17A-099 (9) 27 GRANDVIEW ST BP-2019-1319
GIS s: COMMONWEALTH OF MASSACHUSETTS
Mau:Block: 17A-099 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cmegnry: Deck BUILDING PERMIT
Permits BP-2019-1319
Project s JS-2019-002128
Est.Cost: $7971.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: MICHAEL PHILLIPS 082683
Lot Size(sa. R.): 9365.40 Owner: ALPERNEIL
Zuninz RI(100)/URA(160)/ Applicant: MICHAEL PHILLIPS
AT: 27 GRANDVIEW ST
Applicant Address: Phone: Insurance:
P O BOX 514 (413)250-7990 O WC
GOSHENMA01032 ISSUED ON.512412019 0:00:00
TO PERFORM THE FOLLOWING WORK.REBUILD DECK, ADDING TO THE FOOTPRINT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Undergrolmd: Service: Meter:
Footings:
Rough: Rough: House s 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 Occuoancy Signature:
FeeType: Date Paid: Amount:
Building 5/24/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i
File p BP-2019.1319
APPLICANT/CONTACT PERSON MICHAEL PHILLIPS
ADDRESS/PHONE PO BOX 514 GOSHEN (413)250-7990()
PROPERTY LOCATION 27 GRANDVIEW ST
MAP 17A PARCEL QQI ZONE IU(100)IURA(100
OFFICIAL
P P N
N OSED REQUIRED DATE
ZONING FORM FILLEDT
Fee Pi
Building Permit Filledt
Fee Paid
TTvpeof Construction: REBUILD DECK,ADDING TO THE FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included
Owner/Statement or License 082683
3 sets of Plans/Plot Plan
THE FOL—COWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN179MATION 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 Spacial Permit— Variance.—
Received
ariance• _Received&Recorded at Registry of Daods Proof Enclosed
—Other Permits Required:
Carb Cutfrom DPW __Water Availability Sawa Availability
Septic Approval Board of Health —Well Water Potability Board of Health
Permit from Conservation Commission Pmntit from CB Architecture Committee
,Permit from Elm Street Commission Permit DPW Stour Water Management
Demolition Delay
t7�^— �fn✓'.mow S Z 3 1
�gnature'oPu ding Offlcia( Date
Nate: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 MOL 40A.Contact Office of
Planning&Development for more information.
�l.j bFi(y-ia� y
Deparbnerd use only
C4 of Northe pto it.
.rf Building Depa an AAl 2 p 7 Ilrb ueDn sy Permit
�. 272 Mein St t Sewed opt! Availability
:i Room 100 11 A ilability
Northampton, MA 1 1o=nortnlurM1l I.T cturel Plans
MP10
phone 413-587-1240 Fax 1 PloVSite Plans
Other Spedfy
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION Ola,s. 'ok(tC
1.1 Property Addreest ` - This vection to be completed by office
Q r �SC�N�.1 1�J Map — Lot 0`19 Unit
S(_ m „�/I A Zone Overlay District
-� �L7tC Elm SL District CB District
SECTION 2•PROPERTY OWNERSHIPIAUTHORIZED AGEM
Arta Gk✓r ��—
Ne Current Mailing Address:
Telephone
slur
2.2 Authorized Agent
-� (So��Ib 1 fYIA
Name ring Current Mailing AddressIF
Signature T J)
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
ompletedbypermflapplicant
1. Building (a)Building Permit Fee
i
2. Electrical (b)Estimated Total Coat of
Construction from 8
3. Plumbing Building Permit Fee Ll
4. Mechanical(HVAC)
5. Fire Protection
8. Total=(1 +2+3+4+5) / Check Number
This Section For Official Use Only
Building Permit Number Date
Issued.
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
ii;.( �di:,j
Section 4. ZONING Al Information Must Be Carnpleted.PermR Can Be Dented Due To Immffptete Information
Existing Proposed Required by Zoning
'lies column in be filled in by
Building Depamnent
Lot Sin
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(lut mea minus bldg&paved
Parking)
#ofParking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O 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#,
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 t YES O NO O
IF YES, describe size, type and location:
E. Nil the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part Big common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION b-DESCRIPTION OF PROPOSED WORK(Check all anulinblel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
or Doors l]
Accessory Bldg. ❑ Demolfttlo�n ❑ NNow�Signa (O] Decks Siding[EI] Other(C]
Brief Description of Proposed&,b�wlX nU v d,CK
Work:
Alteration of existing bedroom_Yes No Adding new bedroom Yes - No
Attached Narrative Renovating unfinished basement _yes No
Plans Attached Roll -Sheet
ss. If New house and or addition to existing housing, complete the followlna.
a. Use of building:One Family Two Family Other
b. Number of moms in each family unit: Number of Bathrooms
c. Is Mere a garage attached?
d, Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstows Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 R.of wetlands? Yes _No. Is construction within 100 yr. floodplain_Yes_No
j. Depth of basement or cellar fioor 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
OWNE AGENT OR CON CTOR APPLIES FOR BUILDING PERMIT
I, otkas Owner of the subject
Prop"
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Ov Date
�gn�
1, / I /r� ,as Owner/Authorized
Agent hereby declare tha 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 pe of perjury.
1
Prim N
Signature M Owner M Date
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervis r: Not Applicable 0
Name of LI"nw Holder: , (TJU41W/
did
ZZ Licerme Num ar
V W J
Adtlre m n Dare
Signature Teepha e
8.Realstared Home Im t rce t Contractor: Not Applicable ❑
Com an Nar o Registration Number
Address /�'7 ��� � Expiration Date
Telephone 7th
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.162.§26C(6))
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....... N....... ❑
_ City of Northampton
Massachusetts
.. A
�� liPan�4 or BUILDING 1bsPDCrz01M v
212 rWn atrwt • aY NA 01l auilaina
� .. NortAapton, 01060 —Pa
�- 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, alteralion,renovation, repair, modernization,conversion,
improvement, removal,demubbon, orconshuction of an addition to any pre-exisling owner-occupied building conmoung
at least one but not more than four dwotling units....or to structures which are adjacent to such residence or budding'be
done by registered contractors.
Note:Lf the homeowner has contracted with ac r wn or LLC,that entity must be registered
Type of Work: 'C ew-%Mr'd I�&.Vo , Est.Cost:
Address of Work: V S i�.J
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 WFTH 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:
1 hereby apply for a building permit as the agentIf the owner:
5w-wal mjc w(e-411 :eJ -74c 1—n42
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:
Date Owner Name and Signature
City of Northampton
.'�. _ Massachusetts
� DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal B—Miw yJL
�,,,:,. Mor1 a1t:n, !A 01060 rvp y j
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 I IO.R513.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.85,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
Q-
r
1
Massachusetts A=¢ cmc
1� 'I I` DESARTIffiIT OS BOZLD26G ZNSPLCTZOPS ,t
212 Nin SCrwt oN iclp l Buildinq �. C
NorUa t, ! 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:
(Please print house number and street name)
Is to be disposed of at:
U kl(¢--( n
(Please print name and 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.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gowilia
WWorkers'Compensation Insurance Affidavit:BaildenKbntmNan/Eimtricians/Plumbem.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Mason,Print Lenibly
Name Bminess/Organieationlndividual):
Address://mo�o . `('ja- c SI K
City/State/Zip: 1"TeS�\M &,,, Y�,a37 Phone#: 1��- C KC1 .-79 SQ
Areyou an employer?Chao tae approprlide Eos: Type of project(required):
1.[3 I am a employer with employees(full shwer pmt-trete)• 7. ❑New construction
2.❑Imnasoleproprietorapemwrahipandhavemmploymworting farmse 8. Remodeling
any®pucity.[No warkcrs comp.inso mn« "uimd.l
3.❑Iamehomwwn &mgMtw mysdf pNossmrker'comp.immamscree,mil' 9. Demolition
4.❑I am a lwmeowna aM will be hin%mnur:mrs m mMuctall work m my pmpmty. 1 will 10❑Building addition
morethat allconma .either have worker'wmpmwriosinvis eerr are sole I1.❑Electrical repairs or additions
prapnmrs with no employees. 12.❑Plumbing repairs or additions
5❑1use a general contractor and!I have hired the sub co ecton Iimad on the anacMd sheet.
Theo sub-contractors have employees and hove workemcomp.immmaeJ 13.❑Roof repairs
6We m s mryomian and at M.have conesed their right orieusta ion per MGLc 14.❑Other
152,§I(4),and we have rm emplayees.Mo workers'comp.imumms regaind.l
'Any applicant that clerks hux#l must also fill out the section Mow showing their workers''compensation polity inf ation.
t Ihomeowners who submit Nis andtod milcating to,arc doing all work aM then hire outside mmuscmts must submit a Mw affidavit indicating such.
:Conaacmr that crook Ws box most mtseled an additional sheet showing the came ofthe sub-contrucm s and state whether err trot thou entities have
cmploycea. If the subcontractors have employers,0,must provide the,, wmkm rump.policy numher.
I am an employer that is providing workers'compensation insurance 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/Smtelzip:
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 in$250.00 a
day against the violator.A copy of this statement may be forwarded in the Office of Investigations of the DIA for insurance
coverage verification.
/do hereby certify ander the 'ns 'es rjury that the information provided ve��it``�PNa awdconecR
S'anature' / Date: W
Phone#:
ficial use only. Do not wear in This arca,m be completed by city or town ollic at
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/rove Clerk 4. Electrical lnsperiar 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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 ajoint 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 mother 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),address(es)and phone number(s)along with their certificate(s)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
sel&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/icense number which will be used as 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 order"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 proof that 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 bum 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.If 617-727-4900 ext 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
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Drawings for a Basic Deck
The Ptan View
mloist.16M.O.C_ ��Pcst
121n. Woo gh
—left.—
The Elewallon Drawing
RO&V
MCedardeclorV
9210 presstuwtreated DDLV--&
bearn(2).Wilh spacer
pre=retmated Doug&,*
jow,16 in.o.c.
ameacier
4YA Pffiss�4reoled POS;
Post tDose
A%.WA*AM-Gsb�
20 Chopterl