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31A-263 (2) 63 DRYADS GREEN ST BP-2019-0027 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-.Block: 31 A-263 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeom KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2019-0027 Project# JS-2019-000029 Est Cost$47000.00 Fee $306.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sa.R.l: 20211.84 Owner: SALLOOM SIMON Zoning:EU(IOOVURC(loO)/ Applicant: SALLOOM SIMON AT: 63 DRYADS GREEN ST Applicant Address: Phone: Insurance: 206 ELM ST NORTHAMPTONMA01060 ISSUED ON:8/2/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN AND BATHROOMS RENO 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 ft Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: O0I• 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: FeeType: Date Paid: Amount: Building 82/2018 0:00:00 $306.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner NOD - WO-c wo File#BP-2019-0027 SC( Ypw C APPLICANT/CONTACT PERSON SALLOOM SIMON ADDRESS/PHONE 206 ELM ST NORTHAMPTON } G U.1 PROPERTY LOCATION 63 DRYADS GREEN ST C 5 CC lw\ A 1 MAP31APARCEL263 001 ZONE EU(100VURC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: �j Q^ l / ^ "Q18 PERMIT APPLICATION CHECKLIST D REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid TypeofConstruction, KITCHEN AND BAT 00 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 e olition Delay Aqiamtx*hF`BuiIdm O t is Date Note: Issuance of a Zoning mit does not relieve a applicant's burden to comply with all zoning requirements and obtain a 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. - City of Northan pion Building Depart en JUL - 2 2 FeelpliF��III i. 212 Main Str et Room 100 Bull DING NS Northampton, MA 01 K.O."HAMPION PA bllcfitYal'Plens -VI'II li phone 413-587-1240 Fa;-413-587-1272 APPLICATION TO CONSTRUCT, ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWOo- FAMILY DWELLING SECTION I -SITE INFORMATION &, iq-;;t-7 1.1 Property Address: This section to be completed by office Map Lot 13( -� I IS3 . / - Unt A) 0 r- ',It04%0 .Zorn_Owirlay District_ Elm St.District_ CS District SECTION 2-PROPERTY OVINERSHIPIALITHORIZED AGENT 2.1 Owner of Record: S'-,' o I -C Name Pant) CVLIMP 0 -Add Telephone adaus 2.2 Authorized Agent: Name(Prim) Current Mailing Address Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building f-5-7 000 (a)Building Permit Fee 2. Electrical Es (b) timated Tal Cst of oo 0 Constructionoto from(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection a o 0 6. Total=(I +2.3+4+5) 00Check Number ^� This Section For Official Use Only Date Building Permit Number: Issued: Wilding CoadmiSle,04 KII -pector of Buildings Date 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 aolumo on h fillM m by Building DCLarhnmf Lot Size _ " Frontage "... Setbacks Front Side L. R' _. LR ... ." ....... Rear Building Height ------ ---- ' Bldg.Square Footage % ----- -' ' Open Space Footage % -- (Lot an,amiousbids&Loved _,_,.., ..... rookies) .. _. _".._. #of Parkin Spaces Fill: .. .". '.... _... ....... .... A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT 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 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 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. , SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Rooting Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks [p Siding(01 Other[0] Bref Dei_cof/ opidianWork ' Ne f Alteration of existing bedroom Yes_No Adding new bedroom Yes No alive -I ,� G 6'6l��UJri- Renovating unfinished basement _Yes No _;�s Attach Roll -Sheet r (oJ P'� aa If Now hi and oF8ddltlon to eXiSt) 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 stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? In. 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]a-OWNER AUTHORIZATION-TO BE COMPLETED 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 Date �_ 1 I, 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 Name Signature f 0w /Agent D to SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Realstemd Horne Improvisor nt Contractor: _ ; Not Applicable ❑ Company Name Registration Number Address Expiration Date 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...... ❑ r City of Northampton _ Massachusetts DE?"TNENT OF BMWZNG INSPECTIONS \ 212 Hain Street a .­.11a1 auilaing w,rNa ton, N 01060 :n\ 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 ownerbccupied building containing at least one but not more 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: 1 hereby certify than 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 owner-occupied 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: 1 hereby apply for a building permit as the agent of the owner: 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: -u Date O er Name and Signature City of Northampton -s Massachusetts DEPARTMENT OF BUILDING INSPECTZONS 5 212 Mein Street 1e 010 da euilng Noi'CAampton, IbM 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.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.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 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 Massachusetts f - � DEPERTNENT OF B"I DTNG INSPECTIONS \ 212 M xn BCraataMunioipal 0106Building `ip ai x.rtha ton, N.B 0 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 Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from constructionworkbeing performed at: G J 9DrYa AS c, , (Please print house nu(nber and street name) Is to be disposed of at: K4 '/c /I �- (Please print name and local on of facility) ° -\ Or will be disposed of in a dumpster onsite rented or leased from: Ci /4A� , 2e «i=STs (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 ` Department oflndustrialAccidents I Congress Street,Suite 700 Boston,MA 02114-2017 Is wrvw.mass.gov/dia Workers'Compensation Insurance Affidavit:BuHders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Bus]messOganizatioNlndividual): /"rxa, st�U //VV Address: -I-0 (� ���M S1 - /I July/State/Zip: I 7� , fJ hone 7 Y9 {'(, rf, Are you an employer?Check the appropriate box: Type of project(required): I.[:j l am a employer with en,itoors(full and/or par-time)." 7. ❑New construction 2 l am a sole proprietor or pcomadaM and have no employees working for mem g. ❑Remodeling any capacity.[No workerscomp.msutanve mounted] l❑1 a humrowntt doing all work in,wif[N.workers comp.memance required.]' 9. ❑Demolition 4.V a homeowner and will be hiring10❑ Building addition onsurcontractors or sole twill e that an contractors diner have workers'compevsamninswanvc or am sale I1.❑Electrical repairs or additions pmpnemis with no smil as. 12.❑Plumbing repairs or additions s❑l an a general contractor and l have hired the sub-contractors listed on the attached shoes 13.[:]Roof repairs These subconsaoorx have employees and have workers'comm.insurdnve. 5.❑We arc a coryamtion and its officers have exemised theh tight ofexemption per MGLc 14.❑Other 152.Al(4),and wehmc m,employees_[Na wmkem•camp.insurance mqulrall 'Any applicant that check'box to must also fill nature section below showing their workers'compensation aahey information. 'Homeowners who submit this of davit indicating they are doing all work and then hire outside cmnmactors must submit a new affidavit ladicatlag such. :Conhattors that check this box most attached as addimmal sheet showing the time of the sub-mntr ctors chat now whether or not those entities have employees. If the sub-connacmrs have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensatiop policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury thmthe information provided above is/true and correct Signature r----. Date 7�7 /✓�� �// Phone#: Official use only. Do not write in this area,to be completed by city or foam official. City or Town: Parmit/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 Persian: Phone#: 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 aioint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an 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 be an 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 of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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 if you 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 sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you in fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peramulicense number which will be used as a reference number. In addition,an applicant that must submit multiple permiVlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit most be filled out 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, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or I-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mms.gov/dia Information and Instructions Massachusetts Geneml 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 ofthe foregoing engaged in ajoint enterprise,and including the legal representatives ofa deceased employer,or the receiver or trustee of an 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,constmction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an 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 of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill 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. Ifan 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 if you 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 sure 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 pernit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out 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 I Congress Street Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-NMSSAFE Fax#617-727-7749 www.mass.gov/dia Fmm Revised 0223-15 T/3/2018 City of Northampton Mail-(no subject) CHY Of d Louis Hasbrouck<Ihasbrouck@northamptonnni (no subject) 1 message Louis Hasbrouck<Ihasbrouck@northamptonma.gov> Tue, Jul 3, 2018 at 4:07 PM To: simon@pcsre.com Simon, Is the house at 63 Dryads Green a single or 2 family?Can we get some slightly more extensive plans so we can see how the unit(s)ft together? Is any of the work affecting dwelling unit separations? Please mark smoke and CO alarm locations on the plans. It looks like the window in/next to the shower will need to be tempered glass. Is it shown properly on the plans? Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax Mips.//mail.google.comlmaillcalul0/?ui=2&ik=ec5flga57e&jsverH8yFb09hWE.en.&cbl=gmail_fe_160626.14_p5&view=pt&search=sent&th=16461c_. ili