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31A-295 (5)
86 VERNON ST BP-2017-1315 GIS s: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 3I A-295 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 Permits BP-2017-1315 . Project# JS-2017-002180 Est. Cost: $63782.00 Fee: S414.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TOM DOLAN 039281 Lot Size(sq. ft.): 5314.32 Owner: PHILIPS BRENDA 7 Zoning: URB(100)/ Applicant: TOM DOLAN AT: 86 VERNON ST Applicant Address: Phone: Insurance: P O BOX 297 (413) 585-0612 CHESTERFIELDMA01012 ISSUED ON:S/15/20170:00:00 TO PERFORM THE FOLLOWING WORK:NEW KITCHEN CABINETS, NEW DRYWALL, NEW PANTRY AND 2 NEW REPLACEMENT WINDOWS 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 5/15/2017 0:00:00 $414.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2017-1315 APPLICANT/CONTACT PERSON TOM DOLAN ADDRESS/PHONE P O BOX 297 CHESTERFIELD (413)585-0612 PROPERTY LOCATION 86 VERNON ST MAP 3 IA PARCEL 295 001 ZONE URB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL ED REQUIRED DATE ZONING FORM FILLED OUT Bee Paid Building Permit Filled out �7 Fee Paid TypeofConstruction: NEW KITCHEN CABINE S N DRYWALL.NEW PANTRY AND 2 NEW REPLACEMENT WINDOWS New Construction Non Structural interior renovations • Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039281 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay Signature of 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 ;1'.."-.:-.43:4501.“1146.1e,%' „%z"�C4� !w a�sadH Building Department � �an,j3 -Vyll` ea - '212 Main Street 5,,:t;;IF7s1 dr rt Room 1001rtflid7i l `".t11LLJ + +' .. Northampton, MA 01060 ,7,t x ' ,, t,4 phone'413-587-1240 Fax 413-587-1272 t-�T ; `�" ' ' —PLI4T1ON TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING s SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to becomplete// bffi ddy oce 56, t//_/2 Nan/ ST map a/14 Lot a%O/ Unit //e E'he41,,a/on //?,ss 0 W g i) Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: tX,eF/t ' a (94/95-//2!/+1/o42<agh44+ t6 ki,V*'Oi, s1- 741044is1p.41r Wet, Name(Print) Cj/1 Current Mailing Address: /�j l- y/3- 5,2?- VV1O �t /�'Y�7� �l/Y-CSS-� Telephone Signature Fm a,I: 2.2 Authorized Agent: (� � / e 'c • pow, / ( (13 )00 wt 61-C 4t/Jii–� rJ/i //ei/C.r on If—/4/49A-I47/44 Na a(Print) '—'( C';J J� XI �`Current Mailing Address -_ I/2 - W t(e Signature Vi Telephone O SECTION 3-ESTIMATED CONSTRUCTION.COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant t Building 6r 7 / / v (a) Building Permit Fee 2. Electrical /j f7 a (b) Estimated Total Cost of i//0Q- Construction from(6) 3. Plumbing Building Permit Fee 07-asA. . 4. Mechanical (HVAC) in. ---.”5. Fire Protection 6. Total=(1 +2+3+4+5) A 6Ir2, '- Check Number'9'1 CS /791) This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING ALL Information Must Be Campteted. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size "_. _. _____ _ } r_____ I L I Frontage1 --..__._ I1 1 Setbacks FrontF1-1 Side L:1 -1 R:L_-J LI--_-] R:L._..i LII Rear J L -L Building Height L_ r-1 Bldg. Square Footage IJ 1 /o r 1 L_"__I P Open Space Footage � % r— — 1 (Lot area minus bldg&paved 1 J I_ a parking) #of Parking Spaces �1 ] Ell] Fill: FL i I (volume&Location) -_ - — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW © YES Q IF YES, date issued: _ -1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book I_ _ 1 Page I and/or Document it 1 ! B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW 0 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: 1 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 O 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 O NO O fF 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 WjmJows Alteration(s) Roofing D Or Doors J Accessory Bldg. ❑ Demolition ❑ New Signs [C] Decks [p Siding [0] Other[O] ,[ Nrr /zsn/*e en r'✓..,./L✓, /?a//e/.vew/:///4/x-7- aa.-- Brief Description of Proposed Work' Sgft/</l .vow /<r{br'n C/al/.er!-(SAette Larcr.Y'/us.+Av ccr* MA's4' - ,t/cw A 4-y. a/i/, 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 hotise'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? 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, g 1- Cki,Ce. P ( III j S ,as Owner of the subject property hereby authorize 'P- (� Pt( /em ail/9// hw "d%fre 'c to act on my behalf, in ail matters relative to work authorized by this bIrling permit apation. Signature of Owner �j rl Date ?a /y/ !/(J'j/7/U lye`/7P/dat (41'/4✓6}/72 , as Owner/Authorized Agent he70-14 - y declare 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. /O/Yl /JOL Nuc/ Print Name i,,,, ,, // yt4tiy // 2. /47 Signatur of Owner/Agent Date SECTION B-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 — Name of License Holder: /up'r i %),,LAM ZS -6393 ct/ License Number PO fox clr7 ehes/e r-//// fl . ,roil /9 - ,G- z0/7 Address Expiration Date Signature(//(�/• Telephone Einar'/• %OsYI Do/4,y 6,' & 44- Low, 9.Registered Home'Improvement Contractor jl .-.. ±! Not Applicable 0 kaon D0a,�A/ Owen t- Lon tie / 9O Company Name Registration Number Number ?,o Box cS > Ch Klett fried Me/.040;2, 094- 801 Y Address Expiration Date Telephone 1/45-E727-5761/ 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 builddii99 permit. Signed Affidavit Attached Yes q' No 0 - Home=Owner.Exemphon 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 will be required from time to time,duringand 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: 5/ ? 'e woe jr The debris will be transported by: 7dfrfrt- �� r4 v The debris will be received by: //,r//ey A n/4e/, Building permit number: Name of Permit Applicant /' s' /JO/t1,r/ Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 i Office of Investigations WHAif M 1 Congress Street,Suite 100 &c�, L= Boston,MA 02114-2017 `�a� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information � Please (Business/Organization/Individual): —y Name (Business/Organization/Individual):ndividual): p 7jaL 4 e/ ojcn en A /4n kno ttoo Address: ?o & x , q7 City/State/Zip: Phone#: 2 ' —a? 7.-s e Areyouan employer?Check the appropriate box: Type of project(required): 1.R l am a employer with / 4. ❑ I am a general contractor and I ` • have hired the sub-contractors 6. El New construction employees(full and/or part-time). ,�,L 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 'Remodeling 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 U.S1Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.5 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.5 Roof repairs insurance required.] t c. I52, §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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suck tContractors 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. �q�j / Insurance Company Name: 2/6fidy /r 1,116/RL _1-in Policy#or Self-ins.Lic.#: W65 -315 -3ez tri f- cab Expiration Date: 9-/7-17 Job Site Address: ,E' 4zonitsH .f/- City/State/Zip: ge,0 tlizy h a /PK. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern),uund the pains and pena of perjury that the information provided above is true and correct. Signature: i6Date: `1/Lf .y—// 7O/'% Phone#: 1/1? 7—( /]p/--5 /ji/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License if Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone 4: t ..30" / 2$"_�„ r 2 i 3 a —'tIg wia;6 f 3 t$p f ;A/ N 1 , 3Q3 W62933 W2433L I W2433R C: City of NorthamPton. ~<, n N Building Department _ 0D30.o3 I 0D34.4g 01Sn-106 $0833 Bute 34ef Plan Review b ` 1 1 / I N. 212 Main Street Northampton, MA 01060 31 / 11 11 N T ‘,.,1 ' / els , /4, • GE.GAS.30.19021 43 y ` tt Q rLDLLi ,19 i v i T ' N .�_ v N A \ m N1 i ,(rr-411284, 1 I 13sod7 enaN All dimensions_size designations [This is an original design and must Designed: 8/5/2016 given are subject to verification on (not be released or copied unless Printed: 3/23/2017 job site and adjustment to fit job 111 applicable fee has been paid or job conditions. 2020 order placed. i i phiUips i n1 New Ycp kern',cut 001,11:10 0.) 1 3 5itok 0 3 cvablwerts EXSi,a 2 '/ gc}Le. 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