32C-218 (9) 28HOLYOKE ST BP-2017-1389
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-218 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit BP-2017-1389
Project# JS-2017-002316
Est.Cost: $950.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group:
NATHANAEL ALMEKINDER 102079
Lot Size(so.ft.): 6621.12 Owner: KWIECINSKI JAMES P&CYNTHIA L
Zoning: URC(100)/ Applicant: NATHANAEL ALMEKINDER
AT: 28 HOLYOKE ST
Applicant Address: Phone: Insurance:
66 CLARK ST (413)250-3007
EASTHAM PTON MA01027 ISSUED ON:6/1/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR OF PORCH REQUIRING NEW
FOOTINGS
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 6/1/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1389
APPLICANT/CONTACT PERSON NATHANAEL ALMEKINDER
ADDRESS/PHONE 66 CLARK ST EASTHAMPTON (413)250-3007
PROPERTY LOCATION 28 HOLYOKE ST
MAP 32C PARCEL 218 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT p/'
Fee Paid K.-4
\ 'y )
Building Permit Filled out R 1Vty
Fee Paid
TvpeofConstruction: REPAIR OF POR IRING NEW FOOTINGS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102079
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
proved 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: §
FindingSpecial 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
sC-3/-/2
Si_ . re .. Bu ding OiciaTT l 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 Curb Cut/Driveway Pramn
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
orthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Slte Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address: This section to be completed by office
c -Qj -30 FIoeyO/<p ST Map 3A C. Lot 2, Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: JE✓, APLC %%PAk••e' K'N (cit/5/l/IIII ''II
77 NANNVM ERpp A' ilii
Name(Print) j Current Mailing Address:
cTh
>Cy ✓ sH/4m rp 7c -
w �//3 �'j 5'�Jd?
' t ^ _ TelephonetR7
gn ore
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / 5c c"' (a)Building Permit Fee
2. Electrical / (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee r
4. Mechanical(HVAC) 46:5
5. Fire Protection
6. Total=(1 +2+3+4+ 5) 75f, Check Number yijpy
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 Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be tilled in by
Building Department
Lot Size 5-1
Frontage ,}eame 5•r`
Setbacks Front row 5are_
Side L: R: 1.wr44 L: A: Soy
Rear 5 c
Building Height
Soni* oa_
Bldg. Square Footage
Open Space Footage
(Lut area minus bldg&paved
parking) —LL-Le Semc).e
ft of Parking Spaces t Fill:
(volume
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW e YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document it
B. Does the site contain a brook, body of water or wetlands? NO 0. DONT 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:
C. Do any signs exist on the property? YES 0 NO O
IF YES, describe size, type and location: //d940S f Sega
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO a
IF YES, describe size, type and location:
E. Wilt 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 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs IC] Decks ID Siding IC] Other OA
Brief Description of Proposed
Work: rerair C i-' , rcn, VEY,v,y) :t*H. IC"nil7 .
Alteration of existing bedroom Yes & No Adding new bedroom Yes X No
Attached NarrativeRenovating unfinished basement _ Yes -X. No
Plans Attached Roll kSheets
ae.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
I. Depth of basement or cellar floor below finished grade
It. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. ICY/11P_d WIC ...... ...,as Owner of the subiect
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application,
Signature of Owner Date
I
i, J U " c rid Ar t'' f i
Ute" P ( t ,as Owner(Auttuxized
Agent hereby declare that the statements adddddddiinformation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
•P' .ame
C/31 3( c ' ?
Si. ature ,f t e A mit Date
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable 0
NameoaLtomise Holder: lila el H,... 7 j-1(,M,,,tr,n,ier Ia JJJ71
License Number u
Address Expiration Date
l ro 3 not
Signature Telephone
8.Registered Horne Improvement Conpeefoer Not Applicable 0
OV
Company Name Registration Number
tVejfar sin j Ater e4..lei
Address Expiration Date
66, C eivki S— FAL ii.a tun M4-tlot1 Telephone 115 dtio-3.w7
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a.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 St No 0
11. -Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Owellines of one(I) or two(2)families
and to allow such homeowner w 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-veal 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 buiidinn permit.
As acting Construction Supervisor your presence on the job site will he required from time to time,during and upon
completion of the work for which this pemdt is issued.
Also be advised that with refermree to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
Employees fur injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perfomr work for you under this pemrit.
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: - ? 3na/4 c r,
The debris will be transported by: CohJ,,C/.,,
The debris will be received by: PA- l0 t . 5Jv11/4D'. c11.9 recycl,<1
Building permit number:
Name of Permit Applicant
`
Da( 1731/>� "? Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
6=
_s' Office of Investigations
I=
t�..'C1 Congress Street, Suite 100
• =FPI= :1)aT Boston, MA 02114-2(117
www masxgovfdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information L
z Please Print Legibly
Name (BusinessfOrganixauoni[adividual): jet Cd 1 o ' / 4101 e KI n.-1e« _
Address: 66 (td ✓ tC 5+
City/State/Zip: e(Is 44on,pitx. M4Qi0al Phone#: °//3 - ) S 0 - 3o0 7
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with 4. 01 am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ['New construction
listed on the attached sheet. 7. Q-Remodeling
2.�I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9 0 Building addition
[No workers' comp. insurance pomp. insurance3
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] f c. 152, §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.
`Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such.
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
employes 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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature:. /"----- — . Date: s /?V f(7
Phone#: 4113- ) 5-0- 3&J 7 !!! _.... ._
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#:
i
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City DtNDhamon rtment _) 8- H„Iyk.
Building Depa
Plan Review C- .
212 Main Street ''"' -
Northampton, MA 01060
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Z-TUBE SPECIFICATIONS:
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A PRODUCT OF Z•z CRETE LLC' B„ ;.... HARDWARE TOP VIEW OF BASE SECTION
BUILD A BETTER FOOTING -4-- 11 '
12"
OPENING FOR 0y..,:+x..m.._
-Upper sections weigh 60#, 20# lighter than Sra N DA ; METAL Roo
the top selling bag of concrete mix, only SIZE '
without the mixing!
-Base section easily rolls into place and
drops into hole once the anchor is inserted. 6
SIDE VIEW
-Early engineering performed by the UNH UPPER SECT
Engineering Dept. shows an average load
strength of 135,000 pounds*.
-System can be used with or without a -
Ilr
base section. <"
-System installs and is ready to build on in
1 22" r
minutes.
1 AIL
1. Insert anchor into bottom section
7.5"
2. Drop base section into place and level
3. Slide Upper Sections over anchor to
PP _
achieve desired height o J SIDE VIEW OF BASE SECTION
4. Add mounting hardware and tighten nut
5. BUILD!
20# Ll
'Further engirceering information available upon request. e
IF THAN A + 'EZ-Tube may be •
OF UNMIX-t used with or
CONCRC 1 without a
base section.
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per[ c �� have J r Sed the aio
CHI Ch Locnl coots . ;
of ri Ihi by 1 � I� In? t . i ii:n YJ A FouNOAION rvr=F '
fi'c r J tra {L �" sI n�ANI Is NF LIJM nFNoro
SIDE VIEW OF BA. # Hf IrS,VLE Na sFL l IuNS uF EZ TIME.
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