36-206 (13) 59 WINTERBERRY LN BP-2019-0235
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map'Blmk:36-206 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeorv'New Structure BUILDING PERMIT
Permit# BP-2019-0235
Proiea# JS-2019-000299
Est.cost $50000.00
Fee:$325.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MATTHEW WEST 078278
Lot Size(sa.It.): 45738.00 Owner: CARLAN MARGARET A&JOVAN JAMES
Zoning: Applicant: MATTHEW WEST
AT. 59 WINTERBERRY LN
Applicant Address: Phone: Insurance:
P O BOX 235 (413) 588-4231
CONWAYMA01341 ISSUED ON.8/24/2018 0:00.00
TO PERFORM THE FOLLOWING WORK 24X12 POOL HOUSE WITH 1/2 BATH,
OUTDOOR SHOWER
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 Signature:
FeeType: Date Paid: Amount:
Building 8242018 0:00:00 $325.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0235
APPLICANT/CONTACT PERSON MATTEW WEST
ADDRESS/PHONE P O BOX 235 CON /AY (413)588-:'.31
PROPERTY LOCATION 59 WINTERBEF '.Y LN
MAP 36 PARCEL 206 001 ZONE
THIS SE( 'ION FOR OFP)C IAL USE ONLY.
PERM i P APPLIL AP'.-" _ ':.CKLIST
ENCLOS. D REQUIRED DATE
ZONING FORM FILLED OUT _
Fee Paid
Building Permit Filled out
Fee Paid ZL
TypeofConstruction: 24X12 POOL HOUSE WIT 1/2 BAZ OUTDOOR SHOWER
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Building Plans Included:
Owner/Statement or License 078278
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
(/ Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER§
Intemrediate Project: Site Pl'ah AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §:'. '
i
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
,4 ,_._ 8 2`tc C S
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.
Department use only
i
City of Northampton status of Permit
..> Building Department Cut,CuVDreeway Permit
L 212 Main Street Sewer/Septic Availability
Room 100 WaterNYell AvailabiNy
Northampton, MA 01060 Two Sets of Svucwral Plans
phone 413-587-1240 FoxA3�E- Ib PloVSPlans
APPLICATION TO CONSTRUCT,ALTER REP R,RENOVATE OR DE LIS A ONE OR TWO FAMILY DWELLING
AUG 2 2 2018
SECTION 1 -SITE INFORVITIONM
1.1 Address: 1y DEPT OF BUILDING INSPECTIONS IS b be completed by OlTlpe
Ln NOHTHA1.IPr AptOsc Lot Unit
J K/%a p t bZ Zone Overlay District
Elm SL District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Joy^,% �a.-I.v � 5 S`I i4jg}arinul•,� Ln iFW cA&- N1,4 o1062
Name(Print) C°nem Nagi*" "dd'ess: i!J 13 2. 14 3411
Telephone
sigma u e
2.2 Authorized Agent:
6Je,5 Po I50X 2-35 COAIJ47 ►VU1 olmI
Namarprim) Cunem Mailing AddPess:
�Y'Aj�, `117 SSS yz31
Sre aMe Telephone
ECTiOY 3- -gliATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
coon leted b it applicant
1. Building caroo 00 (a)Building Permit Fee
2. Electnpl (b)Estimated Total Cost of
5 sr9v •�T7 Construction from 8
3. Plumbing a �v S� Building Penna Fee
4. Mechanical(HVAC) U 3i a5
5. Fire Protection
5. Tetat-(1 +2+3 +4+5) 6UO.OD Check NumberJr L17
This Section For Official Use Only
Date
Building Permit Number. Issuetl:
Signature:
Bulling Comniseiona/inspeclw of Su9aigs Date
rr ww�-143$ � � ^''•m.,1 - �b^--I
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Neat Be Completed. Permit Can Be period nue To Incomplete Information
Existing Proposed Required by Zoning
iris column ro be nBed N by
Building uepanmeni
Lot Size ( .OSA(_ ) -Og AL
Frontage f3S t /75 r
Setbacks From lot
Side L: R: L: 3V R: M2
Rear ZO
Building Height yzr
Bid&Square Footage % yg$
Open Space Footage % e
(Wansioirvasbklgapned 41�18Ys�' /o
parklr,e
M of Parking Spaces Z
Fig: NUv1 f.
(vomme a aion)
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 YES O
IF YES: enter Book Page and/or Document If
B. Does the site contain a brook, body of water or wetlands? NO • DONT KNOW O YES 0
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(cleaning,grading,excavation,or filing)over 1 acre or is it pan 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 S DESCRIPTION OF PROPOSED WORK(lack all aooYcabiel
New House ❑ Addition ❑ t. O rrdows Akwation(s) ❑ Roofing
Accessory Bldg. thmolitlon ❑ New Signs 1I71 Decks 10 Sidingp1g) Other[SCj
Brief Desorption of Proposed 4wt�din5 a 12mXZai m Pool
Wadc �'IN St Sin �t S{ory, OJ'�f Show �Z�
a
Alteration of existing bedroom_Yes No Adding new bedroom Yes x No
Attached Name w Renovating unfinished basement _Yes X No
Plans Attached Roll -Sheet X
ea.N New house and or addition to existing housing complete the following:
a. Use of building:One Famiy Two Famiy 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 stones?
f. Method of heating? Fireplaces or Woodstows Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
K 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. WIN building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ?D v'tir1 `fF r.. -(h ,as Owner of the subject
property ,t
hereby authorize W�S�
to act on my behek m 11 matters relatne to work authorized by this building permft application.
3111 Z-gl$
Signature A__^^Owner (( 1� Data
I, ry{hWtii� ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and amurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Pdrq things ,
8� i �2ag
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suoen1d1s��or: NW ApplicableName,Nrof Ueense Holder: r h4 Lie'J IL 0.7 S 'Z-1
13
License Number
po (3wL 23S Lo 1 � � WL., ot7`il A31o5IZo
� zo
Erpire Dare
/ N,13 SSS yZ3 �
signal. Tdephona
9.Registered Home Immoranlart Contractor: Not Applimble ❑
ti4 f- wea - /8o 65'S
Com ianv Name Registration Number
111 b`a 5wA"u — FAS to [y n u- M.a 013 Al /7� bs 2018
Address Enpiraba Date
Telephony/36'M yl,�)
SECTION 10.WORKERS'COMPENSATK)N 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 W the issuance of the building permit
Signed Affidavit Attached Yes.__.Ji No...... ❑
The Commonwealth of Massachusetts
....,_..__.., Department oflndus'triWAceiidaits
- I Congress street:suite 100
Boston, MA 02114-2017
` ;- www.massgov/dia
Weirkeri Compensation Insurance,Affidavit:Builders/Cmntraeors/Eleclrkkns/Plumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Infermatfan r_..� /L Please Print 'bl
Name Business/ ganlaaOmJlmlividual): I Ik
Address: 1'4 34 SL.J 6—aT'C, F,11s
City/State/Zip: nf..rr t LMh O t 3 41 Phone#: `113 98`d y 231
wreyaa.n aaplayen chaak the apprapHete boa: Type of project(required):
L[]l am a employer with employm(fill]anion inn-nurl7 1311illewconstrurtion
2[ZlamasdepmprinororpnunshipaMbnememp]oyemworking formein g. ❑Remodeling
any caparity.[No workers implmumme nyuired.l
3.O l on a himeovmer doling all work myttlf.[No workers comp.immure on,mi .it 9. ❑DemOlhian
4.C]1 am a hummal aM will be hiring contmceoa to coMuot all work on my property- 1 will 10❑ Building addition
murethnailamractmseltherhoseworke;rompermuonimacuweoramsAe 11.C]Eleetrieal repairs or additions
propriemrs with no emplovrea.
12.E]Plu!nbulg repairs m additions
s.❑l am a geneit vial and l have hoed the sub-mnmclom how]on the auarhal shret. 13.❑Roof re frs
Thee,out, natnxn workers P.hove employe .wal love kromp.inunnrn.l
6.❑We are a cotpomtion anal its oill haveexer,hed theh right ofexaaplon pa MGL c 14.QOlher
152.4114),aM we have no nnployees.INo workers romp.imamm'e rryuimd.l
-Any awlien t Ihot checks bur#1 must aho fill out the semWa below showirng their workers cnmpmson.policy infommtion.
4lomenrvners rvhumbndndub am.devu Indicating dreg all doing all work dull(lit orhimuwsidewnma Tors nnuuubout a ii—affidavit nu]' niginch.
-Conmeors that cheep the box mss amched en additional sMa showing the name of the all,-cnimumm and sine wretM or not throe rani,,have
anployala now suo-omuraaon nave"Inoees,they mat povde lhetr workers rump.policy manner.
lam an employer thatisimaidbrg workers'coapeasation fnsruance foray employees. Below is thepollcyandjob site
Information.
insurance Company Name:
Policy#or Self ins.Lic. C Expiation Date:
Job Site Address: City/Stale/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 tine Of rap to 8250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
I do hereby cer�rdAy,�u`ndarlhe�payms and penalties ofpedutythat the lnlerma0ion provided above is true and correct.
S' t a'vlK; V "�'��f— Dew
PhoneC t-11) �ka '/ZJ)
01Bdal use ody. Ducal write in fids area,lobe mmpkied bydfyor fawn official
City or Town: Permit/License#
Issuing Authority(eircle one):
1.Board of Health 2.Building Department 3.CityTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts °�
rr
OFP.dR--N�Xf OF BUILDING 7'NSFECTIONS
212 Yet Street •Yunldpel Building
��_ Nm Wamyton. MA 01050 r�Lp ypP"
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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
51 IA7 ;n 6c.�T Ln
(Please print house number and street name)
Is to be disposed of at:
yft �L� t11(Plea print na a an a =Ere nn .
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant a 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.
City of Northampton
='(( Massachusetts
DEPARTNENT OF BUILDING INSPECTIONS
212 Yeln Street • nun Yun Bu 11 ding
Nur Liwapwn. HA nmtiU
�W
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Cunsuarer Affairs mid 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 14ZA requires that the "recanslmGfion, atteretion,renovation,repair,modernization,conversion,
improvemem,removal. demoldion,m consmxc oran addtbon ro anypm�xisdng amer-occupied building mntaintng
at least one but nor more than four dwelling units....or to sinxtures which are adjacent to such residence or building" be
done by registered contractors.
Nme:ffthe homeowtrer has contracted with a cmparaBon or LLC,that enmity must be registered.
Typeof Work: AC(,`tbS" T)u1kNr�5 Est.Cost:450)ct>a GD
Add,na Work: Lti Ffhr'crc�t AK b1o62
Date of Permit Application:
1 hereby certify that:
Registration is not required for the following reason(s):
_Wok 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 14M 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:
(Ark#_ P1 S'f-
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:
Date Owner Name and Signature
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