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17C-177 (12) 29 PLYMOUTH AVE BP-2017-1287 GIS#: COMMONWEALTH OF MASSACHUSETTS :B Maplock: 17C- 177 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2017-1287 Project# JS-2017-002140 Est.Cost: $10800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NEWMAN'S CONSTRUCTION 64690 Lot size(so. ft.): 4791.60 Owner: WALLACE WILLIAM J Zonine: URB(lom/ Applicant: NEWMAN'S CONSTRUCTION AT: 29 PLYMOUTH AVE Applicant Address: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 NORTHAMPTONMA01060 ISSUED ON::5/9/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP 2 LAYERS & SHINGLE ROOF 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 5/9/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Departmentsee on : i City of Northampton usof P mifF-S4'" ' '" t "}—{°1 Curb CuWnue va Permlf Building Department 212 Main Street SewerrfSeetfoAvaifabiiity - P., ...% Room 100 WaterlWei Avallabiuty 0 Northampton, MA 01060 Two Sets of Structural Plans _ phone 413-587-1240 Fax 413-587-1272 Plat/Site Plans z -. Other Specify ,APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION It-t7-4.2129 1.1 Prope�/rtyJ�Atldress: /,J /) ^This section to be completed by office c29 ? 'mOotAAAt Map I / C- Lot / 77 Unit nit NCf /'/4 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ((J // n ( L//scf list �✓1 h:efirt �n Cf/062 Name(Print) Curren tMaAddress Y/ -S59 -0;0103 Telephone Signature 2.2 Authorized Agent: thyRUS /yF.[J,yify / f97 /tZ ? / r�Y N�/ diddd Name(PA) Current Mailing ASss 1- 13 -.CF-6 -JO? Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS / giO Q 00 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 Construction from (6) 3. Plumbing Building Permit Fee 4 Mechanical (HVAC) 5. Fire Protection /(/j TO T w /41`710 6. Total=(1 +2+3+4+5) Check Number g65- Q q / This Section For Official Use Only Building Permit Number: _ Date %/ / Issuu ed: /- p /7 Signature: 4/10/ .../011S J to/-/ Blinding 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 1.01 Size _.. ._.___.—. i_ .._..__...._ � .____ rt—_____—__.._.— Frontage - �- _ _.._ ' Setbacks Front ( Side .I - Rear I _ .__.._ ___ Building Height - f--' Bldg. Square Footage -- I % - I Open Space Footage % ---- (Lm area minus bldg P raved ___I I l -._ Parking) _... _ ..._ _.. of Parking Spares ---- _-, c--..- Fill: _ �,�.... a (volume 8.Location) r- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued:L _I IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book I i Pagel and/or Document#i B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained l..) Obtained fl , Date Issued: L. C. Do any signs exist on the property? YES 0N 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: 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 a NO O IF YES,then a Northampton Storm\Nater Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House in Addition ❑ Replacement Windows Alteration(s) D Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [EI] Decks [M Siding[0] Other[Q] Brief Description of Proposed / , Work: rn y o! L.1Yf'G5 74/57i4LS /1faj�9s�h- s4 -Wrs 22t vrn* 6cc Alteration of existing bedroom Yes No Adding new bedroom Yes LY No Attached Narrative Renovating unfinished basement Yes No Hans 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 stories? 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. .7/2/4/✓/ Zdi/C , as Owner of the subject property �'/ hereby authorize AO �L in-749 to act on my behalf, in all m ers relative to work authorized by this building permit application. Signature of Owner `�,r� w/ Date / I r[vr/rrr✓ ,as Owner/Authorized Agent hereby d are 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. 4V5 yfw ld,1 Pri Name / Signature of r' ner/Agent •-te SECTION 8-CONSTRUCTION SERVICES .$ -Licensed-Bonstruction Suunervisor. -=-=— . --. ..,___ _. Not Applicable_❑__.. _,__ Name of License Holder: ( r AKe 5 �d.Lt✓X'1ttJCSS nA 617 6 ® .. J d License Number er 677 'ZY> yt .f40.1224/ I d/oa _ Address Expi on Date 1/7,5516 -4) Sign re Telephone / . Registe Home Improvement C tractor. . ; Not Applicable ❑ A FeLifi! ' _s i5cee../reg,"7" -_. /31,7451O 'Company Name Registration Num er 6 f7 �ia'7t Address Expirati n D e 67 d 6A Telephone 1773 6-7O9S' 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. - 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, $ixth Edition Section 108.3.5.I. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is, oris intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm stmctures.A person who constructs more than one home in a two-veer period shall not be considered a homeowner. Such`homeowner"shall submit to the Building Official,on a form aceeltable to the Building Oficial 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: r,27 /jyin �y ELco-e jrof The debris will be transported by: //,d s The debris will be received by: 4/e y Building permit number: / Name of Permit Applicant 4„ Date Sig' ature of Permit Applicant The Commonwealth of Massachusetts --r—s= Department of Industrial,4ccidents - 1, - - Office of Investigations = , I Congress Street, Suite 100 _ '' Boston,MA 02114-2017 ��,. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): ,eu_4r-1_/ 4 efee,��/d7(e _ • Address: (, f 7 a4.,,o \r Z. t (� City/State/Zip: A a 1 ol.a d .r , , . Phone#: Iyi 3Sr--7� /d'3 Are you an employer? Check th appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ f am a general contractor and I ,(employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.YN I am a sole proprietor or partner- listed on the attached sheet. 7. 5 Remodeling 4 `ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. 5 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.5 Plumbing repairs or additions myself [Noworkers' right of exemption per MOL comp. 12.Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *My applicant that checks box NI 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 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. 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. Lie. #: Expiration Date: lob 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 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 certify under the pains and penalties of perjury that the information provided above and correct. Signature: Date: -5IJ /7 Phone#: �// --3-5n1 /d 9`5 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#: 1j)roposal Page No. of Pages\ //, 1 // ( 6 '/// �4 ., l.J NEWMAN'S CONSTRUCTION 697 Bridge Rd. Northam ton- MA 01060 1230 +- J ""'1 413--586-1093 _ JLC . T 4Li olo PROPOSAL SUBAIITTEDYO I PHONE DATE /- /L E. 0 H ;S�' kvc 1/ 9//7 STREET ' JOB NAME / ?r-1 CA\ f k- NO A d, t F . CITY,STATE and ZIP CODE JOB LOCATION iiFl :-:,'a 1,1C:ei, m A .,,, ,c(-_, _ .m./i7 A-2 ,,,, ),b- - .-- -2-4:00,Ckef ARCHITECT DATE OF PLANS I / I Job PHONE We hereby submit specifications and estimates for:-- ,sT+2t p jx, 1 r� -'3 �</4YL5 Q t-" 1 6A i arVV/CQ "pt\ontS ArZc,o, •C,�7 .t•�� J >15A2i1 f}lvt,,n: v‘v "j)a.%'-'- ..ifkQ an ALL Q S b` f�VfS 6.,..) r+�}l =In 5.1 k k SC2 k t•-- RT1►Z 4Av�5 it VekWf7S ) A-r 5t0f-0k15 4 AQ.,,,, i Cl"1 ev1rfr5 45 ...0 IC r „'t". 1 rsA-all �-21 ZS —i`t S Fs '. t ',C LAI,/1:Yt Alfa . ct\ tZft\t �� rt Sc,Y2 �c�5 i.,., ,\,0 1 t r -, 1 ,, L , '1�1 t t,.L ork .,.Tf -.-- ,c, t.lJ'fjt( `ti s1-,r t\c,�5 i`�5 !Y f�10 __J ,,. 4 l R� NU 4. 5ft•14•4-- f ( �� Q( l.r Fix \Milts S •f ' '"f0 Z---;w 5Fz1 r R,LC i k,A- ,„1_ 5I, oi-, \, :zf tem,,, ,,4+2fpr sy 6 (>5 }c t 0 t rS i1 6,. i sKti (.6.roy ,-vo l�) 00 '12ia poRc� t L n5 I\ Fiat s f cl`jz r ,4?1> r6a go bb-0-1- g c,c,F ...: 14t‘-t 4�5 elct,otat • , � ' '` St t a`t z t s . ct,, % tom\, 6.94c. ' ��, .---*- .=--, ?..4u_r.,,,,,,, .,5 .:nfA/44,0„ ._ ► irk Propos, hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: 1 t "7- ,t 'T-`tn[.t)SGI t'1�� X Ile-0- it V Z, i ,/,Vii i vI U c, ---- dollars(S IG) L C_.<::, ). Paymenlb be made as follows: • C p / j ^�^'\1{ _ 1-4 1. 4 At material is guaranteed to be as specified. All work to be completed in a workmanlike %) manneraccording to standard practices.Any alteration or deviation from above specifications Authorized •/ • i�- --- involving extra costs will be executed only upon written orders. and •wail become an extra Signature �- charge over and above the estimate. All agreements contingent upon strikes, accidents "`[. or delays beyond our control Owner to carry tire.tornado and other necessary insurance. Note:This proposal ma be /� \Our workers are full,/covered by Workman's Compensation Insurance..--- withdrawn by us if not accepted with' days/ / Arreptaitrr of Proposal —The above prices. specifications i�� v' /�✓�J/��v r \ and conditions are satisfactory and are hereby accepted. You are authorized Signature /�'� Ai-.1,--• to do the work as specified. Pay ent,will be made as outlined above. Date of Acceptance' T /f/ \ p / �/l Signature / j g ;)