24D-089-264 NORTH ST
GIS #:
Map:Block: 24D - 089
Lot: -001
Permit: Building
Cateeorv: renovation
BP -2016-1154
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Permit # BP -2016-1154
Proiect 9 JS -2016-001998
Est. Cost: $1500.00
Fee: $100.00
Const. Class:
Use Group:
Lot Size(sq. ft.): 7100.28
Zoning: URC(100)
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
MICHAEL L HARRINGTON 102948
Owner: HARRINGTON MICHAEL L
Applicant: MICHAEL L HARRINGTON
AT. 64 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 393 (4I3) 575-8345
NORTHAMPTON ,MA01061 ISSUED ON.•4/6/2016 0:00:00
TO PERFORM THE FOLLOWING WORK. FOUNDATION REPAIR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service: Meter:
Rough: Rough: House #
Driveway Final:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
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 4/6/2016 0:00:00 $100.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck — Building Commissioner
File 4 BP -2016-1154
APPLICANT/CONTACT PERSON MICHAEL L HARRINGTON
ADDRESS/PHONE P O BOX 393 NORTHAMPTON 01061(413)575-8345
PROPERTY LOCATION 64 NORTH ST
MAP 24D PARCEL 089 001 ZONE URC(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Building Permit Filled out
Fee Paid
Typeof Construction: FOUNDATION REPAIR
New Construction
Non Structural interior renovations
Addition to Existing
Accessoty Structure
Building Plans Included:
Owner/ Statement or License 102948
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION PRESENTED:
pproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR
Major Project: Site Plan AND/OR
ZONING BOARD PERMIT REQUIRED UNDER:
Find
Special Permit
Special Permit With Site Plan
Special Permit With Site Plan
Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW
Septic Approval Board of Health
Water Availability Sewer Availability
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
U*Mlition Dfjav
oey
Sign f Building AficKI 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.
Versionl.7 Commercial Building Permit May 15, 2000
Department use only
ity of Northampton status of Permit:
APR - 1 2016 Euilding Department Curb Cut/Driveway Permit
212 Main Street sewer/SepticAvailability
Lops Room 100 WaterM/ell Availability
"-- ""` ° hampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/ Site Plans
Other Specify - -
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
L{ N O L Map Lot Unit
Non —NA -m P Ok//�
M f9 U 6
/61 Zone Overlay District
........ _. __..._ .... Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
- I IV1'P J - C'# I IIYIP11 Gld VVIYJ 1 RUIi I IIIIV lrVJ 10
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
- of
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2+ 3 + 4 + 5) 0 Oa � Check Number
---- T_his_Section_For_Official--Use_Onl _
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description ?Enter a brief description here.
Of Proposed Work:
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A 1 ❑
A-4 ❑ A-5 ❑ 1B I ❑
B Business ❑
2A
2B
2C
❑
I ❑
❑
E Educational ❑
F Factory ❑
F-1 ❑ F-2 ❑
H High Hazard ❑
3A
3B
❑
❑
I Institutional ❑
I-1 ❑ 1-2 ❑ 1-3 ❑
M Mercantile ❑
4
❑
R Residential R-1 ❑ R-2 0 R-3 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify
M Mixed Use ❑ Specify:
S Special UseElSpecify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
_ .
Existing Use Group: Proposed Use Group.
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): .....
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor (sf)
7. Water Supply (M.G.L. c. 40, § 54) 17.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ F-1Private Zone Outside Flood Zone[] Municipal ❑ On site disposal system[:]
Version L7 Commercial Building Permit May 15, 2000
S. NORTHAMPTON ZONING
I I Existing I Proposed I Required by Zoning
This column to be filled in by
Building Department
Lot Size
# of Panting Spaces
Fill:
& Location) I -
A. Has a Special Permit/ Variance/ Find in er been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Reg' ry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page an /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 Obtained 0 , Date Issu d
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 0 NO
-------IF YES,—describe-size, -ty- p--eand-location:
-- -
E. Will the construction activity disturb (clearing, grading,e
ion, 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.
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not APlicable 171
_...
Name
....... .. .............
P
Name (Registrant):
Registration Number
Registration Number
Address
.... ..
Telephone
__...
Expiration Date
Signature
Expiration Date
Telephone
Signature
9.2 Registered Professional Engineer(s):
Area of Responsibility
Name
.. _ .....
Address
Area of Responsibility
...
Name . _.... _ _ _ _..
Registration Number
Address
Telephone
Expiration Date
Signature
.. ................. .. ..... ................ .... ......
Area of Responsibility
Name
..
Registration Number
Address
Telephone
Expiration Date
Signature
_...
Name
....... .. .............
Area of Responsibility
Registration Number
Address
.... ..
Telephone
...........
Expiration Date
Signature
.....
Area of Responsibility
Name
Registration Number
Address
Yosinol7Commercial Building Permit May l5.2000
SECTION 10. STRUCTURAL PEER REVIEW (780 CMR 110.11) 1
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11'OWNER AUTHORClATON-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
_
Agent hereby declare that the statements and information on
Signed underthopains. andPenauieegfperju[y.
-
foregoing sAioationare true and accurate, tothe best ofmyknowledge
Print N2me
�Jel_ T
Signature ofOwner/Agent v Date
SECTION 12 -CONSTRUCTION SERVICES
SECTION�3 JRKERS(COMPENSATlION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be c nd submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
The Commonwealth of Massachusetts
f Department of Industr fad Accidents
}= Office of Investigations
600 Ul'ashington Street
Boston, MA 02111
www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/S
Phone #:
Are you an employer? Check the appropriate box:
❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
!. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
worl � g for me in any capacity.
employees and have workers'
comp. insurance.*
workers' comp. insurance
5. ❑ We are a corporation and its
equired.]
I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.7 Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ oof repairs
13.VOther JLMJOA-_06�
*Any applicant that checks box #1 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.
lam az employer that is providing workers' compensation insitrance for my employees. Below is the policy and job site
inform ation.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 agai st the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DI�f r insurAce coverage verification.
I do _hereby certify�fW4e t e p and penalties of pe> jury that the information provided above is true and correct.
Of use only. Do not write in this area, to be completed by cit) or town offzciaL
City or Town:
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6. Other
Contact Person:
Permit/License #
City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone
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