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25C-103 (4) 31 -33 GRANT AVE BP-2017-1253 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 103 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2017-1253 Project# JS-2017-002096 Est.Cost:$14330.00 Fee: $94.25 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRYAN DARGIE CONTRACTOR 103170 Lot Size(sq.f): 5270.76 Owner: ALBANO ALFRED Zoning: URB(100)/ Applicant: BRYAN DARGIE CONTRACTOR AT: 31 - 33 GRANT AVE Applicant Address: Phone: Insurance: 25 HUNTERS SLOPE (413) 533-1470 0 WC WESTFIELDMA01085 ISSUED ON:5/3/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO AND REPLACE 2 STORY PORCH @ RIGHT SIDE, FRONT FACING 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: 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 513/20170:00:00 $94.25 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1253 APPLICANT/CONTACT PERSON BRYAN DARGIE CONTRACTOR ADDRESS/PHONE 25 HUNTERS SLOPE WESTFIELD (413)533-1470 0 PROPERTY LOCATION 31 -33 GRANT AVE MAP 25C PARCEL 103 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATI N CHECKLIST LOSED REQUIRED DATE ZONING FORM FILLED OUT Bee Paid Building Permit Filled out v` Fee Paid TypeofConstruction: DEMO AND REPLACE 2 ORY PORCH(05 RIGHT SIDE,FRONT T FACING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103170 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 Permit DPW Storm Water Management I•molition I-lay 3'2 -/ 7 Signa ure of Bui ding rcra( 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Pemet 212 Main Street Sewer/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 Property Address: )” ---j--Th �� This section to be completed by office crrch.r Map 2.• Lot /o.3 Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT V 2.1 Owner ofRecord: R\\� IN\\air:, \ - ....,..,,,,-„,„\\ S\ . a o,,,�S- -rr (Print) Current Mailing A r s 0c-/ �\z � , 1� Telephone Signatur L am st, Current Mailing Address: N �-__\.— ..`-\\-\ � Signature -- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of \�\ �-V Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) T4.025 5.Fire Protection r-'.-.--7. fr-^) 6. Total=(1 +2+3+4+5) Check Number NM This Section For Official Use Onl1 MS :.120A Building Permit Number Date Issued: • mmArtm nu MA n �OelN<MnON M>n,['m 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 filled in by Building Department Lot Size Frontage Setbacks Front Side L R: L R: Rear Building Height Bldg. Square Footage Open Space Footage fir: (Lot area minus bldg&paved Parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW a YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW ® YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT 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 O , Date Issued: C. Do any signs exist on the property? YES O 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 IF YES, describe size, type and Location: E. WSII 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 O NO Ca 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. 0 Demolition ❑ New Signs [O] Decks [0 Siding [O] Other[ Brief Description of proposed . \ ..-1-A , r� Work: �,MC,� t��c.C.e *>,A.- Ti '�O+'" % �,5�� Si X t+.� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing. complete 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 stones? 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 ,IIIVI OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I -Cklft.-..) .3 AV34k—k) ITN_ A&6&. ELM a) it - L ..L_ ,as Owner of the subject Properly he authoriz �i� pie ,iii-x____ to ct o my behalf ��i ma,- eative to work authorized ge'this building • reit application. t beii! t. -C. i it Signature nature of MW r I ate a I, � ,as Owner/Authorized Agent heresy decSrgthat the stateme???Illtttsss"'an�infomiation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. int Name V i Signature of Omer/Agent Date SM, 61 / T SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ' Not Applicable 0 Name of ueenea Hdder ��\C�¢��G c \r \-- (C ) VVsy License Number ress ` l v\v�J Expr3tion Nat Signature Telephone 9. eeietered Home Improvement Contractor: Not Applicable ❑ v. ny,� ��y rr ,v C e,�. ., wr.J \(,) ".\-1\(_Company a `1 Regi tration Number Ad ress (/u�\\ c� Expir tion Da e TelephonB, \\, `�� p0 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 bpilding permit. Signed Affidavit Attached Yes l l No 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 wilt be required from time to time,during and upon completion of the work for which this pennit 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 Slate of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton 212 Math 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: 3\ �� \\ ms - N The debris will be transported by: . The debris will be received by: c.v\i\i\s\,eT r� Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents i�p7' _it Office of Investigations Air�� 1 Congress Street,Suite 100 �\ ,IBoston,MA 02114-2017 """�aaa.... www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Basiness/Organizatior✓Individual):� .., c)v,—, T;\--it.,„,,,= t._ Address: \\ ,, '. ��,^ ''- A _ r_ City/State/Zips, .k ♦ Phone Phone#:\---\\-). ).SL\ -SA nfe you an employer? Check the appropriate box: Type of project(required): I.IrFJa I am a employer with 4. 0 I am a general contractor and I employees(fidl and/or part-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. 0 Demolition workingfor me in anycapacity. employees and have workers' P ty. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.[ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions q ) officers have exercised their 11.0Plumbingrepairs or additions 3.❑ I am a homeowner doing all work P myself [No workers' right of exemption per MGL Y comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no \ employees. [No workers' 13.0 Othe2 V sr vu - I 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 die 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: f( j \• w Policy#or Self-ins. Lic. #: V\PSC> \ ,73\ Expiration Date: �� 7 I s 3 \7 Job Site Address: A\�� Cyv-t..�� V� ep 1City/State/Zip: iL cL c 4,3, NC\ 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 coverage verification. I do he r(ify under the p '' and s of perjury that the information provided above is and correct. Signature: - --- ----___ Date: Na . \ Phone#: CA\) '>,-->-\ `,\A t lc \-S\\ 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#: 4✓272OI7 32 Grant Ave-Google Maps Go gte Maps 32 Grant Ave w ¶ t .6 !w r• �Gf'iI et _ T • 1 ! _ � an5 Google , u „/f'Tr4 erC mage capture:Aug 2013 ©2017 Google Northampton,Massachusetts [ -//n+ Street View-Aug 2013 31 Grant Avenue https//wwwgoggle.wmimape/@423280181,72.6258991.3a25y3833h,9935Utlata=!3m611e13m4tIeGYelOhHn_h9Xl'RbQSZunw•gl2e0i711331218i6656 IH Dargie Contracting Bryan J. Dargie 3\1'I ? SYo,r t rL Resident c,t,s\sAM n, pp Licensed and Insured $' )�� MA Construction Supervisor License so3170 c Cl �� Ute\ �.^\\'O Construction Management Residential&Commercial eS Hunter's Slope Cell 913-244-8839 N'asrfield,MA 01085 \ 913-533-147u See Mii:cs 0 C\- \ �r„•N ,Pv� �)r.A \.„ i 1-1. Il x �� 1 '' c,c x `'I Ic 11 le° __• hS37,500 hs Ibbo Ib Building Northampton tOPlan ReviewI� r 212 Main Street ...-3'-' 2 �S'aq4SC /9"P ' uc/ 1 ° 1 Northampton, MA 01060 00 , � tri .5-- -17re)�ac? .5-- -17�-� / uarg■e wniracnng Bryan J. Dargie President r`) l''' 'n`\�cJ P��;,�YJ1'y'1 Licensed and Insured Q t MA Construction Supervisor License 103170 Construction Management 25 Hunter's Slope Residential&Commercial Westfield,MA oto85 ------ - Cell v3-244-8834 413-533-1470 ��( , Ny iIN 1 I �> ' L ! 1 , �`� �wUC- eQS,i.AFV I \ 1 Z---,,\,\\-,.„ JVr �c �� r � c«� ti c ,\-s r4\\,•„)t- ti.2,c,ti1 \W �