24C-028 (2) 98 NORTH ELM ST BP-2018-1364
GIS#: COMMONWEALTH OF MASSACHUSETTS
MamBlock:24C-028 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
permit, Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category, Bath reap BUILDING PERMIT
Permit# BP-2018-1364
Proiect# JS-2018-002422
Est.Cost, $11000.00
Fee:$72.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ALLEN GUIEL 054248
Lot Size(sp.ft), 17685.36 Owner: SULLIVAN SUE
Zonine URB(100 Applicant: ALLEN GUIEL
AP 98 NORTH ELM ST
Applicant Address.- Phone: Insurance:
63 CHESTERFIELD RD (413) 268-9200 O WC
WILLIAMSBURGMA01096 ISSUED ON:6/20/2018 0.00:00
TO PERFORM THE FOLLOWING WORK 2ND FLOOR BATH REMODEL NO CHANGE TO
FLOOR PLAN
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 serrature•
FeeTvpe: Date Paid: Amount:
Building 6/20/2018 0:00:00 $72.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1364
APPLICANT/CONTACT PERSON ALLEN GUIEL
ADDRESS/PHONE 63 CHESTERFIELD RD WILLIAMSBURG (413)268-9200()
PROPERTY LOCATION 98 NORTH ELM ST
MAP 24C PARCEL 028 001 ZONE URB/100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvaeofConstruction 2ND FLOOR BATUITMMODEL NO CHANGE TO FLOOR PLAN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 054248
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOATION 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 Bond of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Pernit DPW Storm Water Management
Det plition Delay
�Gw�.r BuildiDate
Note: Issuance of a Zoni 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.
Department use ordy
City of Northampton Status of Permh:
.>� Building Department Curb CuUodveway Permit
" 212 Main Street Sewer/Sepdc Availability
! Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 41&587-1272 Plot/Site Plans
--—" Other specify
APPLICATION TO CONSTRUCT,ALTEREP ' ENGVA]EiLMLbew ONE OR TWO FAMILY DWELLING
SECTION 7 -SITE INFORMATION
1.1 Property Address: / 6 Nnr his stction to be completed by office
o4 c1 Lot 0`19 Unit
o 3 n 1 D a I Overlay District
Elm St District Ca Distdct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
21 Owner of Record: �y �// J /— J�/
V vL I7S /V //✓t S/ / I/OIu ✓v,
Name(Print) Current Mailing dress:
4�r(' —� TS
Telephone
Signature
2.2
Authorized Agent:
U EL-
Name(P Current Mailing Address: D/Qp
_yi� a&3 9de`0
Signal Td phonc
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building ?a G� (a)Building Permit Fee
2. Electrical aLb (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee f�
4. Mechanical(HVAC) I�
5.Fire Protection
6. Total=(1 +2-3.4 t 5) Check Number J� 7
This Section For Official Use Only
Date
Building Pennit Number: Issued:
Signature:
Building Commissbnw/Inspecor of Buildings Date
tc��A @ U12 ' Cutin
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
This mlann to be filled in by
Building D,amincnt
L,ct Size
Frontage
Setbacks Front
Side L: R: U R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot atwminus bldg&paved
ariiin
N of Puking Spaces
Fill:
volmne&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO `� DON'T KNOW O YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO e 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 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 (0
IF YES, describe size, type and location: '0
E. Will the construction activity disturb(d aring,grading,ex "lion,or filling)over 1 acre or is it pan of a common plan
that will disturb over 1 ane? YES NO ff
IF YES,then a Northampton Stoml Water Management Penult from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel
New House [3 Addition ❑ Replacement Windows Alteration(.) til Roofing Q
Or Doom El `-'
Accessory Blldmdnng. ❑ Demolition tt / New Signs 1171 ,^l Decks (O Siding lot Other lOj
Brief DescrDlL,ErfiilGTSe t '(
Work:
Alteration of e)dsting bedroom_Yes)—No Adding new bedroom Yes 14No
Attached Narrative Renovating unfinished basement _Yes _,V No
Plans Attached Roll -Shoat
se. If New house and or addition to existino 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 there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stores?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 n.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_ Prvate well_ City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on my behalf,in al a relative to work authorized by this building peril appli tion
to 5
Signature of Own Dale
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 pais enalti f perju
print Name
Signature of OwnerlAgent Date
SECTION 8-CONSTRUCTION SERVICES
.1 Liceraland Construction ry or: Not A//pPP''liceble
Naof Mosma Holler (/ leN �� /
License Number
47 qjc
Atltl Eayiration Date
0 I Gj
sigmato Telephme
.Rei ctor Not Applicable !
Com n Registration Number
C zUn ' l30 - � - /9
Ad IExpirahan Da
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 will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes...... ! No...... !
City of Northampton
'.�
Massachusetts
'.I t%F� OF 9OZZOZNO INSPSCTZONS
212 Min Street •aanitipal Building i
t aorttaapton, M 01060 °r
W Y]Po
Debri s Disposal Mfi davit
In accordance of the provisions of MGL c40, 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:
qase print N �I
(PI house number and street name)
Is to be disposed of at:
(Pleas print name and im i n of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
SignienmWiFpllawl,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 Massachlesetts
ulkrkemrs'
Department of IndustrialAccidents
1 Congress Street,Suite 700
Boston, AM02714-10/7
www.masagov/dia
Compensation Insurance Affidavit:Builders/Contractors/EleMricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le 'bl
Name (Businessi�OngraloatioMndivldualy l..i
Address: (D 2� P47-0 _ ac 4,D -lam
City/State/Zip:VJ Phone#: A&�j gdLo
Are you an employer!Ch®k thhe appropriate Dox- Type of project(required):
lelamaemploycrwiN 1 employoes(full mdlor pan-time).' 7. ❑New construction
2.❑IamasokpropriemrorpeMcership"M venoemployeesworkirg formein 8. SARemodeling
any capacity.[No workers'comp.msmorlce requ've,l 1
1[]l am ahomrowmr drum all workm self 9. Demolition
g y [No workers'comp.insmane requirN.l t
4.❑I am a Mmeownm and will h hiringcontractorsw coMuc[all work on my property. 1 will
•risme that all contracmrs eiNtt have worktts'compensarirn insurance or are sole 10❑ addition
I.[]Electrical
repairs or additions
proprietors with no,employees. 12.[]Plumbing repairs or additions
5. I ran a general contractor end I have himi Ne sub-,manctom listed m the i mached short.
These sub-contractors have emdoyae and have wmkers'comp.in.,; 13.❑Roof repairs
6.❑Weareacory mtionanditsofficershaveexemmdtheirnghlofexemplionper MGLc. 14.E—]Other
152,g1(4),ma we haw momlwbyces[No wektte'romp narrencc rNumdl
'Ar,,applicant Nat checks box 41 most also fill our the section below showing Neo wmk<rs'rompeiunion policy infmmanim.
'Homwsvners who submit Nis affidavit indicating they an doing all work and Nen hire outside contractors must submit a new affidavit minims,such.
:Cmmema-a Nat check Nis box most arachW au additional sheet showing the name ofthe subcontractors and site wDUher or not those emium have
employeeslfthe subcontractorshave employes,tMy must provide Heir workers'comp.Whey number.
I am an employer that isprov/ding workers'compensation Insurance for my employees. Below is the policy and job site
informoNon. �/
Insurance Company Name: A 1 ,(�U��Q(� I'1to��-(��
Policy#or Self-ins./Lie.#: OV 1-J —�� 1 -at�Expbgbn Date:�, \
Job Site Address: ' � 'E�-'-'� City/State/Zip: I`ur-I Mcp)j c
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to senna coverage as required miler MGL c. 152, §25A is a criminal violation punishable by a fine up fn$1,500.00
and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage ve ' ion.
I do herebynder'he al(irs ofperjury that the information provided a/bbore is true and correct
m
Sign Dam' LO (] I O
n
Phone#:
Offutal rise only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/Liceose#
Issuing Authority(circle one):
1.Board ofHeaBh 2.Building Department 3.City/fown Clerk 4. Electrical Inspector 5.Plumbing Iuspector
b.Other
Contact Person: Phone#: