24C-153 51 ARLINGTON ST BP-2017-1463
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C- 153 CITY OF NORTHAMPTON
Lot:-ON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Bath reno BUILDING PERMIT
Permit# BP-2017-1463
Project# JS-2017-002434
Est.Cost: $14500.00
Fee: $94.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BENTON D COOK 049209
Lot Size(sq.ft.): 10018.80 Owner: MACH CLAIRE F&ELIZABETH MACH
Zoning: URB(100)/ Applicant: BENTON D COOK
AT: 51 ARLINGTON ST
Applicant Address: Phone: Insurance:
908 BERNARDSTON RD (413) 478-1078 O
GREENFIELDMA01301 ISSUED ON:6/20/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:FULL BATH RENO ALL FIXTURE LOCATIONS
SAME
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 H 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 6/20/2017 0:00:00 $94.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Fi3e#BP-2017-1463
APPLICANT/CONTACT PERSON BENTON D COOK
ADDRESS/PHONE 908 BERNARDSTON RD GREENFIELD (413)478-1078 O
PROPERTY LOCATION .51 ARLINGTON ST
MAP 24C PARCEL 153 Q01 ZONE URB(100)/
THIS ' CTION Ff 3 OFFICIA. SE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT I ,
Fee Paid a `"dty
Building Permit Filled out
Fee Paid
Typeof Construction: FULL BATH REM)ALL FIXTURE LOCATIONS SAME
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 049209
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
ieXpproved 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 Variances
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
Signature o '3u di g Official Date
Note:Issuance of a Zoning permit dots 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 MOL 40A.Contact Office of
Planning&Development for more information.
City of Northampton
Building Department
212 Main Street
Room 100
/ Northampton, MA 01060
\\ phone 413-587-1240 Fax 413-587-1272
APAtLiC TION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
CTION 1 -SITE FNFORMATION •
Property Address a TilwAis %ibnHblib cdm,fe1btFblsifif44
7 S a !LroC LLHAInit;
/1 / et":
CTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
Owner of Record:
/e,, . & AC' ,T/ A r/n-.q/0--r. S fi
ne(Print) Current Mailing Address:
Telephone 5-61/4/-
nature F/97Gi I
Authorized Agent:
ct CAA,i<s—v 0 G0k 90 - r��--0 i? ateen et/4
lie(Print) Current Mailing Address: 0 /30/
^ re Telephone
CTION 3-ESTIMATED CONSTRUCTION COSTS --
Estimated Cost(Dollars)to be Official Use Only
p��I completed by permit applicant
Building / Or' " (a) Building Permit Fee
Electrical 01,/ pili) (b)Estimated Total Cost of
',i et-e Construction from(6)
Plumbing -5 to 7T- 1{ Building Permit Fee
`7v
Mechanical(HVAC) '/
=ire Protection 1Y/ i7/��v(J �� ,A, fl9
Total=(1 +p+3+q+5) Check Number / / Y.
This Section For Official Use Only
ilding Permit:Number: Date
Issued:.-.
mature:
Building Commissionemnspectar of Buildings Date
Section 4. ZONING Alt 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 Depa anent
Lot Size .. I I __._ __I .11
Frontage �. — 1 1
Setbacks Front
Side L:I 1 R: L: R:
Rear
Building Height
Bldg.Square Footage L__J Bo
Open Space Footage No
(Lot area mime bldg&paved I ,.1
parking)
#or Parking Spaces _- 0
Fill:
(volume&Location) f
A. Has a Sp ial Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book { Page and/or Document#I
B. Does the site contain a brook, body of water or wetlands? NO Of DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained V , Date Issued:
C. Do any signs exist on the property? YES O NO 0
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 e
IF YES, describe size, type and location: 1
E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it pan of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
ECTIONS. OF PROPOSED WORK(checkalt aoolfcable)
rw House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing In
Or Doors ❑
:cessory Bldg. ❑ Demolition El
, New Signs [0] Decks
[0 Siding[0 [
] Other
ekDescription of Proposed ,./J a ti. tivl(1 .-ef(/1 (-/ 1( Ir-t e 61 ATIQ'B 5 .SOYY(/}l Q
eration of existing bedroom/—�t Yes 1' No Adding new bedroom Yes No
ached Narrative l Renovating unfinished basement Yes { No
ins Attached Roll -Sheet
Use of building:One Family Two Family Other
Number of rooms in each family unit: Number of Bathrooms
Is there a garage attached?
Proposed Square footage of new construction. Dimensions
Number of stories?
Method of heating? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance. Masscheck Energy Compliance form attached?
Type of construction
Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
Depth of basement or cellar floor below finished grade
Will building conform to the Building and Zoning regulations? Yes No
Septic Tank City Sewer Private well City water Supply
CTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN;.
VNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,as Owner of the subject
rperty
ieby authorize
act on my behalf,in
all matters relative
to work authorized by this building permit application
-f,] Copt 041( eill It I) S%II l\ A, C0 tAi 0.L+ Cx+
nature of Owner Date
as Owner/Authorized
ent here y declare that the atement and information on the foregoing application are true and accurate,to the best of my knowledge
i belief.
Ined under the pains and penalties of perju
g Q a
it Name
nature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction S
uperviso
r
f� '�.,.� Not�Aryp)�
plliccaable'')❑,.ry fName of License Holder: l.le�'YZ 11T1t\ `/ . IW d' 1lq ! 2 V
License Number
�i�
R6 9 vnew �/L [ t i& O/ 3 0 ' ,26 _
Atltlress
Ex ration ate 21/5 i°72-6.--
Sig
u 6.'Sig
ure Telephone
EmQr"/- COC) 5 4-o ., 0-41a I /- attPT
i Not Applicable ❑
Company Name Registration Number
14 old,-mux-rtiZ MX, ep "? t �
Address tan Date
61''"-42pl 'G/de Oki ( ( C I Telephone �77r Ex ration
3S9�
SECTION TO-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M:G L,c.152,.§25C(6jj
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resul
in the denial of the Issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No 0
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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(a)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.
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 150k
Address of the work: 4---/ R F/ '1,1)4, 5 V"."
The debris will be transported by: 1)---4,17 4 c%
The debris will be received by: /0
Building permit number: VV
Name of Permit Applicant 3 eirt ,ro r
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
'Eormoi= 1 Congress Street,Suite 100
tra ' Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/OrganizatioMndividual):
Address:
City/State/Zip: _ Phone#:
Are you an employer?Check the appropriate box:
4. I am a general contractor and 1 Type of project(required):
J.❑ I employees
m aemployer ees( illwith ❑
employees(full and/or part-time).* have hired the sub-contractors b. ❑New construction
2.cY0 I am a sole proprietor or partner- listed on the attached sheet. ' 7. J Remodeling
ship and have no employees These sub-contractors have $, h:I Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp, insurance..
required.) 5. 9 We are a corporation and its 10.111 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions
myself, workers' right of exemption per MGL
Y [No comp. 12.0 Roof repairs
insurance required.] t c. 152, §i(4),and we have no
employees. [No workers' 13.0 Other-41Ai Nina 0.111
comp, insurance required.] CAA n; 17 t
"My 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 such.
teonuactors 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 u 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:
Job 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$25001)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 certify under the pa' . and penalties +, perjury that the information provided above is true and correct
Sit ature: —ad it ../ Date: /V R//'7..
r — L/
Phone#: L/7 7 -7Z c''' /I ,
Official use only. Do not write in this area,to be completed by clot or town official.
x 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#:
Betty and Claire Mach June 14,2017
„ ' 51 Arlington Street
I
Northampton, MA
-
CR&C will remodel the 1st floor bath at Betty
Cook
and Claire's Arlington Street home in the following
manner:
RESTORATION& @remove sink and toilet, bath tub to remain.
CONSTRUCTION @remove plaster/drywall walls, find and repair
908 BERNARDSTON ROAD leaking pipe, add blocking for grab bars.
GREENFIELD,MA. 01301 @Install new vent fan in ceiling and new GPI outlet at
413-475-3833 sink
@Install new plumbing as necessary for new toilet,
new sink and new dual valve showerhead and hand
held.
@Insulate exterior wall with 3.5" Roxul and foam
chink seams and joints in exterior sheathing.
@New M.R. drywall on walls and ceiling and
beadboard wainscoat with 3.5" towel rail 39.25" high
@New .25" plywood substrate and Marmoleum floor.
@New "right height" round front toilet and sink (not
yet chosen).
@New porcelain tile shower surround.
@ Install grab bars, robe hooks, towel bars, TP holder
and medicine cabinet when painting complete.
All above to be completed on a cost plus time
and material basis for the estimated cost of$14,500
to be paid one third at start, second third as drywall
begins, one sixth more as tile and linoleum begin, and
final sixth at completion.
Benton C k Betty Mach Claire Mach
c.
a7