31A-083 (6) 302 ELM ST BP-2017-1228
GIS it: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31A-083 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 ft BP-2017-1228
Project# JS-2017-002063
Est.Cost: $120000.00
Fee:$780.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SACKREY CONSTRUCTION 079384
Lot Size(sq. ft.): 13329.36 Owner: STERNAL JEFF
Zoning: URB(100)/ Applicant: SACKREY CONSTRUCTION
AT: 302 ELM ST
Applicant Address: Phone: Insurance:
83 SOUTH MAIN ST (413) 665-9995 O Workers
Compensation
SUNDERLANDMA01375 ISSUED ON:5/S/2017 0:00:00
TO PERFORM THE FOLLOWING WORK ADD NEW KITCHEN & MASTER BATH WITH
LAUNDRY, NEW RAILINGS FOR FRONT PORCH
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: 001: 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 Occu sane Si'nature:
FeeType: Date Paid: Amount:
Building 5/5/2017 0:00:00 $78000
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-12280 N I if
APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION
ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLAND (413)665-9995 Q V
PROPERTY LOCATION 302 ELM ST
MAP 3IA PARCEL 083 001 ZONE URB(100)1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENC o D REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid i ^1
Building Permit Filled out I
Fee Paid
TvpeofConstruction: ADD NEW KITCHEN& \1ASTEt :ATH WITH LAUNDRY,NEW RAILINGS FOR
FRONT PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement oLicense 079384
3 sets of Plans/Plotf Plan �(2e— w t- `..r/
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN RMATION PRESENTED:
THE
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 CommissionPermit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Den: ' on !elay
/ —5 /?
Signature of Building •ffrcial 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:
-•\ t. Building Department Curb Cut/Driveway Permit
_1�\ 212 Main Street Sewer/Septic Availability
rL� Room 100 Water/Well Availability
Q. Northampton, MA 01060 Two Sets of Structural Plans
Q phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
\N Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE
)..OR),f�yy/O[JF,/A/MMII/L//f�/DDW�/E�LLING
SECTION 1 -SITE INFORMATION 1rT W�v�
1.1 Property Address: This section to be completed by office
3O Z r1Lv S T, Map 304 Lot a 43 Unit
0012.—C+1r P'vv,e ?m-) VA idb' - Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: /
Secc/4y Q�Invt S\-errtA) 7? r *l 5Jr/e &'teoF 0/,040
Name(Print) Current Mailing Address: q/3_69s_/ 7�``
`,i/// Telephone f0 -f J
Signature
2.2 Authorized Agent:
j C lA r3 14' , .., A U/ C e.1 S5 S. v,/V14 v-.I .c-F . EV ty.f11f,./LLN-SLO
Name(Printf Current Mailing Address:
J /� `t13- to-2,- G 3 s
Signature J Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building a (a)Building Permit Fee
4-: (a C , C:57)
2. Electrical (b)Estimated Total Cost of
W Z S t (nsO Construction from(6)
-
3, PlumbingBuilding Permit Fee
t 1SU
4. Mechanical(HVAC)
5. Fire Protection (27.3t1
6. Total=(1 +2+3+4+5) -I2O1 TOO Check Number /330 �re
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:Signature:
Building Commissioner/Inspector of Buildings //�� Dale
tai/ SQct✓€yV rl�/Cer , ( Ni,_
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 N
Frontage
Setbacks Front
Side L: R; L: It:
Rear
Building Height
Bldg.Square Footage
Open Space Footage aPo
(Lot area minus bldg&paved
parking)
•
•
N of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finrd^i�n(g ever been issued for/on the site?
NO O DONT KNOW V 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 e 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
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 11
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,ex avation,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) lir Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition ❑ New Signs [0] Decks [0 Siding[CO Other[CI]
Brief Description of Proposed n c P,,; -}_
Work: A )--. y,Tcd<>_] a it ASYIc..r a ru —0) LiArw-LOP7
303 rK,�_
Alteration of existing bedroom ✓ Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - hoe
Ba. 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: I I Number of Bathrooms 3
c. Is there a garage attached? "10
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? CGP t 'Y'-6- 1-1/1 Pins rr( Fireplaces or Woodstoves i Number of each 1
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction t-U P
i. Is construction within 100 ft.of wetlands? Yes \7 No. Is construction within 100 yr. floodplain Yes No
I. Depth of basement or cellar floor below finished grade Cs
k. Will building conform to the Building and Zoning regulations? ✓ Yes No.
I. Septic Tank City Sewer ✓C Private well City water Supply ^/
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTORI\( APPLIES FOR BUILDING PERMIT
h rt7 420417 Si-e0/4/ ,as Owner of the subject
property
herebyauthorize JO44 1f ^
V4
to act on my behalf,iv) matt five to rk authorized by this building permit application.
y/a7/2Q17
Signature of Owne Date
I, J6\14 q- . c,..c..Vi .i ,as Owner/Authorized
Agent hereby declare that the statements and informabl on the foregoing application are true and accurate,to the best of my knowledge
and belief. //��
Signed under painnnd penalties of perjury.
Print Name ��V' //
Signature of Owner/Agent Gate� 'I
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder_ �01-1-3A S / ( 5 " 079 5
License Number
gJ b 5 1/A-4-14-4 Ste. �tAAQF✓ deP.19 I d/I y li &
Addre Expiration Dale
3 - �� 5 - � L (17
Signatu ) Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
pc-/-.Ro 6+-61''huC,-n _ b 1 `P S 9
Company Name Registration Number
g3 . m.-Ar cc, 44- I/ 30 /1 &
Address
Expiratidn Date
y ;. •-•ay. 4 ' 3T
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 ( 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 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 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, as defined by MGL c 111, S 150A.
Address of the work: 3 0Z �� S i ,
The debris will be transported by: Du 51 LA-IA-S Z iQ
The debris will be received by: fr
Building permit number:
Name of Permit Applicant SR c. k-fzrt, 1 O
12‘iin 0_717-
Date Signature of Pe it Applicant
The Commonwealth of Massachusetts
I -g
Department of Industrial Accidents
=110• Office of Investigations
Congress Street, Suite 100
,-` Boston, MA 02114-2017
j www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information // � /' Please Print Legibly
Name (Business/Organization/Individual): 5 R L p I`[ Li 6- _ 5 l 0 ,
Address: d b 5, ISA, w-D 5 C
City/State/Zip: Svµp hpe_ P Phone #: 4 i_ 3
Are you an employer? Check the appropriate box:
Dl
Type of project(required):
I.LJ I am a employcv with 4. ❑ I am a general conaactor and I
employees (full 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 g. ❑ 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
3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions
myself [No workers' right of exemption per MGI,
Y comp. 12.0 Roof repairs
insurance required.]' c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f 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 sub-contractors have employees,they must provide their workers'comp.policy number
Iain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: V`+ , ,
Policy#or Self-ins. Lie. #: uin?( It c k, fttl N Expiration Date: Z / 4 //6
Job Site Address: 30 7- e cwt Sir I�O'er(rk R w.�to 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 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 hereby ce r and the
p nd penalties of perjury that the information provided above is true and correct
Signature: r • Date: L Zl/ l
3
Phone#: � - , .I# f
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#:
John Sackrey
From: Jody Barker<jodybarker.aia@gmail.com>
Sent: Tuesday, April 25, 2017 4:10 PM
To: Jen; Jeff Sternal; John Sackrey
Subject: Fwd: Certificate of Nonapplicability
Hello All—
No formal letter yet, but I presume that the"whole project"may be submitted without a hitch. See response from Sarah LaValley below...
Thank you!
-Jody
Begin forwarded message:
From: Sarah LaValley <slavalley@northamptonma.gov>
Subject: Re: Certificate of Nonapplicability
Date: April 25, 2017 at 3:54:04 PM EDT
To: Jody Barker <jodybarker.aia@gmail.com>
Hi Jody-
I reviewed this but haven't yet had a chance to put a letter together. The railing work qualifies for a Certificate of Nonapplicability as
specified in the Ordinance, and no additional review is required.
Sarah I.LaValley
Conservation,Preservation and Land Use Planner
Northampton Office of Planning and Sustainability
City Hall,210 Main Street,2nd Floor
Northampton MA,01o6o
413-587-1263
1