16A-018 (5) 478 SPRING ST BP-2017-1484
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16A-018 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Bath repo BUILDING PERMIT
Permit# BP-2017-1484
Project# JS-2017-002477
Est.Cost: $15580.00
Fee: $97.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: EDWARD RICKEY 96159
Lot Size(sq.8.): 14549.04 Owner: BRIDGMAN JAMES E
Zoning: URA(1001/ Applicant: EDWARD RICKEY
AT: 478 SPRING ST
Applicant Address: Phone: Insurance:
P O BOX 62 (413) 695-7059
W ILLIAMSBU RGMA01096 ISSUED ON::6/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM
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 $97.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1484
APPLICANT/CONTACT PERSON EDWARD RICKEY
ADDRESS/PHONE P O BOX 62 WILLIAMSBURG (413)695-7059
PROPERTY LOCATION 478 SPRING ST
MAP 16A PARCEL 018 001 ZONE URA(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ppp� g
Fee Paid
Building Permit Filled out ,f1iV ///��J `` I
Fee Paid ..�\ (Ut
Tvpeof Construction: REMODEL BATHROOM , 1
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 96159
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INRIRIVIATION 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
%/7
Signature of Building Olficia 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.
-/
City of Northampton '' ' + '3,Ej
Building Department 4 .h .: -s
�� 212 Main Street
Room 100
`1i Northampton, MA 01060
<5 •/')-e.•` phone 413-587-1240 Fax 413-587-1272 t d
\p . .LIGATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECT ON 1 -SITE INFORMATION
1.1 Property Address: 0 This section to be completed by office
278 Art�CJ� Map t( /7 Lot OSUnit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
X N7-glz4 edy nig- oioS3
am.°(Pdn Current Mailing Ad ass:
1 r�,7 Telephone
Sign �UQJ /
ure
2.2 Authorized Agent:
P. sax 62 Z LPO .-G� 2124 0/074
Name(Print) Current Mailing Atltlress:
41/3-675-7•41Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /6—
ggO a. (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) ,f(��
5. Fire Protection �yy 11.
6. Total=(1 +2+3+4+5) /5 T8O.'- Check Number a4171 77
7
This Section For Official Use Only
Building Permit Number Date
tIssued:
Signature'.
Building Commissioner/Inspector of Buildings Date
•
,
Section 4. ZONING AB 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 Depvtment
Lot Size
Frontage _.
_-
Setbacks Front -_- - -.
Side L: R._.."" Lit
Rear
Building Height
Bldg.Square Footage - °° ---- -- - ---'.
Open Space Footage —. -- --
(Lot area minus bide&paved
parking)
#of Parking Spaces ---- --- -
Fl:
(volume&rotation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:..
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book , Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® YES 0
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 O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) I I Roofing n
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [Cl Decks [CI Siding[O] Other[O]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes 1/ No Adding new bedroom Yes v No
Attached Narrative Renovating unfinished basement Yes ✓No
Plans Attached Roll -Sheet
so If New house or iJ'it`i$i n ta'ezis h8 fiolieinti 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
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/LyOR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, X 1411 rS Z. SK/P617/911/ as Owner of the subject
property ! / .fi
hereby authorize aa.e //vx
to act on my behalf, in all matterative to do authorized by this building permit application.
eot , r a Que », c ,7 irr afladc
Signetreof Owner/ / �0
I, /w�ereb / �-!cy ,as Owner/Authorized
Agent hereb dare thatat t statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Signed under the pains and penalties of perjury.
Oc'ARc 2 R/ckfY
Print Name
a 7
Signature of 5.'ner/•_m nt D. -
•
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicabl
e £
Name of License hinder: Tet 094/57
License Number
Pte. 8 2 // 0 09 /4 iY
Address E Inti Date
Y/a-o:s-20.57
Signature Telephone
S.Reinstated Nome•hn srMremeiieen tacmr`_ Not Applicable £
/_�_ t&- iregYo
om.an N e Registration Number
Aft 0/0PG 52t
Address Expi ti kDate
Telephone 41/3-47S.7a57
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.c.152,§25C(5))
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 buil ing permit.
Signed Affidavit Attached Yes No £
11. - writ t}SP#f i E%effiT3ti011
The cu -it exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two ' mikes
and to allow r homeowner to engage an individual for hire who does not possess a license, •nodded tha • owner cts
as .ervisor.Cut;, 80 Six i Edition S . Nu 108.3.5._.
Definition of flonuown • Orson is)who own a parcel of land on which he/she resides or ince.= ,o reside,on which there
is,or is intended to be,a one or • family dwelling,attached or detached structures acce r': to such use and!or farm
structures.A . -on who cot ' nets • than one ho t' in a two- ear I eriod • I it be consii red a homeowner.
Such"homeowner"shall submit to the Builds • 4 o• the Building Official that he/she shall be
re tensible for al such work ierformed n,to
As acting Construction Supervisor your presence on the jo.r will be required from time to time,during and upon
completion of the work for which this permit is issu-•
Also be advised that with reference to Chapt (Workers'Compensatio' .nd Chapter 153(Liability of Employers to
Employees for injuries not resulting i e-ath)of the Massachusetts General Laws A•toted,you may be liable for person(s)
you hire to perform work for yin •-r this permit.
The undersigned"homeow • certifies and assumvb responsibility for compliance with the State : "ding Code,City of
Northampton Ordinan - ,State and Local Zoning Laws and State of Massachusetts General Laws Anna d.
Ham4 I er Signature
• The Commonwealth of Massachusetts
= Department of Industrial Accidents
=sr-=tit1t=Err Office of Investigations
=` itiga 600 Washington Street
=�rl= Boston, MA 02111
www.massgov/ilia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant InformationPlease Print Legibly
Name (Business/Organization/Individual): ```o‘w ✓ 77
Address: P qo-A- G2
City/State/Zip: o mA otofc Phone #: 1793-675.7or7
Are you an employer?Check the propriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
__employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction2. I am a sole proprietor or partner- listed on the attached sheet. 7. N Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.[
required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions
3.❑ 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❑ Roof epairs
insurance required.] t 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.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContracrors 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:
Policy#or Self-ins. Lic. #: 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$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.
Ido hereby certify under
the pains and penalties of perjury that the information provided above is true and correct
Signature: oa�uG.� /i $ Date: 4/al/
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 •
yMassachusetts L r.
ft
t.
DEPARTMENT OF BUILDING INSPECTIONS o `5®/ M•
{
213 Main Street • Municipal Building ce.
� • Northampton, MA 01060 �SY1Y
INSPECTOR
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/.- -
cons ction supervisor. The state defines "Homeowner' as, " Person(s) who owns a parcel o• hich
he/she r- 'des or intends to be, a one or Iwo family dwelling, attached or detached struc .res
accessory to -uch use and/or farm structures. A person who constructs more than one ••me in a two-
year period sha not be considered a home owner."
The building departm- t for the City of Northampton wants any person(s)w . seek to use the home
owner exemption, to act is their own construction supervisor, to be aware at by doing so you
become responsible for •mpliance with state building codes and r gulations. The inspection
process requires that the buil..•• department be called to inspect wor. at various stages, which include
foundation/footings (before ba. ill), sonotube holes (before p• r), a rough building inspection
!before work is concealed), insu - ion inspection (if require, and a final building inspection.
The building department requires thes- spections before th ork is concealed, failure to secure
these inspections can result in failure • obtain a ce ' tate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform ,•- (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hire. :ec - their proper permits in conjunction to the building
permit issued, and that they get their re. - red insp- tions. Failure of the individual trades to secure
the permits and inspections as require. an DELAY the • sect until such time as the proper permits
and inspections are made
u •erstand the above.
(Home owner/residh 's signature requesting exemption)
I will call to schedule - required building inspections necessary for the b 'ding permit issued to me.
Date
Addres •f 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: y 8
The debris will be transported by: ,$I
The debris will be received by: V
Building permit number:
Name of Permit Applicant
1-20 -/7 dl
Date Signa rrmit Applicant