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36-114 (3) 199 BROOKSIDE CIR BP-2019-1326 GIs a: COMMONWEALTH OF MASSACHUSETTS Map:Block:36- 114 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BASEMENT RENOVATION BUILDING PERMIT Permit a BP-2019-1326 Project k JS-2019-002139 Est.Cost$41925.00 Fee: $272.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES PETERSON 107525 Lot Size(so.R.): 16814.16 Owner: PLEWA CHRISTOPHER Zoning: Applicant: JAMES PETERSON AT: 199 BROOKSIDE CIR Applicant Address: Phone: Insurance: 1310 SOUTH MAIN ST (413)689-8359 SOLE PROPRIETOR PALMERMA01069 ISSUED ON.5128/2019 0.00.00 TO PERFORM THE FOLLOWING WORK:REPLACE EXTERIOR DOORS, reno 1 st floor bath and kitchen, INSTALL EGRESS WINDOW AND ADD BATHROOM TO BASEMENT 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: 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 5/28/2019 0:00:00 5272.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner I File N BP•2019.1326 r�/� �,yf�O APPLICANTICONTACT PERSON JAMES PETERSON y+l Il etl/ ADDRESS/PHONE 1310 SOUTH MAIN ST PALMER (413)689.8359 PROPERTY LOCATION 199 BROOKSIDE CIR MAP,3kZ&&QXL 114 001 ZONE TH15 SEQ3:ION FOR OFFICIAL USE ONLY• PERMIT APPLICATION E LOSED REQUIRED DATE ZONINGE T Fee paid L Fee Paid Filled o Twcof Constructiom REPLA E EXTnohINSTALL EGRESS WINDOW AND ADD BATHROOM TO BASEMENT New Construction Non Stmciurel interior renovations Addition to Existing Accessory Structure Building Plans Included; Owner/Statement or License 107525 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 ProjeeE 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 Penult Variance• Received&Recorded at Registry of Deeds Proof Enclosed�,T :Other Permits Required: ,Curb Cm 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 Warm Management /2 olition Delay 5 28 Zoj Signature of Building O ciai Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all"Ring 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. S arbnent use only City of Northamp tall m t� Building Depannr ant Caro CWDn y P anni 212 Main Strw t MAY 2Wa er ell k naik Irty y� f Room 100 A Wall& Northampton, MA t 1060 T.Sets of 5 Iwtur I Plans phone 413587-1240 Fax 13 uaol , NORTHAMPT BtIM APPUCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TING FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Pt."M"on", This s fiction to W complaNd by office I99 &0'#6;de c;e61 e U" :!�c2— L« -Nmt F/oren ce my a jo6g zaae Owrtay District W.W.0iatn« Ca DI.uiet SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT f R.w : L Pmu Qalela;P AOyp.L1� ES- GI Tebphone 9 2 h n A nC R,\ lNn � 1 � s"A�a- C]rrl-L iPr011 cumt'l MdiAny sus'.'5 kl3 335" GTS- alurt cella nme SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Esnmated Cost IDol ara;to be Offival Use Only completedby applicant t Bu9mng 3y 5--e (a)Builaing Penmt Fee s 2 ElecbrtN (b)Estimated Total Cost of W� • Cons"dw hom 8 3. Plumbing 00 Building Permit FN I4. Mechanical MVACI 5.FRe Prytacnon W 6 TotaI•(t •2,3.4.5) • Check Number This Section Fa 011ielal Use Only euldng Permit Data be Issued Bgreale BudbM c«nnlisdi«lerllnslle««4t BWOings Oy. howAes',n 413 @ 9 ariOL;1. Lo w, EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SZ,on 4. ZONING At Inrwmanon mixt!e Canpixud.Permit Can Be Demed Due To ii a plere Information Existing Prop..d R,taind b,Zunmg Tb.,lehlmn in h lil4d m nr dmWmC lkNnmrm I a Suc Fenn Sctbcks Fmm Sid, I: R: I: R: Rmr Building Ndght Bld,Square Fwtagc Op'.Spas Foulage I I a vex m,w,M4.k p.al =uf Parkin S er Fill: ,nlumv S Lcamml A. Has a Special Permit/Variance/Finding a been issued for/en the site? NO O DONT KNOW YES O IF YES,date issued: IF YES: Was the permit recorded at the R ry of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document if B. Does the site contain a brook, body of water or wetlands? NO 0/DONT KNOW O YES O IF YES,has a permit teem or need to be obtained from the Comer uition 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 tor additions of signs intended tar the property? YES O NO IF YES,describe size, type and location: E M me construction acliMy disturb Nearing,grading ex n.or Fling)aver t axe or m a ped of a cannon plan that wA dmum aver 1 aoeo YES O NO IF YES.then a NoMamplo t Storm Vill Menayenuum Pennn from me DPN Is niquued. SECTION l DEWRIPTION OF PROPOSED Never House 0 Addition ❑ RePixement Wl,lAows NWallarys) Roblin Q Or Doors Cd AGc nni Big. ❑ Oerrloieipn Q New Signs I01 Deoka IO SMing(p) Olf ar Ila Brief Dncrippon d Proposetl Alteration of emitting bedroom_Yes Z Ageing No new bedroom Yas Na Aeamad Narrative Re io atmg unfinisliM basement TY. _No Plans Allsmetl Roll -Slwat v.M New house and or addition to existing housing complete the following a. Useofbindmg Oro Family Two Famiy Olmer b. Number of rooms in ear family ural. Number of Bathrooms le there a ganga afteli d. Proposed Square footage of rlew mnstrucpon. Dimensions e. Numberof stonesn f McMod of heamg? FirplaC Or WoOdsMves Number of each_ g. Energy Conservapon Camplai aloss<1NG ErergY ComPhaMar form aexhedi h. Type of cpruWtlian Is conatruopon wimin 100k of"daraft _Yea _Nb Is oo MMn swwn i W O. noodplaM_YN_No j. Depm of basement or cellar fipr bol.finished grade X. Will building comform to Me Bwldng and Zping regulapons9 Yei I. Seppc Temk_ Ciy Sewer_ PMVMe weY_ Chy,Beeler SrOay_ RECTION To-OWNER AUTHORRATION-TO BE COMPLETED WHEN OWNER^S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I.�1�' --> I a Owner blale aMbjeGi properly 'l yadsombe Iba.m J P1"C/�c•� /( pAev �br^l Z.wN:a.ity»e.t>R' p my behMf.fo all matters relative to want aumonaed by n pudding Ilermrt upon. ZO t of 0. Day I. as OwnarlAOMd¢ed Agent heroby Matters Mat Me statements ant information on me foregoing epplrrapon are was and acc awe io me bast of my knowledge and belief. SgMA under Me pans and oenames of Pei PiW Name np.e alpaenAgsm Bela SECTION$-CONSTRUCTION SERVICES 9.1 Licensed Construction,SupeMsor: nn Nott Applicable O Name of License Holder JN.rrL�< B ig?" /SU-L C5 -/0 License Numeer 0,0L4 /0– irl – /5 Address Expiration Dab gnature Telephone S—RBBIstered Nene ImorovemaM Contractor: Not Applicable 0 #0 a -L!"2 .n o.n✓crR /"03797 Comoa Name Registration Number iA S Mu.;n St /lnr ) /f - /A -Ad Address I Expiration Date nal.»P,- Mu 010&y Telephon._%a_ L_y_W SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in dle denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 51" No...... ❑ The Commonwealth of Massachusetts Department of IndustrialAccidents pf 1 Congress Street,Suite 100 Boston,MA 02114-2017 kvit,w %,wso.#oassgov1dia % urkers'Compensation Insurance Affidavit:Builders/Contractors/EleetrlciansfPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information q Please Print Les ibly Name(eusinessOrganaatiom Individual): ,)awrg> /GpptY/SCn /plrhs (/,i ZNfTv✓r mc/lf Address: / 3/D S. I(tja,n St /i:./user Mist orobr City/State/Zip: P „ Phone#: del3 -L E7 *2-1S 5 Arc you an empbyw"Cheek me aDDroDriam hoa: Type of project(required): I.❑I am a employer wild empm.ceftlandexpan-timet' Z ❑New construction 262rm a sole pmprimmor pamenda,ami here on employeesrurkmg fm,mm S. Remodeling any apathy.[No workers comp.lnsmawe regmred.l 1a.b, 3,n l amal,omwok myseif. eowner don,dl r [No w« regan kers'<wnp.mourowe ed.I' 9. ICI umolition e.[]lam a burromnerand wilt be hwrg ennnaetortnennduman workonmy property, lout 100 Building addition ensure Wmaa emnuaemm"do,Im,e workers emsgremadon ins.Ineareinle 11.[aflectrieal repairs or additions p,viniemrs wnh no empbyees 12.[2f amusing repairs or additions S{:3lwin agvmemi conuacmraW iluve hued tbe sub-contrr'mnlisted onflue anached sheet 13.❑Roof airs These sWawtrectw.ha.ecmploYen aMhav<wwkms'coup.imwa,re. � &OWe mea emp,m,ion and its offices Tuve esersoo d d,eh nght ofe—sipmn MMOL c. 14.QOther IS?,:Ilak and we lure oo employees.[Na workers'compmsu same retuned] •Any applicant tha clucks bus al must also 611 our the section below showing thew wurkers'emmpeos nam pnlieY mein sidam 'Hmmvwnms who submit this affe,no ir,muna,they arc doing all work and then hie outside wntmcmn m,ut+nbish a new affidavit iminiong such. fovmcnns and clink W,s boa must an:u:hed an icliamnal sheet showwg the namx of,he sub-mnatows rs and smm xhnher"'.a'Wine endrin love employee,. If We mh,mdm'mrs bare anplor«s.,her nous,provNe then wmkw, cusp.Whey number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and jab site Information. Insurance Company Name: Policy#or Self-ins.Lic.el: Expiration Dior. Job Site Address: CiryrStaterZip: Attach a copy of the workers'compensation policy declaration page(showing the pokey number and expiration date). Failure an secure coverage as required under MGL c. 152,a525A 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 stolator.A copy of this statement may be forwarded to the Office of lnvestigations of the DIA for insurance cacemge terification. Ido hereby cert/fy under the pa�inssandpenaldes of perjury thus the information provided above h arae and correct SE t L/ -vna.�L 7a/�.is�tr't� D t Phone# �y/ ? LE7- 9.3szl Official use only. Du not write in this arra,to be completed by airy or fawn offciof City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton H szachusetts LYPAN15110417 or 9UILUISf. Ia"P ZOMS 111 w n f[[«t •Mmieiyl lu:le;ny . .�; fw[t�ap[on, w 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54. I acknowledge that as a condition of the building pernd 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 pedomred at cam ►. ►,�. �+� ( ease pont house num Eer and street name) Is to be disposed of at (Please prim name aM braoo of fanlity) Or will be disposed of in a dumpster onsite rented or leased from: ' "f lw)Exs �xnA.ltxt Gr (Company Name and Address) S�Lo 10 06, rature of Permit Applicant or Ovafer Date If.for any reason,the debts 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 rr Massachusetts f L � ILIPARTr6NT OF BUILD2Na INSPECTIONS 7t y f 212 lain attaat • Municipal Buildlnq TQC --�� North, ton, 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("1110'). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to anypre-exisfing cwnerbccupied building containing at least one but not more than four dwelling units....cr to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted Kith a corporation or LLC,that entity must be registered Type of Work:Add &AW a -&,e Ano — jn Cellae Est.Cost: Address of Work: ITY Ataskside CIYGIe Florence 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 pmjury. I hereby apply for a building permit as the agent of the owner: 5,20-11F /83797 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property: Date Owner Nance and Signature City of Northampton Massachusetts t� DEPARTMENT Or BB WIM INSFEOTZONN 212 Min Street • Municipal Building Not[hae¢.Cnn, to OlOfiO rihq.�1 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 fans 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 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. 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 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-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 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 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 pernit/icense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/licrose 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 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 Departments address,telephone and fav 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 www.mass.gov/dia 40'-b 3/6• 12-9 SIB• 9'•10 1/6" 1T-10 S/6" �-5'-1 S/6'—�I}�7 5'-0' 6'-59/16' 714916'1/16" 01 \\\ \ / \ I / \ / - O g �OOPq �\ / \ / I ` Kill / 12'-3'919'-5" sD ` 05E / \ -5"X \ CLOSET _ __________ SD SD \ I �/ B (, . �M Living Room \\ / BE$"DXROQM \\ I \ I �5'•1• 7�#"--4'-11• 4'-511/1674'-T 9116" V-0 116' 4'-2 T/6' 7�1r�7.1�'7+F'-05116" 17 -- --11'-11/4" 1T•5116" 1079 50 FT -J-ZQ/•�� Proposed 1st Floor Plan No charge X-- Besides Added Hardwired Detectors. 40'-b 316" 12-95/6" 4.10 116' 17'-10 516" 414 516' 5' 5'-2'' b'-5 9116" 2'11.4 91 6"1176"_5' 51-6 9176" 7 3•-9" ___ _____ _ _�- - ___—� --- 4 I \\ I \O Kitchen // a :o I \ / ■ in \ O5E / 9 CLOSET in / I ------------- 7•_6" mm I \\ I M1 I \ \ I I y to I Bp,�OM rtO f 6K*V Ro \\ in I K 11'--wx 1'2--10^ LJ / BEOROI M\ \ 10'3"X12'- 0: \\ \\ � I 4'-7" 3' 4'3" 3'•1111!16" 9' 4'-19116' -01/16 4'•2716" 2'+1r+7 Al z 4'-03176" 17 11'-1 114"LIV77'-5 116" FND 6de9ng let Floor 1079 50 FT 41' 11'-10 716" 29'-1 1/6" :o R in 'o � I1P `"I = fi R m OFFICE BASEMENT LIVING ROOM a $ in 11.4"x 25•-1" 28'-3"X 25'-1" I in N STORAGE 9'-7"x 10'-11" r in 41' . LIVING AREA 1068 50 FT Existing Walkout Basement Set Uo 41'-3 7/B' 1Y-2 5/4' 1T-10 15/16" 11•2 3/16" 1'-17 91116'_ 4'-113/16" i✓ 5'-0 7/16" 'o Egreaa YVlndow Slider Palo Door m v 4 IN BATH J-4"Xcr-1" c � LOSE B•x a'- BEDROOM 1 t'-8'x 20'-7" ® UP FAMILY 28'•3"X 24'-9" STORAGE C 10'-2'X 1 r-4" GLOSET ' 11'•8"X 9'-9" J1Y-23/4' 18'-11/8" 41'-3 7/8" LIVIIN�GSQAREA 1111IIv Proposed Layout adding ergn:ss u4ndow end cbsat to ueele bedroom Adding full bathroom u*th linen c oset. Egress u•a ve• 1249M 1T-1019/16• 11'43/16' W 3 '-il 1/16• g 1'-119/16' 7 S-0lli6' E6nr Wndau 911der PeEo Door C a 4 N BATH x a-r L ® LOBE y a 'n 2 BEDROOM tl 9 n•-6•xzD-r ® UPWH*-H FAMILY 76'3'X 71'-9" H t_ STORAGE � V w CLOSET * H'a'X34 17-73M' 1D-1 1IB' fl' n•a W LIVING AREA FroCosed La k adding ergreas udndma rdtJaaelbt1eMe betrooWAddirg fullbMroom uiN linm closet.Egress Wind= H be a e ground.Adding hwd d drlgk6/ftlbLA deterdwa. . � �r