24C-179 (5) 199 CRESCENT ST BP-2019-0990
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW-.Block:24C- 179 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category, ADDITION BUILDING PERMIT
Permit# BP-2019-0990
Proiect# JS-2019-001633
Est.Cost: 5190000.00
Fee: 51235.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CRAIG MARNEY 057159
Lot Size(su.ft.): 21605.76 Owner: COOK BRIAN J&DEBORAH C
Zoning; URB000)/ Applicant: CRAIG MARNEY
AT: 199 CRESCENT ST
Applicant Address: Phone: Insurance:
P O Box 128 (413) 586-5512 WC
LEEDSMA01053 ISSUED ON:3/12/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.1 STORY MUDROOM/ ENTRY ADDITION,
PORCH, DECK, INTERIOR RENO, 2 REPLACEMENT WINDOWS
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: O_1: 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:
FccType• Date Paid: Amount:
Building 3/12/20190:00:00 $1235.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
DiMakirawrit use only
City of Northampton SfeWnolPermtt: •.aqyw� "�
Building Department Curb nnR
212 Main Street SdIMV)ASepticA
Room 100 Waw*OVAwdisbH '
Northampton, MA 01060 Two BiIN YYBg11C111rel Plana ,, ,;,'•.•
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALT H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooenv Address: NAR ) 2 2019 Thseo..n tb �e7
Nap / by office
Unit
l99 i DEFT OF 6uIIDINp�y$p�
x'tsr"NT NORTMAMPTOIfM. i11O10ON Overlay DlaVlCl
Elm SL DIMct... CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT -
2.1 Ownar of ReeoM:
'g�tn-r�7. Cu,l� - DEf3o¢A1l G. LAK-_ i�9 Cvr=scnr� S}-�Nw'f�oH1�
Name(Pd Current Meiling fNtlres
Teleptione /nit'
Signet
2.2 Authorized Aaent:
G sin sf� P.\dV—%.5 L8 1 5
Neme dnt) Current Mailing Address:
58 6 - .5_99 {z
SignatureTelephone
SECTION 3-ES MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be ORtlal Use Only
completed by permit applicant
1. Building 156, D-V- I- (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
IC Construction from 6
3. Plumbing /s 60 Building Pemrl Fee
4. Mechanical(HVAC) /O W 406
5.Fire Protection b
6. Total=(1 +2+3+4+5) /90J 000. DL Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commisslanenlnspector of Buildings Dela
Il*-0 -`l Z a aS\S eJ . Gbr`
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 fillod in by
Building Depenment
Lot Size -----
--
Frontage
Setbacks Front t L•1. 4)
Side L f O' Rl L;Uds
Rear
.............
Building Height
Bldg.Square Footage
Open Space Footage /
(loons mints bldg&Pevoi 100 QD] 04,
eicu
4ofPuking Spaces
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO er DONT KNOW O YES O
IF YES, date Issue& '
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0..... _.._..
IF YES: enter BookI Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued: ---,-�
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(dealing,grading,(e��zctWanon,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre'? YES O NO V
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION e-DESCRIPTION OF PROPOSED WORK(check II applicable)
New House ❑ Addition Replacement Wifitlows Alteretion(s) Roofing Q
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [C3] Decks [p Siding[[3] Other[CO
Brief Description of Proposed
Work: V&stc.J 6GKV 6R TLaGL ti.
L SLS.. �•u 9
Alteration of existing bedroom Yes No - Adding new bedroom Yes No
Attached Nartati Renovating unfinished basement Yes No
Plans Attache Roll -Sheet
ea.If New house and or addition to existina housina.complete the following:
a. Use of building :One Family V Two Family Other
'a Cr.x.sT
b. Number of rooms in each family unit: O Q=yJ Number of Bathrooms Z
c. Is there a garage attached? OJ
-46t Lry-4PAt1
d. Proposed Square footage of new conshuction.,3yas oa�imensions i 4 x -4!1
e. Number of stories? I
U Method of heating? az..b'S� Lypy Ga1y.1 Fireplaces or Woodstoves O Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction SES
I. Is construction within 100 fl.of wetlands? Yes V Ni Is construction within 100 yr. Floodplain_Yes-Z-No
j. Depth of basement or cellar floor below finished grade 7
k. Will building conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ City Sewer Y Private well City water Supply ✓
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING�P�E1RIMIT ,.',.t /
1 � NitAP tawµ— O Yj .{7✓tr-n 51 6- - wW`— ,as Owner of the subject
property
hereby authorize
to aon m half ' all matters relative to work authorized by this building permit application.
�ECv>rlC- 2/2-2/I
8I,nr of Owner Date
i
J154'5
/ IN as OwnerlAuthorized
Agent hereby declare that the s ements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed u er the pains and penalties of perjury.
AA�
Print Name
7
Signature of 6wrer nt Da
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of Clem..Holder /aa" ` A\Js . _ _ .] e>-S ? t 59
License Number
'JO S'3Cf.. 2$ "MHL4>5 n�
Address Expiration Date
413 •�58cS•.5312
Signature Telephone �= t
g, roNot Applicable ❑
A\ V a 4 4
Company Name Registration Number
Ir-7 t e2r1Z
Address
Expiration Date
Telephone-5"-.S5 VZ- G�2 !>
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Ill c.152,¢25C(8))
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 buildin rain.
Signed Affidavit Attached Yes....... N....... ❑
City of Northampton
Massachusetts
�( rs
DEPARTNENI OF BUILDING INSPECTIONS �` s
212 Win Street Municipal Ruildi�
4D RortLaepfnn, W 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:
t 99 G�tv�cc�� Sr
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
3/ R
Signat a of a mit 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.
I1\/ City of Northampton
lL8988Ch1198t:t:9
i
D212 Min
OF BBIDOINi nl Bui din,
212 Main rtraa! o Municipal Building ZJ�.v„�1i� Fhb
aorU,ampWn, 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-exisilng owneraccupied 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:Lf the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work:b,�vrw ownI .'Z ta�./wrsc Vl Est.Cost /90.04200
Address of Work: 1 N s €L,
Date of Permit Application: 3./1-4 �9
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}p y for a building permit as the agent of the owner:
379 h� 4N\h V-Qk�_-,P orz ,tz
Date Contractor Name HIC Registration No.
OR:
� Z�
Notwiths ruling the above notice,l hereby apply for a building permit as the owner of the above property:
2
Date' Owner Name and Signature
iL The Commonwealth ofMassaehusetts
Department of Industrial Accidents
I Congress Street Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO DE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organaation/individwl): *��/.j•IZ.5Ga�1
Address:•67 0s.k Ra.air., l s� e-:,
City/Sta1e/Zipy1u-1aNwt! A !n Phone#: -14,b -,5H •.5,612
Areyouan employee Clerk the appropriate boa: Typeof roject(required):
Le l l am a employer with employees(foland/ta"mr-rime)" 7. New construction2 l am a sole propnetm or partnership and have no employees warking for me in g, ga'Itemcdeling
any current,[No warkers comp,macrame mounted]
3.P I sm a homeowner doingall work If No workers co man red 9. []Do Olitinn
a myself I comp,vs ce ralui �'
4.❑lama homeowner and will be hiring contactors to conduct all work on my property. ]will 10 Building addition
arraturs,that all tontmctma either have workers comprmaation insurance none sole 11.❑Electrical repairs or additions
prop rstors with no employes.
12.❑Plumbing repairs or additions
5. lam a genera]annotator and l have bored the subcontractors livad on the mucked sheat 13.E]Roof repairs
These subeomtmcmrs have employees and have workars comp.insurance!
6.❑Weare a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§I(4),and we have m employees.[No workers'comp,insmanee required]
"Anyepplienntiva iduscksbox#1 mustalso filloutthesectioebelowshowing theirwohersearnvosalionpolicy information
'Homeowners who submit this of nitwit indicating they are doing all work and then hire outside commdors must submit a new affidavit indicating such.
:Conbsetors that check th,has at mouthed an additional sheer showing the name of the sob-amormaors and state whether of not those entities have
employees. If the aubcontractors have employees,they must provide their workers'comp.policy number.
I"an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
Information.
Insurance Company Name: / ��,'
Policy#or Self-ins.Lic.#: l zsu+a ' LYZi.+,✓a_.yHd•L•If Expiration Date: p/ /' 9_
Jab Site Address: 199 - -AT 15—% City/State/Zip:L'��—III A` Vb AA Cistlelea
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 cerci/ij'undcrr�thaepains andpenalaes ofperjury that the inforehationproaidedo /vJ is true andcortec6
Sinature / H/a'Y Date: 9
Pn #:41s •a • .,Is t�
Oficial use only. Do not write in this area,to be completed by city or town offleial
City or Town: Permit/Lieemc#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CItyrfown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: