24D-089 (11) 64 NORTH ST BP-2019-1370
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-089 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Categorv:renovation BUILDING PERMIT
Permit# BP-2019-1370
Pm*w# JS-2019-002208
Est.Cost:8800.00
Fee:S 100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: MICHAEL L HARRINGTON 102948
Lot Size(sp.0.): 7100.28 Owner: HARRINGTON MICHAEL L
Zoning:URC(100V Annlicant. MICHAEL L HARRINGTON
AT. 64 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 393 (413) 575-8345
NORTHAMPTON ,MA01061 ISSUED ON.•6/3/20I90:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL INTERIOR DOORS, WINDOW
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: 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 Occupancy Signature:
FeeTvpe: Date Paid: Amount:
Building 61320190:00:00 $Hs0.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i
File 0 BP-2019-1370
APPLICANT/CONTACT PERSON MICHAEL L HARRINGTON
ADDRESS/PHONE P O BOX 393 NORTHAMPTON , (413)575-8345
PROPERTY LOCATION 64 NORTH ST
MAP24DPARCEL089 001 ZONE URC000Y
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid tl
Building Permit Filled out
Fee Paid
TTv2eofConstruction, INSTALL INTERIOR DOORS,WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102948
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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: She 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
Z2 -3-2019
Si re of Building Oficial Date
Note: Issuance of a Zoning permit does not relieves 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.
r
Versloi Commercial Building Permit May 15.2000
Department use only
City of Norther ECEIV o e it:
Building Depa men uvD y Permit
212 Main $2 t Sewe Sep Availability
Room 10 MAY 3 p 2 ater ellvailabili y
Northampton, 010 0 Two S is of tructural Plans
phone 41&587-1240 Fa 41 587-1272 PIOVS a Pla s
DEPT OF FUILDING IN=. Ogldwi Mmecl
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE, OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN.A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This
!s action W be completed by office
lD/ H Nd�Ta /��/L�T Map 1 f y/ Lot 6 $9 Una
Zons Overlay District
Elm St.District C8 District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.7 Owner
M(c _ -_ 2wrr(a13 —M$ 3 3 —
Name(Print) Currem Mailing Address:
Signal �/ Telephone
2.2 A thorized A ent
Name(Punt) Current Mailing Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building (a)Building Perms Fee
2. Electrical (b)Estimated Total Cost of Y
66 . OQ Construction from 6 a
3. Plumbing _ _ _ Building Pail Fee
4. Mechanical(HVAC) b
5. Fire Protection
6. Total=(1 +2+3+4+5) QQ. 6Z) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Com IssionerdnspMar of Buildings Date
Versionl.7 Commercial Building Permit May l5,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs Additions ❑ Accessory Build g❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description Enter a brief description here.��,USTfi�L 50/fp7/tV06 fL lLC�.Gt t�t'Ea1 pdd�
Of Proposed Work: 100& syv\ U1(JJf1Dt✓1!%1h6Yf V(-TFCOQ
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly11A-1 11A-2 ❑ A-3 11 IA ❑
A4 ❑ A-5 ❑ IS ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ I-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential R-1 ❑ R-2 R-3 ❑ SA
S Storage ❑ S-1 ❑ S-2 ❑ 5B
U Utility ❑ Specify
M Mixed Use ❑ Specify.
S Special Use ❑ Specify.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND7/OR CHANGE IN USE
Existing Use Group: Proposed Use Group: 12 —
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1s
2n° 2-
3 3ra
4"' r 41,
Total Area(sf) Total Proposed New Construction (sf)
Total Height(R)
Total Height it
7.Water Supply(M.G.L.c.40,S 56) 7.1 Flood Zone Information: .3 Sewage Dlapos.1 System:
Public 0 Private ❑ Zone Outside Flood Zone Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
l whrn mbefi1k1 in by
Building Dcpenmen,
Lot Siff
Frontage ��' /Q /P'• L
Setbacks Front
1 7 /
Side I. 31�^ R: 4J;' R:L
Rear
Building Height /v
Bldg.Square Footage
Open Space lntvinus bldg&bids& rd Footage ��
ru mryvF7 rJ-r-�
N of Parkin Spaces
Nft
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO O DONT KNOW Qi YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page .�� and/or DocumentN ....._........_.
B. Does the site contain a brook, body of water or wetlands? NO 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 Cr
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
IF YES, describe size, type and location:
E. NAZI the constructon activity disturb(clearing,grading,ax tion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Stan Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
N Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name /V Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiretion Data
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature - Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Mluf � er L ,
Address Tllrvry
Signature Telephone
Version l.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Vee O No
SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR
BUILL"DIN-G.PERMIIT
I, IM'W"' - /- . 4''Ire`-1 " I() U as Owner of the subject property
hereby authorize to
act on my behalf, in el afters rel to work authorized by this building permit application.
Signature of Dale
I, as Owner/Authorized
Agent hereby deG at statements and information on me foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the poi an p train ry
Print Name _..
M(c�EL L- � NGTDf✓
Signature of OwmerlHgent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Superv'is�.oer.: Not Applicable ❑
Name of Li cam as Holder:
License Number
CS Ido
Address Eviration Date
go a/06 a,5_ �
Signature Telephone
SECTI 13- ERS' MPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,S 25C(0((
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 O No
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: `p Alai-t ,4T
The debris will be transported by: 4 /bF ObQ1410
The debris will be received by: mc Y FG7CNl—
Building permit number:
Name of Permit Ap icant Mkc NAL- L • rtilLYr��
j� Date ignature of Permit Applicant
The Commonwealth ofMassachuseas
Department of IndustrialfAccidendis
! Congress Sheet,Suite 100
7
Boston,MA 02114-2017
wwlvmass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contrastors/EleMrieians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leiribly
Nagle(Business/Organ¢atioNlndividuad:
Address:
City/State/Zip: Phone#:
Areyoa an employer`Chaclt tae appropriate hoer: Type of project(required):
L[]I ama employer with employees fall and/or pen-timet.' 7. construction
2.�Ianna sole Pmpnmarmpmmenhip and havem employm wode.:6 farmew 8. Cmpdcing
crpaciry_INo workers'wand.w:varsce mquued]
3.el am a homeowner doingall work If. No worlhao'com and 9. Demolition
er myx [ P.imwmcc"uned]
an Iama hemwwner and will behiringcion...m wnduwdl workanmy pnosm,. 1 wJl 10 Building addition
mmm than a contractors ewer have workers'comsamonm unman``or are saw 11.[ ]Electrical repairs or additions
moprrmom with on employees. 12.[]Plumbing repairs or additions
5C]lama general sonwcmr and l hava hired the sub-cmtrumrs luted on the mashed sheet ]3.�Roof repairs
These sub< employee and have employeand have worisma'comp mnce
insu
b.E]W'e.a evaporation and in oaicros have`mimed the.nBpt ofeaempnoo pm MGL e. 14. Other
I52,11(4),and we have an employed.[No workers'conv imummw requimd.l
'Any applicant that checks has#1 most also fill out the section below,showing door workm wmpmomen policy adi nm.
'Hum comers who submit this affidavit indicating they art doing all work and then hire outside contractors must submit a new of idava indicating smh.
1contmcmrs that check this boa must amched an additional slow showing the mane of the sub-enn menus and show whether or not those entities have
employees. If the sub-comodors have emplovees,they must provide Wer workers'whoprolicv natter.
/am an employer that is providing workers'compensation insurance for 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 m secure coverage as required under MGL a 152,p25A is a criminal violation punishable by a fine up to 51,500.00
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 violato . copy oft s statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
/do hereby cerdpenalties ofperjury that the information provided above is true and correct
Si am r anDate:
Phone#: 17ikL5
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 one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 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 ttuswe 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 another 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-cormuclor(s)name(s),address(es)and phone number(s)along with their cenificate(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. Alan be sure to sign and date the affidavit The affidavit should
be mounted 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 a 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 as a reference number. In addition,an applicant
that mus[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 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 titian 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
1 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 ww jnuac;.gov/dia
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