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24C-160 (6) It ARLINGTON ST BP-2019-1490 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24C- 160 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: Deck BUILDING PERMIT PermitBP-2019-1490 Project e JS-2019-002414 Est.Cost:$2800.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Gmuo: WILLIAM ROCK 050081 Lot Size(sq.ft.F 5445.00 Owner: HOGAN EDWARD&CANDICE REFFE Zoning: URB(100V Applicant: WILLIAM ROCK AT: 14 ARLINGTON ST Applicant Address: Phone: Insurance: 23 Amherst Rd (413) 256-4930 SOLE PROPRIETOR PELHAMMA01002 ISSUED ON:6/27/20/9 0:00:00 TO PERFORM THE FOLLOWING WORK:FLOATING DECK 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 Shmaturr FeeTyne: Date Paid: Amount: Building 6/27/20190:00:00 $65.00 212 Main Street. Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-1490 APPLICANT/CONTACT PERSON WILLIAM ROCK ADDRESS/PHONE 23 Amherst Rd PELI IAM (413)2564930 PROPERTY LOCATION 14 ARLINGTON ST MAP 24C PARCEL 160 001 ZONE URB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid i _t/1 Building Permit Filled out Fee Paid Tvoeof ConstructionFLOAIINGDECK New Construction Non Structural interior renovations Addition to Existing Aceessory Structure Building Plans Included' Owner/Statement or License 050081 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO $MATION 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 Sewcr Availability Septic Approval Board of Health _well Water Potability Board of Health Permit from Conservation Commission Permithurt C11 Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demo ' ion Delay G ZG ZDI? Sign eof Building 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. Department use only City of Northa rrit Building Depa me ECEIV , away Pemxt J,.. 212 Main S eel S Availability Room 10 Wats NYsit veiwlity Nortnampton, M o1 sOJUN 2 5 20 wp ets StnwYural Plane phone 413-587-1240 F x41 -587-1272 Plou itaP ns DEPT OP BUILDING IIIRP P O 0a0 APPLICATION TO CONSTRUCT,ALTER, REPAIR, ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address This`1 � �Thiiss/s�ection to be completed by oRca /"z Irt5r+D, $t- �f-V, — Map�C, Lot Mco Unit ✓ I Zone Oveday District Elm St.District Ce District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Prim) C Ve,VI ;ddf" Tel" 2.2 Authorized Anent: Q3 A� Levj rpt -Pe I L,C.,, Name(Prim) Current Mailing Address: ),l 545ati_ i y3C-7 c11 a5G yP Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only correlated bpermit applicant 1. Building rya boo (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from fi 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) -•//� 5. Fire Protection B. Total =(1 +2+3+4+5) a DU Check Number This Section For Official Use Only Building PermitNumb Date Issued / / » Signature: G Building Commissioner/lnspector 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 column to be filled in by Building Department Lot Size _ ..... Frontage Setbacks Front Side L R: L: R: Rear - ---- Building Height Bldg. Square Footage Open Space Footage % ( t ama minus bldg&paved rrin #ofParking Spaces - Fill: � volume&',tenon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T 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 Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained ® , 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 O IF YES, describe size, type and location: E hill the disturb overs loativity cre?disNEs(clOearing, gradiYNOng, evah or filling)aver 1 acre or is it part of a common plan IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(check all aoallcablel New House ❑ Addition ❑ Replacement Wlndows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks 10 Siding[0] OtherlOJ Brief Description of Proposed Work: Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet ea.If New house and or addition to existina housing, 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? of Proposed Square footage of new construction. Dimensions e. Number of stories? If Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy,Compliance farm attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. Floodplain_Yes 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, ( Od An > � . 1"e qH1 as Owner of the subject property I hereby authorize ��..( �atl to act on my behalf, in al�ers relative to work authorized by this building permit application IF /)Signature of Owned ' 1 Date � W 11I `4 W '" KOC�a'` as Own /Authanzea Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best c edge and belief. Signed under the pains and penalties of perjury. Print Name .0/. � 5 i9 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su er1visor: �� Not Applicable ❑ Name of License Holder: )I1 r�C'c� 18 1 1 License Number d3 A ,4Ine t'�ol �e� l a P� loa9 o% s�a0 Address Expiration 7�SA K3a7 a5� v43a Signature Telephone 8.Realstered Home ImwovemeritCaritraotor: Not Applicable ❑ rrp ,,.1 WCg>,C - 51 +- C-o 167 S79 Comoanv Name ) Registration Number �3 Awl er5 I fd Ve midi,,, hia 6l /0//-3 aG Address Expiration Ddte Telephone S75 4D67 3a 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 the denial of the issuance of the building permit. Signed Affidavit Attached Yes- .... SK No...... ❑ r _ City of Northampton - , Massachusetts s DEPARTMENT OF BUILDING INSPSCTZONG = S, 212 Main Sweet Hvnicipa13-1ding Nor[hampfanI . 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"reconstruction, alteration, renovation, repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than Pour 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 Type of Work: WorA `F-4+•o Est. Cost: OBC Address of Work: IIj /}r I•Md'�('a cn a.F� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): —Job under S 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 perjury: I hereby apply for a building permit as the agent of the owner: 16 7579 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 Massachusetts U DEPARTMENT OF BDILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, I9. 01060 Massachusetts Residential Building Code Section I10.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 farm 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. City of Northampton r s — �." Massachusetts a ``s DEPARTMENT OF BUILDING INSPECTIONS 212 Nein Street ON icipal Building ?y a Northampton, 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 being performed at: /'t A L..Tr o,. nal (Please pont house num rand 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: (Company Name and Address) wil 1. Signature of Permit Applicant or Owner Date 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 LnduslrialAccidents 1 Congress Street Suite 7 V'V�' Boston,MA Street, Suite 1 wltnemass.gov/dia R orkers'Compensation Insurance AlTrdaviH Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print L c'bl Name (Business/OrganizatioNIndividual): soo 11 I}!NU LJoOd 5 t Address:_ �3 � k la' Y•�' City/State/Zip: ao o160a Phone#: s75 1{307 X2$6 1036 Are you an employer.Check the appropriate box: Type of project(required): I I oma employer with employe,si fell surmoanaimer* 7. $t New construction 2 I ran a sole proprietor or partnership and have no employees working for me in g. ❑Remodeling any capacity.[No workers camp.inc required.] 3.[:]l sm a homeowner doingIl work myself No workers came, 9. El Demolition a b p. suanrin �e required]' to 10 ❑Building addition 4.El 1nsua homeowner and will behiring wntmdorsnrnoatioall workce or property. 1well ensure that all contractors either have workers'enmpensmion announce or me ante 11.❑Electrical repairs or additions propdemn with no employees. 12.E]Plumbing repairs or additions 5 I an a general conhowmr and I have hued me suNconewerors listed he the attached such, These subconmevmdr , rs have employees and have woers13''cor, incruncet ❑Roof repairs 6 W are a consortium and its omcers have exercised then right of exemption 14.E]Other tpom g prion pe MGL c. 152,g 1141,and we have no employers.[No woAers'wrap.submarine reyumxL] 'Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. 'Homeowvsrs who submit this affidavit ivdisming thus,are doing all work and thrn hue outside contractors must mount a new affidavit uidicating such, kommemrs thin check this box must anachcd rn additional sheet showing the name of the svb.nnuaaors unit rims,whether or not now entities have employees Ifthe sub,meacmrs have employees,they must provide their workers'comp.policy number. 7 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Citv/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. 152,525A is a criminal violation punishable by a fine up to$1,500.00 ander 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 violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under thepains and penalties of perjury that the information provided above is trite and correct Signature: � D t G/2S/�� Phone#: .577/ 93o 7, Oficial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/Licerew if Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrfown 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 ofan 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,A25C(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 contacting 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)camels), address(es)and phone number(,)along with their certtficate(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 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/license number which will be used as a reference number. In addition,an applicant that must 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 most 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth 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 I FENCE REMOVE DOOR REPLACE W/ AWNING WIN I `MOVE JR HERE ON � o � I l7 d I CABINETS BY OWNER REMOVE WINDOW I I ON q'_0" n I� ALIGN e - - -- - x _ m N 00 PROPOSED FIRST FLOOR PLAN I LYNN POSNER RICE. ARCHITECT 88 PM1one 613-S96M83 Fq 013.501.3898 HOGAN RES ALTERATIONS 07-16-18 FLR PLAN � \ a ��\ -,,,� � ,1 7 � o O -_,a � 0 7 �. --_.� _ _._.___ '9N U1�9Q .`7dS =;?�Yf1�P'07� � �^°-����{ ^� ht # J per' 102 ,0 House tom. Amon t 1 as s� +I-j,4 cEale� 1"a 8 fea Existing Conditions Hogan Residence 14 ArtFdOw SOWC Nor OM MA Plan It Green Landscape Areh#ectere NorthsmPtoa, Massachusetts �WVLa.C" Wntk�i 1.�4rMiNfrs ----- =t� � �1�W hS{'u}+'i�-C DP•ttrt�' "�� � � `�6` STtz'PS Mad (. 1 '14 t 3 Site Preu and Demo Planr„�� , Began Kssidsses 10 ,e-+, tz 11 Aust.OWK MA Mm It Grp LAR&OOP Aroh ere Northampton, hIssuthaastts - + I r house ----------- ----------------------- — Gag �runinAa/�-sib-s Cv l02 Z I � � (P� wlcs-o SuuO. �r6N4� I sTFhRS OL pkTo �pC�t�G Bc' �_� 12' _ �n � '•' l WAV 23�-CDr la' V./odq SO-0 Ki Scale: t"=4 feet Layout Plano Hogan Residence 14 Arlington Strut,NoMampter,MA Plan It Green Landscape Architecture Northampton, Massachusetts 16 ,U . l8