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23D-182 (2) 14 NONOTUCK ST BP-2017-1490 GIS4: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 182 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Porch Enclosure BUILDING PERMIT Permit# BP-2017-1490 Project# JS-2017-002486 Est.Cost: $8000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: Homeowner as Contractor Lot Size(sq. ft.): 10715.76 Owner: JARRETT MATTHEW Zoning: URB(100)/ Applicant: JARRETT MATTHEW AT: 14 NONOTUCK ST Applicant Address: Phone: Insurance: 14 NONOTUCK ST (413)455-4323 O FLORENCEMA01062 ISSUED ON:6/23/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE EXISTING PORCH ENTRYWAY 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: O_b 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 6/23/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner o tc- � &PIH3 File#BP-2017-1490 J tfAij APPLICANT/CONTACT PERSON JARRETT MATTHEW p ��� r frr ADDRESS/PHONE 14 NONOTUCK ST FLORENCE (413)455-4323 () 9 9 PROPERTY LOCATION 14 NONOTUCK ST MAP 23D PARCEL 182 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / Fee Paid �F"/") Building Permit Filled out N7 Fee Paid TypeofConstruction: REPLA "ISTING PORCH ENTRYWAY 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: a 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 em.liti.• Delay Aioe Si• ature of Buiding 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. w YtR e.. ,; e:: • _ City of Northampton Building Department . > �,,y 212 Main Street A ', li it _ "¢ +•wi ^-. till Room 100 W bit .rthampton, MA 01060 '—�^"` •? 41 .-587-1240 Fax 413-587-1272 ,,.& '. o nomm�+.H PA aln:droaHes ' a' ;¢; a?'m" x< xx • APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: 1/},TThis section to becompletedby office Il\ a 6.St— Map n Lot $ t+ Unit A(NtA(R- f. A Otb(QL Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1' Owner of Record: J�o .)4nw A �u AJ44o).xk% /• r T (Print) C rent Mailing Address: Telephone Si` re 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ,A _ ° (a)Building Permit Fee 2. Electrical bC� (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection m` 6. Total = (1 +2 +3 +4+5) fit ^ Check Number 3 0 r This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Ro6hw) toit) (� ynoti tcarvk EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) f 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 Frontage Setbacks Front Side L:. Ra L: . R ._._.,.i Rear __ --- Building Height Bldg. Square Footage —_-- % -- — ----' Open Space Footage duiareaminusbldg&paved Pig) — _ if of Parking Spaces _ Fill: (volume&Location) ---- --- ------ - ---- — - — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued:j IF YES: Was the permit recorded at the Registry of Deeds? NO (3 DON'T KNOW O YES O IF YES: enter Book Page', and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO 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 IF YES, describe size, type and location: 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. v. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition E Replacement Windows Alteration(s) 9f/ Roofing C I� Or Doors 0 Accessory Bldg. ED Demolition 4^�' New Signs [CO Decks [❑ Siding [C] Other Brief Ders�ripf�'on of Proposed Work: CD�1ACe PxC5f1NR �'TA^�S+Ni,i� Alteration of existing bedroom -J Yes v No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ca.If New house"and or addition to existing housing. "f"" 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 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 Date .1111111 I. h) ,, __ ,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 under the pains and penalties of perjury. nnt Na� �a MX-LA rr�F— Or e /- Signal � .r - sent Da SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / I1 /I)) Not Applicable 0 Name of License Holder: G-6 e�Qn(l V Pgci'r'l Lt l/eC / G ©S�tt{/� 1 1--i a ,,//tc ci'r't ldlJ Lilce_nse-!Number / / u !1Q 0,501 �/0�7 n20ft� Address Expiration Date /t/ `� NI3 .51) -06 LC Sig re ' Telephone S.Registered Home " ' t tie.. i • : . . .. Not Applicable ❑ _ •_o P.0 e /08 '46 3 Com•an fl , � ,�f Registration Nu��'er 5�1.�t J 0w(a t,A7I 013 j> . < lam/,�O/S Address ✓ Expiration Date V Telephone 143 555cos 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 0 • City of Northampton _ Massachusetts Sv 5 b.„u As Id DEPARTMENT OF BUILDING INSPECTIONS+. ! i 212 Main Street • Municipal Building .A-- Northampton, MA 01060 CciAFFIDAVIT 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("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing 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 has contracted with a corporation or LLC, that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Pei mit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 )CI Owner obtaining own permit(explain):?eic ,,, t VJr\'(ac r tiic Ntelc. y;r.,s, t v 2 m..a c vk,,,tir b Building not owner-occupied Wt •w .e5, J 3 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: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a buil‘g pe ''t as the owner of the above property: Dat Owner Name and Signature / ..,. City of Northampton tltk Massachusetts ,r g * � ( i I. 2 DEPARTMENT OF BUILDING INSPECTIONS �/J 212 Main Street • Municipal Building .;ep�s Northampton, MA 01060 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.R5.13.1 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 maybe liable for person(s) you hire to perform work for you under this permit. City of Northampton // i ti.� Massachusetts 5 t' a /... s V!tifi ; 1, DEPARTMENT OF BUILDING INSPECTIONS ,,,°2 S S. 212 Main Street •Munici l Buildin 0`. tewerr Pa 9 1- be' � Northampton, MA 01060 1% ,").1 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 constructionat: fwork being performed I Y ktb1VGk S'- (Please print house number and street name) Is to be disposed of at: 1\.)ril�y D e p>1 Racy C Cocom (Plea a print name dnd to tion of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Com•any Name and Address) OP Signatu °!mi.. ••pplicant I r 0 er 'ate lir 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. Soa xDepartment of Industrial Accidents I _'-lih=1 Office of Investigations `'Igi'- ' 600 Washington Street "7,1174'g _ Boston,MA 02111 as' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business//Organization/Individual): VAid t I Address: ts\NINub\vtk City/State/Zip: 'Regina. MP - O(Ole 7— Phone #: LI(3L( 3L3 Are you an employer?Check the appropriate 4ox: Type of project(required): 1.❑ I am a employer with 4. J1 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ 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. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions Iam a homeowner doing all work right of exemption per MGL 11.p Plumbing repairs or additions myself. [No workers' comp. c 152, §I(4),and we have no 12.0 Roof repairs 4211 hsurance required.] t employees. [No workers' 13$O1herQ2 8_,W comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. '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 showing the name of the sub-contractors and their workers'comp.policy information. 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby ,r the pains and penalties of perjury that the information provided above is true and correct. II � � t Signature: "c Date: I�r T /` Phone#: 4i +,l 37—a 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit license number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727.4900 ext 406 or I-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov(dia The Commonwealth of Massachusetts I " G Department of Industrial Accidents tEl Office of Investigations t e ' �L � � 1 Congress Street, Suite 100 e Boston,MA 02114-2017 1/4... . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orrganization/Jodiy id : �'� O'c\/ ,) eatesvti St.5 Address: Ca Su � ( ��t pts�^I lls. l� /1 City/State/Zip: /10bt` HIQI36IPhone #: 1- I3 Sb9 - ,j0. ©6IJ _ Are you an employer? Check ttgapprOpriate box: Type of project(required): I.❑ I ammployer with 4. ❑ I am a general contractor and I ployees (full and/or part-Lime).' have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have R. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roofr air, insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.111 Other q9 ' Iii t y I< comp. insurance required.] /J X. `/ t / 'Any applicant that checks box#1 must also till out the section below showing their workers compensation policy information. Homeowners who submit this affidavit indicating they are doing atl work and then hire outside contractors must suhmit a new affidavit indicating such. Contractors 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. 1 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance jjcoverage verification. I do hereby certify rad t pains n�enalties of perjury that the information provided above i )tr//ue nd correct.'-7 Signature: lUG�L� �—. Date: 6 �llO true / Phone#: Al1 -5 .5,5-9 - O6 I J 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#: c 510 Cron a � , 07 fiafibieol � / ���� CA),of Northampton Barreling Department Plan Review /' O 212 Main Street lLfl C/ Northampton. MA01060 D'19°4 d}or o kfatl s t 14v c a 1` P. ( e \ Liilij 1 /s o Nd u.v ' 11 is p,,��o a `o 9 as C � � ct . P � I Int, e` adale P' T i ly c,.LA oiFII '6 f 1 ci.s hil J _ 'aio�10, a. boll Il jD Ge„a g a1 �b l�(N���fi:�' eec \ oi,,,,, k\ .:,45 - b ”° � � � � a 3,s ©w �j,�1 �° hf 'ossa 1 �aa 't 7 �! ��vN°N f p '091 of „...��" Y