11A-017 (4) 42 EAST CENTER ST BP-2018-1184
GIS#: COMMONWEALTH OF MASSACHUSETTS
MamBlock: l IA-017 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: $mir BUILDING PERMIT
Permit BP-2018-1184
Proiect9 JS-2018-002123
Est.Cost:$3400.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group KEVIN AYER 061973
Lot Size(sp.ft.): 37374.48 Owner: BOUDREAU TYLER E&SUZANNE M
Zoning:URA(100)/ Applicant: KEVIN AYER
AT: 42 EAST CENTER ST
App[icantAddress: Phone: Insurance:
1192 WHATELY RD (413) 369-0078 0
CONWAYMA01341 ISSUED ON.511112018 0:00:00
TO PERFORM THE FOLLOWING WORK REPLACING STEPS/RAILING ON SLOPED
GROUND LEVEL
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 5/11/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
Building a rtment LCurb Cu0mrsirway Penna
t MAY 11 21�1ffiM in rest ensePncAveieauyRo m 1 0 rMeii Availability
qry( ry�gSpryg n 01060 Sets of SWaural Plans
FrT � eY9U F x 413-587-1272 Site Plans
r Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: NA ----
section to be completed by office
',. Map ...___f`_A--.__ Lot._..__D L_l-- - U't
42 E. Center St
Leeds, Ma 01053-9716 Zone overlay District
Elm St.District Ca District-
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 42 E. Center St -
Tyler Boudreau Leeds, Ma 01053-9716
Name(Prim) Current Ma I rg Atlprtn,
Teieorona - 413-209-7584
S gnatoro
2.2 Authorized Apert: 1192 Whately Rd
Kevin Ayer Conway, Ma 01341
. lame IPnnp Currorl Ma Ing Address '.
^" 413-695-2263
S gna ve ielepMne
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dol'.ars)to oe OR,ca'. Use Only
completed by permit scot c nt
1 Building $ 3,400 (a)Building Perms Fee
2 Electncal (b)Estimated Total Cost of
Construction Spm 6
7 Plumbing I Building Permit Fes
a MCChanoel (HVAC)
5 Fire Protection
_6 Total (1 12 - 3 + 4 - 5) _ _ deck Number
This Section For Official Use Only
Date
Budding Permit Number..__ - _. . . Issued. /
Signature: -5/09
// / -.
9 ullding co, aerlespecter of 9ulldings Date
yEjlJ4 Aiy -e yAfm) , e"M
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Existing Proposed Required by Zoning
:F.In rclumn m he fi:.N:n h�
liwldinu Ucnmmcm
Lot Site
Frunta e
Setbacks Front
I
Side L'. R. I L''_. R:—
Rear
Bmldiug}lmght
Wdg.Square Fumagc K
Open Space I colagc
..a ace:r—'a c H Ya c
. e
#u:
Parking S aces i
Fill:
,e x:,n'i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW � YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW � YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW 701J 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
IF YES, describe size, type and location:
E. W I the construction activity distum(Gearing, gradng. excavation, or fills g) over t acre or Is ,t pan of a common plan
that wil disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW s required.
SECTION S DESCRIPTION OF PROPOSED WORK(check eli eoolleeGe)
New Mouse ❑ Atltlltlon ❑ Replacement Wlntlowe Alteretlon(1) ❑ T RooRnq EJDr Door, O
Accessory eltlq ❑ Demalltlon ❑ 1 New Signs lel Decks Iv Sidinillol Othi
Brief Descriptor,of Pr000ssd Center of front yard/entry, replacing steps/railing on sloped ground level
WO•k
A feral on of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Namative Renovating unfinished basemen Yea _ No
Pans Altac"in Roi -Sheet
ea.If Now house and or addition to existlna houslna. Complete the followlna.
a Use of our ng One Family _ __ _ _ Two Fahh, Other
b Number of rooms n each tamely in Number of Bathrooms
c Is there a garage attached? _
J. Pmoesed Sgua,e rootage of new construction Dime cions
e. Nimbi 00 slOnes,
' Method O heat i Fireplaces or Woodstovers _ _ Namber of each _
g. Energy CoriseNalion Compliance Masscheck Energy Coil since rorm attached?
'.,
in Type or construction
Is construct on w thin log ft of wetlands? _ Yes No Iscoostrdctonwinn 100y. roodpla.n Yes No
I Depth of basement or cellar floor below Lnisio d grade
K W I lou Idmg conform to the Ba ding and Zoning regulations, _ __ Yes _ No
1 I. Septic Tank City Sewer Prvale well CIry water Supply
SECTION To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Tyler Boudreau .as Owner or the suoect
property
Kevin Ayer
hereby authorize
to act on my Dena', in Iters relaL o worn aut0orized by this burl ng permit appi,cat on
May 10,2818
S gra�ow cl6xnar_ . . _. Cato
EMIL—
Kevin Ayer as OwnerlAvthonted
I Agent hereby declare that tae statements and informaton on the roregoing apphut on are true and accurateto he best or my Knowedge
I and belief
Signed under the pains and pena'ties of peryry. Kevin Ayer
' Print Nano _
S,,i-ii m e Cw,r,Agan: _ - - Dom
8.7 Licensed Construction Suoervlsor. Not Applicable ❑
Kevin Ayer
Name of Ucense holder
I License Numba-
___ 1192 Whately Rd _. CS-061973
"°ares= Conway, Ma 01341 `-aphat un Date
- — ---- --- — — — ---- 06-27-19
S gnalure Telepnore
413-695-2263
8.PwIsNred Homs Imorovemem Conlini r: .Not Applicable ❑
Kevin Ayer
' Company Name Registrar on Numper
-1 12Bd 1 z6s2s
- - - - -
Address COnwav, Ma 01341413 695-2263 Expiration Date - -- --
. . .- -- --- --_---- Telephone 06-9-19
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
wor[ers Compensation Insurance afflcay.t must be completed and submitted with th s applicaton. Fai'.dre to prov-de this a�davit w9 result
in me denial c the Issuance o`the buildng perm.t.
Signed Af`iday.t Attached YesNo..__ ❑ J
City of Northampton
Hassachusatts
j -~
p6PAATNLNT OF BUILDING INSPLCTIONS
}{ 2:2 aaln Strut • Nvniclpal Bu1lErna
NartAampton, lU 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulatca the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
perfuming work on such homes,a contractor must be registered as a Hume Improvement Contractor("NIC").
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 mora than lour dwelling units,_.or to structures which are adjacent to such residence or bwldmg" be
dune by rulstered contractors.
;Vote:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Step replacement $ 3,400
lypc of Work . . ._ . _ Est. C'osC.
Address of W'urk: 42 E. Center St Leeds, Ma 01053-9716
Date of Permit Application 05-10-185
1 hereby certify that'.
Registration is not required for the following reason(s):
Work excluded by law(explain): . . .. .. . . _ _
Job under $1,000.00
Owner obtaining oven permit(explain)
Building not owner-occupied
Other(specify): .. ....._. _ _.
OWNERS Off ININING 1'HF:IR OWN PERMIT OR EN ERING INTO CON I RAC'IS WI I If LNREGIS'I LRLD
CON'IRAC IORS OR SLBCON'rRAC FORS FOR APPLICABLE HOME IMPROVEMLN'I WORK ARE SO"1'
ELIGIBLE POR ANO Bo SOIHAVL ACCESS TO 1 B ARBII'RA'I'ION PROGRAM OR GCARA]'I'V FC NO
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME 'I HE RESPONSIBILI'I'ES FIFR ALL "ORK
PERFORMED UNDER I'HE BUILDING PERMI I'. SEE NEK'1'PAGE: FIFR MORE: INFORMATION.
Signed under the penalties of peryury:
I hereby apply for a building permit as the agent of the owner:
128928
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
'X
Massachusetts
OSPARTNSNT OF BUILDING INSPECTIONS
212 lain Street a M icipel Building
NorthaMton, MA 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 two 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 110.115.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s)
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 he responsible for all 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
DLPAA�T OF eUILf11N0 INSPECTIONS
212 Win Bt[aat Municipal Buildie
bvtht ton, M 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 Parmit 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:
42 E. Center St Leeds, Ma 01053-9716
-(Please print house number and street name)
Is to be disposed of at:
Valley Recycling Northampton Ma
(Please print name and location of fauhly)
Or will be disposed of in a dumpster onsite rented or leased from:
(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 Commonwealth of Massachusetts
:1I "j�a� ! ; Department of IndustrialAccidents
I Congress Street,Suite 100
i 1' Boston, MA 02114-2 01 7
www.massgov/dia
Uurken' Compensation Insurance Affidavit: Builders/C'.ontnmtoNEleetricianvPiumben.
1'O BE !il.l:D N 1'111 fill. Pt:R]Ill"I'I SG ALIr'110R1'I Y.
Applicant Information Please print Legibly
Name I6 rin....Vrpamtauon9ndicWaal l: Kevin,Ayer
Address: 1192 Whately Rd
City/State./Zip: Phone r!:
Conway, Me 01341 413-695-2263
.
vma,r(has rh..verunrudk bus. -_--_ -__ Type of project(required)
❑ t
I : e npa•.-..:;h c-.P�, e. c. 7 ❑ lewcunstruction i,,
2x o P;no, r rwdn .r'. . x 4 .y : . ..,. i„ M. ❑ Remodeling
p s xu:F P ., , ,I: •ail
:❑:. . .n d... r ...In s w,.v. sly r uvey.=oJ', '). ❑UcnwliGun
11) ❑ Bu:ldl Ig addition
a In al a..vr 1 . .,......r ma..:mu, .a,r .ra.,.a I1.❑1 'scvma: repairs or uddouuns
12 E]plumbing repair,or addi.:oro
,❑ Ih vn Ir I,. J; 1 t.. .r J r as lac IJRoof repau,
n ❑w rv .: - , _ I - art s:• :f r,.h r..a 14 Other replacing
.....I a.. ., , .,ra a r,�.a, r..� .r .a ay. a,.. Steps/railing
•tw appl. , a�b f.n u I. IL,Y
I L... .x whm :f.Ja, l Jr IAM M1v.-nJ nr.11 Iha .Ja um +;u., -h , x i,,Jiaa,,ry wci
t -.vw:b 1 huFLJ.M1, '.'..1.aJ w, I . .,nnaoi,h .y la.nnul❑ -b. n.:..f n'a, awh.Cmr ,, ,uf,.a an'. . Lw
o,r do :
!am an employer shot it providing workers'rmrfpemirtion insurance fur my rrnpilopen. Brlow i.r the polity andjub sit,
information.
L•ra:rancc( otnpany 1mw _.. -- _.
Pulsv -or Sel(--ins. Lie a' I:apirauun Dine,___-
Joh S:lc Address City:Surto ZiP'.-_
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dale).
I"niton to secure coverage as required under M(iL c. 15'2, �25A in a criminal viu:miun p:ani-.huG.c by a f nc up lu SL'OU.IIo
and:or une-yeur imprisonment,as wdl as cavil pens:tics in the form ofit S'I'OP WORK ORDH<and a tine of up to s2SLLIRI e
day against the%o ntor. A copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
!do hereby certify anter the pains and prnalarx ofperjury that she inJ'ormasian prustidW about is true and rurrrca
fs 4 _ 5—ID 18
jae ,. ,e
Oficial use only. Do not write in this area,to be completed by city or town o)fesat
Cltv or'I'own: Permltil.iceose g
Issuing Authority(circle one):
I. Board or Ilcallh 3. Building Department 3.Cityrf own Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact person: Phone g: