25-075 (22) 3 RIVERBANK RD BP-2019-1327
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Blmk: 25-075 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category. Stairs and porches BUILDING PERMIT
Permit# BP-2019-1327
Proiect# JS-2019-002140
Est.Cost:54500.00
F«:$65.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor. License.-
Use
icense:Use Gronp: JAMES FINN 88014
Lot Size(w. R.): 24698.52 Owner. KENNEDY MARY
zoning: Applicant: JAMES FINN
AT: 3 RIVERBANK RD
Applicant Address: Phone: Insurance:
29 HICKORY DR (413) 58 -4566 O
FLORENCEMA01062 ISSUED ON.•5/28/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL LANDING AND STAIRS FROM
EXISTING SLIDER
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 Occuoancv simulator.:
FeeType: Date Paid: Amount:
Building 5/28/20190:00:00 565.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BR-2019.1327
APPLICANT/CONTACT PERSON JAMES FINN
ADDRESS/PHONE 29 HICKORY DR FLORENCE (413)584.4566 Q
PROPERTY LOCATION 3 RIVERBANK RD
MAP 25 RARCE{�075 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FILLED OUT 45
Fee Paid
Building Permit Filled out
Fee Paid
TyoeofConstructiom INSTALL LANDING AND STAIRS FROM EXISTING SLIDER
New Construction
Non Structural iptedor renovations
Addition m Existing_
Accessory Structure
Building Plans Included: _
Owner/Statement or License 88014
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved_Additional permits required(sea 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:§_,.,,._„,_,_,_e.�_ ,,,,
FindinS___.. .�_.. Spacial Permit _ Variance•_
Received&Recorded at Registry of feeds 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 - M261
Silidea6m of Building Official r Date
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.
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-- City of North, npto sof F ermit: Department use only
Building Depa Inneicu Cut,1 nveway Permit
212 Main S real MAY 2 1 2011sewl,r/Sel tic Availability
Room 10 Wat r/We Availability
Northampton, Ili k 0 o etmolvc INss.1111 ets f Structural Plans
��. phone 413587-1240 F x 4 +ArF7P�N r�^ PIkShe P ans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property AddressThis section to be completed by office
Map �S Lot Q 'X9 Una
Zone Overlay District
Elm St.Distal CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: I �fiiYllieslMl
�cefvwN
Name(Print) CurrentrMailkq Address:
Signature TeMph— G ( 7–510
2.2 Authorized Apeml: r
3 f�� 2ci W tcl j ry Or Oo r-CNc-c l4l(
Name(Print) f_ current Melling Address:
140 -
Signature LzTelephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pentrat applicant
1. Building UQ (a)Building Pemtit Fee
2. Electrical (b)Estimated Total Cost of
Construction from B
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) - �G✓,
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Of ficial Use Only
Building Permit Number: Date
Issued C
Signature: –47
Building Cornmissioner/Inspector of Buildings Date
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 m1.ro be fitied N by
Building 1)ep ant
Lat Size
Frontage0 -
Setbacks Front O ��
Side L:= R:= L: R:
Rear
Building Height O
Bldg.Square Footage
Open Space Footage O % O O O
(tut vee minus bldg a paved
mki
#of Parking Spaces 0 O
Fill:
wiume a I.ocaniw A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW YES O
IF YES: enter Book _ _ _ _ Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (P) 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
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 Ob
IF YES, describe size, type and location:
E. WAIT the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is g part of a common plan
that wit disturb over 1 acre? YES O NO MW
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION e-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ /' C
Name of License Holder'. I U Rt1.j Q K,1 ll�'I R inIT L J
License t umblir
2� 11 11u
Addres Expin n Date
sgnature Telephone
lo 96
9. Im n v m o ofr t Not Applicable [I I L ( �l
Company Nettle Registration Number
Su MfZ
Address /n/1� Fxpiration Date
Telephone
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this alfidsyil will resua
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No._... ❑
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ gNew
cement Windows Aneratlon(s) Roofing
rs [�
Accessory Bldg. ❑ Demolition ❑ igns [I71 Decks [p Siding 1171 Other[C3
Brief Description of Proposed
Work: J
Aherafion of existing bedroom_Yeti No Adding new,bedroom Yes No /A
Attached Narrative Renovating unfinished basement _Vas Y No
Plans Attached Roll -Sheet
tie.If New house and or addition to existina haueina, 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
a. Number of stories?
/ Method of heating? Fireplaces or Woodstows Number of each
g. Energy Conservation Complitatce. Masscheck Energy Compliance form attached?
K Type ofconstruction k)
I. Is construction within 100 ft.of wetlands?_Yes --DL No. Is construction within 100 yr. floodplain_Yes-y—No
I. Depth of basement or cellar floor below finished grade
K. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank_ City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS '�AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, J cr �re as Owner of the subject
proberty
hereby authorize r
to act on my beha to work authorized by this building permit application.
Signature doWim Date Z /
�yy
I, /(n J1M1f.S nh , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Signed under the pains and Pees of perjury.
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Print Name
Signature o en m Date
City of Northampton
� S/n
Massachusetts A?s
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ffiaRTlalT OF BUILDIHa IBaPdCT1019
212 I In St Gt • MWuclp l bullfrog �'•.
Northaaptm, Nle 01060 0•
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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("FDC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
impmvement, 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 are 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
ad
Type of Work: t Est.Cost:
AddressofWork: 3 iud Gu.� WOfreN lU�t
Date of Permit Application: I I 112?1/1A
1 hereby certify that:
Registration is not required for the following wason(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 RESPONSIBI ITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply fora building pe it as the agent of the owner:
112� IY —G jso4911
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
+f Massachusetts
t
�T or BMWIBO IB8rS=QFS
'\ 212 l Str t • M icip l Building
Northam n, M 01060
Massachusetts Residential Building Code
Section 110.85.1.2
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.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.
City of Northampton
E 4 Massachusetts 4=9
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.1. DAWN MffiT OF BUILDING INSMCTIGNS - s
212 Nair Strut .N .ip l Builtl W
Nor� t=' M 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 beiing �p�ej�rformed at:
3 Riu(r�uJl�/ OCX
(Please print house number and street name)
Is to be disposed of at: ��((��))�
U(A 1 �t/ I UC4
(Please prim name and "ion of fla,
Or will be disposed of in a dumpster onsite rented or leased from:
ti 1A
(Company Nanle and Address)
7 ok
Signature0i0liftisfedlit or Owner D L
/
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 Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-20177
www.massgov/dia
Wm.rkersl Compensation Insurance Affidavit:BuilderslContractnrs/ElectricianJl'lumben.
TO RE FILED WITII IHE PERMITTING AUIBORITY.
Applicant Inform ion ' 1 Please Print Legibly
Name(Business/Orgavir ioMndividual): TLCsf 4s W -Inn
Address: 2 1LT, uf-
City/State/Zip: ge/t cf' / r`K Phone#:
Are you an employer?Cheek the apprapsgaH boa: 'type of pmjeet(required):
Lc``1conaemploye,with _ employns hol amVor pun-rima)' 7. ❑New construction
2.�Ivnasolc pnmrietor orpmnersM1ipaM hale na employees working to,mem 8. ❑Remodeling
any capacity.INn milsets'compins. re,ured.I
9. ❑Demolition
3.❑I cors a homeowner doing all wmk myuV[No workers'comp.imw—"•required.)r
4.13 I am a homeowner and will be hiring contrcHm to conduct all work on my ptopeay. Ivan 10❑Building addition
emure that all cootrxHrs eider naso wakam,compensation room..or see cele 11.[]Electrical repairs or additions
,en,nmms with no employ«s. 12.❑Plumbing ulg repairs or additions
3.E3 1 are.gestmd contraztor end 1 M1eve hiredthe sub-cono-xmrs listed onasem ms amend Set13.[]Roof repaha
These mbconvazmrs have employees mMlmve workers comp.incur®re.: .1.
6.❑Wemeam rrtionmditsoffi rs eexmixd kritgafexemptionpm MGLe. 14.JpOther ///III L
132,41(4),stet we hive m ertglayen.pia workers'coruP.imurana required.] r4
-Any Whemt tlmt checks box%1 rent atm fill oW the sedan below showing their workers'can,manon poh,infomunan.
t Homeowners who submit this iti id;wk indicating they are doing all work and den hire outside contractors must submit a new aff lavit indeating such.
tCarmaime not,chock this box must aaached an additional shmt showing the tine of the wh-comraqur.a.d,t tW whethe,or not thou entities have
employees If the suhwntracmrs have anpinsees.Ince must provide dxir wmka%consp.pohev numhn.
lam an employer that is providing workers'compensation insurance fin cop employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Exphatim 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 51,500.00
and/or me-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 may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby cert' n the pains and pesea#iev ofpedm y that the information provideda is Ime and correct.
sign. e: D' W �d
Phone N:
Ojyi'ciat use only. Do not Ivrite in this area,to be completed by city or town ofltciat
City or Town: Permit(Liceose#
Issuing Authority(circle one):
1, hoard of Health 2.Building Department 3.City/fovin Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#.
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Commonwealth of Massachusetts
Division of Prolessional Licensure
e Board of Building Regulations and Standards
Construction Supervisor
CS-088014 EXpires: 11/1912019
JAMES W FINN
29 HICKORY DRIVE
FLORENCE MA 01/1006,22
Commissioner ✓"
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q6q Cemunar ABalis CONTRuuusACTOR
FAME IMPEN
TOPEMIividual
e"I ton
152921 1011912020
JAMES FINN"
JAMES W.FINN 1,
29 HICKORY DRIVE Undersecretary
FLORENCE.MA 01062
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