11A-017 (5) 42 EAST CENTER ST BP-2018-1379
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: I IA-017 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permir. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: KITCHEN RENO BUILDING PERMIT
Permit ft BP-2018-1379
Project# JS-2018-002441
Est Cost: $36000.00
Fee: $234.00 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
Applicant Address: Phone: Insurance:
1192 WIIATELY RD (413) 369-0078 0
CONWAYMA01341 ISSUED ON:6/22/2018 0:00:00
TO PERFORM THE FOLLOWING WORK RENO KITCHEN WITH NEW CABINETS, DOOR
AND WINDOW
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 Fimplace/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 Sienature:
FeeType: Date Paid: Amount:
Building 6222018 0:00:00 $234.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1379
APPLICANT/CONTACT PERSON KEVIN AYER
ADDRESSBHONE 1192 WHATELY RD CONWAY (413)369-0078 Q
PROPERTY LOCATION 42 EAST CENTER ST
MAP IIAPARCEL017 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T eofConstruction: RENO KITCHEN WIT EW TS DOOR AND WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included'
Owner/Statement or License 061973
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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 Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
am"
(tion Delay
Z
of Building OffrcDate
Note:Issuance of a Zonin 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.
r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
✓f Building Department Curb OADrNwwy Pft*
,f 212 Main Street ewlailikiAvw'Mwy
{ Room 100 WardweEAvaEimpy
Northampton, MA 01060 Two Soft at Structural Plies
phone 413587-1240 Fax 413567-1272 PWSlle PWR
Other Spedry
APPLICATION TO CONSTRUCT,AL rER,R04URyRENOMATE(GR DEM LISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Adtlroaa: /is a" to be��"by a!Map I
42 E. Center St Q D n I EN unrt
Leeds, Me 01053-9716 Oved"Dlavkt
Elm 8L gMrlel CB DNMdI
SECTION 2-PROPERTY OWNERSIRP/AUTNORIZED AGENT
2/ Owner of Regard: 42 E. Center St
Tyler Boudreau Leeds, Me 01053-9716
Name(Print) ---- — Current Mailing Adorers'
S�gna ---
_ _-__,-- -------_—_--__—_.—. Telephone 413-209-7584
tum _
Kevin Ayer 1192 Whately Rd
Conway, Ma 01341
Name(Print) Current Mailing Address:
413-695-2263
S,gnaturo T epnone —------_--_
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Offioal Use Only
cpm leted by Permit applicant
1. Building $ 36,00000 (e)Building Permit Fee
2, Electrical to)Estimated Total Cost of
Construction Nom 6
3. Plumbing Building Permit FN
n )
4. Mechanical (HVAC) ,'( ✓
5, Fire Protection
6, Total 1 +2 +3+4 5) Check Number 3S
This Section For Official Use Only
Building Permit Number IIsssued
Signature
autistic sararnnix+aor of Buildings Delo
EMAIL ADDRESS (REOUIRED; EITHER HOMEOWNER OR CONTRACTOR)
��ulTr AYeJZCYgffdOZem
Existing Proposed Required by Zoning
Ibis oolumn m k final!n by
Building Dcpmlmcm
Lot Sim
Frontage
Setbacks Front
5id4 L R_ L:_R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area mmu,bldg a pave
Parking)
K of Parking Spaces
Fill:
volume a W:atiun
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Vy YES O
IF YES: enter Book Page and/or Document p
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW C 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 0
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. Wdl the construction activity disturb(clearing,grading, xcavation,or filling)over t acre or is it part 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.
SECTION b DESCRIPTION OF PROPOSED WORK lchaak all MWkMblal
Now Nouns ❑ Addition ❑ R la mrnentO rWovn Albnllonla) ❑ ROWIng EJ
Or Dooms Accessory Bldg. ❑ Demolition ❑ Now Signe la] Decks IO Skiing loo OIMr
Brief Description of Proposed Renovate kitchen with new cabinets, door and window
Work'.
Alterni of riveting bedroom _Yes__x No Adding new bedroom _—__-Yea ,___No
Attached Hall Renovating unfinished basement __,_____Yes ______ No
Plans Attached Roll -Sheet
sm.M Now houBar and or adf91I0r1 to exhMna hewing.OOmoleft the followlna:
a. Use of building:One Family____,_ Two Family_---Other___
D. Number of momam each family unfit:___,_ Number of Bathrooms
c. Is there a garage attached?------.__.
d. Proposed Square footage M new construction.__., Dimensions
e. Number pf Stories?
C Method of honing? Firepleoss or WOodstove6_-__—.Num0or Of eaoh. __
g. Energy Conservation Compliance._ Masscheck Energy Compliance form attached? __,.-----
h. Type Of cimainldion
I. is mnstwct+on wthln lib%.Of wetlands? Yes No. is consllucti0n wlm.n 100 yr. flpodplain _._ _ Yea _. ..No
J, Doom of basement or ceder floor below finished grade
k. Will building Conform to the Building and Zoning reguli lions? .......Yea _No .
I. Septic Tank City Sewer Pnvate well,..._...__- City water Supply
SECTION 70-OWNER AUTHORIZATION•TO BE COMPLETED WHEN —�
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDINO PERMIT
LTyler Boudreau ae Owner o+tne dub act
Fill--
property
hereby authorize Kevin Ayer
to act on my OSheH, in all miglers relative to work aumorized by titin DuliO+ng permit application
6/22/2018
61 etureMOwner
Deal-
Ayer
eroAyer ea ownerrapmaized
Fill --
Agent hereby Declare that the statements en0 inWrmabon on the foregoing eppirat+on are true and accurate,to me beat of my kno-Medge
and belief,
Signed under the pains and penalties of perjury. Kevin Ayer
Pnm Name �1
.. ___-__.. _-___l_. _ ------- _______
scum dwmt OerrA Due
5.1 Lic"w d Construction SupaMaor: Not Applicable ❑
Kevin Ayer
Name of JUM.Holder
License Numbe,
1192 Whately Rd CS-061973
Moms Conway, Ma 01341 Expi,apon De:e
Signature Telephone
06-27-19
413-695-2263
Not Applicable ❑
Kevin Ayer
Company Name Registration Number
1192 Whately Rd 126926
Acidness Conway, Ma 01341 413-695-2263 E'mmation Date
Telephone 06-9-19
SECTION 16 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.15Z 4 2585))
Workers Compensation Insurance affidavit must be completed and submitted vath this application.Failure to provide this aftmavit W11 result
in the denial of the issuance of the building permit.
Signed Afridavt Attached Vas....... No...... ❑
City of Northampton
Maaaachusatts
DaliAaSamJ2' or AU21:DIAG Imalls"ZoNa
212 Win atrwt • Municipal Builain,
Northa ton, W 01060 )h y
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulaus the registration of contractors and
subcontractors performing improvements or renovations on detached one to four famity 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"reconsmretion, site ovon, renovation, repair, modernization, conversion,
imanomment removal, demolition,w construction of an addition to any pre-exish g owner-occupied building containing
at least one but not more than/our dwelling units....or to structures which ere adjacent to such residence or budding"be
done by reeistered contractors.
Note:Ifthe homeowner has contracted with o corporation or LLC,thin endry roust be registered
Kitchen Renovation $ 36,000
"type of Work:_�.__�_�_..__..- Est.Cost
Address of work: 42 E. Center St Leeds, Ma 01053-9716
Date of Permit Application:_ 06-21-18
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by low
_ Job under$1,000.00
Owner obtaining own permit(explain):__
._ Building not owner-occupied
Other
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CON'TRAC'TORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS'1'O THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILI'IES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMK'I[ON.
Signed under the penalties of perjury:
I hereby apply for a building permit as the astern of the owner:
128928
Date Contractor Name HIC Registration No,
OR:
Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property,
Date Owner Name and Signature
City of Northampton
Massachusetts
Q r
DEPARU@!T or BUXZDINC rliapacrra+s
212 Min Street • Municipal Building
Northampton, NA 01060
Massachusetts Residential Building Code
Section 110.115.1.2
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.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 110.115, 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
Q
MassachusettsWPMDaNS OP ae2LDZM M&P=r1WS
212 win sort eM icip l auildi,
/ S
Yor[Arpton, YA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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 property 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, Me 01053-9716
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpsler onsite rented or leased from:
Austins Dumpsters, Whately, Ma
(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 Commtonweaith of Massachusetts
Department of InduserldAmWnts
I Congress Street,Suite 100
: a+ Boston, MA 02114-2017
wwmanass.gov/dla
%%urken'Compensation Insurance Affidavit; BuBder✓Controdars/Electdcions/Plumbera.
TO BE PILED WITH THE PERMITTING AUTHORITY.
Aopllcant laforreatlon Pince Pdnt Le&"
Name (HusmwOrgenimtiongndividid):._Kevin Ayef_
Address: 1192 Whately Rd
IUab-T34i- - -----------------
Phone
. _ -_-----Phone # 413-695-2263
n.e rvv.a emptorr.^.cheek tot epprow4u Fv.: Type of project(required):
i.❑i am a emriuyc wnh anpkrytt,(!wt ona,rc rar.+:rml• 7. ❑New construction
:�eanawmo+wrm,rc yr wnnnwti,ra,d n,ve n,<m,plvYtta workinY ert mein 8. Remodeling
vnY cynntr lNu w,rtkrn':nn:P.:munn<e rcuuireJ.-r
9. ❑Demetttion
J.❑I am a Fum<vwmm Joiny ul!work mY.cl.`.;]o a,mkcn'cn,ra.:n.waac<seu:rad I'
4.❑1 m,a Mmmrwner:md xx:h<hinnY ronvnaun:u cnmdwt uo work.m n,Y nna,rny. 1 x:ll 10❑ Building addition
rn.u:e tnu:ul:ay.+tnron<ithm here xvnk<ri eumr<mmi,m immense or arc wd< II.❑Liecincal repairs or additions
m,r:<s„rc w,m nn rnnl^r«� 12.❑Plumbing repairs or additions
s 01a;:axone:y:am+ncsrc anal bare mmlrht.uF.cvneynun FauJ,m me anauhN,hsr.. il,E]Rwfrepairs
Ibew wFe,m::aelnn hour emPluytt.anJ Owe wmktta'eurt:p :mmwx<i
n.❑wear<aa,rr„rmi,my,J:;.or.cnn.r<c.crti.oJ men nan+nr<,a+me,:n r<r msec 14.QOther__—_---__
1`=.544).anJ we ha.e nu smrloree..:vn woh<-r:comp.:n.umvrcyu:rNl
•Any arrliwn;thn creak.M.a ul v:w:alxn rill,mane uc:iw hc:uw ahowinY+heir wmkw:i<o,m:cmmum ryp<y m4rcmu:ion.
'I la,xuwnen whu,unm::m:x uff:Ju.i+inJ:utiny,hry arc Juiny all work anJ mrn h+rc nuaiJ<amvacnrtx mw'.what,:a nee uP.idavit ndnwona ouch.
't,mtrwea that chak chi.hn mm:aaxheJ an aJdinnml ahttt ahw:ng tins name of the wbcvmsudun anJ atom wMha m no+tM,w m:i+ic,has
anrlun'.a. I`m<suh-c.m:rvnm!uve smpluYew.they matt puv+Je:heir wmten'comp,grlicy nwnM
1 am an employer that is providing workos'wmpenmdon insurance for my employees Below it the polity and jab site
Information.
Insurance Company Name:
Policy n or Sclf-ins. Lic. a. Expiration Uatc: _
Job Site Address: _ _ - ___ City/Slate/Zip: _
Attach a copy of the worken'compensation poilcydeclaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL a 152.§25A is a criminal violation punishable by a fine up to$1.500.00
and or one-year imprisonment,as well as civil penalties in the form of a S'I'OP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy of this statement my be forwarded to the Office of Investigations of the DIA for emotions:
covcrege verification.
I do hereby terrify under the pains andpie ddri,ofpeJury that the Information provided above Is cue and correct
Siteraturc � ��
Use,
Phone W 413-695-2263
Official we only. Do not write in this area,to be completed by chy,or town officid
City or Town: PermltlLieeme A
Issuing Authority(thele our):
I. Board of Health 2.Building Department 1 City/l'own Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Perron: Phone p: