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30A-003 (4) 280 FLORENCE RD BP-2017-1295 GIS a: COMMONWEALTH OF MASSACHUSETTS Man:Block: 30A-003 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS • Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit4 BP-2017-1295 Project# JS-2017-002152 Est. Cost: $12000.0.0 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BENJAMIN GREENE 96066 Lot siae(so.ft.): 24611.40 Owner: Amanda Anderson Zoning: URA(I00)/WSP(100)1 Applicant: BENJAMIN GREENE AT: 280 FLORENCE RD Applicant Address: Phone: Insurance: 47 Chapin Street (413) 374-9826 0 EASTHAMPTONMA01027 ISSUED ON:5/10/20I 7 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN CABINETS AND INSTALL POCKET DOOR IN NON-BEARING WALL 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 Si 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 5/10/2017 0:00:00 $78.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1295 APPLICANT/CONTACT PERSON BENJAMIN GREENE ADDRESS/PHONE 47 Chapin Street EASTHAMPTON (413)374-9826 0 PROPERTY LOCATION 280 FLORENCE RD MAP 30A PARCEL 003 001 ZONE URA(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out .(;)(1:1) Fee Paid Typeof Construction: REPLACE KITBINETS AND INSTALL POCKET DOOR IN NON-BEARING WALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 96066 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Health Permit from Conservation Commission Permit from CB Architecture Committee _ Permit from Elm Street Commission Permit DPW Storm Water Management -mo - ion Delay S-/o -/7 S _•. re of tuilding 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 .3t-1 a 4ifai iir I Building Department t/1'to'imlijn7� n•'s!' `las - I r 212 Main Street :- ' :rY15( > "771n Room 100 !°are���lorr�rlu t d It M� • - q Northampton, MA 01060 s„ ,ra1'Yr rq— r7� W phone 41;3-587-1240 Fax 413-587-1272 :c7�'��C `1t , APPLICATIONTO OOtASTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Z.80 P0/67 C6 1701 Map C A Lot Ova I Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �`2} 4)AnA9t,dA erSoh 240 Flamm* A. FlDrevtarlMR Ole ln2 1 V Name( n t) Current Mailing Atl cess: ![/-Itt N t 8 - 3 �o Sr 3 oD Telephone Signature ,mar /: akatn�Qrsa1 -ekol•wtail•wwI 2.2 Authorized Agent: / DL02 rZ- • r 6�r-CL't2. cy7ez : 5)— 41-1-4,176-- Aiit- d//RI1il9 Name(Pr(It) Current Mailing Address' 41l3T7-79824 9-nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant (a)Building Permit Fee 1. Building (2- pO' 2. Electrical (b)Estimated Total Cast of Ai/A- Construction from(6) Building Permit Fee 3. Plumbing N/4- 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 +3+4+5) /2, two — Check Number ,3i1.Z / i'] This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date I Section 4. ZONING Alt 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 _ .1 1 i 1 Frontage L i r — J Setbacks Front 1 I I Side 121 I R: I L: 1 R:I 'L I 1 Rear I I Building Height 1 CJ Bldg. Square Footage O % Open Space Footager_ % - (Lot area minus bldg&rnvcd j i LJ F U parking) #of Parking Spaces EH L—J I 1 Fill: (volume&Location) ` 'I ; A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW © YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O ___,, IF YES: enter Book 1 Page and/or Document #j B. Does the site contain a brook, body of water or wetlands? NO O 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: 7 C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: !, D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: 1 E. Will 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 O 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 n Addition ❑ Replacement Windows Alteration(s) tin Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs Io] Decks [p Siding[0] Other[o] Brief Description of Prop sed / . Work: grret t2 klia -^ ea 1:);44-44Y/f " Ctit8 � ehni- uoi An/ ✓ro Y- /i^' Alteration of existing bedroom Yes No Adding new bedroom Yes No 4n// / Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet pa. If New house and o-r ed iition to existinSl housing, cOrniii tethe folio-Whig' : 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 OWNERSt�AGENT O/R�CONTRACTOR nAPPLIES FOR BUILDING PERMIT - I. F 'v m �ndevSO►n , as Owner of the subject property hereby authorize �( set/4 CO(tea- to act on my be alf, in all matters relative to work authorized by this building permit application. a(y�� 11/120 � Signature f Dnp /' Date 1111.1 I, itbatiO.W i4 6M-4-0-0— ,as Owner/Authorized Agent hereby decl a 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 and penalties of perjury. Print Name Signature of 0 ner'gent Date SECTION 8-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: /n�^. Not Applicable /❑ game of License Holder' ?C1 01.0eti 4 2-`..M P 6-012- 740 r/G+ j License Number _ -k14,0f., sic 6;Sf4tnt,4104., cK r/` Ofoe,.4. 712,179 ..� Address I t Expiration Date 7/3 - 3 f y 7792-t Signature Telephone Amari / age/eS/bts?4'o cr +.,10(1/l Cour 9.Rea�l/storedHome lmprdvement Contractor ." Not Applicable ❑ Dc�IHon to Cc.-Q+-- I55'X333 Company/damn y� Registration Number � TCk�O(n S / t shoot f-, 41,1A oe Oz W— /tg,y ZC' 2oi-9-_ Address // Expiration Cate Telephone Y3 - 37 '-1044 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 ❑ 11. 1Tom6Owner Exemption The current exemption for"homeowners,"was extended to include Owner-occupied Dwellin¢3 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 fm'm 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 tie 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: 260 ,a., 4e- Ka/ The debris will be transported by: (en Ac Ar The debris will be received by: �/a//ts gec,,% Building permit number: p - - Name of Permit Applicant X t0/h a-,r 4-it, Date Signature of Permit Applicant The Commonwealth of Massachusetts nDepartment of Industrial Accidents I I _; I 1 Office of Investigations I Congress Street, Suite 100 ?_ .. __ __Bostnn,MA.02114-2017 . _.. .'tyre www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual): t y 4&C a Address: 47. 9- C4 f/4 g f- 0/02=" City/State/Zip: .t fro Phone#: Litt?_ 3 ,syr 9626 Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. I.❑ I am a employer with ❑ employees(full and/or part-time)." have hired the sub-contractors 6. ❑New construction 2. am a sole proprietor or partner-I kfisted on the attached sheet. 7. ❑Remodeling s ip and have no employees These sub-contractors have 8. U Demolition workingfor me in anycapacity. employees and have workers' P n'' 9. ❑Building addition rworkers' comp.insurance comp.insurance? required] 5. ❑ We are a corporation and its I0.❑Electrical repairs or additions .3.❑ I am a homeowner doing all work officers have exercised their 11.E Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.)r 0, 152, §1(4),and we have no ��" employees. [No workers' 13.�Other 4aw �i.'/z«..n comp.insurance required] _ *Any applicant that checks box#1 must also fill out the section below ihowing 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 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'comppolicy number. I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy f<or Self-ins. Lie, #: 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 c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisomnent,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 certify undertns and penalties of perjuty that the information provided above is true and correct Signature: 2 lt ryn Date: y/2?47- Phone IR Lf(3 Z 1 r '!y—'fn6 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#: • -_ ____._—_ - c wk�� +- TLAy1 i1' 'Icor i5 its.,, om O F kite,/ �c7u-� A / ---36"- -/ 3&'i k' - 60" --__ -_.. / 1e . w/7 �^ UF330 p eculni 1 1 i (*-1-(pie All Plywood Construction (Maple Melamine Interiors) I Soft Close Drawers and Doors ; _gym � M Full Depth Adjustable Shelves '.. co p Exposed Ends Finished 01 Light Rail Molding Options Not Included in Price: 3e/ Just top TCMB a Molding will wrap N—_.. ililli. Handles/Knobs around the room I3: N" I e a m co • Bi l r \ Vii- ----• ■ '..co N re w -0 g OS Lazy Susan 8(1 to o 9e. xipo mit W Trash Pull Out will W ? o m m ,. N- - 0 not have Soft-Close - �+ I 3 om _ -_ � » o J jn _- .. N O BER36-SSL SBA36 BWB18 ' WR361824 (m m I- m W N M 7 - N 336 W3336 ---W3618 W1836L -- -- IN. `I. I Blocking Be and I /-- uUUF361430" _.._ Extra Requested Fillers 280 flOaKtR-- NOTE: