Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
05-020 (11)
395 AUDUBON RD BP-2017-1516 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05-020 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPAIR BUILDING PERMIT Permit# BP-2017-1516 Project# JS-2017-002532 Est.Cost: $6000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOHN B OTIS 002688 Lot Size(sq. ft.): 386377.20 Owner: BASKIN LISA&LEONARD Zoning: RR(102)/WSP(25)/ Applicant: JOHN B OTIS AT: 395 AUDUBON RD Applicant Address: Phone: Insurance: 612 EAST ST (413) 268-7106 W ILLIAMSBURGMA01096 ISSUED ON:6/282017 0:00:00 TO PERFORM THE FOLLOWING WORK:STRUCTURAL REPAIR & REINFORCEMENT OF TIMBERS IN CELLAR OF BARN 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 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1516 APPLICANT/CONTACT PERSON JOHN B OTIS ADDRESS/PHONE 612 EAST ST WILLIAMSBURG (413)268-7106 PROPERTY LOCATION 395 AUDUBON RD MAP 05 PARCEL 020 001 ZONE RR(102)/WSP(25)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 1 Building Permit Filled out Fee Paid Typeof Construction: STRUCTURAL REPA R • REINFORCEMENT OF TIMBERS IN CELLAR OF BARN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 002688 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 ��`' ` d-a8 i7 v attire o u m O inial 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. JUN • Department use only L_ - City of Northampton status of Permit: ` Building Department Curb Cut/Driveway Permit tI a, I.' --- .5_ - 212 Main Street Sewer/Septic Availability •Q i '!. !pi Room 100 Water/Well Availability ;. rr t Northampton, MA 01060 Two Sets of Structural Plans _' phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 property Addmgr This section to be completed by office 395 Audubon Road Map 06 Led O010 Unit Leeds , e.A 01053 Zone Overlay District Elm St.District CB DIstrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT y1Owner of Fl co fit ' Kill/ PD Box 314 , LL£OS, /114 O/oS3 Name(Pnn1'a7 Current Mailing Address: 9/3 sss -Y/zT Sign As Telephone 3.2 Author rnd Anent: John U. Otis 612 East St, Williamsburg, IsA 01096 Name(Print) Current Mailing Address- . fill's 268-7106 - 695-4879 Cad( j4iiJ a Signe N Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 36,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protectio 6. Total=(1 +2+3+4+5) ii6,000 Check Number (fib This Section For Official Use Only Building Permit Number Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 'TI.N . .. r,�.. : .. ..._... New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [0 Siding g71 Other ] All work to •e done by hand. Briefcd do of ProRwse Wo bt`r Uictura rtlepair O. reinforcement of timbers in cellar of barn. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba. If New house and or addition to existing housing,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 fl.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 Ta-OWNER AUTHORIZATION- BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR : ' FOR BUILDING PERMIT I, diSFPFrommiklIMe Li 5.4 V. 8 nx',✓ ,as Owner of the subject property herebya ' e John B. Otis to act• ,'n all .:rs : :five to work authorized by this building permit application. Sit 6 /2.0P7 Sig, Oy.i Date 1. John 11 Otis ,as Owner) len hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge {Fief Signed under the pains and penalties of perjury. John u. Otis Print Name I) /gif/_44 Signal . 7. • a -gent Section 4. ZONING All 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 Open Space Footage (Lot area minus bldg&paved µalong) X of Parking Spaces All: (volume&lnr.uon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document N B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® 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 O 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. 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 SECTION 8-CONSTRUCTION SERVICES 84 Licensed COnstruction Supervisor: Not Applicable ❑ Name ofucense Nobler. John B. Otis 002668 License Number 612 east Street n/ t1/17 Address Eviration Date 11ii Liaws burg, i:A 01096 signature Telephone 268-7106 & 695-4879 o Registered Negro Imorovenrent Contractor: Not Applicable 0 John 1 . Otis Ctupoanv Name Registration Number 612 east Street 102687 Address Expiration Date kii11iam,burg. luA 01096 Telephone 6r95-14879 7/2/18 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT M4.01_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.,._.. W No...... 0 The Commonwealth of Massachusetts Department of Industrial Accidents t! k7 1Office of Investigations _ - 600 Washington Street Boston, MA 02111 '4=1" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): John rl. Otis Address: 612 East st. City/State/Zip:Wiiiiams burg, siA 01096 Phone#: (413) 268-7106 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employeesjfull and/or part-time).' have hired the sub-contractors 2.® I am(sole proprieto?for 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 area corporation and its required.) officers have exercised their 10.171 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGI. 11.9 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.9 Roof repairs insurance required]' employees. [No workers' 13 ®O[her�tr;r^tdual reps Sr comp.insurance required.] // `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infmmatioa t Homeowners who submit this affidavit indicating they are doing an work and then him outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comppolicy information. 7 am an employer that is providing workers'compensation insurance for my employees Below Ic 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. I do hereby certify under the pains an'penalties of perjury that the information provided above is true and correct Signature: �fp� I� .4 Date: 6/26/2017 Phone#: (41V3) 266-7106 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 City of Northampton s ' f Massachusetts e ' s�O2 � t A 'I r r,l• G rs12 Main T os s• tinicc zaseilding J`SS�)'4.; 'OF 212 Nan Street oMuniclpal Buileins �,,,.. ..,. Northampton, NA 01060 +YH � 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: J95 Audubon .road (Please print house number and street name) Is to be disposed of at: Valley Recycling (Northath.pton) (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Wil; , vi • -.i": 6 2b I ign;r re of Permit 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 r ,> G"'f Massachusetts 4s c! A A tf" F.r,' DEPARTMENT OF BUILDING INSPECTIONS ,t �' /11'�iJ<y 212 Main Street • Municipal Building Northampton, MA 01060 rhp 3,.,, 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 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 reeistered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work - - _ Est. Cast: 46,000 Address of Work: 395 Audubon .toad, Leeds , rnA 01053 Date of Permit Application: June 26 , 2017 I hereby certify that: Registration is not required for the following rcason(s): Work 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 NO'f 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: 6/26/17 John u. Otis 102687 Date Contractor Name BIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature