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23B-008 (14) 267 LOCUST ST- 1C BP-2019-0529 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-008 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) CateaM:Bath reno BUILDING PERMIT Permit# BP-2019-0529 Proiect# JS-2019-000854 Est.Cost: $28700.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CORY DOUBLED" 112033 Lot Size(sq.ft.): Owner: CHRISTINA HIBBARD Zoning: SI(100)/ Applicant: CORY DOUBLEDAY AT. 267 LOCUST ST - 1 C Applicant Address: Phone: Insurance: 564 WHATELY RD SUITE D (413) 665-7402 WC SOUTH DEERFIELDMA01373ISSUED ON:10/31/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENO BATH, REPLACE LIGHTS IN KITCHEN AND DINING, REPLACE FLOOR THROUGHOUT CONDO 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 10/31/2018 0:00:00 $200.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0529 APPLICANT/CONTACT PERSON CORY DOUBLEDAY ADDRESS/PHONE 564 WHATELY RD SUITE D SOUTH DEERFIELD (413)665-7402 PROPERTY LOCATION 267 LOCUST ST- 1C MAP 23B PARCEL 008 000 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL ED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid !ypeof Construction: RENO BATH,REPLACE L KITCHEN AND DINING,REPLACE FLOOR THROUGHOUT CONDO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 112033 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:§ 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 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. . N `' Q'ddrr�'l� Com rruK-0 � n cVA'i'l'`�� artment use on City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterNNell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify r.. MO ISH A ONE OR TWO FAMILY DWELLING APPLICATION TO CONSTRUCT,A4ER, I SECTION 1 -SITE INFORMATION OCT 2 9 2018 1.1 Property Address: T is section to be comp ted by office DEPT OF BUILDING II�J[�CTIONS � / Lot 0'pUnit NORTHAMPTON,MA 1 267 Locust St, 1 C Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Christina Hibbard 267 Locust St, 1 C Florence Z me(Pri Current Mailing Address: � ��(� • � 203-747-0292 K= �j Gt.1 Telephone Signature 2.2 Authorized Agent: Zinnia Stetson PO Box 132, South Deerfield, MA 01373 Name(Print) Current Mailing Address: 413-665-7402 S nat re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 16,250 (a)Building Permit Fee 2. Electrical 2,700 (b)Estimated Total Cost of Construction from 6 3. Plumbing 9,750 Building Permit Fee Q 4. Mechanical(HVAC) 5. Fire Protection N/A 6. Total=0 +2+3+4+5) 28,700 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date HaydenvilleWD @ gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 No changes Frontage No changes 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 Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: Condos/Offices D. Are there any proposed changes to or additions of signs intended for the property? YES © NO Q 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 Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 1 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑✓ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[tom] Other[O] Brief Description of Proposed renovate bathroom,replace lights in kitchen and dining,replace floor throughout condo unit Work: Alteration of existing bedroom Yes X 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: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 Christina Hibbard as Owner of the subject property Haydenville Woodworking&Design, Inc. hereby auttRrize to act onbehalf, in all rgatte_rs relative to work authorized by this building permit application. \ -.;�.. Z Signature of Owner 6ao I, 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: Not Applicable ❑ Name of License Holder: Cory Doubleday License Number PO Box 132, South Deerfield, MA 01373 112033 Address Expiration Date 10/17/2021 Sign elephone 413-665-7402 9.Registered Home Improvement Contractor: Not Applicable ❑ Haydenville Woodworking & Design, Inc. Company Name Registration Number PO Box 132, South Deerfield, MA 01373 110732 Address j Expiration Date Telephone 413-665-7402 11/2/2018 (renew in proceli SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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...... J City of Northampton 4 Massachusetts DEPARTI&NT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ,,;:•.Y: Js,L ca Northampton, MA 01060 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 has contracted with a corporation or LLC,that entity must be registered Type of Work: renovation Est.Cost: 28,700. Address of Work: 267 Locust St, 1 C, Florence, MA 01062 Date of Permit Application: 10/23/18 1 hereby certify that: istration is not required for the following reason(s): Work excluded by law(explain): WJob 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 the agent oft a owner: 10/23/18 Haydenville Woodworking & Design Inc. 110732 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 City of Northampton 5�5•..:".: sic Massachusetts MPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Q g 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. City of Northampton Massachusetts hr •.G DEPARTMENT OF BUILDING INSPECTIONS �'• 212 Main Street •Municipal Building Northampton, MA 01060 fS�...... 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: 267 Locust St 1 C Florence, MA 01062 (Please print house number and street name) Is to be disposed of at: Valley Recycling, 224 Easthampton Rd, Northampton (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) _ r Si a re f P mit Applicant or Ow&r D e 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. '\ The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street,Suite 100 < Boston,MA 02114-2017 t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Haydenville Woodworking&Design, Inc. Address:54 Whately Rd, STE D, PO Box 132 City/State/Zip:South Deerfield, MA 01373 Phone#:413-665-7402 Are you an employer?Check the appropriate box: Type of project(required): 1. d❑I am a employer with 3 employees(full and/or part-time).* 7. E)New construction 2.❑I 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.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]T 10 0 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 11.[]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.[:]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.EJRoof 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#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. ZContractors 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:National Fire and Liability Insurance Policy#or Self-ins.Lic.#: V9WC967711 Expiration Date:7/6/19 Job Site Address:267 Locust St, 1 C City/State/Zip:Florence MA01062 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. 1 do hereby certify under the sand penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#:413-665-740 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#: Haydenville Woodworking & Design, Inc, Custom Cabinetry—Residential Construction—Established 1984 October 29, 2018 To Whom It May Concern: I request that you grant a modification to waive the requirement for control construction for the Christina Hibbard project at 267 Locust St,#1C, Northampton because the work is of a minor nature,will not affect health,accessibility, life and fire safety,or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.Thank you for your consideration. "Mass Amendments,section 107.1 allows for an exclusion from control construction for this project." Respectfully, Cory Doubleday Haydenville Woodworking& Design, Inc. PO Box 132 South Deerfield, MA 01373 413.665.7402 PO Box 132 South Deerfield,MA 01373 1 (413)665-7402 1 HaydenvilleWD@g_mail.com