24D-299 (3) 19 HILLSIDE RD BP-2017-1492
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-299 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-1492
Project# JS-2017-002488
Est.Cost:$5000.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NICHOLAS JONES 066878
Lot Size(sq. ft.): 5532.12 Owner: POPPER LEWIS M&SALLY D
Zoning: URA(I00)/ Applicant: NICHOLAS JONES
AT: 19 HILLSIDE RD
Applicant Address: Phone: Insurance:
P O BOX 515 (413) 665-7927
WHATELYMA01093 ISSUED ON:6/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:RE-BUILD EXISTING FRONT ENTRY ROOF
INCLUDING NEW POSTS - SAME FOOTPRINT
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 6/22/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240.Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File it BP-2017-1492
APPLICANT/CONTACT PERSON NICHOLAS JONES
ADDRESS/PHONE P O BOX 515 WHATELY (413)665-7927
PROPERTY LOCATION 19 HILLSIDE RD
MAP 24D PARCEL 299 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: RE-BUILD E' RONT ENTRY ROOF INCLUDING NEW POSTS-SAME
FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License 066878
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
• or. o•.a-lay
Signature of Building 0 icial 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.
AJN 22
Department use only
——�� ity of Northampton status of Pam*
wilding Department Curb outIDBuewayPermit
.0 • 212 Main Street Sewer/SepticAvaimbnuy
Room 100 WaterAWell Availability
Northampton, MA 01060 Two Sets of Structural Plans
`.\.mois phone 413-587-1240 Fax 413-587-1272 Ptovsite Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 P Ad s: ,, ` - / n//
I Sic 'L \ Map „Z`1 D Lot °k Unit
1111 tWW9 Zone Overlay DIsbict
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sally 1) Popper I q Hii isid e govi
Name(Pri c �1 GCurreniMalingA rasa'.ho )3— i� Kdl/o
Telephone
Signature
2.2 Authorized Agent:
44 . Ca -alai
5 Qo 60l( SIS, tAtclidi Oct_ ctbg3
Name(Print) Current Mailing Address:
913 (6s-- 7g7,7
Signature Telephone
SECTION 3-ESTIMATED C s' STRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building It50>9l _ (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee �j'JJ1
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number s/SJ
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:Signature:
Building Commisaionerllnspector of Buildings Date
a
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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 Department
Lot Size
Frontage
Setbacks Front
Side L R. L: R:
Rear
Building Height
Bldg. Square Footage 90
Open Space Footage
(Lot area minus bldg&paved
parking)
/of Parking Spaces
Fill:
(vdume&Lr.tnon)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Itk YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW ® YES O
IF YES: enter Book Page and/or Document/t
B. Does the site contain a brook, body of water or wetlands? NO acji 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 O NO t11,4
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. Vsfill the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is A part of a common plan
that will disturb over l acre? YEE O NO cCi
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check ell applicable)
New House ❑ Addition ❑ Replacement Windows Alteraaon(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs CI Decks t7 Siding p] Other fa
Brief Description SSf Propposgg q
Work: Re-1,,•r 2,C•KiAny rr•r*C Pnitfv ( sof rn[ ✓ Id Aey-- ec513 - 1{ "�
'IC �l O.FZUc,�e�
Alteration of existing bedroom Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes d No tAw y�
Plans Attached Roll -Sheet 54^+'2 DO`i--t`lr'(l
salt New house and or addition to existing housing.comolete the tollowina:
a. Use of building:One Family Two Family Other
b. Number of moms 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?
1. 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 (� �)
authorizeI, r L // /� CCQ I / f&+-C�r •as Owner Of the subject
PrOfleitY
hereby iks
to act on my behalf,in al�matters relative to • authorized by this building permit application./
Signature of Owner / / Date
aS P •A : .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 undert - +ei . and s-nalties of psi ry.
AS
Print Name
Signature• Owner Agent / Date
SECTION$-CONSTRUCTION SERVICES
$.t LiranaW Conewct �}} Not Appecabke ❑//p •yam
PMmeweKolds
dLic '_ , > / I✓ z+✓"zT
License Number
4ls/ C _ 4 .i i Rd1. - ;at / a17�2
Atl;kl� t. / 71
Expiates Date
Signature / Telephone
/ r-,+o,• Not Applicable O
1214? I
ConnemrNene Registratio, Number
S Cdus �it Pi
at .,� S !o aoi.,
Addr ss
Expiration Date
/V/(I t Telephone ,]13 665
-77
SECTION 10-WORKERS COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,$25C($))
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 a No O
The Commonwealth ofMassachusets
q
Department of Industrial Accidents
k la= Office of Investigations
�_ t 600 Washington Street
]-—Willa
Boston,MA 02111
www.nwss.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers
Applicant Information / —� Please Print Legibly
Name(Business/OrganiratioMlndividual): �L/to/ay/� oV —JO Q.5
Address: \J5 \\ C-L' � If61r.�itq PL 0I P3 . 'J /
City/State/Zip: �Y1et .1�] , 444. ot013 Phone#: ill-3 -- O 6.S-791.7
Are you an employer?Check the a))))))ppropriate box: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors rii�aa
2.�I am a sole proprietor or partner- listed on the attached sheet.2 7. Kat Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. 0 We are a corporation and its
required.] officers have exercised their 10.0Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.]No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box el must also fill cut 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.
:Contractors that check this box must attached an additional sheet slnwng the name of the subcontractor and their workers'comp.policy information.
Iam 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.
I do hereby cerdffyy%y�+"� ` the pains
'and
/penalties of ry that the information provided abowejs true and correct
Signature:"'NI-3
, ,///!` t /p`' " Date: ll/2017
Phone it: '// 3 -60J-71z7
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 .
City of Northampton
v ,`fMassachusetts
0 iE . 8 DWPARaflNT OP BUILDING INSPECTIONS ff
$' „\
e ', r . 212 Mean Street •oM, Q.0l 8u11azM
.1:.. Northampton, MA 01060 tfry 3
Debris 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.
The debris from construction work being performed at:
1 lOki( J.
Please print house number and street name)
Is\to be Idisposed of a at: �/1
Voll,( seta \'�Cc{ lot
(Pleas print name add local' n of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Pi it Applicant or Owner Date
If,for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
• City of Northampton
.MP
Massachusetts +
X k
eIr; P� 316PAR1}Q'Ml' OF BUILDING INSPECTIONS
$' s`�)\Dw:
J�^ 212 Bain Street . Itnicipal Building l��✓/
Northampton, ii. 01060 •rfI cP
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor CHIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion,
improvement removal, demolition, or construction of an addition to any preexisting owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner contracted with a corporation or LLC,that entity mast be registered
Type of Work. -2 J'JbVQ DI( Est Cost: 8 O 0
Address of Work: / c 17/(7_5 t r� e i<
Date of Permit Application: 6 "" d � [ /
I hereby certify that:
Rggi;Mation is not required for the following reason(s): _y— >"
Fork excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner: / ( C(7(
Date Contractor Name WC Registration Na
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton •
Massachusetts ?`'
9 DEPARTMENT OF BUILDING INSPECTIONS \>i
4212 Main street a Municipal Building
i:
--.' Northampton, !A 01060 rn,f lye
Massachusetts Residential Building Code
Section 110.R5.1.2
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.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
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.
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Northampton. MA 01060 �
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