31D-208 (2) 97 SOUTH ST BP-2019-1385
GIS a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:31D-208 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 0.142A)
Category REPAIR BUILDING PERMIT
Permit# BP-2019-1385
Proiect# JS-2019-002225
Est.Cost:$1150.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: GARY DUPREY 073876
Lot Siae(sa.R.): 15202.44 Owner: DUPREY NICHOLAS D&BETTY L
zoning URC(I Applicant. GARY DUPREY
AT. 97 SOUTH ST
Applicant Address: Phone: Insurance:
22 CEDAR ST (413) 586-6589 SOLE PROPRIETOR
NORTHAMPTON ,MA01060ISSUED ON:614/20790.00:00
TO PERFORM THE FOLLOWING WORILREPLACE EXISTING 1ST FLOOR PORCH ROOF
OVERHANG
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 Deoartmen[ Fireplace/Chimney:
Rough: O_ 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:
FeeType: Date Paid: Amount:
Building 6/420190:00410 $100.00
212 Main Street,Phone(413)587-1240,Fag:(413)587-1272
Louis Hasbrouck—Building Commissioner
File q BP-2019-1385
APPLICANT/CONTACT PERSON GARY DUPREY
ADDRESSIPHONE 22 CEDAR ST NORTHAMPTON , (413)586-6589
PROPERTY LOCATION 97 SOUTH ST
MAP 31 D PARCEL 208 001 ZONE URCf 100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid /
Tvueof Construction' REPLACE EXISTING I PORCH ROOF OVERHANG
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 073876
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: 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
DarBmld,ng
molition Delay
1- 3-Zoj9
Sig Official Date
Note: 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 MGL 40A,Contact Office of
Planning&Development for more information.
1
Versionl.7 Commercial Building Permit May 15,2000
Department use only
ity Northampton Status of Permit:
JUN - 1 2019 uildi g Department Curb Cugoriveway Permit
21 Main Street Sewer/Septic Availability
om 100 Water/Well Availability
DEPT Fe UILDING INSPE,j OwA
NORTHAMPTON.M 87-1240 Fax 413-587-1272 Plot/Site Plansro ra Plans
e 1 1511
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address: .This section to be completed by oNics
97 J00th si. - Map Lot gip$ unit
{/aUf/JAmP7oNy mA. 0Jo60 Zone Overlay District
-- -- - Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(P Curtent Mailing tltlress: _
Sig Telephone
22 Authorized All
Name(Print) Current Mailing Morass
Signalum Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed be"it applicant
i. Building y / Q (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fes
4. Mechanical(HVAC) u
S. Fire Protection
S. Total=(1+2+3+4+5) -" Check Number
This Section For Oficial Use Only
Building Permit Number Date
/7 Issued
Signature:
&$tig Cormnissionermnspector of Buildings Date 3
�r'i7Q/�r �' �'OuPne� ; �•vTi>/an.�1��Yce.h4�..co�
Versionl.7 Commercial Building Permit May 15,2000
SECTION4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition[] Repairs Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signe❑ Rooting® Change of Use❑ Other ❑
Brief Description Enter a brief description here.J?.p/,C5 �11-yA,? S/6T Fes^- aOGCn
Of Proposed Work: / / y Ila- u - W
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP Check as applicable) CONSTRUCTION TYPE
A Assemble ❑ A-1 ❑ A-2 1:1A-3 ❑ to 13
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ IJ ❑ 38
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 14 R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ _ S2__ ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: ._.__ .. _ Proposed Use Group ___. .
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
ie OO x
2w .. 2n° —.
r
3p
m _.
__...
Total Area(sf) _. p a/00 Total Proposed New Construction (so
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone beformation: 7.3 Sewage Disposal System:
Pudic Private 0 Zone Outside I"Zone Municipal On site disposal system❑
Vcn ionl.7 Commercial Building Permit May 15,2000
g. NORTHMBTONZONBVG
Existing Proposed Required by Zoning
Thu wM1wn a be fim by
Budding Deryrtm
Lot Size
Frontage
Setbacks Front
Side L:— R:— L:'--- R: — _l
Rear u ---
Building Height
L _
Bldg.Square Footage
Open Space Footage __. %
(W.mora bug& wM
#ofParld S aces — -
FDI: _. ..
v,u &[. .uovl
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ja DONT KNOW O YES O
IF YES, date issued: _ -- — -j
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 0 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 140 J&
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 construction activity disturb(clearing,grading,a vadon,or Ming)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 Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Pemdt May 15,2000
SECTION 4 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)
8.1 Rpbtared Arehhael:
_ Not Applicable ❑
Nanta(Registrant): - ----
__— R4g4tra0m NumM
Address
-- Eapirai Date
Tahowe
9.2 Registemed Prof"Wonal En Inser(s):
Name Area of Respomibiliry
Address-- ---- —� — Registration Number ---
SV
Telephone Fxpiratbn Dale
I
Nome Mea of Responsibility
Andrew - Registration Number
Slgnatoe Telephone EiiiIneon Date
Name Area of Respomb iity
Address Reglat2don Number
I
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Siglabn Telephone Expi adon Date
9.3 General Contractor
---- - Not Applicable ❑
Company Name:
Responsible In ChoW of Coabudbn _
t
Addrua
SI nature TOMplwre
Version L7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER RENEW(780 CMR 110.11) ,��T7jrr
Independent Structural Engineering Structural Peer Review Required yes 0 No 11y
SECTION II -OWNER AUTHORIZATION-TO BE COMPLETEDWHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILOING PERMIT
as Owner of the subject property
hereby authorize l._____ _______._. ___- _.___. .__..___.. -- .._'Ito
ad r"Y half, in Live to work authorized by this building permit application
�Id �•-, n2 6 -,�-�o_ly —
SI r of r ` \D Data
,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
Pont Name _
Signature of Owner/Agent pate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction`Supervisor Not Applicable E]/
Name of License Holds : )-/QP/ 1, —.(/I1n�f.Y
i Uce Number
'57--zy-�o
Aeare c: l ` AN r Exdratbn pate
Signature 4 Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e))
Workers Compensation Insurance affidavit must be completed and submitted with this appimlion. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached yes 0 No O
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, Sr150A.
Address of the work: 47�Jifi� STT/ iJ 7�/�,
i 7
The debris will be transported by: /.r? r Ni>yG /91fAY J91J1�pk'
The debris will be received by:. y f�e t! LLin�
Building permit number: /�
Name of Permit Applicant l rAjZr /)g,olte,Y
Date Signature of Permit Applicant
77ie Commonweafth ofMassachusetxs
Department of industrialAccidents
I Congress Street Suite 100
Boston,MA 02114-2017
svww.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Coatraeton/Eimtricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print L-6bly
Name(Business/OrganaanowInn�dividual): ��jty f/� Il
1 UO e y
,�
Address: A Ce,44d- dj
City/State/Zip,/do d Phone#:_y/3 586-658 y
Are spa as cooler.?Cheek rhe"ospdae boa: Type of project(required):
1.❑I amaamploy.wan emplorces(fan and.pans-I®a)• 7. ❑New construction
2. I=4Wkpiopietmmpr 1paadbavemamploymwo.king formai•
any capacity.[No workem'corny.wsarnae regwed.l S. ❑Remodeling
3❑I am a hmmmwmr doing all wort mywlf.[No world comp.immm.nano•.]t 9. Demolition
0.❑I am a homeowrur and wall be huine rnnpacfOrs to conduct all workon my Pmpmw 1 will 10❑Building addition
urethan dl contmcmm cim.h.vc wmters'cu�en.,.tion imunnce ora.sok 11.❑Electrical repairs or additions
Min.won.employ... 12.[]Plumbing repairs or additions
5❑1am.ennead mono-nor and I have hired tae sub traetom hatedon thema,hed shawl. 13.®Roof repairs
these submoo-emn have cmnlure.aedbave wmkars'comp.imurame
b❑We an,a earwation aM Ip.Rears haus exercised tlmb nabt ofexemplion per MGL c. 14.❑Other
152,§1(4),and we have an mnployees.[No workers'comp.maunom manned]
•Any
applicant that chxka brtox so maalso fill out the action below slwwing Nehwmkars'eompcnsmioa policy wfonwnon.
t Ilom =who submit Nis aR-Wavo indicating dray are doing all work and thea hue outside convenors mon submit a new amdwit indiwtwg such.
1Cnn.e.that chedr this box muss couched..Win...lsheet showing tae Dame of the sub<onvaams sad sate wheher or not dune canes have
employees. If Ne sub-eoumemm have employms,Ney must provide Noir workeri comp.policy mmnbrn.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and jab site
information.
Insurance Company Name: ,
Policy#or Self-ins.Lic.#: Expiration Daze:
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 MOL c. 152,425A is a criminal violation punishable by a fine up in$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 on$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 certfy and th pins and p s of perjury that the infurnmaon provided above is one and correct.
S'g t U Dat
Phone#'
Officialuse only. Do not write in this area,to he completed by city or rows official.
City or Town: Permit(License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department J.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employersto 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 alimmepts 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 issusuce 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)nates"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),addrem(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 resumed 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 To"Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space ar 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 at a reference number. In addition,an applicant
that mug 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 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 Cornmonwealth of Massachusetts
Department of Industrial Accidents
I 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
Commonwealth of Massachusetts
f Division of Professional Lkensure
IV' Board of Building Regulations and Standards
Construction Supervisor
CS-077876 Expires: 05/1412020
WRY J.DUPREY
22 CEDAR ST.
NORTHAMPTON
01060A OtO
C,4
Commissioner