17D-024 (3) 89 STRAW AVE BP-2019-0693
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-024 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate og ry:renovation BUILDING PERMIT
Permit# BP-2019-0693
Proiect# JS-2019-001129
Est. Cost: $50000.00
Fee: $325.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES B CALLAN 105654
Lot Size(sq.ft.): 10541.52 Owner. SPENCE ALICIA
Zoning:URB(100)/ Applicant. JAMES B CALLAN
AT. 89 STRAW AVE
Applicant Address: Phone: Insurance:
151 RIVERSIDE DR (413) 923-1553
FLOREN CEMA01062 ISSUED ON:1/3/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE VINYL SIDING, NEW WINDOWS, NEW
KITCHEN CABINETS, NEW BATH IMPROVE STAIRS
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 1/3/2019 0:00:00 $325.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0693
APPLICANT/CONTACT PERSON JAMES B CALLAN
ADDRESS/PHONE 151 RIVERSIDE DR FLOREN CE (413)923-1553
PROPERTY LOCATION 89 STRAW AVE
MAP 17D PARCEL 024 001 ZONE URB000Z
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
E D REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid Aft — A
Buildina Permit Filled out
Fee Paid
Typeof Construction: REMOVE VINYL SIDING OWS N W KITCHEN CABINETS NEW
BATH IMPROVE STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105654
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
l jF�RMATION PRESENTED:
l!/_ 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.
Department use only
City of Northampton Status of Permit:
.,:-- Building Department Curb Cut/Driveway Permit
_-, 212 Main Street Sewer/Septic Availability
� a
Room 100 WaterMell availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 F x I` ,► e,
pec'
APPLICATION TO CONSTRUCT,ALTER, 3EPA R,RENOVATE OR DEMOL ISH ONE OR TWO FAMILY DWELLING
UtC 2018
SECTION 1 -SITE INFORMATION
DEPT OF 13UII_DfNG INSPECT, r se(tion to be completed by office
1.1 Property Address: NORTHAMPTON,PAA 01060
mapLot Unit
Zone Overlay District
1 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
L pa mi. 6 V'N �O/AtIeA-k
Na rint) Current Address:, � ��
Telephone
Signature "
2.2 Authorized Agent:
Name(Print) Current Mailing Address: Q 0 to
L-Z�z— 4 a--°IZ3 l��3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by permit applicant
1. Building � -, �. (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing d Building Permit Fee
4. Mechanical(HVAC) ,— ✓
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector 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 — 17
000
Frontage
Setbacks Front/O
Sideo/16 L: R:..VQ L' 1S ` R: �.
Rear
�S )pp ' 10L
Building Height
Bldg.Square Footage � a % W6 (,3
Open Space Footage&p p % ' 1#1(001#1(00o
(Lot area minus bldgIdg&paved 10 `
371-
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW,,j YES
IF YES, date issued:':
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued: ,
C. Do any signs exist on the property? YES NO �f
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;.,exg?vation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 N0__,T
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Sidin Other[cq
Brief Description of Proposed 1
Work:nip Vl ] SIID1"7 X�lw� Uk"100h(mc. 'e`� dim CG��� PAi IM�NV
Alteration of existing bedroom Yes No Adding new bedroom Yes No �✓}ci,t r"
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, commlete 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 i Z k as Owner of the subject
property
hereby authorize
to act on m behalf, i all matters relatiye to work authorized by this building permit application.
/ t1A
<Z
Signature of Owner Date
I, � <✓1 5as 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 NapRq
Signature of Owner/Agent Date
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ,
212 Main Street •Municipal Building
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:
(Please print house number and street name)
Is to be disposed of at:
VAL.Lt
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
1� (ZT-
(Company Name and Address) /
// ?—Y�
STrhaturfa of Per it Applican or wrier 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
v, I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Vq�-Pl�.D
Address: vz MA Q19(oZ
City/State/Zip: Phone#: 5(5 7-3- 155-3
Are you an employer:'Check the appropriate box: Type of project(required):
I am a employer with 0_employees(full and/or part-time).* 7. []New construction
2. I am a sole proprietor or partnership and have no employees working for me in $. Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 Q Building addition
4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c.
14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
+Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
-Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: . v�u IqZ Il�l�2✓ — Qo✓>�
Policy#or Self-ins.8Lic.#: G— —�� X� 46 Z�1$ Expiration Date:
Job Site Address: ` 1 >Typw � City/State/Zip: 9m-�•J V\-
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 cert' u der the pains and penalties of perjury that the information provided above iss7true and correct.
Si nature: - `f Date: Z— <
Phone#: /3-q 3 --15 S3
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:Q Y�L1 /Not Applicable/ yl'❑�
Name of License Holder: l�1♦i C7/J \.� ,�— `0 Sv� 1
License Number
Addres Expiration Date
1�-4123- i5 5 3
Sign Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
?1, 1 i u,� k 66 g39, l
Company Name Registration Number
Ad
dress
Expira ion D e
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.......T— No...... ❑
.......... ...
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