17C-318 (7) 45 HIGH ST BP-2019-0162
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 17C-318 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:ADDITION BUILDING PERMIT
Permit# BP-2019-0162
Project JS-2019-000271
Est. Cost:$36950.00
Fee:$290.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sp fi l: 12719.52 Owner: RECKHOW DAVID ALAN&WANAT CATHERINE GRACE
Zoning: URB(100)/ Applicant: STEPHEN D ROSS
AT: 45 HIGH ST
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584-1224 0 WC
NORTHAMPTONMA01060 ISSUED ON.81912018 0:00:00
TO PERFORM THE FOLLOWING WORK.•ADD NEW FRONT PORCH, REPLACE KITCHEN
CABINETS
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 Sienature:
FeeTvoe: Date Paid: Amount:
Building 8/9/20180:00:00 $290.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0162 �0 IL
APPLICANT/CONTACT PERSON STEPHEN D ROSS ✓1
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224 Q (r(J�Tz
PROPERTY LOCATION 45 HIGH ST Hol (f
MAP 17C PARCEL 318 001 ZONE URB000)/ � p op(c'
THIS SECTION FOR OFFICIAL USE ONLY'
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ADD NEW FRONT POR PLACE KITCHEN CABINETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License 079160
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved_Additional pemtits required(see helow)
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
Demolition Delay
rg / � � 8 9 t 0
Signature of Building Official Date
Note:Issuance of a Zoning 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.
-if (?,4&& W4E4-1166WV y-X
Department use only
City of Northampton Status of Permit:
,a^ Building Department Curb CWDrivewey Permit
�> 212 Main Street Sewer/Septic Availability_
Room 100 WaterlWell Availability__
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PlotlSits Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION Z-
1.1
1.1 Property Address: This section to be completed by office
Ft-Ok'E1.7CE Mei Map t7L' Lot ✓( V Unit
(!5t04,2-
Zone Overlay District
Elm at District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: O\cs fol
dA,x/ID Veuy-NoW GJ17A68t,v6 WXA)hT h Ilk 14 L-1 SV PFLOr-cNCt✓ AAA
Name(Pr� �r Current Mailing Address-
Telephone
Signature
2.2 Authorized Agent,
"i(lt6N D QOSS 3(v y6eyitE [C—NTE 42b
Name(Print) Cument Mailing Address: p/UQfi{A,M P-TUAI F'r /k Ot OEj
_ At3 • moi&*- I 7-zA-
SWaturef Telephone
SECTI N 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
complWd by permit applicant
1. Building S JffG (a)Building Permit Fee
2 Electrical
G J V o (b)Estimated Total Cost of
D Construction from 6
3. Plumbing / Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 04
6. Total=(1 +2+3+4+5) 471f 36 D . Check Number
is Section For Official Use Only
Date
Building Permit Number: Issued:
Signature'.
Builtling Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doo s O
Accessory Bldg. ❑ Demolition ❑ New Signs [OJ Decks [CJ Siding[OJ Other IQ
Brief Description of Proposed
Work: ;s.DP flEw t6OAYC P0ii l QE.QI.A4.E KIS[-t1EJJ GAPJI N���
Alteration of existing bedroom_Yes )� No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes __I, No
Plans Attached Roll -Sheet
as.If New house and or addition to existing housing, complete the following:
a. Use of building: One Family Two Family Other
o Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
it. Number of stories?
L Method of heating? Fireplaces or W oodsloves 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 COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, DAvID il2ee y," as as Owner of the subject
property
hereby authorize Sic-.FN Ili D. 19055 Glz--AJGeAl- cO.J'72Ac1O2
to act o half,in all matters relative to work authorized by this building permit application.
art
Signature of Owner to
I, -5 1�—f�k EA(J p. eOS'� EI✓EPA L- CU�PAC TOP, ,as Owner/Authorized
Agent hereby declare that the statements and in ormetbn on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
STEP to eons
Print
nature OwnerlAge It Date
Section 4. ZONING7 All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This comms m be fined m by
Building Dwzmnmt
Lot Size ,Zz1L flGR6A7 NO f I.NGE
Frontage
Setbacks Front
Side L: it b R. k L: t R:
Rear i3ox 1-50r
Building Height L Z(o� No GHhUGb
Bldg Square Footage
Open Space Footage 1 p oX
itt area minus bldg&paved 'ZZ 63 S� ZT�3
parking) 0Ptea/ aPeu,
#of Parkin Spaces
Fill:
(volume&Loeatian) I"
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO � DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOWO 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 (G L
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES,then a Northampton Ste"Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Hold. STtPt-�C—rl� et ] ` ` L�
License Number
36 5G-Qv�c� cr✓,�r� eo�D 2 /c7
Address Expirali Date
/giQ—
gnature Telephone
9.Registered Home Improvement Contractor,. Not Applicable ❑
10TEPN ep t> , 4EA/I-1 tO ZrlciO/Z /S o 8 V7
Company Name Regist`atiop Numbe2 �r
3se
G Pvlcrc cE1r,E,� PWD S 30
Address Expiration Date
I)0C 1AAAAP_A0J MA 0I060 Telephone1ZZ4-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(l
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...... ❑
lc) iFgot.>T 15'✓TeA4Y--
U�� 1 'SSIDE SE.TF�ALK
70.01
r43. 58
0 17C-081
83
206.57 177 .24 256
153 17C-082
17C-318
211 .21 7
z-sToeY
15
11 woo o H
12. 575.00
20
y 72. 32
48 5
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:
The debris will be transported by: /V, C-
The debris will be received by: Yid ems_
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of lndustrialAccidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
%VW.rkeyrs'Conapenswthm Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �p Please Print Le ibl
Name (Business/Organizatioo/Individuap: //—a w ( Y
Address: —37 jle-�
City/State/Zip: r (U Phone#: y/3
Are you an player?Check to appropriate box: Type o���fproject(required):
LE]1 aemployerwnh empleyees(fall and/or part-time).• 7, �W can ban
2 I am a sole impostor or partnership and have no employees working for me in $. Remodeling
any capacity.[No workers'comp.insurance requind]
3j1I am a homeowner doing all work myself[No workers'comp.insurance res ifed.]• 4 ❑Demolition
10❑ Building addition
4.❑lama homwwnerand will behiring comments toconduct all work onpro twill
eruure mal all conhacmrs siker have workers'wmpenration ivswaviceor are solein IL❑Electrical repairs or additions
proprietors with no employees. 12.[]Plumbing repairs or additions
s❑I ran a general tamarack,and I have Idred the sul-comorou,listed on the attached sheet. I3.�Roof repairs
These subcontauors have employees and have workati comp.commuter
6Fl Weareacuryoration and itsoRcers hrreexricised theirrighlofe.ernarm per MGL r. 14.❑Other
153,§I(4),and we have m employees.[Na workers'comp.insurance required.]
'Any applicant that checks box 41 most also fill out the section below showing their workers'compensation policy information.
t Hommwners who submit this undiscriminating they are doing all work and then hire outside contractor,most submit a new affidavit indicating such.
:Connectors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or red those entities have
employces. If me sub-contractors have employees,they must provide their workerscomp,policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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 W$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify under th�in�enalties of perjury that the informalion provided bare true and correct.
Date l
ph ..
Official use only. Do not write in this area,to be completed by city or town offciaL
City or Town: Permit/License#
Issuing Authority(circle one):
/.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ACC)R& CERTIFICATE OF LIABILITY INSURANCE ce�62 2p, '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
REPRESENTATIVE OR PRODUC ER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be en4omeE.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an enclormurtmL A statement on
this certificata does not confer rights to the Certificate holder in lieu of such endo emen4s).
CT
PRODUCER nAoOCMRNEEBerybera Grynkievn¢
Webber B Grinnell
B , (413)586-6
e North Ong Street Ne
a .
com
INSUREBLERAPFORDINGCOVERAGE NAID
Northam,kin MA 01060 INSUREPA, WeetAmenWNLibety 44383
INSURED INSURERS. AI.M.Mutual
Stephen Ross SEUREERC:
Ann Kim Clairtmonr
36 GENXv Center ROBC INSURER B
Northampton MA 01060 MSURERF
COVERAGES CERTIFICATE NUMBER: EXP 7/1119 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WtlICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TS TYPE OF INSURANCE PYFUCYNUMaMm
EN DM'W MWWM'W LIMITS
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c RSKLGENER.LUAIuu1Y BA.HoccuRRENCE S 1,000,000
C-MSMADE O OCCUR PREMISES ESAPIn SCR S 100,000
MED EXE L,,one RAPIP S 16000
A 8KW58371783 W/01/2018 03/0"2019 PERSONYLSADVINJURY s 1,000000
GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE s 2,000,000
PoLICv O RECUT D LOC PRODUCTS COMEOPAGG S 2,000,000
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DISEASECIDENTLovEE s x00,000
IDESCRIPTIONOFOPER0NSMlox E.L DISEASE-POLICY LIMIT 5 500000
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DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1ACORD 101,AW genal Ralnarks BCOWUIa,SAY Oe named if men S,is nyuin
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
"For OSurance Into OFj,-- ACCORDANCE WITH THE POLICY PROVISIONS.
AVT➢ORQEDREFSESENTATNE
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