24D-089 (12) 64 NORTH ST BP-2019-1391
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-089 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: Egress Stairs BUILDING PERMIT
Permit BP-2019-1391
Proiect# JS-2019-002233
Est Cost,$650.0
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group MICHAEL L HARRINGTON 102948
Lot Size(sp. ft.): 7100.28 Owner: HARRINGTON MICHAEL L
Zoning'URC(100 Applicant: MICHAEL L HARRINGTON
AT. 64 NORTH ST
ApaRmtAddress: Phone: Insurance:
P O BOX 393 (413) 575-8345 WC
NORTHAMPTON ,MA01061 ISSUED ON:6/17120I90:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 2ND MEANS OF EGRESS FOR FRONT
AND REAR FIRST FLOOR APTS
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 Signature:
FeeTPpe: Date Paid: Amount:
Building 6/1720190:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File 8 BP-2019-1391
APPLICANT/CONTACT PERSON MICHAEL L HARRINGTON
ADDRESS/PHONE P O BOX 393 NORTHAMPTON , (413)575-8345
PROPERTY LOCATION 64 NORTH ST
MAP 24D PARCEL 089 001 ZONE URCf 1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvueof Construction: INSTALL 2ND MEAS OF MESS FOR FRONT AND REAR FIRST FLOOR APTS
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
INFOATION PRESENTED:
tApproved_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
a
lition Delay
G- 7-WSign 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.
Versionl.7 Commercial Building Permit May 15,1000
Department use only
City of Northampton Status of Permit:
Buildin rtment curb Cut/Drivewey Permit
21R am CEI ED W rANeIIrlSepIIAalalbilityly
Northam on, A 01060 T Sets of Structural Plans
phone 4l&587-1 40 axj*5B7,_1 � Plo Site Plans
-
r Specify
APPLICATION TO CONSTRUCT,REPAI R ED OCCUPANCY OF,OR DEMOLISH ANY BUILDING
E IL DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be completteedd by alike
��if� Map ac-(0 Lot �6 / Unit
-e4 ' - 1j( MA, 0/d A9 Zone Overlay District
- - - Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Re
TOJ 314 313
Name(Print) Cunent Mailing Morass:
JJ0(LT-eKAM1J MAI DloGl
Signature I Telephone
2.2 Autho 9L A ent:
Name(Print) Cunent Mailing Address:
Signalure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Esdmated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building - (a)Building Permit Fee -
2. Electrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing —0 — Building Permit Fee
4. Mechanical(HVAC) �leo
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number 3
This Section For Official Use Only
Building Permit Number Data
Issued
Signature:
6. 7- 20iy
Building Commesionemnspector of Buildings Date
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 ❑ moII6RdQ i�e�alrL'd-AddiUonsLK
Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ N w SI ns❑ Roofinppgg❑ Change of as❑ Other
Brief Description EtUeerraa,brief description he e. N5A/tL(.,,4M v 5 O l7 RG� (dtk f&� "
Of Proposed Work: i�^n- FtRSt
t-400 PAri7 M.)-""
SECTION 5-USE GROUP AND CONSTRUCTION f4E �Mprt-"" '�0" .�. � r'•1 i
USE GROUP(Check as applicable] CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 131A ❑
A< ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Facto ❑ F-1 ❑ F-2 ❑ 2C ❑
H Hioh Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ I-2 ❑ I3 ❑ 38
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 58 ❑
U Utility ❑ Specify.
M Mixed Use ❑ Spedfy:
5 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 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1s _. 1e
2. 2-
3'°
4
m 411,
Total Area(sf) Total Proposed New Ccnstruction(sf)
Total Height(ft)
Total Height It
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sswaps Disposal System:
Public ❑ 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
This wlnmo to be WIM in by
Build,,Dry on
Lot Size
Frontage
Setbacks Front
Side LR L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot eme mine beds&Prvcd
rkiv
#ofParking Spaces
Fill:
(volumc&Location)
A. Has a Special Permit/Variance/Finding er been issued for/on the site?
NO O DONT KNOW 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 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
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,e.-3abdr,or filling)over 1 acre or is it pan 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 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:
Ir i Not Applicable ❑
Name(Registrant). /�'
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professi^onral Enginser(s):
V
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Tekphane Expiration Date
9.3 General IC�.on�tr/actor 1 �/.,�//�
rAliq (— y,....11•tr•+�� T� Not Applicable ❑
Company Name.
Responsible In P.?e pf Corrob,I n 1
(V�,(L( 1 L• {0(,70(,/I
Address
Sign Telephone
f
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(760 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No
SECTION 11 -OWNER AUTHORIZATION-TO BECOMPLETED WHEN
OWNERS AGENT OR
CONTRACTOR
/APPLIES
IFOR BUILDING PERMIT
I. Y"� T z� L �� �7(�4Iy"'�'7GA/ as Owner of the subject property
hereby authorize ____ �f1"' to
act on my in maser rve to work authorized by this building permit application.
Signal r Data
as Owner/Authorized
Agent hereAlecla , Lse.nfl5 information on the foregoing application are true and accurate,to the best of my knowledge
and beliefSignanry.
Pdm Nam
M(CffPtc-G � - lfdt�l/1-r,U6.-�,c�
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction
,Supervisor.
/ Not Applicable ❑
Nameof License Halder:
License Number
Address Expiration Date
Signatur Telephone
SEC N 13- RI(E 'C ENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,J 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavitwill result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes O No Q
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: ♦'Lf !D 11d01`'f" f*wd 4 4 I
The debris will be transported by: (C ISL L• (ffV-Af N�T�f1
The debris will be received by: rlwt(-� t2-&CYCL-(dd6'—L
Building permit number:
Name of Perm' pplicant A-(((t7y L I- , (4-4r1-(')C-P11
Ll- 4
Date Signature of Permit Applicant
The Commonsvealth of Massachusetts
Department of IndustrisifAccidents
I Congress Street,Suite 100
Boston,MA 0211 4-2 01 7
svrvw.mass.gov/dia
11'orkers Compensation Insurance Affidavit:Builders/Contrastors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AtITHORiTV.
Applicant Information Please Print Legibly
Name(BusinessiOrganization,Individual):
Address:
City/State/Zip: Phone M
Are rano replayerr Cheek the appropriate box: Type of project(required):
L❑I am a on play.with es"loyees(fulimSerpmt-tutwh• 7, ❑J New construction
2.❑1 am a wk propd.,or patmephip and hove m employers working far me in g, g Remodeling
any capacity.[No wotkers'ronN.iesweree nx uved] 1rK�x
)AW I rmahommwvcr doing all wink myself IN.woskers'econ,insurance"mai.] 9. ❑Demolition
e❑1 am abomrowmr inter wdl tx hiring eonmemrs m condna as work m my Poparey. 1 will 10❑Building addition
asnuradmialcauttracumartbarbaccuoulars compcn tion msumacc err aresok l[.❑Electrical repairs or additions
,someb rs withm employees. 12.❑Plumbing repairs or additions
SCI I am a acetal conwmor and I be.hired the subcuunacmn hated on the sham.
These 13.❑Roof repairs
subcontractors have employee and and have workers'com ..urenp.
6.❑We are acoryomtum and its coke.have e..m l their fight ofexcemo.per MGL,, 14.00lher
152,II(47.and we love oo mwmyees.[No webers'comp avoicance rt ored.l
*Arty applicant that checks box#1 must also all out the section below showing theirworkeri compensation policy utf etion.
'Homeowners who submit thia affidavit indicating they are doing all work avd Nato hire outride contractors most submit anew affidavit indicating such.
ICono-acmrs Jet check this Mx must aoucM1eJ un eddipovl sheet aM1owing the nam ofthe wbKonmcton and sate wM1ethm ur not thou rntitie have
esnployae. Ifthe sub-wntmmors have employ«s,they mutt provide their woAers wmp.policy nwnber.
I am an employer that is providing workers'eampensation insurance for my employees Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lia#: 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 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 impri ent,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 violat r. copythis statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifica'
If
I do hereby catandpenaldes ofperjury thatehe information provided above is true and correct
Si nature: Date: �Y
Phone 4- (—
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?own 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 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 certificam(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,arc 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 permit/icense number which will be used as a reference number. In addition,an applicant
that must submit multiple pcnnidlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"lob 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 Comroonwealth of Massachusetts
Department of Industrial Accidents
I Congress Sheet, Suite 100
Boston, MA 02114-2017
Tel.#617-727-4900 ext. 7406 or I-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
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