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17C-089 (7) 112 CHESTNUT ST BP-2018-1164 GIS n: COMMONWEALTH OF MASSACHUSETTS Map-.Block: 17C-089 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pennh: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Porch Repair BUILDING PERMIT Permit q BP-2018-1164 Project# JS-2018-002091 Est Cost$10470.00 Fee $68.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group THOMAS DOLAN 039281 Lot Size(sq. ft.): 10628.64 Owner: WHITHAM CHALLENGER I&HELEN P Zoning:URB(100)/ Applicant: THOMAS DOLAN AT: 112 CHESTNUT ST Applicant Address: Phone: Insurance: P O BOX 297 (413) 585-0612 () Workers Compensation CHESTERFIELDMA01012 ISSUED ON:5/W/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REBUILD EXISTING PORCH COLUMNS AND BEAM 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: O�1• 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 5/9/2018 0:00:00 $68.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1164 APPLICANT/CONTACT PERSON THOMAS DOLAN ADDRESS/PHONE P O BOX 297 CHESTERFIELD (413)585-0612 U PROPERTY LOCATION 112 CHESTNUT ST MAP 17C PARCEL 089 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out z / Fee Paid to Typeof Construction: REBUILD EXISTING POOLUMNS AND BEAM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Pians Included Owner/Statement or License 039281 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO.RMATION PRESENTED: pproved_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 TONING 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 Stomt Water Management Demolition Delay 3ssa� � t. me of mi7t tcial Da 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 EC E I V E[Dity of Northampton Stews of Permit Da rtrnent use only 13 ilain 3 Department Curt)Cutmnvaway Permit MAY ' 42016 212 ain Street Sewer/Septic Availability m 100 Water/Well Availability LNor ham yton, MA 01060 Two Sets of Structural Plans PT Cr©Ua .F7-1 40 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON,MA01W i Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION b P_ t P-r t fiC/ 1.1 Property Address: /This section to be completed by office Ila Gwr -- wen / -5-fewor Map�y` Lot D jog unit f l.o a el" VKO. zona Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: cHAzo�7 /ER T. VV1117HRIP //2 e1Y871VV7ST, 640&ek(52� Md Name( p t) 3curery Merl O/d(o2 Telephone 6ignaWre 2.2 Authodze Aaem; �AM L7rJL A1.J /� �OI 1�7 MII .fo�3l. sfY.I lli aThul�i / Name(Pont) Conant Mailirg Address: ry,a 0�0�1 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by pertnit aDolicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee ,C 4. Mechanical(HVAC) /OJ 5.Fire Protection 6. Total= 1 +2+3+4+5) Check Number a This Section For 01111cial Use Only Da e Building Permit Number. Issued: Signa Building missbner/lnapec lBuildings Date 6+n,''t I -7-vw�h SECTION 5-DESCRIPTION OF PROPOSED WORK(check all abolicablel New House ❑ Addition ❑ Replacement Windows Atteratlon(s) Roofing Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs 001 Decks ID Slding101 Odrerl&e Brief Description of Proposed � Work: 4Aw l/ diab_j. /Omit Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet Ga.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 them a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of healing? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 R,of"Uands?_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 la-OWNER AUTHORIZATION-TO BE COMPLETED= OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING I, C HAc-cEN✓c - ' WNi TWh M .as owner of the subject property hereby authorize ./—OM �I.�N✓ (I YNII.IL /!7thA4f(s� to act on my behalf,in all millions relatNe to")k atnhorized by this Duliding permit application. a z6 s Signature M . fir- f / / / Date I, / O/71 /J D/i/f✓ �`GN.fKA� LON rArKal/M .as Owner/Aumorized Agent here- deAcf that the statements and information on the foregoing application are true and accumte,to the best M my knowledge and belief. Signed under the pains and penardes of perjury. rm AvAmv Print Name Signature of OwmeNAgeM Dant SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoe[[Msor. Not Applicable ❑ Namaof Lkenss Nnldar: ROM'saa ,d 7to Ib✓ C,s �.771YO License Number �Po6pA. �4� (Ilre,tsaGartlO /j1a cgv/2 ��- 8- zo/q Aoaresa � /) _ Expimenn Dale —�� -/IJ,rs... /.,J/G/vG/� ti/ a-x57-sitiy 'ism Telephone 9.Registered Morn,Immcna ment Contractor: Not Applicable ❑ %b/H %�drCNI✓ bleglpteL Co.r ltA.cfv,� ��/g00 Company Name Registration Number 9v boa agg_ a5-p?o/B Address/�� // ExpireC Date ///1 Telephone 5/'J /AY SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.125C(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 buildi permit Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-accunled DweNiPss ofone(l) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,Provided that the owner acts as subervisor.CMR 780, Sixth Edition Section 1083.5.1. De11Pitim of 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 Perron who constructs more than one home in a two-year Period shall not be considered a homeowner. Such"homeowner"shell submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for W such work Performed order the ImUdine Permit As acting Construction Sunerybior you 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 ref nce 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 maybe Mable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth ofMassachuseus Department of IndustrialAccidents Office oflnvestigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -70- 0- � Please Print Le¢ibly Name Business/OrganiradoM / ndividual): p/N &wes'.4 Zo#fV"!sr1V x _ Address: a 801 497 IV -'CVl4 sf City/State/Zi : Phone#: it 3 S 6e Are you an employer? Check the appropriate box: T p I e of ro'ect(required): 1.LIL r am a employer with 4. [:] I am a general contractor and I employees (full and/or part-time).* have hired the subcontractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' re P ty. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.[ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, and have no 13. tQ�0[her A�lA4� employees.ees. [[No workers' comp. insurance required.] *any applicant that etweirs box#1 must also fill out the section below showing their workers compensation policy information. I Homeowner who submit this affidavit indicating they are doing all work and thm hire outside covtractors most submit a new affidavit indicating such. lCouhactors that check this box must attached an additional shat showing the name of the subcontractors and state whether or not thou entities have employees. If the subcuntractots have employes,they must provide their workers comp,policy number. Iain an employer that is providing workers'rompensodon insurance for my employees. Below is the polcyndjobisite informadon. Insurance Company Name: /r Gler� ///✓J/Va,�[ far S Policy#or Self-ins. Lic.#: 1AX 5 —36a 119 - O B 7 Expiration Date: qv -/d Job Site Address: City/State/Zip: A/OAA, Ier Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required order 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain aand penahies ofperjury that the information provided above is true and correct Sitmature �//N/ ,/Ja� Date 2WJ -7 74p/ 11 Phone 5­16Gy Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/Liceme# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/To"Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: ag &&.oAAud7'a;�' The debris will be transported by: n az.4"1 The debris will be received by: ��/�,�✓ �{P�icli Building permit number: Name of Permit Applicant 7,00f / .q1 xAr1 Jo,rl Date Nwj7 app$ Signature of Permit Applicant Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Thu column to be filkl in by auading Depmm,em Lot Size - - — Frontage Setbacks Front Side L:-R: L:_R:— Rear Building Height Bldg.Square Footage _.._ _ _' % Open Space Footage _. . .. % - (LotameminusWSJ,pave jv�ms -_ --- ) _. # fPkig Spaces Fill: A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO O 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 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. WIII the construction activity disturb(deadng,grading,a cavation,or filling)over 1 arse or is it pan of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r i - J^- r���s� _,\ ,�-' C � ✓ � � �T~� h'� � i �., t Y�;� �' . P � �� �1�_y['ti m i � � PSrN r* � ��� q1E. wC . ° „ Coc.. i � h� � � a y,i� ��. /SIL Y � 5 T di � 4 `v. � 4 .;�'i' i F. L h..� .. � . �l�' ��\�' � i i i CCx- J�� , �' iC _ �..,� � � �� �t- , ��� � � `� �f • ,, � f � � �.. m^y �J vG, �C ' � . � {� XEM.4lN >. � � � i 'Z fes- ���� ,_ . _ ,_�. _. _�_,.._ ..J._ � � � � � � ¢_ �--- - -� `',� sT - -� i � i I I �� �? � ivz -;-rr (� � i - - I i, , i ��. N ,� __ V ' , . I ^�,I ' _ i I _. _.. _ _ �i - �; 9 :, ,. 9s ��; _ i=� -- _: FRc7N7- C 14 �aX to r)'PrcAt �_-- Y., c LLAR , I iT------ N n s . fJ. t ti E i a ' io 21 r"