17A-104 (7) 310 BRIDGE RD BP-2019-1196
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 17A- 104 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Deck BUILDING PERMIT
Permit# BP-2019-1196
Project# JS-2019-001942
Est.Cost:$2500.00
Fee,$65.0 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor. Lkense:
Use Grow: Homeowner as Contractor_
Lot Size(sc. R): 14461.92 Owner: DUSHAME LAURA L
Zoning: RI000VURA000 Apylkant. DUSHAME LAURA L
AT. 310 BRIDGE RD
Applicant Address: Phone: Insurance:
52 ORCHARD ST 0774-94790
GREENFIELDMA01301 ISSUED ON.51212019 0:00.00
TO PERFORM THE FOLLOWING WORK:12 X12 DECK
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 Flreplace/Chlmney:
Rough: Oil, Insulation:
Pinel: mo • Find:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeTvpc: Date Paid: Amount:
Building 5@i20I90:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fag:(413)587-1272
Louis Hasbrouck—Building Commissioner
File is BP-2019-1196
APPLICANT/CONTACT PERSON
LAURA L
ADDRESS/PHONE 2 ORCHARD ST SHGRREEENFIE D Q 774.9479 Q 0 fG 1 p
it
PROPERTY LOCATION 310 BRIDGE RD
MAP I7A PARCEL 104 001 ZONE R1000YURA000
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING O FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvpeofConstly_qti2_n: 12X12 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE EOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
F RMATION 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 Cm from DPW Water Availability Sewer Availability
_Septic Approval Board of Health Well Warm 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
5 -2-20)9
Si re 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 Northa plonREG'EI i5
Building Depa an nDrl way Permit
212 Main Sl et Sewer epti Availability
Room 10 APR 2 5 W�ystar en vailability
Northampton, M 01 60 - Two S Is of tructural Plans
phone 413-587-1240 F St
4 Ions a PI s
i UILDING MSP Nspeci
NORr"AMPTON,rAAt1
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 •SITE INFORMATION g 0 1 R-f 1'? 6F
1.1 Properly Address: This section to be completed by office
3 to k�.4- n (1 Map Lol Unit
KTX Zona Overlay District
F�
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
1 Owner of Record:
AalryL t -f. y_JynI��Y �'1p (1t-t r�Lc1-� 1C.L�( . 0.2rxa d(� �r -
NamCureja11_%Ad7d� -7';
Telephone Telephhoone
Signature `
2.2 Authorized Apenl:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by p rmit aPDlicant
1. Building Q L/CiC (a)Building Permit Fee
2. Electrical C, (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) v
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued: ''hh
Signature:
Building Commasionerlinspeotor of Buildings n Date
L av ro, Lbvtko me_ -LyL0 @ C bmect • net'
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
G Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size i__ ----�
Frontage
Setbacks Front
—_ _
Side L:'--____� R: _.__� L: R:'..._.__.
Rear C._1
Building Height
Bldg.Square Footage %
Open Space Footage % _ —r
(km area minus bids&paved
parkinju
#of Parkin Spaces O ��
Fill:
volume&Location
A. Has a Sp bat Permit/Variance/Finding ever been issued for/on the site?
CN( DONT KNOW O YES O
IF YES, date issued:17:=
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book ; � Page� I and/or Document#I�
B. Does the site contain a brook, body of water or wetlands? NO 11 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 tcK
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 (yd
IF YES, describe size, type and location: Y+"
E. Will the construction activity disturb(Gearing,grading,eaavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 'lZl
CIF YES,then a Northampton Storm Water Management Permit from the DPW is required.
0
0
0
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Q Roofing
0r Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs i[3] Decks 29( Siding M Other[[:I
Brief Description of Proposed --D QL,K — 14
Work:
Alteration of e;dsting bedroom_Yes No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes _ )O No
Plans Attached Roll -Sheet
Sa. If 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 Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In. Type of construction
Is construction within 100 H.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_ CitySewer Pnvate well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i, L0. "o` 1J � S' ,( Wnp� ,as Owner of the subject
property
hereby authorize •J'�r�.vjS `'f`"10.
to act n my behalf,in all matters relative to work authorized by this building perm t applice ion.
Signature of Owner Date
I, as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties eriury.
Avv�z Sha C 1 L 1
C Innt No ^ ✓— \ II �l�
Signature of Owner/Agent Date
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City of Northampton
Massachusetts Ars. 4�
" � L
DEPAR2gRNP OF C 9UZZ,DZNG ZNSPECrZONS 212 Win etuet eH—icipal Building j. r
RorNuptOn, He 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:
� (Q D� �f 1� T `vrcnc -F
(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:
pu uack- TraG6"s
(Company Name and Address)
1 - 0 )'ga.._.t
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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City of Northampton
...-"-'....rte
MassachusettsDEP � "-•p
�Y
C OF BUING
222 Main Srnr • Municipal Building IP
\ %
MerNempten, 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, mcdemization,conversion.
Improvement, removal,demolition, or construction of an addition to any pre-existing owneroccupied building containing
of 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:!f the homeowner has contracted with a corporation or LLC,that entity must be registered
�
Type of Work: m-y 1 '6,e 'K est.Cost-- z So a .0 0
Address of Work: ?ilC= �[i RS-k f�t7: f 1'1ar-Ptic�
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
C _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:
J hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,l hereby apply for a building permit as the owner of the above property:
L.r.._.._ A1-.-__. LL6.,.,2�1
Date Owner Name and Signature
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ 1
Name of License Holtler:
License Number
Address Expiation Data
Signature Telephone
9.Registered Home Imorovement Contractor Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.b.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit vnll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
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