25C-144 (7) 35 ORCHARD ST BP-2019-0723
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 144 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ALTERATION BUILDING PERMIT
Permit# BP-2019-0723
Project# JS-2019-001182
Est.. Cost: $3200.Q0
Fed,,,, 6L0o PERMISSION IS HE'REW F GRANTED TO:
9ass: Contractor: License:
Ilse QroU: Homeowner as Contractor
Lot Size,(sg.ft.): 8712.00 Owner: GETOFF SARAH B&CHRISTOPHER N SCAM ON
Zoning:URB(100)/ Applicant: GETOFF SARAH B & CHRISTOPHER N SCANLON
AT. 35 ORCHARD ST
Applicant Address: Phone: Insurance:
37 ORCHARD ST
NORTHAMPTON MAO 1060 ISSUED ON:12/21/2018 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE PORCH POST/CONSTRUCT AWNING
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: Fir, e_D�e�.ar mint Fireplace/Chimney:
Rough: 211: 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 Occul?ancy Signature:
FeeTvpe: Date Paid: Amount:
Building 12/21/2018 0:00:00 $65.00
212 Main Street,Phone(413)587.1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0723
APPLICANT/CONTACT PERSON GETOFF SARAH B&CHRISTOPHER N SCANLON
ADDRESS/PHONE 37 ORCHARD ST NORTHAMPTON
PROPERTY LOCATION 35 ORCHARD ST
MAP 25C PARCEL 144 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICAXION CHECKLIST
ENOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE PORCH POSTXONSTRUCT AWNING
New Construction
Non Structural interior renovations
Addition to Existing`
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION PRESENTED:
_K_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
4 ) I z. _o 1 18
Signature of Bmldmg 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.
6w,h.j
City of Northampton ' �
Building Department
212 Main Street
Room 100 .....
Northampton, MA 01060 s
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR REN' .Afff A ONE RR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION DEC 1 7 2018 9 e/y, 7, 3
This sec#on t be completed by office
1.1 Property Address: / C
oEar�uis si i060 s5 Lot ' ` unit
v0F Pvq ot{0 fzxr O1010 O zoo* Overlay District
Elm St.``DistrictCS District
SECTION 2-PROPERTY OWNERSHIPtAUTHORIZED AGENT
2.1 Owner of Record:
f-a"k 6 e n lVe
l'O(
Name(Pri Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTIQN 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
6. Total=0 +2+3+4+5) Check Number
This Section For Official'Use Only
Building Permit Number: Date
Issued:
signature:
Building CommissionedInspector of Buildings; Date
C0 C. @ rr1� l. CQ 12-1
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
LotSize la_. _ _ _..._,_, . ....,s _._. _ ............. _..._.. ._._.. .... -
Frontage ..........
Setbacks Front
Side L. R:;-- L. ._,_._. R-1
Rear
Building Height
Bldg. Square Footage " %
Open Space Footage % --
(Lot area minus bldg&paved __
parking)
#of Parking Spaces
Fill:
Ff
volume&Location) . ........., _.._ ...., .._...__,.,,,
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book ! Pagel and/or Document#!
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ® , Date Issued
C. Do any signs exist on the property? YES ® 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 0
................._ _...... ... ...w. ._..... ...
IF YES, describe size, type and location: f
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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTIONDESCRIPTION OF PROPOSED WORK(4chock all apolicable)
New House F-1Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 13
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[o]
Brief Description of Proposed n �Q C p D / 7 e)5�� - 5 fro c Q :, 1 n / ,�„
Work: C�/� �(l "- I`1
Alteration of existing bedroom Yes_�No Adding new bedroom Yes _No �.J
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
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 To-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES F'OR'BUILDING PERMIT
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
of— as Owner/Authorized
Agen hereby declare that the statements and i formation on he foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury. /
Sa +tea_ o '
leo(�`r�t
rint Name ^�
Signa a of Owner/A nt Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
6JO F-6-5
Company Name Registration Number
• m vrcfex zlz!
Address Expiration Date
Telephone 5-IN
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 builoing permit.
Signed Affidavit Attached Yes....... S( No...... ❑
City of Northampton
Massachusetts �� .
c
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 j1t
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:/Z_q a_C e— PU�,no�f�Co>7S�r'� Est. Cost: �—�I
Address of Work: 3 s 7-
Date of Permit Application:
1 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:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permi s the ow er of the a ove property:
Lr
-4, -k=
Date Owner Name and Signature U // k_�
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building AA
Northampton, MA 01060
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:
`3s - 3 C�rc �'c� 6f, o (D 6o
(Please print house number and street name)
Is to be disposed of at:
R1fqqr-t ,'vL(::?,
(Please arint name and location of facilit
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit pplicant 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 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 /,, /' /� --j� Please/Print Le ibl
Name (Business/Orga^nization/Individual):_7=5a r�r®1 C�e t-0-( -f / / d Au Ko
Address: 3 J - (' Ct. c 6f-
'41,
�- - - a- 4A�A
City/State/Zip: Phone#: �-'� 5 - 3 S 3
Are you an employer?Check the appropriate box: Type of project(required):
l.JJ I am a employer with 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. E]Remodeling
y capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]!
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 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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#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.Lie.#: 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 certifv under thepains a penalties of perjury that the information provided above is true and correct.
Si ature: Date: t
Phone#:
Official use only. Do not write in this area,to be completed by city or town offieiat
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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