06-022 (18) 44 EVERGREEN RD BP-2018-0119
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:06-022 CITY OF NORTHAMPTON
Lot: -020 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:REPLACEMENT WINDOWS/DOORS BUILDING PERMIT
Permit# BP-2018-0119
Project# JS-2018-000201
Est. Cost: $44000.00
Fee: $308.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: P&B NEW ENGLAND SERVICES LLC 109528
Lot Size(sq. ft.): Owner: YANKEE HILL CONDO
Zoning:URA Applicant: P&B NEW ENGLAND SERVICES LLC
AT: 44 EVERGREEN RD
Applicant Address: Phone: Insurance:
47 COATES RD (413) 650-6010 WC
LEYDENMA01301 ISSUED ON:8/2/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE 9 FOOT DOORS AND
PANELS/INSTALL NEW WINDOWS AND DOORS FOR 30 UNITS
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 8/2/2017 0:00:00 $308.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
•
•
File#BP-2018-0119
APPLICANT/CONTACT PERSON P&B NEW ENGLAND SERVICES LLC
ADDRESS/PHONE 47 COATES RD LEYDEN (413)650-6010
PROPERTY LOCATION 44 EVERGREEN RD
MAP 06 PARCEL 022 020 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
$SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid a
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE 9 FOOT DOORS A I •ANELS/INSTALL NEW WINDOWS AND DOORS
FOR 30 UNITS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 109528
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
dt-L/6"-----.P
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.
f 4 r--
Departmelt uses only
owH�MP,o.. City of Northampton Sta Brit:---��' �:4s
"; Building Department Curb Cl��
hi'eway-f+ertnit
212 Main Street Sewer/Septic Availability
t Room 100 Water/Well Availability
�. . . _ Northampton, MA 01060 Two Sets of Structural Plans
' ligf
phone 413-587-1240 Fax 413-587-127 ..- • ans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, - -'Al , ENyO,VATE OR DEMOLISH A 0 OR 0 FAMILY DWELLING
SECTION 1 -SITE INFORMATION '/ if
> I•,, • .: completed by office
1.1 Property Address: ofd1
t 8 1 0(401�tQ �4`l P V ( Lot - Unit
Lt Cal 5 III q Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of ReC
a n fctt ' 1I G O
Name(Prr t) Current Mailing Address:
Telephone
Signature
2.2 Authorized Anent:
/ 1Na e(Print) �� (Atli
Current MailingAddress:
�`��
bu utQ 14 -(AST) -ti2CC)lD
Sig Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 4Yii 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 Protection J,
6. Total=(1 +2+3+4+5) Check Number / }(6,
This Section For Official Use Only v
Building Permit Number: Date
Issued:
Signature: "1 `Cer -{'.r. 8/
i i I, C ft
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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Fincjing ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 4 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (g) DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location: haft or EPTI-Y ()) y yknif6 1pti-5/6)
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ID
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 0 NO 141
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 [l Addition ❑ Replacemenindows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. 0 Demolition 0 New Signs [O] Decks [p Siding[0] Other[0]
Brief Description of Proposed /i
Work: . a.. / $ cad rt4S /
Iji/51- 1( r.'c,w w+Npa}:› d Jc02.5
Alteration of existing bedroom Yes )4,...No Adding new bedroom Yes 1� No
for 3d
Attached Narrative Renovating unfinished basement Yes KC No an f4 f j
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
*1
property , Its
101.
• '*, i 1 —.40 a feC file, l s_ �: . ,as Owner of the subject
hereby authorize i !> 1.'6+ SE(LUi(cS ,
• =.. on my behalf, in all matters relative to work authorized by this building permit application.
if • ice% '' l $• 1 • aol -3"
Sig-7-1T" of Owner Date
If I, ` J(.1h '`t �► o I�"•. . _ . gob.". � I- Ca- t$• • ,as Owner/Authorized
Agent hereby declare that the statements and informa io on the •regoing ;,•:ication are rue •nd accurate,to the best of my knowledge
and belief. •
S' • under the pains an. •-•.Ides of perjury. Gin
op l' e
a ID 2 fabo 1
nn :I:
'•- . & •. . " f ml eee • ". / • dot 7_
re• Owner/Agent Date
s
* �:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: SHI'VE Cht-Ke e- (e S - 1 69 c2.6
License Number
(t7 (04-1-ci Le Pe to P4. b12'°( --2/
Ad Expi on te
( 13))/ 1-10/
Sig a ure elephone
9.Realstered Home Improvement Contractor: Not Applicable 0
B &L) E1G-1-4$16 j 6
Company Name Kegistration Number
7 Cois g_0„ Lc,/ Del) ritA. 013° 1 'CO PP&
Address Expiralfon Cite
Telephone(r))/11-1 1061
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 p( No 0
City of Northampton
4-,--,
o„,-,--4. ;;;;,
MMp ,. 2,,5 Simi
•'' Massachusetts A. j `G
DEPARTb NT OF BUILDING INSPECTIONS ,
..` 212 Main Street • Municipal Building Jtir c,
sr y�, Northampton,4011: Ma 01060 rNry, 10‘
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: k,,,)�,�()pJJ'a'1*, ��-S a Est.Cost:VY46 60
Address of Work: L/ 1 aid ( % ck L j , /lc
Date of Permit Application: g 1 14
I hereby certify that:
Registration is not required for the following reason(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 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:
1 I t9 pi 11 tie., eJ&SMD sitvit.C.5 /6 1 cl
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
4°-. /.MPS ti \S — sic,�,.....sic,
✓t Massachusetts A,'
Ai �� .-4 �3� cr
it 1 t• ii,41 DEPARTMENT OF BUILDING INSPECTIONS Z >' m
a. * r .'``' 212 Main Strut •Municipal Building vies �``,D
rNorthampton, Mil 01060 NJy '
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:
416 a (I A. L,At (,1 cots, /144i
(Please print house ri mber and street name)
Is to be disposed of at:
Ory/ii
PI ase • e and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
�MI�kD.1Scij
(Co m�any Name and Ad ss)
LII:26(:4)/ ------- ) . 1iT
Signature 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.
The Commonwealth of Massachusetts
=,..=.m-- Department of Industrial Accidents
h t Office of Investigations
iI&'= , 600 Washington Street
�'�'1- r Boston,MA 02111
-�...,'' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):�1 0.6.0e vu,,lc iJ L%\ C('-�
Address: 4.-('7 Cm\e s t J
City/State/Zip: (---y 1 . 0 I t Phone#el 13) r172 7 101
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with 3 4. 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. workers' comp.insurance. 9. 0 Building addition
[No workers'comp.insurance 5. 0 We area corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no 12.[ Roof repairs 'C
insurance required.]t employees.[No workers' 13.p� Other 64)4(00/1/comp.insurance required.] j`�l
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sue
information. f
Insurance Company Name: r r A IA S S. ( . /
Policy#or Self-ins.Lic.#: (0 54 411? - 71-111/ 5-I 3 — 3 —/r�Expiration Date: 3//i/18
Job Site Address: Lib G U'( J( 4 `" 4c City/State/Zip: ) ,
Attach a copy of the workers'coi(pensation 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 here 40 0 1 'r t el,'ins a 'penalties of perjury that the information provided above is true and correct
Signature:fib. , Date:
(J///
Phone IP (Y' 772.. r_.71
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):
r 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Gt � 8
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