35-110 (6) 29 CAHILLANE TER BP-2018-1012
GIS#: COMMONWEALTH OF MASSACHUSETTS
MapHlock: 35- 110 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# SP-2018-1012
Project# JS-2018-001834
Est Cost: $5000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVID YETTER 13225
Lot Size(sa. ft.): 10541.52 Owner: LAFORD JESSE
zoning: Applicant: DAVID YETTER
AT. 29 CAHILLANE TER
Applicant Address: Phone: Insurance:
356 HIGH ST (413)773-3634 WC
GREEN FIELDMA01 301 ISSUED ON:41612018 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACEMENT WINDOWS -8 UNITS UFACTOR
.28
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 ft 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:
FeeTvpe: Date Paid: Amount:
Building 4/6/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i
Department use only
City m,it
y of Northampton Status of Pe :
Building Department Curb Cut/Driveway Pemdt
. A . 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
.'x. Northampton, MA 01060 Two Sets of structural Plans
phone 413-587-1240 Fax 413587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE
/2OOR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION t✓v� ( LID— (o f Z-
1.1 Pro Address' }'— This section to be completed by office
Map D6 Lot ) Q Unit
Zone Overlay District
Elm SL Mai CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record;
Name(Print) ' Curren[Malang Address_
1lie - 2/ - %ilk
Telephone
Sig re
2.2 Authorized Aaent:
i
Nam// Pnirtl ) Cucent Mating Apirress
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permnit applicant
1. Building .fG — (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) r. (-(- Check Number
This Section For Official Use Only
Building Permit Numbe Date
Issued:
Signal re'
Buiklirg Co - slonerllrepector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can ne Denied Due To Incomplete Information
Existing Proposed Required by Zoning
IDis cMu.m be Illled in by
y Building Depnrenent
LO[$ILc
SS
Frontage
Sctbecks Front
Side L:2�6 R: 7e L: R:
Rear
Building Height
Bldg_Square Footage
Open Space Footage
(Lot arca minus beg&Per<d
arkin,)
k of Parking Spaces Z
Fill:
tv,mme x w�liom
A. Hasa Special Permit/Variance/Finding ver been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Gil'
of Deeds?
NO O —�
DONT KNOW V YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q/ DON'T KNOW O 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
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 l'J
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,(e�,�xc��a fion, orfdling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO V
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) Q Roofing El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs ]O] Decks ]p Siding(O] Other is
Brief Description of Proposed
Work p L�`Ir'F/i 7 /1"",
Alteration of Busting bedroom_Ves No Adding new bedroom_Ves No / J Z�T
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Rall -Sheet
Sa.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 adached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stones?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. Type of construction
L 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.
L 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
as Owner of the subject
propery
hereby ori
authze
to act n my behalf,ins 11 matters relative to work authorized by this building permit application.
Signature fOvmer Date
I. +r
re— C as OwnerlAuthorized
Agent hereby declare that the statements and information on the foregoing application are"a and accurate,to the best of my knowledge
and belief.
Signed under tee pains and penalties of pe0uryy
Pnot Name /
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Constructio Su isor: Not Applicable ❑
5'
Nature of License Holtler r lC' � F1. , �- ✓
License Numbs
Address - Expiatlo Dale
Synature Telephone
9 Repirtered Home Imtxovement Contractor Not Applicable ❑
Company Name Registration Number
Address Expirati
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,¢25C(6))
Workers Compensation Insurance affidavit must be completed and submitted vnih this application. Failure to provide this affidavit voll result
in the denial of the issuance of the buildigg permit.
Signed Affidavit Attached Yes....... Cd" No...... ❑
City of Northampton
Massachusetts
DEPARTrffii4' OF NDSSDINO INSPWrIONS
212 Nein street • Nuucvpal Bviiding
NocNampton, NA 01060
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 entitT must he registered
Type 4)/ U!L/c��� .,� Est.Cost:
T of Work: C i
Address of Work. �z ell
__._^
Date of Permit Application:_
1 hereby certify that
Registration is not required for the following reasons}
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 RESPONSHIRAI ES 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:
l Jt, r
Datd Contractor Name HIC Registration No.
OR:
J/ice ZS
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
_`1e `r p�fs gFi+e,:172 uf`h[LSS C�. ;fSiuZS
Q' lCe ay'I 'e51tgadop5
s 600 Washington Street
Boston, MA 01111
wa,mmass.gov/dla
Vvorkers' Compensation ftisurence Affdavett General Bnsimses
Annlicant Information Please Print Leeibly
Business/Organization Name:
Address: 3/6� Z&7
6 HJT,
City/State/Zip:C�c� 1r L phone#- //n- 5;'�' 5
Are you an-employer?Check the appropriate bum- Business Type(required):
J.Ea lama employer with �2 employees(fu)andi 5. ❑ Retail
or part-time).' 6. ❑ Restauram/Bar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp.insurance required] g. ❑Non-profit
3.❑ We arca corpomtion and its officers have exercised 9. ❑ Entertainment
their right of exemption perk: 152,§1(4),and we have 10.0 Manufacuuing
I no emplo;cea.TNo wort en' comp_insurance required
4.❑ We are a non-profit organization,staffed by volunteers I I.[]Health Care
with no employees. [No workers' cnmp. insurance req.] 12.❑Other
•My applicant that eMeU box#1 mast also fill out the section below showing their workers'compensation policy information.
If the wrporne officers have exempted Ihemselve;but the corporation has other employees,a w Mets'compensation policy is requited and such mi
orgaiiza+im should check box 41.
7 am an employer that is Providing worke 'e hnsation hu r y ernptoyeas Beddoo` a the policy info/merlon
Insurance Company Naure: j
Insurer's Address: �(J ��.1� 9/ ��o �OCI 10
45F !lG
City/State/Zip:
Policy#or Self-ins.Lic#1ZZ&41' Date Z J5
Attach a copy of the workers'compensation policy declaration page(showing the policy number andexpirationdate}
Failure to secure coverage as required under Section 25A of MOL a 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.
.1 do hereby cc usdad'repaks and pennald of erjrny tlratYhe btformadon provided W is and correct
Simtatu*e- ' j/ Z/—�,7/�—,/L I Date, Z//�
Phone#: �T�( J `7
OJ)7dat use only. Do not write in this area,to be completed by city or torten gfflt'tal
City or Town: PermitUcense#
7ssningAuthority(curcle Due):
1.Board of Health 2.Building Department .1.City/Town Clerk 0.licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
uw,._mx�a.„sme
City of Northampton
.."a...... Massachusetts s5�s 3j"
- DEPABTM6H1' OF BUILDING MsPWTZUNB i 11y�(1 T
212 Hain Street eNUNcipal Building ry2�`i,.
K. n, HA 01060 IOW 3)�'�.
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:
L r`J �. P/;%'/�/lam+-lam= z'� {�•Ttr'::c
(Please print house number and street name)
Is to be disposed of at:
r �
(Please print name and lot;atibn of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Sign,, off Permit A I' ant or'O er 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.
Apr.05.2018 02 :26 PM COOKE s JONES, INC. 4133760015 PAGE. 1/ 1
commonwealth or Moosachunalts
07oivislonul'Proleseienel Licanaure
Board oMWilding Regulations'and Standards
Constrgctt6r%6"rvisor
CS-013225 Uplres;0 711 412 01 9
4
60 VID AMADISON
YE' RJR
GI ` y
IMEENflELO NIA 01901
Commissioner L