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36-397 (10) 100 EMERSON WAY BP-2017-1519 GIS#: COMMONWEALTH OF MASSACHUSETTS flk:Block: 36-397 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: Porch Enclosure BUILDING PERMIT Permit# BP-2017-1519 Project JS-2017-002537 Est. Cost: $15000.00 Fee: $98.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW BEAUDRY 108605 Lot Size(sq. ft.): 11804.76 Owner: STARR DAVID Zoning: Applicant: MATTHEW BEAU DRY AT: 100 EMERSON WAY Applicant Address: Phone: Insurance: 117 FERRY ST (413) 320-1348 EASTAMPTONMA01 027 ISSUED ON:6/29/2017 0:00:00 TO PERFORM THE FOLLOWING WORK: BUILDING SCREENED PORCH ON TOP OF EXISITING DECK IN BACKYARD 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 6/29/2017 0:00:00 $98.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner Filed BP-2017-1519 APPLICANT/CONTACT PERSON MATTHEW BEAUDRY ADDRESS/PHONE 117 FERRY ST EASTAMPTON (413)320-1348 PROPERTY LOCATION 100 EMERSON WAY MAP 36 PARCEL 397 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERM1LAPLICATION CHECKLIST ^ \ ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / ( DJ Fee Paid Building Permit Filled out Fee Paid Tyoeof Construction: BUILDING SCRtirNED PORCH ON TOP OF EXISITING DECK IN BACKYARD New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 108605 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 S •lit'.. Del. 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. City of Northampton Building Departm>CST ix ' �. I Room100 yt I N Irthampton, MA 0 160, phoneg13 587-1240 Fax 41 581V272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address- This section to be completed by office /1/c) er'IMY5tn 11/Cf y Map 36 . Lot jJ`"/ / Unit / Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n Yt1) i- O 4 S}arr X00 6ovrsin Way N.hrafr * oiu1 - Name(Print) Z@- Current Mailing Address: (`1/'J) — VU 2i Telephone Signature 2.2 Authorized A nt: y�// �7 Name(P' Lyth , Cu n�alliA,kinng Addts�� "Y° /�� 0/UDI (/73— 3J- ave.- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only co mpleted by permit applicant 1. Building / (/(V (a)Building Permit Fee 2. Electrical (J (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) l/ 5. Fire Protection /L� COUW �7 6. Total =(l + 2+3+4+5) / Check Number �� qi q0,( This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 __ _.. u___—_ — -- _ — Frontage — -- ---- --- — Setbacks Front [I—j. r Side L. R: ' _ ____ ' Rear I __ Building Height ( I Bldg. Square Footage _-- Open Space Footage ____.. % __ (Lot arta minus bldg&paved _ __—_ -- parking) -_ #of Parking Spaces __ Fill: (volume&Location) — 11 ---- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW ® YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW est YES IF YES: enter Book : Page °. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ►I.14 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO #j 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 12) IF YES, describe size, type and Location: E. Will the construction activity disturb(clearing,grading, ex vaticn,or filling)over 1 acre or is it part of a common plan that will disturb overt acre? YES © NO 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 n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 star Accessory Bldg. ❑ Demolitionl� II ❑ New Signs n[p) Decks I0 'r Siding ED] Other[ WorfkDescription of Proposed r5uild1 Scenx) In poth �nr�°P of Rx15 d¢rk)vi I?Qcitywa Alteration of existingbedroom Yes No Adding new bedroom Yes ?C /J Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.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 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, JUIIT SJOvr ,as Owner of the subject property it �'y/nfinRIhereby authorize / N(/rto act on my behalf, iry all matt rs relthorized by this wilding I permit a plication. / permit Signature of Owner y/��/-( //'��� Date I, Matt/at r- t4clr11 ,as Owner/Authorized Agent hereby declare that a statements an nformation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under theains and penalties of perjury. Of / iNd Print Name // OP 7/0 Signature of Owner/Agent / Date 4 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supe 1//iis/orI:/'l IM 1 I/��f� /1�yI� Not Applicable 0 (xy'/��/`/^ Name of License Holder'. Ir 1l�7T�Il lr'�'V 1 X W,Uµ ' C 5- I U be 11 License Number I) r s- F—ssthampv�n n 0147 -3/47 72 Address Expiration Date 14.4.../ 71,7 6 113 - 3-V —/3 cr Signature Telephone t•;9-Registered Improvement Contractor: Not Applicable ❑ iAi uthy tht/Pflpop 0707q Company Name Registrati Num er 117 refry 5)-1 l ame/ 4L 0009-7 / r-€l .2-e1 r Address / Z / Expirati n Date (`O Telephone -3?0-13( 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.._.. ❑ City of Northampton r ti. 5 j-------* i Massachusetts .` err 6 n � DEPARTMENT OF BUILDING INSPECTIONS m` r 212 Main Street • Municipal Building Northampton, !A 01060 g 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("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: 5Cretn I)/ t�1rC' F Est. Cost: /5/ (,('/(/ Address of Work: 100 &ndrsal/ Iq/4(1/ Date of Permit Application: (p/1.7/I I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Sob 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: [ak7//7 A1/4# &gaily I-12 (0 ) y Date Contractor Name / HIC 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 City of Northampton idr Massachusetts -/ Z. '? *� DEPARTMENT OF BUILDING INSPECTIONS + t'` 212 Main street . Municipal Building :i 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.R5.1.3.1 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. • City of Northampton Massachusetts It F .t_ DEPARTMENT OF BUILDING INSPECTIONS o lT U 212 !lain Street *Municipal Building ql � Northampton, FID 01060 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: IW P- si.g 6 6/1 Lila (Please print house number and street n e) Is to be disposed of at: 1/ttl2� i2cnro"yclfnu /7 2t jo Shorn, (Please print name nd$ to lion f facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Ari 7%777 Signature of Permit Applicant or Ow - si- e 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. - Department of Industrial Accidents Office of Investigations 600 Washington Street = — Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organixation'lndividual): 41 / 641, /rU✓vpi?Of Address: Il Rtt7 91- /'� ,Irz `, City/State/Zip: 1 (� hJ►t Al O ( X'hone#: I13- j�- )3 y ? Are you an employer? Check 9ie appropriate box: Type of project(required): 1.tS I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-tune),' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. z ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its their Electrical repairs or additions required.] officers have exercised the 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs ,t PO �r insurance required.]' employees. [No workers' 13.0 Other screwea 1't) POTa comp. insurance required.] "Any applicant that checks box#1 must also 611 cut 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. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infurmation. 'JM' / i id insurance Company Name: Policy#or Self-ins.Lie.#: r ' '1. II,,Expiration Date: lob Site Address: 100 Emit-son W 1A)/01T/lgM Olayttate/Zip: Attach a copy of the workers'compensation ptkcy 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. Ho hereby certify under s and penalties of ojary that the information provided abov is true /qnd correct Signature: / / � 77 - Date: 6 --7 ��� / 7 Phone#: LI/ 3 — t � ' 3 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Vi'ner4\-6(1 VI /L . ki JO\\k t , — t j. i c c ‘A e,t.mdc I ty, Jolwy\ I h ,,. c ivimrye 14, 4,0 , i . r -,10),50 ad/ X f It — ,-----71,------ ,- %.„, ! ; f t 1 t , 1 i . 1 I I i 4 ; . . . 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