25C-099 (10) 55 GRANT AVE BP-2017-1324
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 25C-099 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1324
Project# JS-2017-002192
Est.Cost: $1200.00
Fee: S65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK LANTZ 102169
Lot Size(sq. ft.): 8319.96 Owner: HAAS MATTHEW K& DEBORAH K KRISTEN
Zoning: URB(100)/ Applicant MARK LANTZ
AT: 55 GRANT AVE
Applicant Address: Phone: Insurance:
180 PLEASANT ST#200 (413) 529-0200 p WC
EASTHAMPTONMA01027 ISSUED ON:S/16/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL ATTIC & SILL BAND, PULL DOWN
STAIRS THERMAL COVER
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 5/16/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1324
APPLICANT/CONTACT PERSON MARK LANTZ
ADDRESS/PHONE 180 PLEASANT ST 9200 EASTHAMPTON (413)529-0200 Q
PROPERTY LOCATION 55 GRANT AVE
MAP 25C PARCEL 099 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee PaidtO
Building Permit Filled out p7(
Fee Paid
Tyoeof Construction: AIR SEAL ATTIC& SILL BAND,PULL DOWN STAIRS THERMAL COVER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102169
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
L.VApproved _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
Demoliti Delay
Si re of uil.ing 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.
Department use only
5 City'of N rthampton Status of Permit:
BUlid�fg epartment Curb Cut/Driveway Permit
21% Street Sewer/Septic Availability
`i. -.-% 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: This section to be completed by office
5 S G CA n-4 ,q Map ACC. Lot 0 t%% Unit
VI
Q06Th rp 1 U � Zone Overlay District�`+ i' Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'ipe\-)0{ cA. ° R5 55 C-,( tiI 1411-t 4Vor"H'ror)
nnt) Current Meiljng/ddress _1 ] 7
(r,J i rl"
�T� Telephone
_Sig
2.2 Authorized Anent: \ \ \�, a,O�
R AI T 2 \ Q�0 l�l eh5 F f\-c SX 54Y •\ i'11'N M{}
Nam t) Current Ma ing Address:
✓
�/ `10 ' aoa
10 c
Signature Telephone
SECTION 3-ESTIMATED NSTRUCTION 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
Construction from(6) _
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection h
6. Total= (1 +2 +3+4+5) A ) a0b — Check Number 7'flat he
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
I
Or Doors ElI�
Accessory Bldg. I I Demolition ❑ New Signs [0] Decks rl Siding C] Other[0
Brief Description of Prop sed ,,I,
Work: A-.S � r \ iA�iL- St11 \3h`AA. 2VA) kat.; tic ti . Guo-\ ,
i 4,
Alterationcheof existingivbedroom Yes pc No Adding newn bedroom
ished Yes No o J Jt`Q
Attached Narrative Renovating unfinished basement V s No 7
Plans Attached Roll -Sheet a70,7j
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?
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
I, I ,(,7J r "c ku5 ,as Owner of the subject
property
hereby authorize ♦2 g as• ttFoC`MA In.CA
ct on my behalf, in all ,.•ers relative to wo k authorized by this building permit applicati .
\-1,-,IN, SIIIIr)
Signa re of Owner\' 1 Date
I, y 1 IOt Pi _ 1--S1.AA. 2— ,as Owner/Authorized
Agent hereby 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.
meek LP' Ak2
Print Name //
„/l �/y// SI i ) /
r of Owner/t/ganf .r- /J Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicableli0 7 n
Name of License Holder'. m kC\ Le, t- 1\y 2 is// / IL/ G /
License Number
\$ A ` R(6So �� � G� �w� 4'.)t\j' Tt Ot /dli0//�
Addres / Explratio^Date
'4,71/ %/3 - Sag-O&n0
Signature / ,Telephone
9,Reolatered Home Improvement Contractor: Not Applicable 0
C n 2Y I43% - cs
V C ,\ 1 five•( Q 7 (0 C 7 0
Company Name Registration Number
v'6 Ql ebSU,r,c 5\ e.5�)j) \�� m� L1,5 I1
Address �/ Expir tion Date
Telephone 1135d l" I,
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 ('li 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 10835.1.
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 pour presence on the job site will he 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
The Commonwealth of Massachusetts
==== Department of Industrial Accidents
lite_`— l
—=Mitt= Office of Investigations
eel= 1 Congress Street,Suite 100
'=1•1 Boston,MA 02114-2017
s www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information (` *ayPlease Print Legibly
Name(Business/OrganizatioNindividual)_\ n2' _ yyc ',/ e._/4p{yv/)&(h(2 `
Address: (j 1 e�.� G, r,� / 5� a,Oi