24D-089 (6) 64 NORTH ST BP-2019-0030
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 24D-089 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category,ADDITION BUILDING PERMIT
Permit# BP-2019-0030
Project# JS-2019-000037
Est. Cost;
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group Homeowner as Contractor_
Lot Size(so ft.Y 7100.28 Owner: HARRINGTON MICHAEL L
Zoning: URC(100)/ Applicant: HARRINGTON MICHAEL L
AT. 64 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 393
NORTHAMPTONMA01061 ISSUED ON.91512018 0:00.00
TO PERFORM THE FOLLOWING WORK ADD 3/4 BATH IN EXISTING LOFT, ADD 3/4 BATH
BETWEEN SUNROOM AND HOUSE, ADD SPIRAL STAIRCASE FOR 2ND FLOOR APMT, ADD
CARPORT
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:
FeeTvpe: Date Paid: Amount:
Building 9/5/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2019-0030 L�
APPLICANT/CONTACT PERSON HARRI ETON MICHAEL L Lft S
ADDRESS/PHONE P O BOX 393 NOR LAMPTON ^`
PROPERTY LOCATION 64 NORTH ST l/
MAP 24D PARCEL 089 001 ZONE URC 001/
THIS SEC_,ION FOR OFFICIAL L'S ,)NLY:
PERM IT APPLICATION CHECK.L 1ST
EY REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid VV
Building Permit Filled out /
Fee Paid
TypeofConstruction ADD 3/4 BATH IN EXISTING LOFT ADD 3/4 BATH BETWEEN SUNROOM AND
HOUSE ADD SPIRAL STAIRCASE FOR 2ND FLOOR APMT ADD CARPORT
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
V Approved_Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project Site PladAND/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
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.
Versio.1.7 Commercial Building Permit May 15,2000
) LIUt1vtu
City OT Northampton
Bull, ling Department easrl
JUL - 2 2018 2, 2 Main Street
Room 100 ami;
D I F�T Or SUMMING XPECTI §rth; mpton, MA 01060 k
'OPTHAM 3-58 -1240 Fax 413-587-1272
mi-
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION 6 n- tq- 30
1.1 Prol Address This section to be complebed by office
'Map Lot Unit
Zone Overlay District
am at District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
4-
2.1 Owner of Record:
AU4 d6�To UN...(Pnnt) Cur-sra Mailing Address
Sign.tur,! Telephone
2 Atjt�lcriz'e/d Adam,
Agee—
Name(Print) Curent Mali4�Mdre.s
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pernat appliGant
1. Bualdmg (a)Building Permit Fee
✓ffYY
2. Electrical (b)Estimated Total Cost of i
Construction from(6)
3. PlumbingDdO
Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 161z
6. Total=(1 -2-3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature
Building Commissioneranspecow of Buildings Date
fl&M/A)( :ro X/Yf I uw/— P
Version L7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE j
Interior Alterations � xisting Wall Signs El Demolition❑ Repairs El Additions ❑ �ccessory Building[I
Exterior Alteration [ Existing Ground Sign❑ New Signs❑ Roofmg❑ Change of Use:❑ Other❑
_ _..._
Brief Description Enter a brief description here. x
Of Proposed Work: ''. Fl-�
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A AssemblyElA-1 ElA-2 ❑ A-3 1:11A ❑
Ad ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 4 ❑
R Residential R-1 ❑ R-2 R-3 ❑ 5A 0 i
S Storage ❑ S-1 ❑ S-2 ❑ 5B
U Utility ❑ Specify:
M Mixed Use ❑ Specify.
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: .._ _._-. Proposed Use Group ...... -_ _...
Existing Hazard Index 780 CMR 34): .... Proposed Hazard Index 780 CMR 34)
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(s)
Total Area(so �(�c-v Total Proposed New Cair bon{sf)
Total Height(ft9 j) 1nnld��
Total Height It
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E]
Versionl.7 Commercial Building Permit May 15,2000
&.:'.NOR ON zoNING
Existing Proposed Required by Zoning
This column to be filled in by
Building Delmrhnmt
Lot Size
Frontage
Setbacks Front � ,,t(
Side L f R: � L 140 _
Rear1_.
Building Height
Bldg. Square Footage "r o %
Footage Open Space �,r � %
emin ._ - --
Open us Paved
arkiv
H of Parking Spaces
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO 0 DONT KNOW � YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW_ 0. YES 0 .
IF YES: enter Book Page., and/or Document#_
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E, Wil the construction activity disturb(clearing,grading, sxcav n, or filling)over 1 acre or is it part of a common plan
that will disturb over t acre? YES 0 NO
IF YES,then a Northampton Ston Water Management Permit from the DPW is required.
Versiori Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
_
Name(Registrant)
__..
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
_ . .. _. _.. . . tits . _. .
Address Reg stretion Number
_.. tits. .tits
Signature Telephone Expiration Date
Name
Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
tits tits. _.
Signature Telephone Expiration Date
Name Areaof Responsibility
..strati ....
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name
Responsible In Charge of Construction
tits.
Address
Signature Telephone
01
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW 4730 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11.OWNER AUTHORIZATION-TO 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 Owner Date
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 and -inran ties ofpequry........ .....
firm Name -- _
�L
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: r Not Applicable ❑
Name of License Holder'. /rt(C-011 t-L �" 4 Shu of -
License Number
Address DEQ Expiration Data
d `w Nle_ �ff�- -42-7-f7kf y�ti�jq
Signature Telephone
SECTIO 3-WO ERS' OMPEN51ATMN INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
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 O No O
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: l " m)k T,+ S-I ,
The debris will be transported by: (blIc c t- L. Hbw(f 61-0N
The debris will be received by: V�L� ✓ Rw�G��1�
Building permit number:
Name of Permit Applica N �C f L lwf ( , Imo"
Date Sign re of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 01714-20177
www.mass.gov/dio
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ADDGcant Information Please Print Leiribly
Business/Organization Name:
Address:
City/State/Zip: Phone M
Are you an employer?Check the appropriate box: Business Type(required):
I.❑}'fin a employer with employees(full and/ 5. ❑Retail
X616 part-time).* 6. ❑RestamantBar/Eating Establishment
2. KI=P'
a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] g. Non-profit
3.0 Weare a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees. [No workers'comp.insurance required]*
4.❑ Weare a non-profit organization,staffed by volunteers, 11.❑Health Care
with no employees. [No workers'comp. insurance req.] 12.0 Other
*Aay awliczat Net checks box 01 must also fill made section below showing Wer workers'msepensi my polity inrormamn.
*9l.Ne corpomm officers love excmpail ffemselves,but Ne mRoomen has offer employees,a wonoo'compensation policy is required and such m
orgv,i,mon should chink box dl.
1 man employer that is providing workers'compensation insurance far my employees Below is the policy information.
Insurance Company Name:
Insurer's Address:
Ciry/State/Zip'
Policy#or Self-ins.Lic.# Expiration Date:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 st the violato . Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the f r in verage verification.
1 do hereby ce d the sins a na/ties ofperjury that the information provided above is true and correct
Sitimmore: Date:
Phone#:
Official use only. Do not write in this area,to be completed 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.Licensing Board 5.Selectmen's Once
6.Other
Contact Person: Phone#:
www.mass.gav/Wa
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 ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee ofam 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 guy
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 ofthis chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking theboxes 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. Han 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 permit/license applications in any given year,need only submit one affidavit indicating current
policy information(ifnecessary). A copy ofthe 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
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 burn 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
Boston, MA 02114-2017
Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass.gov/dia
ro.Revised 02-23-15
PERoGo
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NORTH STREET
PLAN OF LAND IN
OF ORTHAMPTON, MASSACHUSETTS
RANOALL PREPARED FOR
�
ER N MICHAEL HARRINGTON
135032
4o� SCALE: 1"=20' MAY 24, 2016
'° uavE HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
413-584-7599 413-585-5976 (fox)
email - hleaton®aot.corn
0' 20, 40' 60'