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48-014 (3) 66 LOUDVILLE RD BP-2019-1217 GIs N: COMMONWEALTH OF MASSACHUSETTS MW'A1-Qck:48.014 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:ADDITION BUILDING PERMIT Permit N BP-2019-1217 Project N JS-2019-001972 Est Cost:554000.00 Fee: $351.00 PERMISSION ISHEREBYGRANTED TO: Cover.Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot sizersm.ft.): 14418.36 Owner: MAROTTO ALISSA zorl Applicant: MAROTTO ALISSA AT: 66 LOUDVILLE RD AanlicantAddress: Phone: Insurance: 66 LOUDVILLE RD (619)417-4715 0 NORTHAMPTONMA01060 ISSUED ON.51101,2019 0:00:00 TO PERFORM THE FOLLOWING WORK DEMO ADDITION IN BACK OF HOUSE, REBUILD NEW ADDITION WITH 2ND STORY ABOVE NEW KITCHEN 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: Pini: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certfcate of Occupancy Signature: FeeTyre: Date Paid: Amount: Building 5/10/20190:00:00 $351.00 212 Main Street,Phone(413)587-1240,Fax:(413)587.1272 Louis Hasbrouck-Building Commissioner File X BP-2019.1217 Q� APPLICANT/CONTACT PERSON MAROTTO ALISSA ADDRESS/PHONE 66 LOUDVILLE RD NORTHAMPTON (619)417-4715() PROPERTY LOCATION 66 LOUDVILLE RD J MAP 48 PARCEL 014 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST CLOSE REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building i lied out Fee Paid Tvueof Construction, DE T IN BACK OF ROUTE. REBUILD NEW ADDITION WITH 2N STORY ABOVE NEW KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Builth Plus Included, Owner/Statement or License 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION PRESENTED: Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Pian 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 5- 10 zo)4 Si of Building Official _ Dam Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all inning 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 i City of Northampton Status of Permit. - Building Department Curb Cut/Driveway Permit 1212 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUC VATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ``^ ✓— Plans ns 7.1 Property Address: ;APR 3 O 2019 This section to be completed by oMcs Iola [-oVDV•1�a'- �• M p O Lot—Unit Unit et I1 Nl r•� DEPT OF Bull DING INSPECT NOnTHAMMONMAOlujIC111S.a Overlay District �'• . - Elm SL District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT Z.t con r of Rewrtl: ,,//AA'' G6 La JSV-0t pa. Name(Print) Cu niM Iing old ss: I hon! I — Te hone Signature 2.2 Authorized Aaem: ���pp I—tU"m A 0.+'e'f\� Name(Prim) Curran)Mailing Add98s: S1g�rre— Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by perrnit applicant 1. Building 1. 060 (a)Building Permit Fee 2. Electrical (b)s D o O (b)Estimated Total Cost of Construction from 6 3. Plumbing 13yseo Building Permit Fee I zz 4. Mechanical(HVAC) ,1/. �—�e ✓�/ 5.Fire Protection N 6. Total=(1 +2+3+4+5) POO Check Number This Section For Official Use Only Building Permit Num Date Issued: Signature: BuAding Cammissionerlluspector of Buildings Dare 4C1 ;VAAC0 @ �ll'�b1�yEi� . ( ewe 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 be filled in by Building lk,mn en, Lot Size Id1331.3 .5 ,S} y8 99S 5 Frontage Setbacks Front Side L: tu' R: 20 L: MO' R: ze, Rear So': $'o' Building Height .ZZr,,. 29' Bldg.Square Footage ,ILC / X600. Open Space Footage -- -(Inarta minus bldg&paved ..� pa,l,inju #of Puking Spaces 2, Fill: Nut.&Iwarioo) A. Hasa Special Permit/Variance/Findin ver been issued for/on the site? NO © DONT KNOW YES O IF YES, date issued: IF YES: Was th permit recorded at the Registry of Deeds? NO 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 (2(" DQNT 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: I D. Are there any proposed changes to or additions of signs intended for the property? YES O NO V 11/ IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,�e�xxc�vation, or filing)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO t:l IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition [� Replacement Windows Alteration(s) Roofing ,._,(' Or Doo, 0 Accessory Bldg. ❑ Demolition u New Signa [0] Decks (0 Siding p:3] Other ICI Brief De%nr p0on Qf posed Work: F , ,I 1'Adc Am.i-Ax 4 l"UNC rEG.n L'L.C., is, rtLw,lu w.a hmi,.A W' 2'0 5 Alteration of existing bedroom " Yes No Adding new bedroom Yes ✓ No Attached Harrah" Renovating unfinished basement Yes No Plans Attached Roll -Sheet Go.If New house and or addition to existing houslna. complete the following a. Use of building. One Family V Two Family Other b. Number of rooms in each family unit: -3 Number of Bathrooms 7— c. c. Is there a garage attached? IJ p d. Proposed Square footage of new construction. Dimensions 3 Lf-A 3G r e. Number of stories? 2- I. Method of heating? LLW Fireplaces or Woodstoves_ _Number of each A- 9. Energy Conservation Compliance. AAA, Masscheck Energy Compliance form attached?_A% h. Type of construction till W - I. Is construction within 100 g. of wetlands? Yes " No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade L ' k. Will building cont m,to the Building and Zoning regulations? V/ Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, q-(iSSG k.10,�'b l\�' ,as Owner of the subject property 11// hereby authorize Lev,✓1 to action my belfalf,in all et ars rel iv to work authorized by this building permit a oration. cX o t � l�` Sigd�re timer Data II Of as Owner/Authorized A t hereby declare that the statements and information on the foregoing application are true and accurate,to the beat of my knowledge and belief. Signed u der the pains and penalties pf perjury. Print Name )S I � Signa of O.ww,A ... Dead f SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Erylratlon Date Signature Telephone B Reaisteild Nome Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a.152,9 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 building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ gts The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston, MA 01114-2017 www.mass.gov/dia Wx\.rkers'Cornpenmtion Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lmibly Name(Business/OrganiratioNlndividual): Address: City/State/Zip: Phone#: Are you an employer?Cheek the appropriate box: Type of project(required): I.E]lama employer with cmployces(Nil tnd/orpea-lime)' 7. ❑New construction 2.❑I am a sole pmprictosor pr menship aid have no employees working moment g. ❑Remodeling any capacity.[No worker con,.insurance required) l.�l ahoneowncr doing all work myself[No workers comp.insurance9. ❑Demolition insurance required.]' 4,V1 a homeowner and will be hiring conrcactos,to conduct all work on my pmpcM. I will 10❑Building addition ensure that all contrectors either have workers''comprnsmmninsurance cart sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 50 1 am a general contractor and 1 have hired the subcontmctws listed on the attached sheet. 13 Roof repairs Theo subcommerom have employees and have workers'tromp.insurance.: 6QYmmeacoryormstand its ofiecrs have exercised their right ofcxemptien per MGL c 14.[—]Other 152.§1(4\and we have no employees.[No workers'camp.insurance rryuired.l 'Any applicant that checks box#I most also fill out the section below showing their workers'wmpensation policy infomtadon. I Homeowners who submit this affidavit indicating they arc doing all work and then hire outside eonmet.must submit a new affidavit indicating such. IC'ummaors that check this box most attached an additional short showing the name orthe sub contractors and sum whether or not here entities have employees. Ifthe sub-contmaon have employees,they most provide their workeri comp.policy number. I am"employer that is providing workers'compensation insurance for my employees. Below is the policy and job site lnfonshadon. 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 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 rosy be forwarded to the Office of Investigations of the DIP.for insurance coverage verification. I do hereby c�ertiyfy uu er the pirms andpenaldes ofperjury that the information provided "ove i, true and correct. SignDate: Phone#: Ojj etial use only. Do not write in this area,to be completed by city or town oJrciai City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts e s DSPAN Wr OF BUILDING INSPECTZONS 212 Mi. street •Municipal euildiny tp s Northampton, MA 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: 66 &UbAt �2b (Please print house number and street name) Is to be disposed of at: c C� (PI a e print nUrne a d to tion of facility) Or will be disposed of in a dumpster onsite rented or leased from: Cgmp ny N m n ddres ) 1 S ignatur6lof Permit Applicant or Owno 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. City of Northampton •' Massachusetts DSPAATldNT OF BUILDING INSPECTIONS 212 Win etzMt 0 Municipal Building xozUampton, Ma 0201060 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-exisfing 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:7f 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: 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: hereby apply for a building permit 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: I IJrW Date �— Owner Name and Signature City of Northampton Massachusetts i DEPARTMENT OF BUILDING INSPECTIONS �s 312 Mein 9tr t • Municipal Bulking NorNae¢ton, MM 01060 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 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 110.115, 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.