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17A-226 (8)
117- 119 LAKE ST BP-2018-1009 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-226 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: ADDITION BUILDING PERMIT Permit# BP-2018-1009 Project# JS-2018-001832 Est Cost $195000,00 Fee, $1267.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MICHAEL M POWELL 093015 Lot Size(sq. ft.): 20865.24 Owner: MALONE PATRICK M& SHERYL A zoning:URB(100)/ Applicant: MICHAEL M POWELL AT. 117 - 119 LAKE ST Applicant Address: Phone: Insurance: 149 POMEROY LANE (413) 374-0963 AMHERSTMA01002 ISSUED ON:4/24/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL EXISTING 2 FAM ILY WITH NEW ADDITION AND GARAGE 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 4/24/20180:00:00 $1267.50 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner �1T roe-, File#BP-2018-1009 APPLICANT/CONTACT PERSON MICHAEL M POWELL ADDRESS`PHONE 149 POMEROY LANE AMHERST (413)374-0963 �— PROPERTY LOCATION 117- 119 LAKE ST MAP 17A PARCEL 226 001 ZONE URB(IOO)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLIC CHECKLIST ENCL SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1 .61 Fee Paid TypeofConstruction: REMODEL EXISTKLJX,6ff1LY WITH NEW ADDITION AND GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 093015 3 sets of Plans/Plot Plan THE FO.LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9XMATION 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 ,,Z2 IQ Delay fBuilding Dat6 ' /— V�rat .'e hd 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. 3 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 Status of Permit: Department use only >f Building Department Curb Cul/Driveway Permit I�. 212 Main Street Sewer/Septic Availability Room 100 WaterNVell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413- -1272 Plol/Site Plans Fir r APPLICATION TO CONSTRUCT,ALTER,REPAI R OVATE OR DEMOLIS A O E OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION o 1.1 Property Address eery or su:�-, p:errernans into be completed by office 11 n:a-rmrvrovrw- 1) 7_�/9 �Q KC ST. Map Lots a0 Unit F to f e'»6 e I AAA Zone Overlay District Elm St.DlsMct CS Distrkt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Pa+r;ck l/9 Lglre Sf /o � �e ti/a Name(Pnnn Cg n,Mding Atltlress'. C, /C9 � 3� 3a C — E1/37 Telephone Signature 2.2 Authorized Agent: M; cGuel .at fawPl/ / H Ponrelay 1awe Adt4e,sf g 4 Name lPrinq Curtent Malling Address- ' p/p �tio,va l� 3)37y� 0963 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by 2ermit applicant 1. Building 34 i> (a)Building Permit Fee 2. Electrical q o c v (b)Estimated Total Cost of Construction from 6 3. Plumbing Z ih c C. Building Permit Fee 4. Mechanical(HVAC) �g aG 7- 'V 5.Fire Protection > G D o u 6. Total= (1 +2+3+4 +5) %Qri rap a Check Number 000 This Section For-Off total Use Only Building Permit Number. Date Issued'. Signatur . If�7-o//FJ BmIding Co saionerdnspedor 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 It.,col—,o be filled in In, Pullding Dee nmem LotSizc 20 SdS f+ 20 °3ES FronWne Setbacks Fmnt •22- Side 1, 2 R. Z)� L: 21' R: 2f- Rear . > f 161- Building Heigh 3y. 7 Bldg Square Foetagc /UgQs x.51 7' -2,908 Open Space Footage 17, (lAtar11minnF blaes<Pn,etl l9,SHQ 9J K, 7i3 unklne) #of Pli,kire Spar,, 3 RII: 1 volume&Lacwionl A. Has a/�Spsecial Permit/Variance/Finding ever been issued for/on the site? NO L'J DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW O 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 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 Q 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? YEE O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required, SECTION 5-DESCRIPTION OF PROPOSED WORK(cheek all atwiicablel New House ❑ Addition © Replacement Wintlows Alteration(s) ® Roofing or Doors Accessory eltl9. ❑ Demolition ❑ New Signs ®I Decke 0 Siding IM] Other M Brief Description o Proposed I n Work�t2a,nocPl PM S{rNN 2 �M� I� LVfYh Alf ndd '4;d rn Alteration of existing bedroom a' Yes No Adding new bedroom Yes 3- No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga. If New house and or addition to exletina housing,confolete the followina. a. Use of building One Family Two Family A Other f to Number of rooms In each family unit q Number of Bathrooms c. Is there a garage attached? � pq r r *" 3 6 f // sx ?0�fPti1.7� +'" d. Proposed Square footage of new construction. Dimensions a. Number of stories? f. Method of heating? ��i �- 6 OO7" is-�„Ci r Fireplaces or Woodstoves / Number of each g. Energy Conservation Compliance. `4 Masscheck Energy Compliance form attached? h. Type of construction 1'I'0ndu.t'f C"^/Id&.. 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 7 I,. Will building conform to the Building and Zoning regulations? Yes_No Septic Tank_ City Sewer :V Private well_ City water Supply Y SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ry d/✓ as Owner of the subject property herebyaut nze ��t ! �nG to ✓�:1 �0W P �� to act m ghat(. all matters relative tow k authprizetl by this building permit application. u;z`ri! �I v/serip Signature of Owner Date I i,W till, , as Owner/Authorized Agent hereby declare that the statements and information o the foregoing appli tion are tr and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. _Mi c�, �� ry1, Po �/ e l l Print Name AM V - 15- - Signature Date SECTION 8-CONSTRUCTION SERVICES :,1,1,1:c111.ed ConatrucNo//n��qSupervisor. N Nott Applicable ❑ l Linse NOlCer � License Number q P6-n Itio) La,, t Ah-oliu) z A P1Qa2 I0- 31 - lq Address Expiration Dale L 3 3 y o � 63 Signature Telephone 9.Repbtered Nome Improvement Contractor: Not Applicable ❑ /M« kae Company Name Registration Number "i/ Q >Dii'�'nrnC`l � %<Me y 11/11n�t,e'trV4nlon2 2 — ZS � �f7 Address f/ Expiration Date Telephone � SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and so bm ided with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... %9 No...... ❑ The Commonwealth of Massachusetts Department of Industrial Accidents / Congress Street'Suite 100 Bostnn,MA 02714-1017 wwwmass.gov/dia Workers'Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERVI I I'ING AtTHORITA. Applicant Information pPlease Print Leav ibl Business/Organization Nm ae: Mi G�d L /� (Q w / ir Address: O/o9Z City/Stata/Zip: 4n2 Lei ¢ Phone#: Are you an employer."Check the appropriate box: Business Type(required): I.❑ l am a employer lith _ employees(full and/ 5. ❑Retail orpart-time).' 6. ❑Rest auruntliard,aling Establishment 2.2 1 am a sole propl'ietor or partnership and have no 7. Office and/or Sales(incl.real estate.auto,etc.) employ ccs Ivorking for me in any capacity. tuft Kon- [No,corkers' comp.insurance required] 8. P 3.❑ We are a corporation and its officers have exercised A ❑ Entertainment their right ofc%emption per c. 152.§114),and,tic have lo.❑Manufacturing no employees. [No ttorkers comm insurance rNwredl'c I LE] lealth Care 4.❑ Weare anon-profi t organization.stafle,he columeers tcith no employees. �No tworkers' comp. he Zj 12.©Other t G 'Ane ,,h, nnhm checAs bov at —r visa fill ow tlm senion belm,showing theinmrkers'wvF,n'a tv polio init—thou. —IffnemmnmteolFwrs ho, erav,dthe14 but coryha he retch s otheremploe ,,aaoM1as eompomaom pol ac is mquiredandsuohuu or,azcnonsh—lddeckbu..-L m,e I am nn employer that is providing workers'compensation insurancefor my employees. Below is the policy information. Insurance Company Name: losaar's Address: Cih,'State/Zip: Policy a or Self-ins. Lie+ Expiration Date: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Iadore 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/orone-pear imprisonment.as well as civil penalties in the form at a STOP WORK ORDER and a tine of to$250.00 a day against the violator. Be advised that a copy of this statement mac be forwarded to the Office of Investigations of the DIA for insurance eovcrage verification. Ido hereby verily,under the p s and penalties of perjury ram thre information provided above is true and correct. Signature: � p V ' S Phone 4: Official use act, Do not write in this area,to he completed by city or town offrciaL City or Town: Permit/Liceme it Issuing Authority(circle one): I.Bon rd of Hoa lth 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone k: nm,mess gor:din City of Northampton Massachusetts E DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Nunicipcl Building Northampton, NA 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: III-/!f Lq lze Si-rec f (Please print house number and street name) Is to bedisposed of at: 7 V" f Icy y f 4, G Lu > y rC ,V/V , R-; N„ (Please print name and 10csl'4 of facility) 0 roto Or will be disposed of in a dumpster on//site rented or leased from: 4 "n A e� S f T�-C h , /I el lea fie (� 1 / (Company Name and Address) !Jy v ! 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.