38A-103 (18) 209 EARLE ST BP-2017-1347
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A - 103 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2017-1347
Project# JS-2017-002236
Est Cost:$2800.00
Fee: S100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo: SIEGFRIED PORTH
Lot Size(sq. ft.): 137214.00 Owner: CLARKE TONY
Zoning: PV(I00)/ Applicant: SIEGFRIED PORTH
AT: 209 EARLE ST
Applicant Address: Phone: Insurance:
116 PLEASANT ST SUITE 331 (413) 529-9434
EASTHAM PTON MA01027 ISSUED ON:5/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:18X10X9 PERGOLA
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:
FeeTvpe: Date Paid: Amount:
Building 5/25/2017 0:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Neal LOCPr.1otJ aid
File# BP-2017-1347n P ;IT (3Ar-rS)
APPLICANT/CONTACT PERSON SIEGFRIED PORTH -
ADDRESS/PHONE 116 PLEASANT ST SUITE 331 EASTHAMPTON (413)529-94347 kt'V
PROPERTY LOCATION 209 EARLE ST
MAP 38A PARCEL 103 001 ZONE PV(100)/ 1 (J
THIS SECTION FOR OFFICIAL USE ONLY: o Q (/
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid I
Building Permit Filled out
Fee Paid
Typeof Construction: I8XI0X9 PERG #4
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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 Q '7
S/ZX�///
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.
GcninnI 7(ammncial l3uiidine Penni( blas 15.2(100 (�
Department use only
City of Northampton Status of Permir
Building g Department Curb oSepfic waii Perms
212 Main Street SewerlSepGc AvailabilM1y
Room 100 Water/Well Availability
Northampton. MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PIM/Site Plans
Other Specify_,_
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: hi
This��/ section to be completed` by office
20q ��� sT Map 3 A Lot i�1 Unit
E./14 "m ,Mh OI 060 Zone V Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
iOr.fi LUkA( . _- .... _
2dl EAP-IE ST, NOP—TF1/MPbl Nh olDtO
Name(Prim Curren Mai ng Address.
4t3 5$72-1S0
Sgne Wra "' 1 Telephone
2.2 Authorized Agent
Name lPnru Canenr Matting Address_
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Building Q�� - - (al Building Permit Fee 1
2 Electrical (b)EstimatedTotal most of
Construction from
(6)
3. Plumbing Building Permit Fee
4 Mechanical(HVAC)
5. Fire Protection
6 Total=11 +2+3+4+5) �V s CheckNumber/F, 3
This Section For Official Use Only
Building Permit Number Date
Issued
Signature
Building Commrssionertmspector of Buildings Dale
I
•
'V1,'. •
I _
Vcrsinnl 7(nmm[mial Bu0dme Pcnnir tt0x 15.2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs LI Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign New Signs❑ Roofing Change of Use Other
Brief Description biter a brief description here. '--F —oLh 1$I`fir L)t'Dt O "J * 9'2rH
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
_
USE GROUP(Check as applicable) � CONSTRUCTION TYPE '
A Assemey ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA F ❑
A-4 ❑ A-5 ❑ 16 ❑
IB Bushes ❑ 2A ❑
E Educational ❑ 26 ❑
F Factory ❑ Ft ❑ F-2 ❑ 2C ❑
H Higa Hazard ❑ 3A ❑
I Institutions: ❑ _ i-i ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ i 4 ❑
R Residential ❑ R-I ❑ R-2 ❑ R-3 ❑ 5A ❑
5 Storage ❑ S-1 ❑ S2 ❑ 5B ❑
U Utility Specify:
M Mixed Use ❑ Specify
s Special Use ❑ Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS.ADDITIONS AND/OR CHANGE IN USE
Existing Use Group _._. . Proposed Use Group
Existing Hazard Index 780 CMR 34) —__ Proposed Hazard Index 780 CMR 34)
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(Si)
1
2(1
3'
Total Area Jsfj Total Proposed New Construction LZ _
Total Height(tt)
•
Total Height9 _ _ _
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Sone Information: 7.3 Sewage Disposal System:
Public Private zone -_ __ outsae Flood zone❑ Municipal On site disposal system❑
Vcnwnl]tnnuncmial Redding Permit Alar H_2000
N. NORFIR MPTO\ZONING
Il actin_ Proposed Rcguirod br inning '
rF nmlunmrobellliH mbr
Whams Ofiernml
I of li/c
Frontage
Sethack. I rollt
Side I
Rear
13eildin_Ileicle
OW Sq _Fn li
Op Spas_ 111
bide elbow)
irkai
2 of Parkins.Spruce
ill
A. Has a Special Permit/Variance/Finding ever been issued for/on the site,
NO V� DON'T KNOW Q YES Q
IF YES, date issued.
IF YES: Was the permit recorded at the Registry of Deeds,
NO ® DONT KNOW Q VES 0
IF YES enter Book Page and/or Document#
B. Does the site contain a brookbody of water or wetlands' NO ® DON'T KNOW Q YES 0
IF YES,has a permit been or need to be obtained from the Conservation Commission
Needs to be obtained Q Obtained Q Date Issued
C. Do any signs exist on the property% YES Q NO
IF YES.describe size. type and location
D Are there any proposed changes to or additions of signs intended for the property P YES Q NO
IF YES describe sizetype and location
E Ku the construction activity disturb(clearing,grading excavation,or filling)over 1 acre or Is It pan or a common plan
that will disturb over I acre, YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required
ecation 17 Cpmmncial Building Permit Alas IS.21)f ill
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C-F.OF ENCLOSED SPACE)
9.1 Registered Architect:
s; ,re/5o Po',771 Not Applicable
deg -.
Name 1?Registrant
J e`) '- IO d/ / Alwc/ R 9 l2tor Number
Adores;
�( �3///rf
• Erg ellen Dae
/i _
Si re are reenncne
9.2 Registered'P fessional Engineer)s):
Name Area of Respersibiy
Address Regisration Number
Sipnemre Telephone Expalian Date
Name Area of Responsibility
Address R gs'raocn Number '
Signature Telephone Expiration Date
Name
_. Area of Reapcnslbillry
ATdmss Registration Number '- I
Signature relepncne Expiration Date
Name Area of Rasp ns b.4ty
Address Registration Number
Signature Telephone E prdien Gare
9 3 General Contractor
_ _ . _ Not Applicable
Company Name
Respons tle In Charge of Cons
Address
Signarure Talepncne
'.oio0I (unmarclal Huildine Penna Alar 141duu
SECTION 10-STRUCTURAL PEER REVIEW(700 CMR 110.11)
• Independent Structural Engineeeng Structural Peer Review Required Yes 0 No O
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby auhonze _ _ to
act my behalf in all matters relative to work a utcrized by FIs building permit application
S!gnsure of Ovner , . _ -- Date
TO 1J•-I G)-0r-cCE 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 bete(.
Stoned under the pains anenalties of perjury
Print Name
Tc-- Y Gt.a._KE-
.Spnature of OwnedAgarf oafa_SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable p
Name of License Molder
License Number
Address Expiration Date.
Signaare Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIOAVITIM.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with 0us application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 1110 No 0
05/22/2017 MON 13: 34 FAX ®002/003
The Commonwealth of Massachusetts
Department of Industrial Accidents
�7 tad, Office ofinvesngeitlons
m;
k �' 1 Congress Street,Suite 100
tlpaton,MA 02114-3017
���arrr
www.masslon/dra
Workerg Compensation I neuranceAffidavil: Builders/Contradws/LJmtridaia/Rumbe's
Applicant Information Please Print Legibly
Name(BuwcsaloramhaanmttIndivid oBl V(14 I i l C .
Address: 2-0cl Aur'le /' ,
IYIA- olObo __ _.___.......
Cit /State;ZiI: ♦ if /;, Is '/ Phoned: AP3 - 5TT2759
.Are ypiti ea employer?Cheek the npprnprinl-boa:
L con amploycr wdh Al 4. C I am generale')nundor and Iypc of project Qagalredp.
employees(Ii111rietor pan-Gies Le
have hired the sub-wummlors fi. ElNewoonalmgion
2.CI I am a sole proprietor or partner- haled')')the ullnclmJ sheet. 7. 0 acmolitio
ship and Neve no employees These suboonlreccom have a 0 Demolition
working for me in any tramway
employees have workers'
[Na workers' comp in'uenw comp.insurance?
9, ❑Building addition
required.I 5.0 We ere a colporalion and its 10,0 Electrical repairs or additions
.1.0 I pm n homeowner doing all work officers have exercised(hew 11.0 Plumbing repairs or additions
myself.[No worker corp right or exemption per MOL 12,0 Roof repairs
Insurance maim-odd t aSi.I ,5I(4).and we have no ,,.,/
eTployt� w
[No orkef 13,17uder Pr�2rriu�_
comp.I neurones required]
'Any gpIl lINdaMtmbl ru®Ynr II eiameopsenbeicaivehemingearmeltim mann®Ion P0110/Illrprearou
IHomewner.Mo'AMU Iii emdaii hillaa'wie they me dome ell anal entlweo II rz')'smile mama Nen ink,SE 9 00J0 a new nllidedl adlammo vim.
4200faYrtlxden Winona]sheer Mayday hermits of ht'ub'w"actors and pan rhdha ar not Nou mesial Neve
e;nplry . 1a ur ilcrIMaf ogre
nay teal pv4de Mali niter,'mere,pyla nutter.
I Arran employe that is proutding workers'mmpeiaellon Insurance for my mlployees Below'sthepollicy and lob rite
lrfro'aaaon, A.
Iasmanee Cumpmly Name:Jry MMJ°FALf )Ci Yl CT SELF-I i16&JP-A C-C CTkVv(O
Policy a err Selaine. l he.p. 02-0005/000 et//40 Expiration Dale: /d13/47
Job Sire Address. W9 etre e#, Oitylstate;zip:/ld✓kf7p ryipilr7 'VA- 01 060
r
Mischpolity de
a copy of the workers' compensetton polideralien page(shawl lg the polity number and expiration dale),
Failure In aceurc coverage as required under Section 25A of MOL c. co
x53 n lead to the imposition orm mammal penalties of a
litre no
h to$1,500 00 andlor onc.year imrig mases.as well ar civil penalties in rho farm of STOP WORK ORDER and it fine
of up to 5250n0 a day against the violator. Be advised that u copy of Wig statement maybe forwarded to the Once of
Imerrigmiune of the DIA Nr insurance coverage verification.
/do hereby eerri ander We palms and penalties of pedant Aral the information provided above/s oro ens rorrect.
gtwmoic A83-�AJ'$�[//ter �/ Dale' 11/1/17
Phalle b' "`i I-�Y50.
Opicial use only. Donal wile Maar arca,ro be romplered by clad or lawn official
City err'fnw no Pcr nItILIcense a
loaning Amhorrty(circle Onel'.
I.Heard of Health 2.B olid'rag Department 3,CIty11'ewn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contac Person: Phone a:
05/22/2017 MON 13: 35 FAX 2003/003
City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
•
In accordance of the provisions of MGL c 40, 554, 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: c20l F�,�Ic. c3, /?D✓-ittzmpfnrf, AdfcI:0 60
The debris will be transported by: 1.10A }{-quflr: 4—etedditf3
The debris will be received by: moi . t. Ce a
Building permit number
Name of Permit Applicant —MTh/ GLjr2YCC
CA117
Date Signature of Permit Applicant