23B-085 (3) 25 NEW ST BP-2019-1454
GIS#: COMMONWEALTH OF MASSACHUSETTS
McD.Block:23B-085 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateaorv:renovation BUILDING PERMIT
Permit# BP-2019-1454
Project# JS-2019.002361
Est.Cost: $27995.00
Fee: $182.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Grew STEVEN MACLEAY 070231
Lot Size(so.R.): 35501.40 Owner. PRATT RUBY&KRIEGSMAN ARI
Zoninw URBt100y Applicant. STEVEN MACLEAY
AT. 25 NEW ST
Applicant Address: Phone: Insurance.
20 STOCKBRIDGE RD STE 6 (860) 309-7650 WC
GREAT BARRINGTONMA01230 ISSUED OM6/20/2019 0.00.00
TO PERFORM THE FOLLOWING WORK.-KITCHEN RENO, CONVERT LAUNDRY ROOM
TO BATHROOM, MOVE LAUNDRY ROOM AND ADD HANDRAIL.
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 620/20190:00:00 S182.00
212 Main Street.Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File N BP-2019-1454
APPLICANT/CONTACT PERSON STEVEN MACLEAY
ADDRESS/PHONE 20 STOCKBRIDGE RD STE 6 GREAT BARRINGTON (860)309-7650
PROPERTY LOCATION 25 NEW ST
MAP 23B PARCEL 085 001 ZONE URB(100V
THIS SECTION FOR OFFICIAL USE ONLY'
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvreof Construction, KITCHEN RENO CONVE DRV ROOM TO BATHROOM,MOVE LAUNDRY
ROOM AND ADD HANDRAIL.
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 070231
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF'91414ATION 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 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 Stoma Water Management
Demolition Delay
Z6- 20 Zbjq
SigArtare of Fluilding 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.
p-cr�
Department use only
City of Northampton Status of Permit.
- Building Department R E
212 Main Street 7T—
W-t'
Room 100
Northampton, MA 01060 JUN L� s
phone 413-587-1240 Fax 413 7-1 72PlotiS
DOW
N
APPLICATION TO CONSTRUCT,ALTER REPAIR, E OlIt TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
i.1 Property Adelman; This
This section to be completed by office
a.5- ST
Na Map a&6 Let (I
no I mo- AIA 0 I�---'21� zone Overlay District
Elm St District Ce District
SECTION 2.PROPERTY OWNERSHIPIAUTHOR17EDAGENTI
2.1 Owner of Record: t.'7 JI
Ruby Pot ma hi i Vk-3,wvn a5 Ow � f IDrC/IfZ mrl 01o6•?
Nm
ae(Phno Cusem Malin,Adhess:( W-525 -7 q 90p
m
Telepns 7AJ
Signature
22 Authorized Anent-,
sTe✓eA D_ PAQ(, a 37bCK1oC1� Ra.- 6TE 14
Name(Pdn Cunent Llelling AOtlreaa:6reeT &.-nhyTan /YIA O(23a
Zo -309-7kro
Signature Telephone
SECTION 3.ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by permita icant
1. Building `U O (a)Building Permit Fee
2. Electrical j (b)Estimated Total Cost of
� Construction from B
3. Plumbing % � 0Vy Building Permit I" rJ O
4. Mechanical(HVAC) l7 -7 Ip�•
5.Fire Protection
S. Total=(1 +2+3+4+5) Check Number ) (1 V V
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature'
Building Commisslonemnspeom of Buildings Day
S+tyleA @ Soicred oo-K homy . corvN
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Iii,Completed. Permit Can be Denied Due To Incomplete Information
F Existing Proposed Required by Zoning
This column to be filled in by
Building Department
f :
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Im ares minuv bldg&paved
ft of Parkin Spaces
Fill:
volume&Imatiov
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO Q DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW (2� YES O
IF YES: enter Book Page and/or Document 0
B. Does the site contain a brook, body of water or wetlands? NO Grl� 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 , Date Issued:
C. Do any signs exist on the property? YESa- «.— 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,ex on,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 Stone Water Management Permit from the DPW is required.
A�.1`filf.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicatil
Now House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
ar Doore
Accessory Bldg. ❑ DemoOeon ❑ Naw Sigrrs IO] Decks IO Siding[D] Oder IQ
Brief Description of
Work: a azf� f°w1rS Cganlcf3 In .Hluee ! N:) aP decK. (7tOy2 �atn�r
Alteration of existing bedroom_Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes c—No
Plans Attached Roll -Sheet
so.t lwouse and or addition to existing housing, complete the following:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number or Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
9. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands?_Yes No. IS construction within 100 yr. floodplain_Yes_No
j. Depth of basement or cellar floor below finished grade
k. WIII 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 PERMR
I, U YJ n �' StM� ,as Owner of the subject
property �//�/��
hereby authorize /'/!L'�
to act on hag,in all matters relative to wo uthonzed by this wilding permit application.
61 -
Swatulli0fowriet I
/ Data
I. 5 Ad eA/,/ ,as OwnedAueaazed
Agent hereby declare that therstatements and information on the fore9o1n9 application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains arM penalties a perjury.
Sre✓rer �r
Pr nt Name
Sigatum of OwnenAgenl Dab
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed ConstruWon`+Srupervisolr.. (� ' Not Appliicable ❑
Name of Lfcena.Holder: �] Ie.V1,/1 J/_ I ' 10(iLGo� S— y7 /
S�ckbri d e Rd sGE GrT �rnyra� m q aa3o `cenxa Nunoe
� 3/ate
Adtlmse �j/ 6Plralbn Date '
3i- 745-0
Sigrmhue Telephone
8.R"istered Home Improvement Con4Mlor. Not Applicable ❑
Company Name Registration Number
n�� 7. q'7 i 7a5a3
n Date
$)dN.b� Rd. J,lrb la @tI Teleplwna lJa' J0/'/ � E oa3 -�O
6 O l
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,m 152,$TSC(8))
Workers Compensation Insurance affidavit must be completed and submitted with this app0cation.Failure to provide this affidavit will result
in the denial of ft issuance of the builtlin 22-
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
Massachusetts Fv=s 'cam`
`' "_•f�_ OEPAa� or aazwU Z SvxCrzf Ns
I12 Ms1n Strwt •�<i� 01 Builainq aonwnpton, Marose
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 being performed at:
d' Nad S(. 'Fbrrmce, MA oloP,
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
SA WASU,� W
(Company Name and Ad s)
'Sid—nature of Wrmit Applicant or Owner Dale
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.
i"\ The Commonwealth ofMassaehusetty
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
WWwrlonrs'Compensation Insurance Affidavit:Builders/Contmetors/EimtricianNPfumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information p� I' 1 /� (� Plea" or 'bl
Nellie(Busiiiineelss/OrganizatioNindividwl): ( q V Veg-i C7AC- A W1 JG(.z� (.22� 'RC+ S
Address:, St&"N1bP. ,Rd. SI —9 4y
City/State/Zip:GfCc-1 far-'0 �bA M& Q( 30 PhDneM pub —30`f - 74�
aUeyaa ao rmvMw2 C1ak the apptaPda[e has: Type of project(required):
I.jZIamae IoyawiW Z employees(fulland(caput-time).• 7, ❑New construction
2.❑lamawle proprietor wpaMenhip ami have tm employers working formein g. /❑r'Remodeling
any capacity.[No worium'romp.insurance reauiredl
301..homeowner doing all worlt M.If[No woWa ' amp.is .ns,nrM.]' 9. ❑Demolition
4D amahomeowna mdwill be hiring wntmaara to cmMuct all workmn,r property. twill 10❑Building addition
anure that eft contmaon eiWabave wmkax•anryensanov ivemaviceorare sale 11.❑Electrical repairs or additions
pmpnemm wiW m anpl.Y .
12.❑Plumbing repays or additions
501..ge.I conlmctnruxl l have hirW the s nawmss lived on the woclaA shect. 13E]Roofrepairs
These sub-covnactors have employces and have wmkas'comp.in..:
6.❑We are a corpomM1on and in officerslave exercised their right of exemption pa MGL c. 14.QOthm
152.11(4),aM we have m employees.[No workers'comp.iosucm.required.]
*AYwliwm Wet checks box a l and also fill out the sativn below Wowwg Weir workm•compeveation policy ie tion.
t Nomawners wlw wbmit this arfidavit indicating Way are doing all work mM thm hire onside cononciors must submit a yew atFdaOt indicating such.
tCouvacwn that check this box rutin atuehed w addilwu.l shoul showing We name oMu»ub<onvacm.and sum whether ur not those entities have
employees. If We sub nuv:mrs have employers,they must provide dale wodcas'arum.policy vmober.
I am an employe that is providing workers'compensation insurance for my employees. Below is We policy and job site
infurmadon. ('' / Lt
Insurance Company Name: �r1fm FlM� 0/ Gz,ru.Hy
Policy#or Self-ins,
1Lie.#::�1 lgobl w -(1y3 Expiration Date: IQ 0 ^SOI
Job Site Addmss:;F IVP 5T r(orC✓1e City/State/Zip: M R
Attach a copy of the workers'compensation Polley 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 imprisonment as well as civil penalties in the forth 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.
Ida hereby cerafy d the and E3ltles ofpejury that the information provld/edabcove is osreandtnrrect.
Somature: p qcA`/f Dare' O -( 1
Phone#: O 6�� 3U/ ._7 5'V
Oficial ase only. Do am write in this area,in be completed by city or town ojfmiaL
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/To"Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
City of Northampton
ss
Massachusetts �� y
DEPARnMIIir OF BOILDZNC. INSPlLTIGre 2 `
ti
\ M M
213 Main Street • la,nicipal Building
\` North, ran, W 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("HIC").
M.G.L.Chapter 142A requires that the"mcorstnrction, aheradon,renovation, repair,modernization, conversion,
improvement, removal, demolition,or constriction or an addition to any pre-existing owrrer-occupied building containing
at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building"be
done by registered contractors.
Note:If the hommNater 'hm(contracted with a corporation or LLC,that entity mast be registered
Typeof Work;Rerl nnrJ Est Cost iFS,000•00
Address of Work: ice/ Fl t,FM6x- mA 0106 ,Z
Date of Permit Application: 6— I — ►
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
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 perjury:
I hereby apply for a building permit as the agent of the owner.
4-17- 17 s� o M4cLea�;,,, 1 -7a5� 3 10j23/.k>.V
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
"f/� �.. Massachusetts
p'
DEPARTMENT OP BUILDING INSPECTIONS
212 win c: . Nun 0Building V
\_, NarNamptov, MA 01010 60
Massachusetts Residential Building Code
Section 110.R5.t.2
Homeowner. Person(s)who own a parcel of land on which he/she resides or intends to reside,
on which these 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.
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