Loading...
28-048 (3) 93 CAHILLANE TER BP-2018-1301 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block:28-048 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perms[: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2018-1301 Project JS-2018-001938 Est.Cost: $7485.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TOM DOLAN 039281 Lot Size(sa.ft.): 12806.64 Owner. MOTAMEDI MATTHEW zoning: Applicant. TOM DOLAN AT. 93 CAHILLANE TER ApplicantAddress: Phone: Insurance., P O BOX 297 (413) 585-0612 WC CHESTERFIELDMA01012 ISSUED ON.611112018 0.00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN, BATH, REMOVE OLD HEAT ADD NEW 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 Occuoancv signature: FeeTvr)e: Date Paid: Amount: Building 6/11/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1301 APPLICANT/CONTACT PERSON TOM DOLAN ADDRESS/PHONE P O BOX 297 CHESTERFIELD (413)585-0612 PROPERTY LOCATION 93 CAHILLANE TER MAP 28 PARCEL 048 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT AP TION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typ of Construction KITCHEN HATH REMOVE OLD HEAT ADD NEW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans 1 l ded� Owner/Statement or License 039281 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF931MATION 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 Weil Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management e volition Delay Signa Bu in al Dat 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. only r City of Northam ton t, {y " iqii ANuiw6 mart ant tA11iW say Pwn* 'i 212 Main Str et IS' iiBeplpc,Availability .-!( g(7FF,�DE1MyUtI�a Wats AYBileb111 Iiitl�� ��NOATHAMW�Adtlb"� u10 Tyw Structural Iii) ix �.m Pone - - ax - 87-1272 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 rj3GA /_�// � 7CMQt�G Map 2ALot Oq v Unit Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � pp Name(Print)1 n Current Mailin�,g'AJnei a:R Signatdrc- 2.2 Authorized Agent: 'A '05x a97 Name(Pdnp Current Mailing Address'. .. o 141,01F3 -11297-5/6H Signat a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by bermit aDiblicant 1. Building S -V (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing 600 r✓ Building Permit Fee 7 4. Mechanical(HVAC) jIq 5. Fire Protection 6. Total=(1 +2+3+4+5) ✓ Check Number This Section For Official Use Only Date Building Pertnil Number: Issued: Signature: / Buildng Commis erllnspector of Buildings Date fpm alo lar jiC @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 1; Section 4. ZONING All Information Must Be Completed. Permit an Be Cool, To Incomplete Informatipn Existing Proposed ReliuiredffftZoning nis column to be filled in byi ' .buildivgllryostmmt. Lot Size - Fronto e Setbacks Front Side L R: U R Rear _...... ._.. Building Height Bldg. Square Footage % -- Open Space Footage % (Lot arca minus bldg&pavd kin ) 9 of'Parking Spaces - ---- Fill: .... .. . (volume&Locatiov A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 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 O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO Q 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. WIII 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 NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK Icheck all applicable) New House Addition ❑ Replacament Windows Alteratlonis) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs'[Q) Decks [0 Siding[0) Other[O7 Brief Description of Proposed �in�I�e. yiC A6O�. 701�i41d �� EM ✓M N LK6 /Lvr•�i• Work: /s Alteration of existing bedroom_Yes No Adding new bedroom Yes V/ No Attached Narrative Renovating unfinished basement Ves No Plans Attached Roll -Sheet ea. If New hous"Ind or addition to existing,housino.Comptete the follblill i a. Use of building OneFanl Two Fari Other b. Number of rooms in each family unit. Number of Bathrooms c. Is there a garage attached? J. Proposed Square footage of new construction. Dimensions e. Number of stories? f Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached? h. Type of construction Is construction within 100 h.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, 1. 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, 't/zl I�'�( ) ( 1Jlqt as Ownerofthesubject property hereby authorize to act,4n my behalf, iin all matters relative to work authp�zed by this building per a lication. C ;7 D /111 7 'V a r N Signature of OOVmr Date I, /p/W /�'� 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 Nam ,p �be.o•� e7 Signature of Owner/Agent Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: O �aL�.v GS - 03g' SLY License Number /a- bA- aa/y- -Address Expiration Date � 7 s76� Signature Telephone - S.Reaistemd Havre Improvement Contractor. / Not Applicable ❑ OM -Dr7!»w 6enr��L AOR'Y'A-)4CkA_ /09 fare om Nam /y��j Registration Number 0 3oK l7 / Gl,P� nG.e//�i'!.c ori fal. ?��a Address Expiration ate Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit willresult in the denial of the issuance of the build'ng permit. Signed Affidavit Attached Ves__. No..._. ❑ ` City of Northampton Massachusetts r c t x ` DEPARTMENT OF BOZZDZNG INSPECTIONS e \ 212 Main St.t • Municipal Building Nortaemp[an, IM 01060 rryy� j\'\ar 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 mare 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 of Work: Est. Cost: Address of Work: Date of Permit Application: 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): _Building not owneroccupied 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 RESPONSIBILITES 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: ­%,leaaoa- �� /099oy 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 Massachusetts _�... : DEPARTMENT OF BUILDING INSPECTIONS a ' a ` 212 Msin Sth=p • Mun 010 Building Jy D �. ' . NozNwpton, !➢, 01060 syH:-�.jp6c Massachusetts Residential Building Code Section i I O 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 faun 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 building permit is required shall be exempt from the licensing provisions of 780 CMR 11 0.85, 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 be 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 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: 93 l'I't?A1112ne The debris will be transported by: /p ry /moo/a K— The debris will be received by: ✓/,/�� �Pw r, /�� Building permit number: Name of Permit Applicant of r Date Signature of Permit Applicant The Commonweakh ofMassachusetls _ Department oflndustrialAccidents s I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING ACTHORITV. Aoolicant Information /' Please/Print Legibly Business/Organisation Name: pm /�--�/940-,/ (9>7Pil(z,L. /AJ/7�/7/RtAilU>L Address: -,?ox '4�/ �' GI'I'6fPRi //'G/P�Q lit . Q�Q�oZ City/State/Zip: Phone#: Vanemployer?Cheek the appropriate box: Business Type(required): am a employer with�_employees(full and/ 5. ❑Retail orpart-time).* 6. ❑ResmuranNBar/Eating Establishment 2.❑ I am a sole proprietor of parmcrship and have no 9, ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] S. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,Q 1(4),and we have 10.❑Manufacturing no employees. [No workers' comp.insurance required]* 11.❑Health C. 4.❑ W e are a non-profit organieation,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.[1 Other 'Any apphcam that checks box KI must also an out the section below,hawing their workers'compensation polity Infxon umn. "If thecoryoreteotficees have exempted thmnw1,s,,but the mrporatioa hesother employees,aworkers coin,....policy is requiredand suchas emismastion should chwkhe.PI. I am an employer that is providing workers'coo/Pensatiim,ins/urance for my employees. Below is the policy information. Insurance Company Name: //tI 4/)Pa/Yt ///✓YrIO� �i7� Insurer's Address: /� a &I �7 City/State/lip: Ohlos-taal A'0// � 14rt p/LVW,9 /1 y p Policy#or Self-ins.Lic. # WK-,, - 3�-362� 4T 037 Expiration Date: Z nel% 4- 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 MGL c. 152 can lead to the imposition of criminal penalties of 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpen o perjury that the information provided have is true and correct Phone 4: 7 G 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: xu�..res,.gov,in Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer.or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence ofcompliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)stales`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublie work until acceptable evidence of compliance with the insurance requirements of this chapter hate been presented to the contracting authority." Applicants Please fit out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line City or Town Officials Please be sue that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled.,it each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Fmm Ji—,cd 02-23-15 II I 1 " 27 _@Q AN0_ '27 'IIVi � O_ �O . . —24'- -92, _ 50". - 67d 7 33 4 15!J �.UT43 1M015P ! T LP OISH P1 — 2 al NA L r . o m - N _ m m _ r I m i 73 i All Jlmensbns slu dcsigmrroos M 'e: his it eo origi..=1 afgn J usv t%signc12R126t8 given am subjecunvmfication on LV nor be released or copiM unless PnMetl:b212P16 job site and ie MMot to Ptjob applicable fee has been paid orjob conditio, order placed. f MOCamediHCA ^_ v All Drawing p: I No Scalc. I c I i � . i _ y iv Lr rte_� �j ii I �I to I i (' Nole:'iliistlrnwtn8 is an arl c 20 ( :.� IhSiy�Wlc 2ft1f1018 inRtprelation OPOc F,Cncrel�ssl iotine P�inrod:221/2018 appearance of the design.H is nal meane w be an cxaet rendiHoa I ! MOIA1n tl HC:R .....—.....• Ail U2wia6 p: 1 r I I �f l i�' it Iil A y � , JI 17 11 j ✓, JOH r I / SII' Noll Thwdtawiryg sen ertrslm 7/1 Djnftd: 1/201llfl imerprcmtion of the 6eneml �- wc,e J P 'nte@Y21/2o18 appearanceof Ne design 11 a rtKeal m be Bn eaecl zdition ` MolemetllHCR All Drawing k'1