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17C-315 (4) 19 LAKE ST BP-2019-0111 GIS s: COMMONWEALTH OF MASSACHUSETTS Map:Bloek: 17C-315 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category. ADD BATH BUILDING PERMIT Permit# BP-2019-0111 Project# JS-2019-000181 Est.Cost: $2200.00 Fee: $143.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License. Use Group: Homeowner as Contractor_ Lot Size(sa. ft.): 10585.08 Owner: COLES TERENCE Zoning:URB000)/ Awlicant. COLES TERENCE AT: 19 LAKES Applicant Address: Phone: Insurance: 74 WASHINGTON AVE (617) 833-55310 NORTHAMPTONMA01060 ISSUED ON.81212018 0:00:00 TO PERFORM THE FOLLOWING WORIGADD 2 DORMERS, ENLARGE BATHROOM - 2ND FLOOR 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 q 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 Signature: FeeType: Date Paid: Amount: Building 8/2/20180:00:00 $143.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-0111 APPLICANT/CONTACT PERSON COLI ;TERENCE ADDRESS/PHONE 74 WASHINGTON/. 'E NORTHAMPTON (617)833-55310 PROPERTY LOCATION 19 LAKE ST MAP 17C PARCEL 315 001 ZONE OF•_ 1( 001/ THIS SI .;TION FOR OFF'CIAL "SE ONLY: PERMIT APPLIC_A! �?_;_'HECKLIST_ ;,ICLOSEAULQIJIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Tvveof Construction, ADD 2 DORMERS,ENLARGE BATHROOM-2 OOR New Construction Non Structural interior renovations Addition to E istine Accessory Structure B ildine Plans Included' _ Owner/Statement or License 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: Sit@ Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDEIL'§ L1 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 Demolition Delay A ild itis DatC Note:Issuance of om.g 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 only -"- City of Northampton Status of Permit: Building Department Curb Cut/Driveway permit 212 Main Street Se ver/Septic Availability i ' a. Room 100 Water/Well Availability ` Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Speciy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION �" This 1.1 Pmwrtv Address: i 4 L a—tc.�, S' .CL, This section to be completed by office -p o tC f h l ' \ Map M Lot 316 Unit Zone Overlay District Elm St.Diemct CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: e f'_- (c. Ca ( e S Namp(?�An Cunent,MailinyAddreaj) ' r� Q t 6 Telephone Signature 22 Authorized Argent: Name(Pnnt) current Meiling Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Permitapplicant 1. Building rl O © 0 Q. (a)Building Permit Fee 2. Electrical d (b) Estimated Total Cost of Construction from 6 3. Plumbing 'D DO Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 1)174 Check Number This Section For Official Use Onl Building Permit Number: net Issued: /� /' Signature/, _ /—//Z/�� Building Co sionemnspector of Buildings Date +GU (QS @7aAAe . Cg1%, 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 column 0 he f Ilcd in by Building 13,smuent Lot Size Frontage / t➢D ` ! `JO � Setbacks Front Q Side L: /S R: L. Ir R: 71 Rear 63 o Building Height a( � "Ll Bldg.Square Footage '�Y(s I 7 Open Space Footage (Lot area minus bldg&paved o (J OJ parking) #of Parking Spaces 3 3 Fill: D (volume&Imatiou 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 A& YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that Will disturb over 1 acre? YES O NO IF YES,than a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all aoolicablel New House ❑ Addition Replacement Windows At Roofing 1:1Or Doors D Accessory Bldg. ❑ Demolition ❑ New Sig. [l7] Decks 5[-13 Siding �] Other[OI WorDescription of Proposed R � �a ��3 ��ti L3 �Ofl — -t-� a-,9 !Y X Iy FC r Alteration of emsting bedroom X Yes_No Adding new bedroom Yes v No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet sa.If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit Number of Bathrooms `r c. Is there a garage attached? / 0 / d. Proposed Square footage of new construction. Dimensions e. Number of stones? (� f. Method of heating? Fireplaces or Woodsloves )1-/10 Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction (41 L,9 - (' i. Is construction within 100 fl.of wetlands?_Yes No. Is construction within 100 yr. Floodplain_Yes. '=.No j. Depth of basement or cellar Floor below finished gratle, T�`/ k. Will building conform to me Building,and Zoning regulations? J" Yes No. L Septic Tank_ CitySewer X. Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATIONNN-TTO 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 all matters relative to work authorized by this building permit application. Signature of Omer Date I, e.('a/l c < S ) as Ommer/Aulhonzed 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 p rjury. cte Print Na - ( � Signature of Owner/Agent Dele SECTION 8-CONSTRUCTION SERVICES 8.1 Umsed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contactor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152,§25C(e)) 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 A4rs car c DBP"DiEter OF BUILDING INSPECTIONS 212 Main atsaat Municipal Building =N Y pCa \\ 9orthaaptou, B11 01060 ha. :ygP 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 owneroccupied building containing at least one but not more than lour dwelling units....or to structures which are adjacent to such residence or building"be done by reeistered 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$1$)W.00 _Owner obtaining own pennit(explain): _Building not owneroceupied _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.C.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: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I Y'np or a building permit as the owner of the above property: Date Owner#Jame and Signature City of Northampton Massachusetts uspns226sz or suzanzsa zsspacazoss s4\�iJ 212 Mi. treat • wo 010 Building \` porthmptoo, MOlOfiO Massachusetts Residential Building Code Section I IO 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 I IO.R5.13.1 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 aform 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 I� DSPARTXSBT OF BUZWZM ISSPBOTXMS : 312 Main Street •Municipal Building \. MnathnBptan, NA 01060 abr i s Di s pos al 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 col St constructionwork being performed a ft: I ,I � c�-e NLe (Please print house number and street name) Is to be disposed of at: (Please print name"and of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Slgn o ermit Ap cantor Owner e 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. p� B �\ The Commonwealth ofMassaehusetts Department ofindustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02714-2017 www.mass.gov/dia Uf Markers'Compersiation Insurance Affidavit:Builders/Contractors/El"bicians/Plumbers. TO 6E FH.ED WITH THE PERMITTING AUTHORITY. Applicant Information PI ase Print Legibly i Name (Business/Orgenizati/oMpdividwl): I C r/.n c C Address: Lak ir 1 2 City/State/Tap: T�s ru.c < Phone#: Are yon as employee Check rhe appropriate box: Type ofro ect p J (required): L❑lsmnemploye with Jemployees(full suckergt-rime).* 7. ❑New construction 2[:]l am a svd a propriumm panegram p nor have no rest Dyers working for me In S. ❑Remodeling any eupzaty.IND workers eomp.insurance w,farroI 3MIamahomowtow,do;n allwokmyseI( [No workecomp' mounterewredr 9. ❑Demolition a tam ahimeowncr aha will be hiring oontrscmrsto mnearx all work on my property_ Iwill loWBuilding addition ensure not all conaaenvorcha have workers mmpenauon Insurance or am sole I1.❑Electrical repairs or additions propneters with no employees. 12❑Plumbing repairs or additions s I arae geneon rrgomm hamewrve and 1 have Nran Neve wranaeders lista)on nce'dmhed sheet l3.❑Roof repairs I hese subcontmcmn have employme and have workers'comp.insurance 6❑We are a mrpomdon audits officers have exerciser the;r night of exemption per MGI, 14❑Other 152,§1(4),and we have no employees.Mo workers comp.insurance"oiredl 'Any applicant that checks box#1 must also Fill out the section below showing their workers'mmpenvtion policy lnformanon. 4Commt Hommwners who submit this must vlt elved r ng dreg are aping all work and then hire outside mmmaors must submit a new affidavit ientmes h such. employers, that check this ox must a emplo eeadditional sheet showing the krone of the sub-c y manors ane smte whelha or not those entities have employers, If the subconhmmrstave employers,they must provide their workers mmp,policy number. I am an employer that is providing workers'compensinion insurance far my employees. Below is the policy and,job site information. insurance Company Name: Policy#or Self-ins.Lia#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation 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 ce%b�rw he pains and penalties ofpetlnrythas fhe information provided above is(/r/a,B and correct. Simrature' Phone# 42 J S 3 e Officio[use only. Do not write in this area,to be compleed 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 S.Plumbing Inspector 6.Other Contact Person: Phone C z WILLIAMSBURG - 5 CONWAY RD WB-2018-0142 COMMONWEALTH OF MASSACHUSETTS _ I CITY OF NORTHAMPTON Is# mak: WBUILDING PERMIT Lot Peanit: Wbuilding— ategOryREPAIR ��'CIIDIr# wa-zbta-ota2 _i PERMISSION IS HEREB Y GRANTED TO: bnl ,- ISSUED -201&002248$126,330.00 Contractor: License: Expires: $8t9.Op RALPHOSGOOD CSL-2631 08/26/2019 00 Owner., FLEMING NANCY ..� ,Applicant: RALPH OSGOOD T. WILLIAMSBGRG-5 CONWAY RD ComUClass __--n--._ ISSUED ON: 13-Jun-2018 AMENDED ON: EXPIRES ON. TO PERFORM THE FOLLOWING WORK: REPAIR AND ALTERATIONS TO EXISTING RESIDENCE Williamsburg Building Pertn.it THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Typr: Receipt No: Dete Paid: Cheoh No: Amomon Rcpoir REC-2018406081 04-/un-08 5042 1819.00 212 Moi.Street,Pho.e:(413)587-124x,F..:(413)589-1272,ftmail:Iharbr.ucN@.onhemptonma.gov G: FN". 2018 LmWli a M.Ami"I SOIa&om,I.,