23A-216 (3) 32 BEACON ST BP-2019-0566
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-216 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Door Replacement BUILDING PERMIT
Permit# BP-2019-0566
Proiect# JS-2019-000921
Est.Cost: $2400.00
Fee: $65.00 - PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor: License:
Use Group: ALLEN GUIEL 054248
Lot Size(sq.ft.): 9583.20 Qwner: HENSLEY JILLIAN
Zoning:URB(100)/ Applicant. ALLEN G U I E L
AT. 32 BEACON ST
Applicant Address: Phone: Insurance:
63 CHESTERFIELD RD (413) 268-9200 WC
WILLIAMSBURGMA01096 ISSUED ON.•11/14/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-FRAME IN ONE 6FT SLIDING DOOR, INSULATE,
PATCH SIDING ANDD ONE NEW WINDOW
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: il: 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 11/14/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0566
APPLICANT/CONTACT PERSON ALLEN GUIEL
ADDRESS/PHONE 63 CHESTERFIELD RD WILLIAMSBURG (413)268-9200 Q
PROPERTY LOCATION 32 BEACON ST
MAP 23A PARCEL 216 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
T eof Construction: FRAME IN ONE 6FT SLI ING DRa INSULATE PATCH SIDING ANDD ONE NEW
WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 054248
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
z L4-J�l T
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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
"- Room 100 Water-ANell Availability
yti _ 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 TWO FAMLY DWELLING
SECTION 1 -SITE INFORMATION 7
1.1 ProPertV Address: hThis section to be completed by office
7j a S � Map r/� Lot _unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2Authorized Age nt: �� C � e«
,11u����2w15 D lc�r
Nam t) Current Mailing Address:
/; �46
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)
5. Fire Protection
53 Total=0 + 2 + 3 +4 + 5) oV Check Number
This Section For Oficial Use Only
BuildingPermit Number: Date
Issued:
Signature:
Building Gommissionerllnspectar of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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 Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW Ah YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO � DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q 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 NO
IF YES, describe size, type and location:
E. 'Will the construction activity disturb(clearing,grading,enavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK[check Al applicable)
New House ❑ Addition ❑ Replacement Windows I Alteration(s) Roofing ❑
Or Doors -EEP
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [q Siding[o] Other[lam)
Brief posed
Work:
G'on tAY QPE ' 4101A e eft , 14'x&r6 ' fm 41M , APP o
Alteration of existing bedroom Yes No Adding new bedroom Yes _ No
Attached Narrative Renovating unfinished basement Yes __)C_No
Plans Attached Roll -Sheet
5a. If New house and or addition to existing housing, complete the following:
a. Use of building: One Family Two Family Other
In. 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 .
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMT
I, (4&1" �j L / as Owner of the subject
property
hereby authorize AN
to act on my behalf, in all matters relative tv work thorized by this building permit application.
!� SIle
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 under the pains and pprialties of perjury.
Print Nam '26 RZ
%Mla hll�
Signature ver1A9ent Date
SECTION 8-CONSTRUCTION SERVICES
1 Licensed Co i isor Not Applicable
Name of License Holder: 65-
License Number
�y -1,
14A-
Add Expiration Date
5,�V
Sigr at a Telephone
R2glistered Rome ImDrovernert Cortractor Not Applicable
khm av I-2 U
C m Registration Number
- � d/D�r � • i 3 ' two
Addrmh
Expiration Date
Q4� - Telephone 7�
SECTION 10-WORKERS'CONDENSATION INSURANCE AFFIDAVIT(NLG.L.c. 15Z§25C(6))
Workers Compensation Insurance affidavit must he 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...... !
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 7
4 212 Main Street • Municipal Building �J•.. b
Northampton, MA 01060 ss: -�y'11�ti�
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"}.
XG.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
�a
Type of Work: .f Est. Cost:
Address of Work:
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 of the owner:
AZ61J 6016�, 16 W(q
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
The Commonwealth of Massachusetts
Department oflndustrialAccid'ents
I Congress Stree4 Suite 100
Boston, MA 02114-2017
www.mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contracts^s/Elecfridans/Plumbers.
TO BE FILED WITH THE PERNUTTING AUTHORITY.
Applicant Information A Please Print Leulbly
Name (Business/Organization/Individual): Q1e,4
(/
Address: �� Cf(�T (t`Z� pp
City/State/Zip: W 1U( 6 , )Q lY6 4106 Phone #: /Z v
Are ou an employer?Check the appropriate box: Type of project(required):
1. I am a Employer with I employees full and/or part-time).�_ < P ) 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working forme in $. MRemodeling
any capacity.[No workers'comp. insurance required.]
9. rl Demolition
3 F�I am a homeowner doing all work myself.[No workers'comp. insurance required]t
10E] 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 eitherhave workers' compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees. 12-Q Pluming repairs or additions
5.0 I am a general cmtractorand I havehired the sub-contractors listed on the attached sheet. Un Roof repairs
These sub-contractors have employees and have workers'comp. insurance.t
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.
I 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 on an employer thatssproviAWg workers'compensation Mmirmwefor my employees Below is Mepolky=dJob site
itt/otmadon
Insurance Company Name: A A-a6)C0 Upoe( y -o- �1Jy • L _
Policy#or Self-ins.Lic.#: 664POOL --9 F(06M - 2' 12 Expiration Date:
Job Site Address,? � �, . 1" �e,S-2V�� A� 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 verific tion.
I do herebyr the enalties of perjwy that the ii�ormadon provided arbawe is true and correct
i e: t .
�5 l
Phone#:
Off1-ciaa use only. Do not write bn Mis area, to be completed by city or town off Ickd
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
�` •'� Massachusetts
DEPAR4WXXT Or ,BUILDING INSPNCCTIoNs
212 Main Street *Municipal Building
Northampton, MA 01060 rfE%yy
Debr i s 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:
T-1e1E-1kC0!6
(Please print house number and street name)
Is to be disposed of at:
la6 &L/&)q1qF ftP,6 YA
D�'nA
(P ase print hame a d Iodation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signa a of P-ermft Aplilicaiftror 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.