42-044 (7) 661 WESTHAMPTON RD BP-2019-1142
GIS 4: COMMONWEALTH OF MASSACHUSETTS
MVt Block:42-044 CITY OF NORTHAMPTON
Lot:.00 1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Canaory: renovation BUILDING PERMIT
Pgrn it a BP-2019-1142
Proiegft JS-2019-001519
Est.Cost:$208.00
Fee,S208,00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
Use Group: MATTHEW HILL 098367
Lot Size(su.R.): 25047.00 Owner: O'BRIEN MICHAEL 1&GAIL L
Znninz Applicant- MATTHEW HILL
AT: 881 WESTHAMPTON RD
Applicant Address: Phone., Insurance:
20 COBB HILL RD (978) 227-4044
PHILLIPSTONMA ISSUED OM412Q✓20190.00:00
TO PERFORM THE FOLLOWING WORK.-MAKE GARAGE INTO BEDROOM, 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: Houses Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: ()it., Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF FFS RULES AND REGULATIONS.
Certificate of Occupancy Sienature:
FeeTvve: Date Paid: Amount:
Building 4/2620190:00:00 $208.00
212 Main Street,Phone(413)587.1240,In:(413)587.1272
Louis Hasbrouck—Building Commissioner
File tt BP-2019.1142
APPLICANT/CONTACT PERSON MATTHEW HILL
ADDRESS/PHONE 20 COBB HILL RD PHILLIPSTON (979)227-4044
PROPERTY LOCATION 661 WESTHAMPTON RD
MAP 42 PARCEL 044 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
REQUIRED DATE
ZONING FORM FILLED OUT n
Fee Paid A n0
Building Permit Filled out
Fee Paid
Tvoeof Construction: MAKE GARAGE INTO BEDROOM,2 REPLACEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 096367
3 sets of Plans/Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
_JXApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Projem: 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 Dads 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
D ' ion Delay
Sigalaturb of Building Official Date
Note: Issuance of 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 moa information.
Department use only
City of NDrtam ECEIVE uCut ermd
i
.+^ Building De artCu ermit Permit
f 212 Main tfe t 9e U&Dtic Availability
Room 00 APR 1 6 2019 `W r/W Il Availability
'• Northampton, 060 T Sets of Structural Plans
phone 413-587-1240 ax - site Ilans
DFPT OF mUllrnNG INSPFC
NOATHAVPIOKMAn1101,-Spofy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address'. N This section to be completed by office
GG / GvC S fyAw'OMap Lot Unit
�d/i'h {/LYhPJfON , Zone Overlay District
Elm Sc District CB District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
zJ/'04is. SfoY r. /t4!//-1/ 19
o/P-,( ff 14 a" A".
Name(Print) Current Mailing Address'. S6 p ' 7�
Telephone 0
Signature
2.2 Authorized Agent: pL/i)if e7�407,/4 Y
/iu1T Hy-,( 10 c o/>/> /-J"/f ✓{ C/
Namee(Pynt) ' Cument Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building Z GOv.�a (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 0�6<2
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number /zJ'
This Section For Official Use Onl
Building Pemnit NuDate
m
Issued: 'l
Signature: N-z6-26p/
Building Comindiu nedinspectorof Buildings Date
/fl lfi/fX )9.1V(1 01'g5 ( 6rne,Casit . '4/¢-�
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
fill! -�ttd w e- 1�4'11
Section 4. ZONING All Information Must Be Completed. Permit can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This eoluma w be filled m by
Building Depemnenr
Lot Size _._..._.
Frontage ..-. -_. . ....
Setbacks Front
Side L: _. R: _. L - R._.. ._. _.._.__.
Rear
Building Height -
Bldg.Square Footage %
Open Space Footage %
(Lot am mime bwg&paved
ofParking Spaces
Fill:
volume&Lacadon ----- ----
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document If
B. Does the site contain a brook, body of water or wetlands? NO O 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 O
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 O
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 O NO O
IF YES,then a Northampton Stoml Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows AHeration(s) Q Roofing O
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks IO Siding(Oj Other[O]
Brief Descri tion of Proposed
Work: AGe �' ✓ f✓.v. 1.+ 5
Alteration of existing bedroom_Yes_No Adding new bedroom Ves No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
raa.H New house and or addition to existing 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?
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 f-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=
OMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPPLIES FOR BUILDING PERMR
I, fiter, 5-,010-, - ACR 12'of as Owner of the subject
property �/ Jrf—
hereby authorize / /
to act
tonjmy behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner / Date
as Owner/Authonzed
Agent hereby tledare that the statements and information on the foregoing application are we and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Signature of Owner(Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable O
Nemo of License Holder: �a/l ir -S-O,?65 7
rr/1 � License Number ��
AV Co/50 9•1f Aj �LJ;�I r , ern Y—lO— ao
Pddres EVVabon Date
Signature Telephone
8.Realstered Homo Improvement Contractor: Not%pplicable�/ 1�e
Company Nanta Registrationf/01
�p�
X 00 '-/GSd414 � /
Address Expiration Date
2• Ce4/S !f/ /r � relepnone 47 `177-Y17Vy
SECTION 14 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.11; s YSC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affitlavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
�ba
L0
12
City of Northampton
Massachusetts 'L `Q4
IZPAROWCUT or RMWING INSPECTIONS
212 win etrwt • Nu Cisal euilaL
NorNa ton, Na 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 ofan addition to any pre-existing owner-occupied 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:Ifthe homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Est.Cost:
Address of Work:
Date of Permit Application:
1 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 pemtit(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 apply for a building pemdt as the agent of the owner:
Date 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
•±" Massachusetts
DEPANTNENT OF BB2IDINO INSPECTIONS
212 lain Street • N Iczp&l svllG nq .�
Nortlan,ton, NA 01060 sThA.�ajl
Massachusetts Residential Building Code
Section I IO 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 110.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 110.115, provided that if a homeowner engages a person(s)
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.
City of Northampton
Massachusetts // S. ✓�`
DEPARTABEJT OF BDIIDZNO INSPECTIONS
212 eLin Swat Building
xarthu ton, m1 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:
(u
(Please print house number and street name)
Is to be disposed of at:
/teouxI (, SC�i
(Please print name and location of acility)
Or will be disposed of in a dumpster onsite rented or leased from:
Syr (�u,'1- - M� CbfI'Goapr
)�(CGo/ rNiM-1Name and AdLS))
Sidfiature 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.
�A The Commonwealth ofMassachuseffs
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
svtvat mass.gov/dia
V11.1rers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �/ Please Print Legibly
/k
Name(Business/OrganizatioNhWividual): /'n /La fjON/rte.
Address: 2-0 COAG /-Ji// A.(
�1
G/717 +�
P -AreCity/State/Zip: P14r//t fAX-r a f*/ Phone#: / 2P -
Are,
tau employer^.Cheeek�theappropantehoa: Type ofproject(required):
l. a employer with (&It aoNorppt-twml' 7. ❑New construction
2.❑I am a rule pmpti or ppmnrship and Wve no employees working forme in S. ❑Remodeling
my turnery [No worker'comp.instance required]
l.❑I am a homeowner doing all work myself jNo workers tion,assonance maimed] 9. El Demolition
4.11 1 an a homeowrcr and will be hiring commons in mado,t all wank on on,visionary. [will 10❑Building addition
name Wan alt mnvmmrs eithahave waters'wmpensedn tmmenm or are ink I1.❑Electrical repairs or additions
ptopummus with no anployees.
12.E]Plumbing repairs or additions
s 1amo gcntvslmicimm oand1havehireddove amnhmtorlistedm he unwind ahem. ]3, Roofre airs
llmse sub-emtracmrs have empbrms and have wmkm'comp.insummz.t ❑ P
6.❑We area cmpormn motion,afters have eaomsed fln might ofetempuon Per MGL c. 14.[—]Other
152.111x1.and we have an employees.Mo workers'comp.insurance ox mrad]
!4vy applicant that checks bon#I must also fill out the section below showing then workers conventions.policy infonidum
s Homeowner who submit this a tidavit mdicming they arc doing all work and then him outside conaadms must submit a new i fiidavit indicating such.
:Conbndors that check this bas most attached an additional shem showing the name of We subbvardme ors and score whether or not those entities have
employees. If the subcontractor hose employees,they must provide Web workers comp.pdicy numb
I am an employer that is providing workers'compensation fasurance far 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 ane-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 certiffy rider deposing
anddppenhaall�des ofperjury that the information provided above is true andcorrect
Siartature: 2 /(/ !//if' ( Date'
Phone M 7 7 ln' '5Z- Z7 ct/O YGK
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 ane):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
r Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of moth"who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),addrem(es)and phone numbers)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used m a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proofihat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address.telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
of
FaLouis Hasbrouck<Iro
asbuck@norlhamptonma.gov>
lhcpmrrpon
Re: Building permit completion
1 message
Louis Hasbrouck<lhasbmuck@northamptonma.9ov> Wed,Apr 24.2019 at 10:45 AM
To:Matthew Hill<mhillxpmasonry@idoud.00m>
Matt
The zoning is OK but we do need plans;alone happening in the space,what's the side yard setback,what's the floor framing,what's the insulation,what
about heating,what about window sizes,eb.We need plans to make sure that when we inspect,we don't fail it because It doesn't msel code.
Lpuis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413)587-1240 once
(413)567-1272 fax
On Mon,Apr 22,2019 at 10:17 AM Matthew Hill<mhillspmasonry@icbud.com>wrote:
Hi Miele Matt Hill%P Masonry construction was wondering If my permit was complete 661 West Hampton Rd.N.,Hampton
talk to the secretary said you were Out Sick to 6e0tl you an email
Sent ham my iPhone
Sem from my iPhone
Home Energy Rating Certificate Rating Date: 2019-04.01
Registry ID: 020912731
Final Report Ekotrope ID: bL7bxYK2
HERS" Index Score: Annual Savings Home:
You, home s HERS score is laive 72A Hatfield St
Northampton,a ter
performuince score. The lower the number 1a1
the more energy efficient the home.To $ 2,472 Builder:
54leam,more,visit www.hersinclex.com 'Re4ativ.to an average U.S.home L.P. Audette Builders
Your Home's Estimated Energy Use: This home meets or exceeds the
Use [M8tul Annual Cost criteria of the following:
Heating 35.4 $1,058 2009 International Energy Conservation Code
Cooling 0.0 so
Hot Water 9.2 $274
Lights/Appliances 19.9 $834
Service Charges $0
Generation(e.g.Solar) 0.0 $0
Total: •a.s S2,1"
Home Featum Summary: Rating Completed by:
.rip, Home Type. Duplex,singleunit ElergypatenDavld Gagne
a Model: WA RESNET ID:7013322
Community: N/A
Conditioned Floor Area: 2,036 sq.k Rating Company:Pover House Energy Consulting
u• 479 West St Suite 105.Amherst,MA
m Number of Bedrooms 2
arbenaM Primary Heating System: Furnace.Proome.96 AFUE _
ePrimary Cooling System: N_A Rating limidenEnergy Raters of Massachmatt. ll
w Primary Water Heating: Water Heater.Propane•0.97 Energy Factor 2 Wbodlam Street Amesbury,MA 01913
a House Tightness: 903 CFMS0(339 ACH50) 978-270-3911
0' Ventilation: 06,0 CFM.6.2 Wafts
nialtaaw Duct Leakage to Outside: 21 CFM2511 D3/100 sIJ
a Above Grade Wallin R-19
ya s Calling: Attic R-52
�a a window Type U-Value:0.3,SHGC 0.5 David Gagne,Certified Energy Rater
Foundation Walk R-13
Digitally signed:4/9/19 at 123 PM
etcatrope
Dmkxsure forthis house is ovaAable from the rating provider
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