Loading...
24A-175 (2) 305 PROSPECT HGTS BP-2019-0327 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 175 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2019-0327 Proiect# JS-2019-000529 Est.Cost: $16000.00 Fee: $104.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DANIEL K DACRI 105989 Lot Size(sa.ft.): 61419.60 Owner: SEIDLER ANN GANONG&JAN SEIDL RAMIREZ&WILLIAM DICKSON BAYA Zoning: URA(I00)/ Applicant. DANIEL K DACRI AT. 305 PROSPECT HGTS Applicant Address: Phone: Insurance: 247 RIVERSIDE DR (617) 543-2843 FLORENCEMA01062 ISSUED ON:9/16/2018 0:00:00 T %RbfTHE FOLLOWING WORK-2ND FLOOR BATHROOM RENOVATIO STRIPD SHINGLE _4 .f,d.-R—C�,— R (1 21ig 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 9/16/2018 0:00:00 $19416l " 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 305 PROSPECT HGTS BP-2019-0327 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 175 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CateaoU: Bath reno BUILDING PERMIT Permit# BP-2019-0327 Project# JS-2019-000529 Est.Cost: $16000.00 Fee: $104.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DANIEL K DACRI 105989 Lot Size(sq.1): 61419.60 Owner. SEIDLER ANN GANONG&JAN SEIDL RAMIREZ&WILLIAM DICKSON BAYA Zoning_URA(100)/ Applicant. DANIEL K DAC R I AT. 305 PROSPECT HGTS Applicant Address: Phone: Insurance: 247 RIVERSIDE DR (617) 543-2843 FLORENCEMA01062 ISSUED ON.9/16/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:2ND FLOOR BATHROOM RENOVATION 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 9/16/2018 0:00:00 $104.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0327 APPLICANT/CONTACT PERSON DANIEL K DACRI ADDRESS/PHONE 247 RIVERSIDE DR FLORENCE (617) 543-2843 PROPERTY LOCATION 305 PROSPECT HGTS MAP 24A PARCEL 175 001 ZONE URAL 00)/ 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: 2ND FLOOR BATHROOM RENOVATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 105989 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: 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 Y&1 1 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. } i t RECEIVED Department use only City of North SEP 1 3 201 mpt n tatu of P f rmit: .J Building'Dep rtm nt Curb ut/D iveway Permit 212 Main tre%EPT OF BUILDING INSP $P p.(Sep c Availability Room 1 NORTHAMPTON.M Availability \ Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR ZTWO FAMILY DWELLING SECTION 1 -SITE INFORMATION � ` J P` I Z-� 1.1 Property Address: This section to be completed by off ice 2j� > S -7 , Jv� ,* Map_�1_ Lot l J� Unit 0)06o Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: cDQG cs.&)-- E-m-J- Na (Print) Current Mailing Address: , _ p �+ 1 1 _ :a g g Telep on igna re 7 S ` c) K 4z- uthorized Agent: � • � .��� �l✓Cl3iG�.�� Oit�.7 n ) 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 'Z (a) Building Permit Fee v 2. Electrical �/ �© (b) Estimated Total Cost of 0Construction from 6 3. Plumbing 0000 Building Permit Fee 4. Mechanical(HVAC) ! 9�oy 5. Fire Protection 6. Total=0 +2+3+4+5) ? Check Number l This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) cr+ Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side I.: R: I_: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding er been issued for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO O 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 DONT KNOW 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exgavation, or filling)over 1 acre or is it part 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[p] Brief Description of Proposed a xt C f w f �,,t f ouln Qx�mt,4 f Jn Work: 1—/ t�1 V Alteration of existing bedroom Yes i' No Adding new bedroom Yes "/No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 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? 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, J as Owner of the subject rope here authorize OTt/\\, _—�V.�i r t on my behalf, in allnaers relative to work authorized by this building permit application. ,sInat a of Owner Date EME 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. 1 Print N Sign of OwAWAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructlaq Su rvis : Not Applicable ❑ Name of License Holder: �� 1 C �) )0'} gq License Number IkA C>}V A ss Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ �,� �� ' �G1t .1( -1 Company Name Registratio Number Address U Ex rati n Date TelephoneC- r/ -1S'L)' 3-d t 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...... ❑ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leribly Name(Businnesss/OrganizatiorAndividual): 77�CIV � qC.r) Address: ��v W ��k, .1 )( ��6 �-- City/State/Zip: ��C7�,�— Phone#: G 1 "Sy3 �7 3 Are you an employer?Check the appropriate box: Type of project(required): l.O 1 a employer with errgrloyees(full and/or part-time)* 7. New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.O I am a homeowner doing all work myself[No workers'comp.insurance required.]t 1 ❑Demolition 10 Q Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.a I am a general contractor and 1 have hired the subcontractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4],and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing al work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors 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 policy and job site information. rJ �U� Insurance Company Name: CID Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: :IF3i5 DIr%4U 4' ql , niQ(o® City/State/Zip: �IOi7 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 oLlhis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vejAeTMN Ido here certify uid/tikepa96 and penalties of perjury that the information provided above. true and correct Si e: / —� Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ofciaL City or Town: Permit/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 Person: Phone#: City of Northampton SSS `SSC Massachusetts bL` -A LL ; ,4 DEPARTMENT OF BUILDING INSPECTIONS y z (AW 212 Main Street •Municipal Building --'�� Northampton, MA 01060 ssNyy x7�^�� 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 construction work being performed at: 0-5 (Please print house number and street name) Is to be disposed of at: �G '(Didase printame a location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owner Dat 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 c LZPAR7MWT OF BUILDING INSPECTIONS S ` 212 Main Street • Municipal Building Northampton, NA 01060 rsi `moo 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 owner-occupied 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�rODPI\ has contracted with a corpo�rration or LLC,that entity must beeregistered Type of Work: ACl 4'�� Est.Cost: �f//�- Address of Work:-3 i p5 m6a Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 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: I hereby apply for a building permit as the agent ofthe o >AF / i,-, cr; l &r V Dae Contractor Name HIC Registration No. OR: Vthding the above notice, I hereby apply for a building permit as the owner of the above property: Ate Owner Name and Signature City of Northampton S" Massachusetts '<<c �- EEPARDIENT OF BUILDING INSPECTIONS y a 212 Main Street • Municipal Building C Northampton, MA 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. r - t mol p4P Jl H + M��� -nn ad W'b w v r v% F-r (JI)bNAbQ 50(E I