Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
17C-314 (3)
23 LAKE.ST BP-2018-1028 CIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-314 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: shed BUILDING PERMIT Permit# BP-2018-1028 Proiect# JS-2018-001868 Est.Cost: $5800.00 Fee:$48.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groan: Homeowner as Contractor_ Lot Size(sa. e.): 11891.88 Owner: ANDRUS NAOMI A zonine: URB(100y Applicant. ANDRUS NAOMI A AT: 23 LAKE ST Applicant Address: Phone: Insurance: 23 LAKE ST FLORENCEMA01062 ISSUED ON.411212018 0:00.00 TO PERFORM THE FOLLOWING WORK INSTALL 12X20 PRE FAB SHED 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 sianature: FeeType: Date Paid: Amount: Building 4/12/2018 0:00:00 $48.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-t028 APPLICANT/CONTACT PERSON ANDRUS NAOMI A ADDRESS/PHONE 23 LAKE ST FLORENCE PROPERTY LOCATION 23 LAKE ST MAP 17C PARCEL 314 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPILICATION CHECKLIST NCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Tw f Construction: INSTALL 12X20 PRE FAB SHED 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 F,PLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFqRMATION 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// 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. r I Department rueDoty City of Northa pt n 5 s f Permit Building Depa me m oeaur.orm_v vvrcn oroC Dnveway Permit NOFIHAMPTOM1 NA' IXi 212 Main St epfic Availabildy Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans`:' phone 413-587-1240 Fax 413-587-1272 PlotlSite Plans Other Specify 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 ,-13 L (}tCE STr f. t_ Mope Lot A,` / Unit �LCCt- PI fi o r 0 6 oZ Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /f /ton I r'<. A Name(Print) Current Mailing Address- Telephone Signature 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 b Permit applicant 1. Building 2✓u pz (a)Building Permit Fee 2. Electrical (b)Estimated Total Cast of Construction from 6 3. Plumbing — Building Permit Fee 4. Mechanical(HVAC) � ✓ 5. Fire Protection 6. Total =(1 +2+3+4,-5) S20G Check Number This Section For Official Use Only Building Permit Number. Date Issued. Signature: Building Commissioner/Inspector of Buildings Date CD n roS @ c0" nbt' EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 1 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 Depa¢ment Lot Size _ _ .. ��. .... Frontage ' - Setbacks Front Side L:-R: .. L: R: .. Rear Building Height Bldg. Square Footage Open Space Footage % ~ (Lot area minus bldg&paved - rkin ) k ofParking Spaces Fill: (vo—&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registr/of Deeds? NO O DON'T KNOW C 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 DON'T KNOW O YES O IF YES, has a permit been or need to be obta red from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 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 (40 O IF YES,then a Northampton Storm Water Manacement Permit from the DPW is required. r SECTION 5-DESCRIPTION OF PROPOSED WORK(check II I' bl ) New House ❑ Addition ❑ FReplacendent Windows Alteration(s) Roofing ❑ Accessory Bldg. ® Demolition ❑ igns [0] Decks [O Siding[o] Other Brief Description of Proposed Work_ S..atwlla flu, o4- rQE +P'g 5- h9. b 0.[Ci-Sso4`f Alteration of existing bedroom Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing, complete the following a. Use of building One Family Two Family Other L Number of rooms in each family unit. Number of Bathrooms c. Is there a garage attached9 J, Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating9 Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 It 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 fJfl-U at lk vd2�.5 , 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 Data I, -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. Print Name Signature of Owner/Agent Date SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone S.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Te epi me SECTION 70-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2506)) Workers Compensation Insurance affidavit must be completed and s ibmitted 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...... ❑ -- s City of Northampton Massachusetts DEPARTHEPT OF BUILDING INSPECTIONS s 212 Main Street • Municipal Building J �D s Northampton, !0 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 entity must be registered Type Tv, A+- o., 0 rnccE YP � SS cel 6 d� Est. Cost S Soo, Address of Work: J- 3 L�C t- C,+ H o k E tJ L E- Date of Permit Application: t{-1 D - g 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): C.o�m�av,� �ozS eu,t- oHM,v E;=Hrf S� 4`Iu k 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 RESPONSIBILFEES 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 building permit as the owner of the above property: y-Io - I & Nbrvnt fr RNaizu� `?, u,�- �_ �-k^-�-�-- Date Owner Name and Signature City of Northampton Massachusetts �, c m DEPARTMENT OF BN[LDZNG INSPECTIONS Ma 212 in Street • Municipal Huiltling '�� Morth�torr, !W 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 iwo 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 tuilding permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a persons) 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 311 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 ,35s rye �c DEPARTMENT OF BUILDING INSPECTIONS 2: 212 Main Street •Municipal Buildinq Northampton, ! 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: d3 L K�- 51, (Please print house number and street name) Is to be disposed of at: Wo hcl3Q'5 - � -P ahy -c , I/ '3 KcnOYe � &y , opt c.m --� (Please print name and location of feellity) h Or will be disposed of in a dumpster onsite rented or leased from: (CompanyNameand Address) 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 Department o f Industrial Accidents I Congress Street,Suite 100 Boston,MA 01114-2017 www.ma ss.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Business Type(required): 1.El I am a employer with employees(full and/ 5. E)Retail or part-time).* 6. ❑RestaurantBadEating Establishment 2.0 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] 8. ❑Non-profit 3.❑ We are a corporation and its officers haveexercie,1 A E] Entertainment their right ofexemption pert. 152,81(4),and we t ave 10.❑ Manufacturing no employees. [No workers'comp.insurance required]" 4.❑ We are a non-profit organization.staffed by volunteers l l.❑Health Care with no employees. [No workers' comp.insurance req. 12.0 Other -Any applicirmtbateducls box#1 must also fill out the ox1aabelevoov.fog theb oilers ompeusalimpubeviafrmatum "Iftlw co or,c Nzmion d e k tav empted tl,emsehes,but We wryomtion has o bcv employee ,a orkers'compensation policy rs requuW and meh vn should check box XI. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lid.It Expiration Date: Attach a copy of the workers'compensation policy dedaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MI I e. 152 can lead to the imposition of criminal penalties of fine up to St,500.00 and/or one-year imprisonment,as well a,civil penalties in the form of a STOP WORK ORDER and a fine of up to$250M 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 carafe, under the pains andpenalties of perjury that the information provided above is true and correct SignatureDate: Phone#' Official use only. Do not write in this area,to be eomp.ieted by city or town a trial. City or Town: PermitfLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: cow.. ,:.so,/d,e City of Northampton Massachusetts DEPAffiT T OF BUILDING INSPECTIONS 212 Main Street oeunicipal Building Northampton, Mx 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: a3 LwK�- Si Flor_ t �_ (Please print house number and street name) Is to be disposed of at: �d De Ch4�S c, P,-FcG — � f FE rtoJ< T 6y54�-11c. (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: nJ//t (Company Name and Address) 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 Commonweahh of Massachusetts Department o(IndustriaiAccidents 1 Congress Street,Suite 100 Boston, MA 01114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full aid/ 5. ❑Retail or part-time).* 6. F]RestaurarcBar/Eating Establishment 2.❑ I 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] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercise( 9. ❑Entertainment their right of exemption per c. 152,§I(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]" 4.F-1Weare a non-profit organization,staffed by veluntcers, 11.0 Health Cate with no employees. [No workers' comp.insurance'eq.] 12.0 Other llnv applicant that checks box 41 must also fill out Ne section below showing het workers'compeusa.policy ar mmatiov. "*IrWeco,creeofcem have exempted themu,hcs,Ineflmem,mmen les omvemployees,a workers componsacm pohcy i ,cited aral,wh an otganuation should deck box HI. I am an employer that is providing workers'compensation insurance for my employees Below is the policy information. Insurance Company Name: Insurer's'Address- City/State/Zip. Policy k or Szlf-ins.Etc.9 Expiration Date: 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 M61,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 c-.vil 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 and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone : 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): L Board of Health 2.Building Department 3.CityrFown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wwwmass.gov/dia 1 C 1 Ply i, �. T 9 Se�or�i �u�N � - a . » »< 0 . . : . . \ \ � • a �s � U411U/2018 10:58 14137860989 SKIPS PAGE 03/03 Skip's Superior Quality! 2"x 4"Roof'Rasses w/ Double Gassers Gable vents — 25/30 Year Shingles NOminnm Drip Edge 4 over 4 fire Windows w/9hurtm or Jalousie 1/2'COX Plywood Windows w/Shutters Roof Sheathing 2'x 4"Kiln DriedMauHanence Free YlSiding Studs r6'O.C. 5/8"5 ply CCA 40 Pressure Tri ted Plywood Flom 4"x e Pressure Treated Timbers fall lengrh ofBUdding Mat others consider "options" Clowk are standard at Skip's! 2'x4^Roof Trusses Oeble rents w/Double Gussm .aluminum Drip Edge 1/2"CDA Plywood Roof Sheathing. Dura-Temp 5 Ply Siding 25/90 Year Singles 2"x 4"Kiln Dried studs re"O.C. 4 over 411t Windewa w/shurtm or Jalosie Window's w/Shutters 5/8"S Ply CCA.4o pressure heated Plywood Floor 4"x4"Pressure i Treated'19mbets Full Length M liu➢ding i Sldpsonlinexom O 1-800-822-7547 1 i