24C-070 (2) 64 MASSASOIT ST BP-2019-1245
GIs 4: _ COMMONWEALTH OF MASSACHUSETTS
MamBlock:24C-070 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categ�eplaced BUILDING PERMIT
Permit# BP-2019-1245
Proiect# JS-2019-002009
Est. Corr$2000.00
Fee $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Conlractor. License:
use r Homeowner as Contractor
Lot Simon. fu: 15855.84 Owner; ROACH SUSAN G &STEPHEN M
Zoning:URB(100)/ Applicant: ROACH SUSAN G & STEPHEN M
AT.• 64 MASSASOIT ST
Applicant Address: Phone. Insurance:
64 MASSASOIT ST (413L-586-5351 O
NORTHAMPTONMA01060 ISSUED ON:51612019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 3 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; M 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 Ocounancv sia atue;
FeeTvpe: Date Paid: Amount:
Building 5/6/2019 0:00:00 $40.00
212 Main Street,Phonz(413)587-1240,Pax: (413)587-1272
Louis Hasbrouck—Building Commissioner
ttrryDa cUS
E C E I V Department use only
_ - City of Nortamp sof conk:
Building De rtm nt Cu c dveway Permit
212 Main tree MAY 3_ 2019 s ds do Availability
Room 00 W 1W II Avsilabrilty
Northampton, A sets f Structural flans
..;; phone 413-587-1240 ax R4Vw1?Rc ',not its I lana
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: ��,L CThhiis section to be completed by office
Lf nIV,
0, S S GC SO i to �Y/��.{'-/�� Map �-1 � Lot 6-70 V Unit
N()•" I ' V`(��P�/l , I O Zorra Overlay District
Elm SL District CB Diatrict
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZ GEtyT
2.1 Owner of Record: ` , ( /
Ja,l.Sa-dl
Name((196
•m) 'nn Current Mailing Morass: QiI L) U
Jgnawrla
2.2 Authorlmd Agent:
Nem.(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit a licant
1. Building (a)Building Permit Fee
2. Eledrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee ��
4. Mechanical(HVAC)
5. Fire Protection
e. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Num n Issued:
Signature: 5-6- zo)p-J
Building Commissioredlnspector of Buildings Det.
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 filed in by
Building D"orment
Lot Size
Fruitage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Wt area minus bids&pvM
rafld-g)
#of Parking Spaces
Fill:
volume&LoceNov
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO � DONT KNOW o YES O
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 N
S. Does the site contain a brook, body of water or wetlands? NO )"' DONT KNOW 0 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 Nl
IF YES, describe size, type and location: ��3Y
E. Will the construction activity disturb(Gearing,grading,ex ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO rlf7/(�/
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all applicable)
New House ❑ Addition ❑ ReplacemegI Vlkldown, Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ID Siding[0] Other[L7]
Brief Description of Proposed
Work: T _S'd"' W-I J� u_1 G —aGT"• u.
Alteration of existing bedroom—Yes No 0 Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
5a.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 forth attached?
h. Type of construction
i. Is construction within 100 R.of wetands?—Yes No. Is construction within 100 yr. floodplain_Yes_No
]. 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 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.
Sig nature of Owner , II Date
Owner/ thorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,lot my knowledge
and belief.
Signed under the pains and penalties of perjury.
tt
Print Name yy,,
Signature of Owner/Agent Data
SECTION S-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable D
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home lmprpyement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
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 building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
City of Northampton
-"' Massachusetts v
r- DBPaNTN6NT OF BUILDING INSPECTIONS
L 212 Min St .t • Municipal Builtling
\\. Month�eytnn, MA 01060
Massachusetts Residential Building Code
Section 110.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.R5, provided that if a homeowner engages a person(s)
for hive 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 hive to perform work for you
under this permit.
City of Northampton
s
Massachusetts
I� DEPARTNETIT OF BDZDDZM INSPECTIONS
312 Main etzeat Nu0eulldinq
\ aozUvmpton, M as O10lOfiO
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 hnprovemem 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 more than four dwelling units....or to structures which am adjacent to such residence or building"be
done by registered contractors.
Note:If the 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 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 RESPONSIBHdTES 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 permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notic ,I hereby apply for a building permit as the�vmer off the above props :
Z
[e Owner Name and Signatme
City of Northampton
-•"/" Massachusetts
( DSPASTAfBNT OF BDZLDING ZNSPSCTIONB i
212 M n Street Building
Bothe wn, IP 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at: r vV17�
Ca lry s c�5a �_ AJ"94�`�7�
(Please print house number and street name)
Is to be disposed of at:
y)
(Please print name d location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
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.