29-067 (5) 7 GILRAIN TER BP-2017-1343
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-067 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pennit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit BP-2017-1343
Project# JS-2017-002230
Est. Cost: $13000.00
Fee: $85.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11761.20 Owner: FLORENCE BRIAN&KIMBERLY&GRANDA KERI&LUIS
Zoning.; Applicant: FLORENCE BRIAN & KIMBERLY & GRANDA KERI & LUIS
AT: 7 GILRAIN TER
Applicant Address: Phone: Insurance:
7 GILRAIN TERRACE (508)280-9208 O
NORTHAMPTONMA01060 ISSUED ON:5/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR REMODEL - 2 NON BEARING
PARTION ALTERATIONS, REPLACEMENT WINDOWS, REMOVE BASEMENT PARTITIONS
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:
FeeTene: Date Paid: Amount:
Building 5/22/2017 0:00:00 $85.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1343
APPLICANT/CONTACT PERSON FLORENCE BRIAN&KIMBERLY&GRANDA KERI&LUIS
ADDRESS/PHONE 7 GILRAIN TERRACE NORTHAMPTON (508)280-92080
PROPERTY LOCATION 7 GILRAIN TER
MAP 29 PARCEL 067 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid (
Building Permit Filled out
Fee Paid
Tvpeof Construction: INTERIOR REMO L- N BEARING PARTION ALTERATIONS
REPLACEMENT WINDOWS, REMOVE BASEMENT PARTITIONS
New Construction
Non Structural interior renovations
Addition to Existing
• Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9WWATION 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
I-. oli 'snD- -
i
/11,1111
Signature of Bui .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
�'.'_/ City of Northampton Status of Permit
Building Department Cub Cut/Driveway Permit
212 Main Street Sewer/se cAvaitabili
/ Pd H
///
Room 100 WateoWell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Spedfy
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 completgd by office
71040 Map m Lot 06 � Unit
{-t_c c=,r c a , rv1'8 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Brian&Kimberly Florence and Keri &Luis Grande. 7 Gilrain Terrace
Name(Print) Current Mailing Address: 508-280-9208
Telephone
Signature
2.2 Authorized Agent:
Brian Florence Brian Florence
Name(Print) Current Mailing Address:
Brian Florence
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8,000 (a) Building Permit Fee 13000
2. Electrical 2,000 (b)Estital
ConswumatedctionTofrom(6)Costof 13000
3. Plumbing 3,000 Building Permit Fee
4. Mechanical(HVAC) 13000
5. Fire Protection
6. Total e(1 +2+3+4+ 5) 13,000 Check Number 973 45S6
This Section For Official Use Only
Issued:
Building Permit Number: Date
Signature:
RIkilnn rinmmieeinnarilnenortnr ni 0.uildinn e
T JA22 CnnxcA . ti�
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I:] Siding[m] Other[C]
Brief Description of Proposed
Work: Interior remodel includes paLli L.Irma,tile- non-hearing raItLon J uremm es identified on plaws Rerlacnnure windows.Rennie u^PRm IWW basement pennons.
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet
Sa.If New house and or addition to existing housing, complete the following:
a. Use of building: One Family x Two Family Other
b. Number of rooms in each family unit- 7 Number of Bathrooms 2
c. Is there a garage attached? no
d. Proposed Square footage of new construction, U Dimensions
a Number of stories? 1
f. Method of heating?
Gas/Hot Fireplaces or Woodstoves Existing FP Number of each I
g. Energy Conservation Compliance. N/A(No walls opened) Masscheck Energy Compliance form attached? No
h. Type of construction Wood Frame
i. Is construction within 100 ft. of wetlands? Yes X 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, 2 r Le ,as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
MIIIIIIMMIIMMINIII
f, , 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.
n
( l ,--11.2-IL EF-4 ('-Sr
Print N
SII� It 7
Signature of Owner/Age t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: �)u 4 N e s CS6--;21
License Number
1 1.9'I- 2 .N3 e w 17`5
Address /l _ Expiration Date
JhI (cc-/ 7& )' '1Zv8
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
I
Company Name Registration Number
Address Expiration Date
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(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,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.
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 11,000+/-
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height 20'
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking
#of Parking Spaces 4
Fill: N/A
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES (3
IF YES: enter Book Page and/or Document if
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO Q
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. WII 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.
The Commonwealth of Massachusetts
,, t Department of Industrial Accidents
tE y Office of Investigations
"" 'I . I Congress Street,Suite 100
`
Boston,MA 02114-2017
It* Ile
M1 www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/OrganiratioMndividual): JL., Ary fThv✓t—CSC
Address: 1 C,• t- 2.4.,>,! 7.:i12A,4
City/State/Zip: (Z.c LZ.-5 c_27-7 :WA_ Phone#: cog- 2 g0 - y.. o $
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction
employees(MI andrlorpart time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. 5 Demolition
working for inc in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
a h.]
5. 5 We are a corporation and its 10.5 Electrical repairs or additions
officers have exercised their l i. Plumbingrepairs or additions
3. i am a homeowner doing all work ❑
myself. [No workers' comp. right of exemption per MGL 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 hat checks box#I must also till out the section below showing their workers'compensation policy inhumation_
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 anached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If We sub-contractors have employees,they must provide their workers'comp policy number_
1 an,an employer that is providing workers'compensation insurance for my employees. Below is the policy undjob site
information.
Insurance Company Name:_
Policy#or Self-ins.Lie.rt: 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 SI,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 .- fy under . ' rains and penalties of perjury that the infarnmtian provided above Is true and correct
Signature;. r Date: /
Phone it J08 280 - 9Z 2&
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 d. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: ,,.,,
Massachusetts Department of Public Safety
Board of Building Regulations and Standards --
License:
License: CS-052782
Construction Supervisor tY'
' BRIAN A FLORENCE,8R
120 LA9RIES LANE `
MARSTONS MILLS MA 02610
Expiration:
Commissioner - 0311412019
•
Construction Supervisor
Restricted to: •
Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of
enclosed space
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
OPS Licensing information visit:WWW.MASS.GOWDPS
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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: "7 (2)' �R-4_,� �a�2r+ Lz
E--
The
The debris will be transported by: V cA6 C 2-C„ CV1,.4
VaLA--e (Let1c
The debris will be received by: • '
Building permit number:
Name of PermitApplicant v
Date 1 Signature of Permit Applicant
4S - ; -ft7
//eO '/-cVe4 Q ) au,-/M City of Northampton
Building Department
i;7,6 Pian RevleW
212 Main Street
Northampton, MR01060
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