30B-065 (6) 284 RIVERSIDE.DR BP-2020-0016
GIS#; COMMONWEALTH OF MASSACHUSETTS
MmxBlock:30B-065 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2020-0016
Proiect# JS-2020-000016
Est.Cost:$129355.00
Fee:$838.00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
Use Gmup: JAMES B CALLAN 105654
Lot Size(sp.R.), 6011.28 Owner: NEIMAN ANNA LEIGH
Zoning:URB(100y Applicant. JAMES B CALLAN
AT. 284 RIVERSIDE DR
Applicant Address: Phone: Insurance:
151 RIVERSIDE DR (413) 923-1553 WC
FLOREN CEMA01062 ISSUED ON.7IM019 0.00.00
TO PERFORM THE FOLLOWING WORK.20X20 ADDITION ON REAR OF HOUSE
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:
FeeTVDe: Date Paid: Amount:
Building 7/5/20190:00:00 $838.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File 4 BP-2020-0016
APPLICANT/CONTACT PERSON JAMES B CALLAN Q I�
ADDRESS/PHONE 151 RIVERSIDE DR FLORENCE (413)923-1553 IQ
PROPERTY LOCATION 254 RIVERSIDE DR t(
MAP 30B PARCEL 065 001 ZONE URB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
D REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvueofConstruction: 20X20 ADDITION ON REA OUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105654
3 sets of Plans/Plot Plan
THE 1OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
lt,WRMATION 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
17�Demolition Delay
-7- .5-2019
Signa re of Building Oficial 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 Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
` . Room 100
ED-
Northampton, MA 01060 T u I
phone 413-587-1240 Fax 413-587-1272 PI /site Plans
Ot er ly
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE C R DE oLISH A ONE OR TWO AMIL e DWELLING
DEPT OP tHatDING INSPECna+S
SECTION t -SITE INFORMATION NOrTNAMPTON,PAA 01OW
1.1 Property Address: � TJhis section to be completed by office
oZP!`F -'AV- lbL Mos— Map w/ � Lot Unit
YLOJ'�"LN�-`Lr l '^ o1O 62 Zone Overlay District
Elm St.District 6B District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
6m Q 2B�( Qtzl�— W-1G-Uf Ir-
Na ((Print) CurrentI g Address: � ny� D,r0160
Telephone
Signature ��
2.2 Authorized Arnim: rwk ILW9.01tDf-- Mwf—
�Qxt,,vsr NA N-.� or PVC o1062
Name Print) Curtant(l0allIng
Bigneture Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
complat permit applicant
1. Building (6'T 355
(a)Building Permit Fee
2. Electrical W (b)Estimated Total Cost of
1 D 6 Construction from 6
3. Plumbing ID !7 Building Permit Fee
4. Mechanical(HVAC) � 0
5.Fire Protection Q UQ
6. Total=(1 12 t 3-4.5) A 14 Chao*Number
This Section For Official Use Only
Building Permit Numbs: Date
Issued:
Signature: 7- 5 -209
Bulldog Commesimadlospector of Buildings Data
r b6esi9n (si @ VY\aik• Q c)W-,-
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 Dryanment
Lot Size
Frontage
Setbacks �Front
Side' UR:RL: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
lint arat minus bldg&pavd _
puking)
#ofParking Spam
Fill:
voiumc&L«ation
A. Has a Special Permit/Variance/Finding ev r b an issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:'
IF YES: Was the permit recorded a he Registry of D ?
NO O DONT OW O Y O
IF YES: enter Book Page' and/or Document#
B. Does the site contain a ok, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a perm been or need to be obtained from the Conse ation Commission?
Needs to be ob fined O Obtained O , Da Issued:
C. Do any signs xist on the property? YES O NO O
IF YES, cribe size, type and location:
D. Are It re any proposed changes to or additions of signs intended for the property? YES O NO O
YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of common plan
that will disturb over 1 am? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
R
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel
New House ❑ Addition Replacement WindowsAlterations) ❑ Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signa [O] Decks [0 Siding[O] Other[a
Brief Descri tion of Pro osed n
Work:' —Srh^K�J &ok A'a prOQtho.r� o,) QRPQ_ Oc- oeyi
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 andor 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 2
c. Is there a garage attached? .) D (� r'�Cly
d. Proposed Square footage of new construction. 60 U Dimensions at X a
e. Number of stories? 9,
VW
r�
f. Method of heating? VW-PK- l d n' ? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. gf)NS S7JJ� Masscheck Energy Compliance form attached?
h. Type of construction Wm ?
I. Is construction within 100 S.of wetlands? Yes 4 No. Is construction within 100 yr. floodplain_Yes 1C No
J. Depth of basement or cellar floor below finished grade 622
k. Will building conforn to the Building and Zoning regulations? _X__Yes No,
1. Sepfic Tank_ Chy Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR 13UI1LDING PERMIT
I,�IX O W.A� as Owner of the subject
property /�
hereby uthorize SpfN� C ALL,A,1J
to act my behal n II matters relative to work authorized by this building permit a plication.
-Sign ur wn
of Oer
I, RU N P, C, 1�-'-C-\ 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 pain's and penalties of perjury.- l
N� �.fl�lr�� tJf-\NVQ
lPdntN ma
'S tura of Omer/Agan
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. /� - Not ApplicableG❑'
Name or(License Holdx'. �Pf1�r.'g L,04,11.AtJ C s�,d bGG y■1
License Number
Notz r�w,nP rz.�, MA 0\062 0f 120 202 0
Address Expiration Dete
!i, 23- ISS3
Sig Telephone
9.Registered Home Improvement Cominctm: Not Applicable ❑
R\.Co_c�i Dfsslyd.�,r_t c_ 186841
Company No Registration Number
lG� Q'^'CQ�tDt- '0°'"'�' uaeca�Ptrw, eNk o1oGZ e� 11912021
Address ((� Expiration Date
Telephone — 9 9 1�
SECTION 10"WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,12SC(S))
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....... No...... ❑
c
City of Northampton
Massachusetts ys� er
WNRp TNBNT or BUILDING INSPECTIONS [
�\ 212 Min Street a Municipal auilding q� `<
Northae¢ton, 1 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("H1C").
M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modemization,convereion,
improvement removal, demolition, or construction of an addition to any pre-existing owner-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 homeeown'er has contracted with a corporation or LLC, that entity must he registered.erre
Type ofWork:,1— II rrtLy{1 YT�1'(l0ol!�� Est. Cost
Address of Work:Q84 Pkif'obe— URWrI ��i aloGZ
Date of Permit Application: -]/1 I,�B/9
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 owncroccupied
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:
-711 Ug V D 7Uti�u� 1�� Ba �
aDM6 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
m� yL
! D&PMTMENT OF BUILDING INSPECTIONS p
113 Nain SLvact a Municipal suild nq
NorNampCon, M 01060
Massachusetts Residential Building Code
Section 110.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.
The Commonwealth oliMassaehusetts
Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Tw.rkers'Compensation Insurance Affidavit:Builders/Conti ctors/ElecMcians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Lb-m&.)
^ / Please Print Ledbiv
Name (Business/OrgmimtioNlndividuap: IZb ,A/b Lb-m rA) f LL4—
Address: 151 akJM1p2.. Da, ez 1d le-C �/`I/�lVl�- 01O67—
City/State/Zip: A /f
4'L Phone#: fs— fq a3 — 1553
Are you an employer?Check the appropriate box:
Type of project(required):
Ldi am a employm with (full and/or pxn-time).' 7. ❑New construction
2.❑I amasole Fairmont or pemarstoptinif haven.employees working fce me in g. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.❑I am a homeowner doing all work myself.[No worects'comp.insurance required.]t 9. ❑Demolition
4.❑I amahomc.wn., it will be hiringamoracmrn to conductall workon my property. 1 will 10 Building addition
ensure that all contra abor either have wurken'tuar creari on fins ence m am sole I l.❑Electrical repairs or additions
propdamrs withim employ«a. 12.[]Plumbing repairs or additions
5.Q 1..general contractor and I have hired the subcontmnom listed on no itanohad sheet. 13.�ROof repairs
These sub-contractors have anpand 'a
loyees have work. .,.waumn .
ti.❑We are a coryomtion and its otiicen have eenbuied theb tight of exemption per MGL c. 14.00ther
152,§I(4),and we have vo employees.(No workers'cm,.iruurance required.]
•Any applicant that checks box 41 most also fill out the section below showing their workers'comprnsa min policy information.
I Homeowners who submit this affidavit indicating awry are doing all work and then hire outside comuacmrs most submit a new affidavit indicating such.
lConuacmrs that check this hos must annched an additional sheat showing the name of the subcmonar s,and state whether or not those entities have
employees. If We mbcmanacbrs have employees,they it provide the. workms'comp.policy .be,
7 am an employer that is providing workers'compensation insurance far my employees. Below is the policy andjob site
information. (n�
Insurance Company Name: h'F1M 1 a IU 1V 14i I JV"JVW'/r�.t`/sL
Policy#or Self-ins/.�Lic..{#: tK��W,,,P,.,Kyo-7o J�O�" DI'1T Expiration Dau: tXOpl �
Job Site Address: of B'T 01,A) 1l�I(X 0{_ City/State/Zip: kftye t IV O IA(,Z
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 DIA for insurance
coverage verification.
I do hereby ce der the pains andpenalties ofperjury thin the information provided above is true and correct
Sienalure: e Date: Z /pl ' 0./ (�
Phone#: 113 —q23- /5�3
Oficial use only. Do oat write in this area,to be completed by city or town official.
City or Town: Permit/License te
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#:
City of Northampton
Massachusetts
i
DSPANIM6NT OF` BNILDING ZXSPSCTIONB �212 fain S"est •Nuniulpal Building
� Norther Wn, IM 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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:
aM fZwu ,54x
(Please print house number and street name)
Is to be disposed of at:
UA"Y Rleyccwi�—, 221-1 sT tu .3
(Please print name and locatlonof facility) O i o b
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
igna ure of Permit Applicant or Owner Date I �I
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.
Rev set beat Ilne
2�� gaca'naU D£ac
4r
15'-0" � Proposed Atltlltlon 16'-0'
Zo t
20'-0"
Side set bank line --— 1
Side set back line
Existing House \I I
Front Porch
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Front set beck line
Street
20'0"
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