(S)AFFORDING COVERAGE MAKE Northampton NA 01060 - IXSURERA.Excelsior/Liberty_ , 11045 wwaED INSURER A.I.N. Mutual Robert Walker INSURER Atte: Kam ClaireaLont INSURER o 36 Service Center Road INSURER E: Northampton NA 01060 WSURESP COVERAGES CERTIFICATE NUMBERRxp 3/1/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ POLICY EFF 1101.1CY tY.• ILTR TYPE OP INSURANCE IN,p ayD POLICY NUMBER (NLYooNYYYI IMI LIMITS X COMIERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE R OCCJR DAME TORENTEb A PRE s Eo occur/rue. ,S 100,000 CB/28898298 3/1/2017 3/1/2018 MED EXP(Any one peters) S 5,000 Pm5ONAL ADV NJLRY $ 1,000,000 __.. _. . GEMLAGGREGATE LIMIT APPLIES PER'. GGENERALAGGREW'E 5 2.000.0000 POLICY X °ECT LOC '. Pam T cwdvroPACG 5 2,000,000 OTHER 5 AUTOMOBILE LIAaILIn' BIident)SINGLE„WC6 Aa acc ANY ALTO BODILY INJURY(Per person) S. ALL OWNED SCHEDULED BODILY INJURY(Par ezvdwttl S AUTOS AUTOS HIRED AUTOS _-. AUTOS N-OWuE0 PROPERTYds:J DAMAGE 5 UMBRELLA LIO _ OCCUR EACH OCCURRENCE L.$ - EXCESS LIAS CWMS-MADE AGGREGATE - $ DED RETENTIONS S WORKERS COLPEN6aTIO11 X_ P€ANTE ER _ AND EMPLOYERS'LM&LT' YIH ANY PROPRETORNARTry EXECU➢VF _.._ Et EACH ACCIDENT 5 500 000 OFFICERMEMBER B Mandatory In NMEKCLVOC-0i _XIA a1z800BO065A82016A 7/1/2016 7/1/2017 EL DISEASE-EAEMPLOYEES 500,000 II yes bulbi DESCRIPTION Of OPERATIONS Irak... EL DISEASE-POLICY LIMB $ 500,000 DESCRIPTION OF OPERATIONS LOCATRIN3/VEHICLES (ACORD 101.Additional Regret Sewage.may M attached X more space Y rewired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE **For Insurance Info Only** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUMMQED REPRESENTATIVE F Webber, C_C s2:s/3A I cL.ATc.. e-- m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1N5025I20i4C1, sem)) RA-\1ze - „ /0/ /s �s ,/ y �3-/ 7 �� - - '� City of Northampton t9 6 Building Department 6-ka-wCe_ Plan Review SNS 212 Main Street _Neampton,.MA 01060 e r i t� r,tO A-t,-�GLg ,-_ C t.aa-w l RAST ' Ii A-n,9 GtRA- i / 1 (o c_A45 c w %,_,as / to 0 \ o -- , S 14. SC-C1).4 cF woad U KALA ,-. -e pwA,- v; tAial i- 0 o prate 5L,z © 1-tih' .-A- Neo Q...) IL-41,W s.+Eew�r,rt 17'4-St 4- "'e'vkAL'Sv.t-e ll e wzAlI S ÷. r( acrd U Nki, ,. T 6rLzT + 5 i tai,_