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30B-065 (4) 284 RIVERSIDE DR BP-2017-1448 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-065 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-2017-1448 Project# JS-2017-002411 Est.Cost: $15000.00 Fee: $97.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group STEPHEN CAMP 082531 Lot size(so. ft.): 6011.28 Owner: PASSALACQUA BRANDT Zoning: URB(100)/ Applicant: STEPHEN CAMP AT: 284 RIVERSIDE DR Applicant Address: Phone: Insurance: 46 EAST ST (413) 527-7124 0 EASTHAMPTONMA01027 ISSUED ON:6116/2017 0:00:00 TO PERFORM THE FOLLOWING WORILBUILD 8X8 ADDITION FOR NEW BATHROOM **NOTE INSULATE TO CODE** 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 It 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 Occu.anc si•nature: FeeType: Date Paid: Amount: Building 6/16/2017 0:00:00 $97.50 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1448 APPLICANT/CONTACT PERSON STEPHEN CAMP ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413)527-7124 0 PROPERTY LOCATION 284 RIVERSIDE DR MAP 30B PARCEL 065 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid � Building Permit Filled out /i.6° Fee Paid �/� • DE Typeof Construction: BUILD 8X8 ADDITION FOR NEW BATHROOM N1o5€ — INSNu{11\dN Tp New Construction Pr,OC R_3 ' Non Structural interior renovations IuM.Lc Addition to Existing Accessory Structure it/OR Q - O Building Plans Included: Owner/Statement or License 082531 WINDOWS L( —,SO 3 sets of Plans/Plot Plan THE FOLLOWING 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 1 61161\ 7 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. P\\���� } 2 \§ » �\ \ \ \ � \ \ , 1 Vii\� » \:\ / \ Vii\ }%\ \ c , \ \ c \ l'cl / � \ t '*' '' ➢ePartrPen4 Gs 4Y 9 City of „,- - atiti-a41orPprmll ` 4r up,u - h Building Department Cai6 CuuDi� eway-Ple trftt t } n 'ty` 4 212 Main Street Se rts�g� pA'a"�ra6�id - '�, _ Room 100 40eIe{Wee Avalla�bi ity - ” �' K, �V�� . - orthampton, MA 01060 Thos tsn tructoral Plans ^y p' ` '. K, phone 413-587-1240 Fax 413-587-1272 PWor.§e Plana , , * I!ik`1 Is 'PLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: n This section to be completed4by office Z e-/ �:t/Er/c/O2- ,//✓�"� Map Lot (,f`> Unit c/DJL(4G4 AIet. I:L Zone Overlay 0lsfrict - / EIm SL Distract L. CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1p �jtand� /ra,L54/4gtza- 2gq /Clve✓Sla Owner of Record: t ©✓" e ,orr�t�- Name(Print) Telephone O Current Mailing/iddpss Ate)72y_A Signature 2.2 Authorized Agent: 44,47 4/‘ est s v r/ Name(Print)/ Current Mailing Address: [2?— 2i V Signature / Telephone SECTION 3-ESTIMATED CONSTRU Item EstimaCTIONtedCOSTS Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estattal Csf 3. Plumbing ConstructionimedTofrom(5t) o Building Permit Fee o 4. Mechanical(HVAC) ar 5 Fire Protection Grp 6. Total=(1 +2+3+4+5) '✓(5, 000. CV Check Number U a ,4 9 7 L This Section For Official Use Only Building Permit Number: Date Issued: Signature:Signature: Building Commissioner/Inspector of Buildings - Date Ark Section 4. ZONING AU 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 { 1 I ( I Frontage _.__.__J L _I l...__._____._._-__.__I Setbacks Front [_1 11- I 07 Side L: I R:1 1 L:L_1 RJ ! I I I Rear i—_I ( Building Height I— I 1 1----1 Bldg.Square Footage 1 r % J Open Space Footage { Qat area minus bldg&paved I___J L___J �__._�i L._... parking) #of Parking Spaces I. _. .. . ___._.__. _. ___.__i Fill: 11 (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/en the site? NO Q DONT KNOW Q YES Q IF YES, date issued:{ IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES O IF YES: enter Book Pagel l and/or Document#1 ! B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , Date Issued: ' C. Do any signs exist on the property? YES Q NO O IF YES, describe size, type and Location: I D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: 1 E. Will 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 © NC IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House El Addition 90 Replacement Windows Alterations) 0 Roofing ri Or Doors C Accessory Bldg. 0 Demolition 0 New Signs [C] Decks [0 Siding[C] Other IC] Work:Description of Proposed / 1 tla / - / � nem /311V14 2f X ,( /77�W f Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa If New house and or additionto existing housing, complete the following: a. Use of building: One Family /t Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? /10 d. Proposed Square footage of new construction. Dimensions e. Number of stories? // f. Method of heating? Ott-e & 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 V 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? V Yes No. I. Septic Tank City Sewer ft Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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 / /l Date I. 5�wnJ`�J///ieel/ azite as Owner/Authorized Agst hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge gE belief. Signed under the pains and penalties of perjury. Print Name `//r''/.-� Lnj / 7//r/ 7 Signature of Owner/Agent ^v� Date • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: J //'/ Not/Ajppsuliicaa/bYblle^£ Name at License Holder: 1Yeir•ed l vim' 908233' V License Number Y/' Cwt- 5e 2 // 23 -i ? Address 0, Expiration Date 52.7- ?/zy Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable E s � ,�� ✓ 13 �'ao y Company Name Registration Number 4�6 £sem- S� L J-f�t/ ,2 )(1 Address Expi lion Ca e Telephone S2'2 -?/21 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 E 11. - Home Owner Exemption The cunni 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(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-yen 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, The Commonwealths of Massachusetts • w,= Department of Industrial Accidents It:e F Office of Investigations It—`''..l- 0 600 Washington Street =n ..0 . =^.% Boston, MA 02111 . � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information C(,'''////// /J Please Print Legibly Name (Business/Organization/Individual): /� 4Phj,e,3 Sot? Address: y,6 1,}$--t �r/' Y City/State/Zip: 577 A.) A1rc?OjlL7 Phone#:_ 27 - c'e'2,9 Areou an employer?Check the appropriate box: 1. I am a employer with24. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors Type of project (required): 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 9 Remodeling ship and have no employees These sub-contractors have g, 9 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.[ 9. ❑Building addition required.] 5. 9 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.9 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConuactors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. • Insurance Company Name: /eke 794 er7A „J�� R5 C& ry to Policy#or Self-ins. Lic. #: I_5Z /J 2" ` IV / 6 7 22_ Expiration Date: 9 /--- lQ Job Site Address: / /l ve✓Sto.1 areas City/State/Zip: DJeA 5 Au 0l o b 2 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 MOL 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 cerfffy un the pains and penalties of perjury that the information provided above is true and correct. Signature: J Date: 0 0 7 Phone#: 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#: City of Northampton Massachusetts .1/4 ` e\ - DEPARTMENT OF BUILDINGi INal Building m ,w! 212 Main Street a Municipal Building SV4, pay NS-tit; si Northampton, MA 01060 INSPECTORSP Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 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: 24t lf✓C ?pe Prwc AdcoLe The debris will be transported by: pick✓/ +✓vu.c The debris will be received by: L/t?i-er �eC7C Building permit number: Name of Permit Applicant C97,04-4„.) 4� do' et \--, 62 Date Signature of Permit Applicant Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527-7124 Submitted To ; Brandt Passalacqua Phone- 917-374-8801 Address : 284 Riverside Drive Date - 5-16.2017 Florence, Ma 01062 We hereby submit this estimate for - Bathroom Addition This price is to build a 8'x8' bathroom addition. The addition will be built at the outside corner of the existing bathroom. All rooting and siding will be complete on the exterior. The plumbing will be I shower unit, toilet and sink. I will install a door from the bedroom to enter in. The floor will be I piece linoleum. I will re-install bathroom window to the back wall facing the deck. Electric will have 1 GEL outlet and a ceiling fan/light combo. I will insulate,sheet rock and trim to finish. Building permit and trash removal is included in my price Plumbing price=$5000.00 Electric price=$ 1800.00 Carpentry price $ 7300.00 Total cost $ 15,000.00 Painting=$ 900.00 Contractor Supervisors License number 082531 Home Improvement Contractor Registration number 135204 1 propose to supply materials and labor-in accordance with above specifications. This proposal may be withdrawn By us if not accepted within 30 day. Authorized Signature Acceptance of proposal Signature 6 iii 4.07- oac,sLZ(cal V f}- 2 r fi ✓ i Pl/3/DpJrll I i/ 7 -779- nil// \J OIDb Z LI 5 ,e______ Si" 1.---0 ,e(.2,44,, a,,,e ��i - , ,_ `1 EN lmzAfiloa"/` f 0/iS_ ii6 s 0 1 ke„ , 01- et- --__ /2,4 5 nnA94.r Ii I 6/1 nem N 2 ell 1:11/250./ • ti cic i ! I J! yCox 84,4+9 1 rl ( / 5"4`4....1 1uI f 4 1c- leor F1po2 o- Zx1Z //2” pJ 1 _ \✓ tin pep' 1,00' fo I Cff,n5deity (/°u v 9 \ \ //41/ c>,-(0" 72 54atizt-Weiyt,0,7, 55%ep CeroF 2K3 ,eta Athr 317 7l