31B-124 51 HENSHAW AVE BP-2019-0982
GIs 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31B- 124 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A)
Cateeom KITCHEN&BATH RENO BUILDING PERMIT
Peanut# BP-2019-0982
Proiect4 JS-2019-001614
Est Cost:$34500.00
Pee:$224.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL K DACRI 105989
Lot Size(sa.ft.): 8276.40 OWner: MARTYN TIMOTHY&JANET
Zoning:URC(100)/ Applicant: DANIEL K DACRI
AT. 51 HENSHAW AVE
Applicant Address: Phone: Insurance:
247 RIVERSIDE DR (617) 543-2843 Workers Compensation
FLORENCEMA01062 ISSUED ON:3/11/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN AND BATH REMODEL
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 3/[10019 0:00:00 $224.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File#BP-2019-0982
APPLICANT/CONTACT PERSON DANIEL K DACRI
ADDRESS/PHONE 247 RIVERSIDE DR FLORENCE (617)543-2843
PROPERTY LOCATION 51 HENSHAW AVE
MAP 3I PARCEL 124 001 ZONE URCO 00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
TvoeofCon trutim KITCHEN AND BATH RE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included,
Owner/Statement or License 105989
3 sets of Plans/Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
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
1- _ 3-0 ZO
Sigrlidure 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 Perms:
✓� Building Department Curb CutlDrweway Permit
I" 212 Main Street sewerlSepBc Awilabil'ity
Room 100 WaterhVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
- Dow Specify
APPLICATION TO CONSTRUCT,A T Fill DEM LISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pro Atltl asect�on to be completed by°Rica
�a'N/ . n Lot Unit
!�/� OFPT OFPUIMINGINSPFCTION3
fJnC ccm h hoanlA I'11N I O Farley District
Elm SL District CB Mandel
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
fah N1-rEkr%A
Name(Pd Current Mailing Ad I aas:
Teeph i
Signatu
2 Authoriz
1 �iH�ir�t J7( �o/PylLe�
dnq Current Mailing Address:
<i-� 3-2 Fsy3
Slgrmure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cast(Dollars)to be Official Use Only
completed by mitt applicant
1. Building h (a)Building Permit Fee
OL
Uric
2. Eleal ']V ' \o (b)Estimated Total Costar
P V Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) �� 1
5.Fire Protection
6. Tial=(1 +2+3+4+5) Check Number
This Section For O"Idal Use Only
Building Perms r:NumbeIDssued:
Signature: 3-8-ZO R
Building Commaebneranspector 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 m h filled in by
Building Depamnmr
Lot Size
Frontage
Setbacks Front
Side L R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage nb
(fur area minus bldg&paved
parldnio
#of Parking Spaces
Fill:
(volume&location)
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the NRegisjry of Deeds?
NO O DONT KNOW ( YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO G 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. WN the construction activity disturb(clearing,grading, ahon,or filing)over 1 acre or is it part of a carnation plan
that will disturb over lam? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S DESCRIPTION OF PROPOSED WORK(cheek all applicable)
New House ❑ Addition ❑ Replacement Wlndowa Alteration(s) ❑ Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs IO] Decks [U Siding 0:7] Other
Brief Description of Proposetl
Work: / /
Alteration of wasting bedroom w Yes No Adding new bedroom Yes LNo /
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga. N New house and or addition to existina housing,complete 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?
I. 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
1. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OAR/tCONTRACTOR APPLIES FOR
/.BUILDING PERMIT
V �-T/( / / cGc/'r-(�� ,as Owner of the subject
property
hereby authorize
to act on my behalf,in allmalfters relative to work aut by this building permit application
Signature
ofofcwwnner Date
1. I x�,yc. ] jN� ,as bestOwner/Authorizedyknowledge Agent-hereby ereby dedare 'that Me"statements and information on the foregoing application are hue and accurate,to the best of knowledge
and belief.
Si ned under the pains and penalties of perjury.
1 \ t
Pri e
Signal
O..
Age, Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Ucensod PMJA n=:)2
j Not Applicable ❑
Name of Licence Noldar' ( 1 (-0 Cs- 105-im'-
adress t� v -
E>a»ratian ale
_ 64 -26
Sgnalure Telephone
9�F i a
tar Not AppkaWe 13
I_n 9.2-`)
Camtftegistrartm N
��� Florm� iM
r -
Address E)04-- Data
Telephoneb!f"tJ-y S-d-FH3
SECTION 16 WORKERS'COMPENSATKNL INSURANCE AFFIDAVIT(M.G.L.C.1; f2W46A
Workers Compensation Insurance atfidav et be cwnpleled and submitted with this application.Failure to provide this affidavit wilt result
in the denial of the issuance of the build permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
ss
Massachusetts
rrepna� or apriozMa zMsezc2zons
212 wi sir«t . Maicipa auilEi,,
NortL ton, MA 01060 e�
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, altembon, renovation, repair, modernization, conversion,
improvement, mmoval, demolition, or construction of an addition to any pr: existing ownerbccupied building containing
at least one but not more than tour dwelling units .or to structums which am adjacent to such residence"budding" be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: W YID I JU(Y) ,, / Est Cost:
Address of Work: ly {{CJ'IS�4 A vy— /VOr4LMj12�
Date of Permit Application:
1 hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
_Job under S 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:
]here ayyply for a building permit as the agent of the owner:
Doo 6 l d2g�9
D to Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
010
.rf - NP 010Massachusetts
l�l x
r ARa or BVrL NG M"ECTZONS
212 Hain Stcaet enu,iciauildinq
Noitt,amQpton, 60
Massachusetts Residential Building Code
Section I I O R5.1.2
Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside,
on which there is, or is intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner.
Section I IO R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a persons)
for hire to do such work, then such homeowner shall act as supervisor.
Such homeowner shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she shall be responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to
time, during and upon completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153
(Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts
General Laws Annotated, you may be liable for person(s)you hire to perform work for you
under this permit.
�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 700
Boston,MA 02114-2017
www.massgov/dia
l\orkersCompensation Insurance Affidavit:Builders/COntmctors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant InformationPlease Print Leribly
Narne(Business/OrgmiralioNladividual): ' R 1 L CCI
Address: Y_V5I4,C- 'Df
City/State/Zip:01060 Phone#: 01'1 —SZ/3 c�
Are,...eupbyer?Cheek the approprute hna: Type of project(required):
l1 am a employer with employees(full and/or pantimc)-' 7. New construction
2l oma anle pm nonan or lmnoership and have an crrployms working for on,in 8. ❑Remodeling
my capacity.[No workers'comp.insurance required./
1M I an a human.doing all work mysdt[No warm rs comp.momince mquimd.I 1 El Demolition
4.n I an a homeowner and will be hiring contractorso du
conct ak
ll wman my property. 1 will 10 Building addition
name that ell contracture odd,hoar work. commie ion morranm or are cob 1 L❑Electrical repairs or additions
pmt, taswiNmcmplayces. 12.E]Plumbing repairs a additions
75. anagm nal contractor and l have hired the sub-conhamors listed on the attached shecL 13�RoOFrepairs
These subantraccon have employces and have workers'comp insmmce.:
6 n W e are a mryonsion and its officers have exercised Heir right ofcxcmpdon per MGL c. 14.[]Other
152,§I(4),and we havc no employees-INo workers'comp.insmmce.y,mmd.l
'Any Mplirmn tha checks box at most also fill north,wilco Maw showing dick workers compensation policy information.
I Nomeowmrs who submit this affidavit indicating they are doing all work and then hire nu me contractors must submit a raw affidavit indicating such.
:Contmetors that check this has must mach at an additional sheet slowing the now,of the subcnntramurs and static wlrctla r or amt dose entities have
entpbyecs. Iftle cob-mntunors hive employers,thry must provide ticu workers'carp.rydiry numbs.
l am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. //�� /�
Insurance Company Name: jjV (� W �n� C. _
Policy#or Self-ins.
.LfLia#JExpiration Date: 0� V /
Job Site Address: J/ >"/ +J Arc City/Smte/Zip:-FA11 V/', JI)o�,nl '07CAttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration it eat ).
Failure to secure coverage as required under MGL a 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 ment may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificatio
1 do her certify under a palm d penalties of perjury that the information pram�ded�a o//at77��//����'�``true artd correct.
Si tune' Date'.T'7�J
Pholl
Official use only. Do not write in this area,to be completed by city or town officio/.
City or Town: PernaWLicense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone It:
City of Northampton
•'' Maseachusette
4 i
DS12 a .aT 08 BVILDZPG IRSP IdT g S 'H
212 lrnin Stb. •[Lni 01 Building 111jjjJ
BortrBvpton, ee. 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:
S7 Lle'v�- .w 4't-
(Please print house number and street name)
Is to be disposed of at:
d)'!)
(P191se print nam and ogavon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
S4j— Ghs 50,V1
(Company Name and Address)
i
Signature of 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.
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