23C-036 648 RIVERSIDE DR BP-2020-0065
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23C-036 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate gorv:ADD BATH BUILDING PERMIT
Permit# BP-2020-0065
Proiect# JS-2020-000102
Est.Cost:$13082.00
Fee: $85.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 5270.76 Owner: ZUCCHINO ANDREW
Zoning:GI(100)/ Applicant. ZUCCHINO ANDREW
AT. 648 RIVERSIDE DR
Applicant Address: Phone: Insurance:
648 RIVERSIDE DR (413) 588-8025 ()
FLORENCE MAMA01062 ISSUED ON:7/18/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-ADD 3/4 BATH
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 sianature:
FeeTvpe: Date Paid: Amount:
Building 7/18/2019 0:00:00 $85.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0065
APPLICANT/CONTACT PERSON ZUCCHINO ANDREW
ADDRESS/PHONE 648 RIVERSIDE DR FLORENCE MA (413)588-8025 Q
PROPERTY LOCATION 648 RIVERSIDE DR
MAP 23C PARCEL 036 001 ZONE GI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ADD 3/4 BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
6 Vj Department use only
City of North pto ���- C$��r/Septic
�"o8l
19ermi
Building Depa en \NGA.
veway Permit
212 Main Str t oVp Availability
Room 100 OtipNOP Water/Well Availability
Northampton, MA 0 60 Two Sets of Structural Plans
phone 413-587-1240 Fax 41 - 87-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ao/ CS
1.1 Property Address: This section to be completed by office
rr �j Map (�X Lot U Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �j n
Name(Print) Current M iling Address: ^1
Teleph14 3W S g?
Signature
2.2 Authorized Ascent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated 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 6
3. Plumbing 39 Building Permit Fee
4. Mechanical(HVAC)
s
5. Fire Protection
6. Total=(1 +2+3+4+5 1Q,, 0 p Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Sit fir:; 2;.,t.0 ! 6C.'aMC{5t• If�,1 f
_
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
cli
nIA cirij, C-.,x
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 171
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[O] Other[oj
Brief Description of Proposed 3
Work: AAP
Alteration of existing bedroom X Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. 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 fa/construction.
Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woo toves Number of each
g. Energy Conservatio Compliance. Masscheck E rgy Compliance form attached?
h. Type of constru ion
i. Is constructi h,/
within 100 ft.of wetlands? Yes No. I construction within 100 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.
I. Septic Tank City Sewer Private II City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
i, Ayy-A e.s,j 15 7%j"t l J 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.
Signe under th pains and enalties of perjury.
7
Print ame
AAAV'C w,
Signature of Owner/Agent Da e
f
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 Z A
Setbacks Front
Side R: L: R:
Rear
Building Height N. v
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorde at the Registry of Deeds?
NO O DON KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a br k,VY
etlands� NO O DONT KNOW YES 0
IF YES, has a permit en oed fro the Conservation Commi on?
Needs to be obtai d , Date Issu
C. Do any signs ex' t on the propN O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs inten d for the property? YES O NO O
IF 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 a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
town
Ong OWA
AP� C u 1 Ono 0 v boo
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City of Northampton
- Massachusetts
,A
DEPARTIMT OF BUILDING INSPECTIONS M
212 Main stroot • Municipal Building yeti oD`
Northampton, MA 01060 SSPjy ,`�S
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("RIC").
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 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 by law(explain):
Job under$1,000.00 ``''�
Owner obtaining own permit(explain): �F�/142►^ y 4et;h ;T 0wv% Mr K;-�
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:
Date Contractor Name HIC Registration No.
OR:
Notwithstandi the above notic ,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
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City of Northampton
MassachusettsS`
±, DEPARTMENT OF BUILDING INSPECTIONS
a .
212 Main Street *Municipal Building
rz Northampton, MA 01060 s '
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:
61ft' P, V r 5 6►' 1i-e..
(Please print house number and street name)
Is to be disposed of at:
1.4114 x acc V(,l I. r�
(Please print n&ne an cation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
—ft
x 7ZIGLao I`�
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 Industrial Accidents
I Congress Street,Suite 100
0
Boston,MA 02114-2017
'Y www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Informatio Please Print Le ibl
Name(Business/Organization/Individual): Y ej v uC di1 U-'a
Address: C^'Y?' ;rev-5ixe— of-t'v'e-
City/State/Zip: r A1n#- -kK, hA Phone#:
Are you an employer?check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or part-time).* 7. C]New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in $, 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.[]1 am a homeowner doing all work myself.[No workers'comp.insurance required.]
10 Q Building addition
4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will
nsure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I 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: 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 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 ee under th pains and penalties of p rjury that the information provided above is true and correct
Signature: Date:
Phone#: '113-
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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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