24B-009 65 BARRETT ST 13P-2020-0022
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:24B-009 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category,TEMPORARY TRAILER BUILDING PERMIT
Permit s BP-2020-0022
Project k JS-2019-002333
Est.Cost:$2000.00
Fee:$65.0o PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Siu(sa.R.): 11586.96 Owner: BIBEAU CHARLES&JANE
zonine: URB(l00)/WP(I00 Applicant, BIBEAU CHARLES & JANE
AT. 65 BARRETT ST
Applicant Address: Phone: Insurance:
65 BARRETT ST
NORTHAMPTONMA01060 ISSUED ON.7/9/2019 0.00.00
TO PERFORM THE FOLLOWING WORMTEMP TRAILER
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 ft 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 Sienature:
FeeType: Date Paid: Amount:
Building 7/920190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File q BP-2020-0022
APPLICANT/CONTACT PERSON BIBEAU CHARLES&JANE
ADDRESS/PHONE 65 BARRETT ST NORTHAMPTON
PROPERTY LOCATION 65 BARRETT ST
MAP 24B PARCEL 009001 ZONE URBO 00VWP(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid RE lA(R>�A
TypeofConstruction: TEMP TRAILER Q
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
INFO
_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
Demolition Delay
/LP s I
Signature ofof Building 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
Qty of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street Sawgr/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
IQ other specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: ^ This section to be completed by office
l2�Tc.�1 .1yof��[t`rit� '°rl
Mt k M.p Lot Unit
VV Ill O(D6d Zone Overlay District
Elm St.District cB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Gh"AC5 13t�cti✓ S S<c +f 5! Ne Mam{Foa M� otaeo
Name(Print) n Current Mailing Address:
44u.Yuir -S;u . Telephone
SgnaWre
2.2 Authorized Agent:
`Gf_
Mk -� dL1CEJ 30� 8f� o4L Pr Gird(tvA ` -X -_S607
Name(Print) Current Mailing Address:
11.72 6I2 4%qD
Sig Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completedcompletedby mitapplicant
1. Building (a)Building Permit Fee
2. Electrical S J it, P7 (b)Estimated Total Cost of
Construction from 6
3. Plumbing A tilld Building Permit I"
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) ODO. D4 CheckNu r
This Section For Official Use 1
Date
Building Permit Number: Issued:
Signature:
Building Con missionedlrrapector a Buildings Data
Nebo 9gf',2x @ (/erfzp-Z . &Lt
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING AIL Information Must Do Conipteted. Permit Can an Denied Due To Incanpkete Infdmation
Existing Proposed Required by Zoning
Thu column M be film in by
Buildiag nryawmr
Lot Size
F-mage
ethacks Fro t _.
Side L: R: L: R:
Rear ..-.
Building1lei t
Bldg.Square F %
Open Space Footage °a ..
(Lw arcammus bNg M.Pa ._._I ..
#of Parkin Spam
Fib:
(volume@Lncatim
A. Has a Special Pe
rmit/Variance/1i ' g ever been issu for/on the site?
NO O NT KNOW Y
IF YES,date issued:
IF YES: Was the pecorded at the Registry Deeds?
NO ODONT KNOW O YES O ,........
IF YES: enterk Page and/or Document
B. Does the site controok, body of w ter or rretlands? NO DONT KNOW O YES O
IF YES, has a peen or need be obtained from the Consery 'on Commission?
Needs to be obO Obtained O Date ed:
C. Do any signs exispro rty? YES ONO O
IF YES, describey and location:D. Are there any proangel to or additions of signs intended for the property? YES NO O
IF YES, describeype and location:
E. Will the construction act"disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Shorts Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(cheek all applicable)
New House Addition Q Replacement Windows ration(s) Q Roofing 0
Or Doors El
Accessory Bldg. ❑ Demolition 13 New Signs iOl Deeks M Siding[O] Older[I:1
Brief Description of Proposed i-
�CM
Work
Alteration of existing bedroom_Yes—No Adding new bedroom Yes No
Attached Narafive Renovating unfinished basement Yes No
Plans AUached Roll -Sheet
so. If New house 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 of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. Method of heating? Rroplaces or W oodstows Number of each_
g. Energy Conservation Compliance. Mosscherk Energy Complianceform attached?
h, Type of construction
I. Is construction within 100 ft of wetlands?Yes No. Is wnshuction wfthin 1OO yr, floodplain_Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
L SepticTank City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of One subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
a,HaiL
SigneWre of cion, Dere
I, Akrk 7,r6•+✓ .as Owner/Author¢sd
Agent hereby declare that the statements and information on the foregoing application are tore and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Mart: ��Cu�
Print Name ^t� J
DS/ 'Loi
Signature olillOwnsdAgent Osie
City of Northampton _
f Massachusetts
�c
s
DSPARTl6NT OF BV2LDraG InSPSCTIONS ,y
212 Min inr t • M ieipn Building p�
9ortLampton, W 01060
AFFIDAVIT
Rome 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 bores,a contractor most be registered as a Home Improvement Contractor("HIC").
M_G.L.Chapter 142A requires that the"reconstruction, dit rafion,renovation,repair, modemizatfan,conversion,
improvement, removal, demolition,or construction of an addition to any preexisting 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
Type of Work: Est Cost:
Address of Work
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded bylaw(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 RESPONSIBILMES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed order the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply fm a building permit ivi the owner of the above property:
D,L s/ 2�,q !''1r.r1C 3tbcd✓ ��� I5�"�--'
v
Darr Owner Name and Siglisfiffe
City of Northampton
Massachusetts ;`•� ;' '::,.
j'
DHFART1nT'T OP 317ZLDZlr6 INSPICI'IONS
212 Main Street *Municipal Building
lortLeepton, 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
&S 3arrr�t 5- -
(Please print house number and street name)
Is to be disposed of at:
'\[Al(° RCC C( th
(Please print name nd 1 ion of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signat a of Permit 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.
'` The Commonwealth of Massachusetts
Department oflndttstrialAceidents
I Congress Sier4 Suite 100
Boston,MA 01114-2017
www.massgov/dia
WX1.vkers'Compensation Insurance Affidavit:Builders/CooMcters/Electricians/Plumbem
TO BE FILED WrOf THE PERMITTING AUTHORITY.
Applicant Information Phrase Print Leigh
Narne(Business/Orgmirationflodividue0: Mkrk '3gbcur
Address: &--5' '4�lrrctv 54-
City/State/Zip: NpJ-EBF '}enM 01Dyo Phone#: R72 232 b4gd
Aaeym as emamyer?Check me aPPrnPrisu hass Type of project(required):
I.�ImiacmploycrwiN_ cmpinyas(tullmWmpen-timc).a 7. ❑New construction
2O1an.soln'anPdaanrmP6nnmaSW aal havaro employes wmkhg tar mem 8. E]Remodeling
any nap-do INa wmkms'wder, waaper mgwtea.]
3.Q 1 am n homeowner doing all work myselfINo wodsn'comp,n smmrte aegiure l t 9. ❑Demolition
I.E/1-- oetandvillbchinngcunsaclota tnumdumall work on my propmy. lv4E 10 Building addition
mmm mel on awhaclms cithabavc workms'enownsmene msmancc or me aoic Il.[]Electrical repairs or additions
proprimoro withno eMloyeea.
12.❑Plumbing repairs or additions
s{]tand esubm nrromma havnelnav an the veb-eomnemrsheed mtbeamenea an«t 13.❑Roof repairs
These 6ubconuaaors have mrgrbyees and have wmkma'wmp.insurance: e
6,[]We.re.eonmraeonand in affkwabave exercised 66,right ofenxxinn per MGI.e. l4'QOlhnr�'^vr`(� 7�rter'
152,§t(4),and we Iavems anddo .[No workcrs'rnmp.insaraoee mryireJ.]
*A Y appticaal W61 chocks box#1 siala fell ahoul the sermon below showing then wcrkas'compmuaw policy aderne inion.
t Homcownm who submit this midevis Indicating they are doing MI and then hire outride eonoamms ro,submit a new atFdavir insceaiog such.
ICOmmm0la Mat check this hex mum atuehcd anadmlional shoe sMwiog the.oCihe aubc rxoetors and sate whether en rot lose ened.hoer
esvployma Uthe vubcraceeum have employees,they moat povide their workas'cos,.policy innate.
7 em an emp/oyer that is providing workers'compensation iamrance for my employers Below is Me peficyandjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/7ip.
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 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 DLA for insurance
'coverage verification.
l do hereby ttrtify under}th�e poi-ns�and/penaities of perjury thatihe information provided above is true andcorrecit
DaW a7� mol q
Phone#: Q'72 6': D (a D /
Official use only. Do nm write in this area,to be completed by city or worn offclat
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: