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30B-027
277 RIVERSIDE DR BP-2018-1280 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-027 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateeorv' ROOF BUILDING PERMIT Permit BP-2018-1280 Project JS-2018-002279 Est Cost:$5300.00 Fee:$40.0o PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: UseGrouo: STEPHEN CAMP 082531 Lot Size(sg. ft.l: 19079.28 Owner: HANZEL MILTON&CHRISTINE E LINDERMAN Zoning: URB(100 / Applicant. STEPHEN CAMP AT. 277 RIVERSIDE DR Applicant Address: Phone: Insurance: 46 EAST ST (413) 527-7124 O WC EASTHAMPTONMA01027 ISSUED ON.61512078 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & $HINGLEROOF 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: FeeTVDe: Date Paid: Amount: Building 6/5/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner C00 t= �._ _LL I V C City of Northampton Buil ing Department 2 2 Main Street JUN - 4 Wld Room 100 N rth pton, MA 01060 -58 -1240 Fax 413-587-1272 DFPT.OF UUILDIN,INSPECTIONS NOR7HAMP70N.MA01060 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION g (" — yo 1.1 Property Address: ix XifL.- y trG x h(sss '(`gkFl yU iB`p ��., 277 < yrr k . SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: M1 r /fc4i l � 7C� 277 /�aiCrll�r �✓/vc Name(Print) / Current Mailing Address'. �6 /jam � Telephone � Signature 2.2 Authorized Agent: 5'-}C°0)+r-u✓ �+Au D G/6 £h1�' S�-�wc�' L�»J�/,fQ,k.l Name(Pant) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTIONCOSTS i Item Estimated Cost(Dollars)to be Official Use Only: completed by permit auvificant 1. Building (a)Budding Permit Fee 2. Electrical (b)Eabmatetl Total Cost of Constriction from Sf 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Up. 1� Check Number d ThisiEection For Official U"Only ate Building:Permit Num r.- Issued: Signat4lb.. Building t#nnissfamirAristalidor of Buildings Data Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column in be filled in by Building Department i,,., Lot Size 0 0 0 Frontage O O O Setbacks Front O O Side L:= R:0 L:= R= Rear 0 Building Height O O Bldg. Square Footage Open Space Footage O O / O O (Lot area minus bldg ffi{sued puking) #of Puking Spaces 0 0 Fill: volume&Location 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 0 IF YES: enter Book Page and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © 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. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it pan 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. SECTIONS-DESCRIPTION OF.PROPOSgR�AT FiKf fdtfecicallabolicabTa� New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[I7] Other[1:9 Brief Description of Proposed Wodc 'p4u"��S'/o .�J 'Vl- Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstaves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. 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 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 CO_MPCETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. 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 Dale I, as Own orae ,jje ereby dec re that the st ement nd information on the foregoing application are true and accurate,to the best o nowledge and belief. Signed under the pains and penalties of perjury. Print Name V Signat a of OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICCE$ 8.1 Licensed Construction Supervisor: "I / //�� ,� Not Appliicablet�❑'J Name of License Nolder:Y//K4/ tNr�Pf DO�JJ/ y License Number Address Expiration Date Signature Telephone sus Not Applicable ❑ oy Company Nam G Regis" tretion Number --77 �(o Graf>' S�KKf -T-/3 Address�r /,f �/ Expiration Date �Y'�//7� DIC)ZZ Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 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 but ing permit. Signed Affidavit Attached Yes....... No...... ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(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 supervisor.CMR 780, Sixth Edition Section 108.3 51. Definition 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 person who constructs more than one home in a two-year period shall not be considered a homeowne . 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. 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 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: 12? xz-" r. The debris will be transported by: '/7✓r 111V The debris will be received by: //6L/�G 4f_ Building permit number: Name of Permit Applicant 7 <9 f Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of IndustriettAccidents Office oflnvestigations t 1 Congress Street,Suite 100 Boston, MA 02114-2 01 7 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrgmimtiorAndividual): Address: �b � JTYV�Tf"p City/State/Zip: P22 Phone #: Are on an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 7— 4. ❑ I am a general contractor and 1 6. ❑New contraction employees(full and/or part-time).• have hired the sub-contractors 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 working for me in any capacity. employees and have workers' cora insurance.: 9. E]Building addition rworkers' camp. insurance P' 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 t2X Roof repairs insurance required.]t c 152,§I(4),and we have no employees.[No workers' 13.7 Other comp.insurance required.] "My applicant that checks box kl must also fill out the section below showing their scilmrs'compensation policy information. t Homeownerswho submitthis atEdwit indicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCmdracmrs Nat check this box must attached en additional sheet showing thename of the sub-contractors and state whether or not those entities have employees. If the sub-connadors have employees,they must provide them workers'comppolicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: / /y/YI y�rL+c..✓ � `p Policy#or Self-ins. Lie. #:�7 ,!;l it 2Z-11f- J-41 O f 7 L Expiration Date: Job Site Address: 2 / / /K I�CrJip1 /'l'i t/P City/State/Zip: - ✓' -s[G'C N 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 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. Ido hereby certify under t e pai and pe ffies ofperiury that the information provided aboveistrue and correct Signature: Date' /0 Phone 7— 2 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527-7124 Submitted To: Milton Hanzel Phone- 695-9634 Address : 277 Riverside Drive Date— 10-2-2017 Florence,Ma 01062 We hereby submit this estimate for—Garage Roof Thejob will start with stripping all shingles, flashings etc. and disposing of. I will install '/1"plywood over the whole roof. Any rotten wood will be replaced as needed. - I will install new drip edge and new architectural shingles will be installed. - Color is customers choice. .. Trash removal is included in my price. Materials= $ 1800.00 _.. Labor=$2500.00 Total.=$4300.00 Beam replacement in basement Estimated cost=$ 1,000.00 Contractor Supervisors License number 082531 Home Improvement Contractor Registration number 135204 I propose to supply materials and labor-in accordance with above specifications. This proposal may be withdrawn By us if not accepted within 30 days Authorized Signature 99 Acceptance of proposal Signature /�G/