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32A-072 (12) 19 UNION ST BP-2019-0280 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A-072 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Stair BUILDING PERMIT Permit# BP-2019-0280 Project# JS-2019-000472 Est.Cost: $5000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES O'SULLIVAN 145040 Lot Size(sq.ft.): 9365.40 Owner. MCDERMOTT BRIAN&ZOE PAPPENHEIMER Zoning: URC(100)/ Applicant: JAMES O'SULLIVAN AT: 19 UNION ST Applicant Address: Phone: Insurance: 264 BUCK POND RD (413) 532-1312 WESTFIELDMA01085 ISSUED ON.9/6/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE EXISTING STAIRS, PART OF DECK AND BUILD NEW STAIRS AND LANDING 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 Deuartment 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 9/6/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION �P.../q, ;1) U �/ 1.1 Property Address: This section to be completed by office �rr Map �A Lot O 7� Unit , Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: k�62,A R-N UNION S i Name( rint) Current Mailing Address: Telephone Signature 2.2 uthorized Anent: ��� ���15�� \VArV ` BUG Name(Print Current Mailing Address: Gl d�s yV\ 4i3 z5o - 742-S Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 6� 5.Fire Protection 6. Total=(1 +2+3+4+5) `j C 0c) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date rA @ Qo mct -�i� NET- EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) C/ RECEIVE SEP - 6 2018 DEPT OF BUILDING INSPECTIONS NORTHAMPTON,MA 01060 .....�_ �....., ... ........`r. }}� + 44 ..... - ....,...,......J 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:fZ�S R: y Z L: Q`5 R: 'V 7- Rear 3-2— 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 ever been issued for/on the site? NO O DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 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 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES ® 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: I cern 11.. ---- _•:__..a:,s..r._•...I i_i___:._. _._..,:__ ,..._---- i i Accessory Bldg. ❑ I Demolition New Signs [0] Decks [J4 Siding[Ell Other[a Brief Descrc��.iption of Proposed Work: i! rtotl 5:- FXlszly 4 ST-Al a!-' ��O� -bc/—L �UtC-1� lel�W C;7-Ai i5 4- ►) ,NS Alteration of existing bedroom Yes�No Adding new bedroom Yes O� No Attached Narrative Renovating unfinished basement Yes _b4. No Plans Attached Roll -Sheet 'Z- 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, A- as Owner of the subject property n h C f ,�l hereby authorize Rm� 1'� V clLl ` 1 U14"' to act on my behalf,in all matters relative to work authorized by this building permit application. �� g- -�� Signature of Owner Date "1, �-� 1't 11 \ 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: V C '/ Not Applicable ❑ } Name of License Holder: A- t (�v—S L)A / r[�a�U License Number 20 1 ock 9-/�) /--& --19 Addr ss Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ M/+D/So re)A's- U l�� D (0& 5 S Company Name Registration Number 1Z ��N� 2� (�i�S i�c�� z7—/ Addre s Expiration 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...... ❑ '\ The Commonwealth of Massachusetts Department of Industrial Accidents 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 Leeibly Name(Business/Organization/Individuat): 1l c rne� Address: 2-�LQ�' �jUG(�- (�b�� �-� City/State/Zip: WE99! f_ ) MP--- Phone#: t-{(�J 'Z'a I,-2S Are you an employer?Check the appropriate box: "hype of project(required): 1.F]I am a employer with employees(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.] 9. El Demolition 3.F-1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I 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 I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.[3 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Q 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 41 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 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct Signature: 2 Date: Phone#• 413 o ZG7`�� Official use only. Do not write in this area,to be completed by city or town official. a 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: /9 v�Jlotj o( (Please print house number and street name) Is to be disposed of at: V A-U-E Z Or-� G L w Aj (Please print name and location of face ity) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or 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. 1 j I I i 7z "I SJ3V6 J cit on I i I dgr,Qj 0 ! --9 MCI it ry N n �� ? 'I`d