17A-092 (4) 22 GRANDVIEW ST BP-2019-0331
GIs#: COMMONWEALTH OF MASSACHUSETTS
hjV Block: 17A-092 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADD BATH BUILDING PERMIT
Permit# BP-2019-0331
Project# JS-2019-000538
Est. Cost: $65000.00
Fee: $422.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DOUGLAS THAYER
Lot Size(sg. ft.): 11630.52 Owner. TOOHEY BRIAN&CLARE SHIPLEY
zoning:RI(100)/URA(100)/WSP(15) Applicant: DOUGLAS THAYER
AT. 22 GRANDVIEW ST
Applicant Address: Phone: Insurance:
P O BOX 60322 (413) 530-4785 0
FLORENCEMA01062 ISSUED ON.9/16/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADDITION OF DORMER AND FULL BATH
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 $422.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
_ v `=I �C I y Northampton Status of Permit:
V C uildi g Department Curb Cut/Driveway Permit
j 21 Main Street Sewer/Septic Availability
I SEP Oom 100 Water/Well Availability
N ha pton, MA 01060 Two Sets of Structural Plans
i- nhnnp 41. 587 1240 Fax 413-587-1272 Plot/Site Plans
DEPT OF 13UIL DING INSPECTIONS
NORTHAMPTON,SAA 01060 Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
/'�
V`f Map ( Lot V Unit
IOY FSC M A Zone Overlay District
C[C c a _
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
��t'iUv� �VGF1� � IG(Va �11i Ipl� �;7 �.YQNG< VICk.
Name(Priv-) I- Current Mailing Address:
�- Telephone
Signature=
2.2 Authorized Agent:
Name(Print) \ q Current Mailing Address:
1s) 1��_ V13 - YNS
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building :2 C; OC,•
(a) Building Permit Fee
C
2. ElectricalU, (b) Estimated Total Cost of
Construction from 6
3. Plumbing �Gi CJC�C� Building Permit Fee 4��'
4. Mechanical (HVAC) � � �,
5. Fire Protection l'
6. Total= (1 +2 +3+4 + 5) U17, (� Check Number OZ
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: �+ _ /9//611-H
Building Commissioner/Inspector of Buildings Date
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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 L: R: L: 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 S ecial Permit/Variance/Finding ever been issued for/on the site?
NO DON'T 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 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(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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Z4.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 14
Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding [p] Other[Q
Brief Description of Proposed ] p/
Work: C'I G'Ir I C vin C wmey
Alteration of existing bedroom Yes No Adding new bedroom Yes X_No
Attached Narrative Renovating unfinished basement Yes /X No
Plans Attached Roll -Sheet )
6a. If New house and or addition to existing housing, complete the following:
a. Use of building - ne Family Two Family Other
b. Number of ooms in each family unit: Number of Bathrooms
c. Is ther 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 CONTRACTOtR, APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on myy,behalf, in all matters relative to work aut orized by this building permit application.
Signature of Owner Date
G Gl 1 Cc as Owner/Authorized
Agent hereby dec are that statements and infqrmation on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pa' enaltie of p jury.
Print Name
Signature of Owner/Agent Date
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:) Not Applicable ❑
Name of License Holder: (ti l Q Y l�( C 1076-
q
License Number
Uoyewq 4 0 Y/O 7/1 G2®
Address Expiration Date
_,:;,I
Signature Telephone
9.Renistered Home Improvement Contractor: Not Applicable ❑
1 -7g0 SS
Company Name Registr9tion
/�NNuumber
U lb
Address Expir ti n Date
Telephone
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...... ❑
11. - Homgbwner Exemption
The c/aw
mption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and th homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as suMR 780 Sixth Edition Section 10835.1.
De ition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
i or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
tructures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
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.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature c
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From: customerservice@nCourt.com
Subject: Receipt from nCourt
Date: September 12,2018 at 10:11 AM
To: douglasthayer@gmail.com
Your Receipt
- • Name:Office of Consumer Affairs and Business Regulation-HIC Registration Program
:address 1:501 Boylston Street,Suite 5100
Address 2:
City:Boston
Stale:Massachusetts
Zip 02116
Payment On Of
'Jame. DOUGLASTHAYER
Registration Fee-Reapplication $3.53 $150.00
Guaranty Fund Fee-0 to 3 Employees $2.35 $100.00
Receipt Date: Invoice Number: Total Amount Paid: $255.88
9/12/2018 10:11:34 AM EST bd1c788e-56ac-44df-8e9o-fOebc6df54c6
,.
First Name dougias
Last Name thayer Account Number ----3782
Email douglasthayer@gmail.com
Street 45 spring st
City florence
Stalerrerritory MA
Zip 01062
Important Information»
Please verify the information shown above.Your payment has been submitted to the location listed above.
Powered by ncourt.
Please call 888-283-3757 if you have any questions regarding this information.
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: 2� V� Q t f-
The debris will be transported by: o u a h 4
The debris will be received by: (-2 E
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ��1 C, h a Q r
Address: CL 6 0� �77�J ?-
City/State/Zip: YV k c-f J ` Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 4. ® I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors
6. ®New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
hip and have no employees These sub-contractors have g. ®Demolition
workingfor me in an capacity. employees and have workers'
Y p ty + 9. ® Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ® We are a corporation and its 10.®Electrical repairs or additions
3.® 1 am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.® Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.®Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all 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 sub-contractors 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.
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 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pain nd penalties of perjury that the information provided a ve i true and correct.
Signature: ss:) 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.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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Douglas Thayer woodworking&design
PO Box 60322 Florence MA 01062/(413) 530-4785/www.douglasthayer.com
September 12, 2018
Northampton Building Department
Toohey residence
22 Grandview
Florence MA
Builder: Douglas Thayer
CS # 107699
HIC # 179055
Scope of Project:
Second Floor:
• Addition of Dormer at rear of house with full bath within.
• Bedroom closets in eave space
First Floor: 5INC}ua C -JO(-5 �5
• 8' x 10' c gkId OV Syvvcka
• Renovatii 2�.o(�C �� �Pf�� �u�,�re locations
changed.
• Addition
a�+e,r O1 Pvl��� �fOo
Ve v 1-y X l`s Tint 5 OO►^v` i+`v^5
Structural elen J �/
• Structurai nugu, v., wULL" &,�., be specified by
engineer.
aa�b�1 nO�
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4 MYof Louis Hasbrouck<Iasbrouck@northamptonma.gov>
22 Grandview
Louis Hasbrouck<Iasbrouck@northamptonma.gov> Sun, Sep 16,2018 at 1:28 PM
To:douglasthayer@gmail.com
Permit approved, pending structural report.
See attached plan notes;smoke and co alarms wherever possible depending on work.
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413)587-1240 office
(413)587-1272 fax
22 Grandview 2018-09-16.pdf
289K
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1 ❑
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RIGHT ELEVATION
LEFT ELEVATION
EW DORM R
EXI5TINO HOUSE
- NEW COVERED POR H
■
ELEVATIONS
SCALE 1/4"=17'
PLAN PREPARED FOR
2.7
FLORENCE MA Rn
PLAN PROVIDED BY
LAURA'S DRAFTING
Oou ��-5 Ilia e REAR ELEVATION 2207 AYLOR5T
ORAN BY MA 01033
461-2599
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SECOND FLOOR
LIVING AREA
555 sq ft SCALE 1/4"=1'0"
PLAN PREPARED FOR
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TOOHEY RESIDENCE
22 GRANDVIEW RD
FLORENCE MA
\�f, �u� I / PLAN PROVIDED BY
\'I✓/� U �'nl C_ ANDDLAURA'S DRAFTING
J AND DESIGN
220 TAYLOR 5T
GRANBY MA 01033
461-2899
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?2"IGE AND WATER BARRIER
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- FIN _ 1/2"GDX SHEATHING
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--- - -- - -- - �_- 2X8 RATERS @ 16"OG
VINYL 510INC TO 3-2x10 HEADERS
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w m �,I �i, 6XbFTP05T5
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To the best of my knowledge these plans are drawn --
to comply with owner's and/or builder's GR055 SECTIONS
specifications and any changes made on them after
5GALE 114"=1'0--
prints are made will be done at the owner's and/or
builders expense and responsibility. The contractor PLAN PREPARED FOR
shall verify all dimensions and enclosed drawing. TOOHEY RE5I0ENGE
LAURA'5 DRAFTING&DE51ON is not liable for 22 GRANDVIEW RD
-- - --- - FLORENCE MA
�
j� errors once construction has begun. While every
l US Y �� effort has been made in the preparation of this plan PLAN PROVIDED BY
to avoid mistakes, the maker can not guarantee LAURA'5 DRAFTING
f)� /1 G� / r1��� against human error. The contractor of the job must. AND DE51GN
B, J6 6(� check all dimensions and other details prior to 220 TAYLOR 5T
construction and be solelyresponsiblethereafter.J GRAN BY MA 01033
2-14-18
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12"X 48"GONG.COLUMNS bXb PT P05T5
W/BI6FOOT5 -10' -
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°j NEW COVERED PORCH
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UUUU��` TOOHEY RE5IDENGE
22
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�1 Jv /U7, LAURA'S DRAFTING
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220 TAYLOR 5T
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6` e u Q 461-2899
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