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30B-068 (3) 0 RIVERSIDE DR BP-2019-0927 GIS#: COMMONWEALTH OF MASSACHUSETTS MM Block:30B-068 CITY OF NORTHAMPTON Lot, -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateson' Wood Stove BUILDING PERMIT permit# BP-2019-0927 Proiect# JS-2019-001550 Est.Cost:$500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use croup: Homeowner as Contractor_ Lot Size(sa. ft.): 12109.68 Owner: LANE ALEXANDER zoninx URB(1001/ Applicant. LANE ALEXANDER AT. 0 RIVERSIDE DR Applicant Address: Phone: Insurance: 57 PROSPECT AVE (413) 585-1110 (1 NORTHAMPTONMA01060 ISSUED ON.-212712019 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL WOOD STOVE 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: Oo1• 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 Occuoancv signature: FeeTvue: Date Paid: Amount: Building 2/27/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner - Department use only --`— City of Northampton of P": ' .wk Building Department newsy permit 212 Main Street /Sepuc Availability t !� Room 100Wa'hlvyt±slY ArWltkay Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 Plot/Site Plerls Otter Spa-* APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6 r- " 1.1 Property Address. This section to a completed by office Q`v�cs�c map Lot �JIXIt Unit bcwc y-,toL41 M� D�O�� Zone Overlay District 1 ` Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name P er n2 nt s z rf�f� T 4 .1060 Name(Prim/ Current Mailing Atltlres Telephone Sign*u 2.2 Authorized Anent: Name(Print) Current Mailing Address. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (DO (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �'too ` O. 5. Fire Protection 6. Total=(1 +2+3+4+5) I T Y00 I Check Number I L}Q This Section For Official Use Only Dale Building Permit Number: Issued: Signature: 2/Z'7l1 Building Commissioner/inspector of Buildings Date Gllu . cep01-kir- @ � W16L1�.C'oV� 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 Dcpurtment Lot Size .W N.T4S td �c C<g Frontage Setbacks Front `ps PD Side 1.: SDS R:Pis L: ye' R: 32 '.. 0 Rear Building Height j;; Li^+�..: Bldg.Square Footage Open Space Footage q `d (Luareemnus bldg&paved •dfa parking) #of Parking Spaces ' Fill: (volume&torah..) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page!, and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW © YES O 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 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,excavation or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 19 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) D— Roofing Q 0r Doors Accessory Bldg. ❑ Demolition ❑ New Signs [OI Decks [M Siding [O] Other[0] Brief Description of Proposed ((�� Work: Inst�� WooJC i�V Alteration of existing bedroom_Yes �—No Adding new bedroom Yes ✓No Attgched Narrative__ Renovating unfinished basement Yes ' No Plans Attached- t ea. If New house and or addition to existina housing.:complete the foll*Wina: a. Use of building :One Family Two Family Other It. 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 aftached9 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, 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 I, as Owner/Authorized Agent ereb declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under "under the pains and penalties of perjury. Print Name Signature of 6wr6lAgent ate SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Repisli Home improvement Commi Not Applicable ❑ Company Name Registration Number Address Expiration Dale 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 affidayil will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....._ Ef— No...... ❑ City of Northampton. " Massachusetts DEPARTDrENT OF BUILDING INSPECTIONS 9 m 212 Main Straet • Municipal Building \` xoxtnampton, 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 mom than four dwelling units or to structures which are adjacent to such residence or building' be done by registered contractors. Nale:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: L)n.Q 56Ao -r_(4444 _ \ Est. Cost:ISO10 Address of Work: t ) zz-W-M.—A D P . Date of Permit Application: AI-Q, 111 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: 1 hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I h�7eby p for abuilding permit as the owner of the above property: AJ(. 11 TJZ ��ame M ZKA,,0ar �-o�^+C� Date nen and Signature _ City of Northampton Massachusetts � c DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building =J j• C \.. Noithempt0n, 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 rint house number and street name) Is to be disposed of at: -kQ0cr,c� �^4 (Pleas print me location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) bdE l9 Signat�f Permit Applicant 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 InduslrialAccidents 1 Congress Street,Suite 100 Boston, MA 02174-2017 www.mass.gov/dia Rorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumben. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Leeibly Nalrie (Business/OrganizatioWIndividual): Address: V S4 pis-5 cit Nr-- City/State/Zip:k),FA --w-- -oik 'e' (06o Phone#: `0 �SYS-BIO Are you an employer".Check the appropriate box: Type of project(required): 1.❑l an aemployerwith employees(fall and/or part-time) 7. ❑New construction 2.❑l am a sole proprietor or partnership and have he employees working forme in g, ❑ Remodeling y capacity.[No workers'compinsurance required.] 3,E] aIZ a homeowner doing all work thyself[Noworkersemop.insurancerequired.]' 9. E]Demolition 4 F I am a homeowner and will he hiring contractors to conduct all work on my property_ will 10 ❑ Building addition ensure that all contractors either have workers compensation insurance or we sole II.❑Electrical repairs or additions proprietors with no employees 12.❑Plumbing repairs or additions S I e l tractor and I have hired the subonv -caamis fisted On the aaaehed sheet "� am a g "tiaconE]Roof repairs These sub-connav sub-contractors have and hue workers insurmee.- 13. 6 F We are a coryomtion and its officers have exercised their right of exemption per MGL c. 14''--'_-hCryyQ Ug('nll 152,k 1(4),and we have no employees.[No workers'ecmp.insurance required I •Any applicant that checks box a I must also fill out the section below showing their workerscompensation policy information_ 'Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit anew affidavit indicating such :Comraemrs that check this box must attached an additional shcet showing the name of[hesab ountractors and net,whether or not those entitles have employees. If the sub-cou raetors have employees,they must provide their workers romp 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. Lic.#: 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 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 cerci u er belongs and penalties ofpesi that the information provided above is true and correct. Sig t Date' 'dalel (ea, Ph # 4%,S SBS-IUo 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#: Feb. 26, 2019 Alexander Lane 57 Prospect Ave. Northampton MA 01060 Home: 413-585-1110; cell: 917-470-4122 Alex.reporter@gmail.com BUILDING PERMIT APPLICATION NARRATIVE --Project location: 0 Riverside Drive (at Norwood Ave): --Propose to install a cast iron Nashua wood stove for occasional usein utility barn --Stove has 4" legs --Stove will sit on a wood Boor covered with cinderblocks, ("one course of hollow masonry units not less than 4 inches in nominal thickness', code 12.5.2.2), laid with the ends unsealed and joints matched to provide air flow,covered with 24 ga. sheet metal,extending 18"beyond the stove --Stove will be approximately 20" from the wall behind it,which will be protected by a heat shield of 24-ga sheet metal spaced 1" from wall --The stove pipe will be 7" from the heat-shield wall --On both sides there will be 38" of clearance (36 is required) from the nearest combustible surfaces --Will use all necessary components of Duraplus all-fuel chimney pipe system, including transitioning at second floor to double-walled,stainless-steel,insulated chimney pipe,installed according to the building code and the manufacturer's instructions --Chimney pipe,supported by any necessary guy brackets,will terminate 2 feet above the highest point of the roof within 10 feet END U {� CD �P-TT`• tV1 i l 1 `y, c, VOOiiff/ R__"lly 1 �