24A-172 (2) i
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16 TAYLOR ST BP-2020-0256
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:24A- 172 CITY OF NORTHAMPTON
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Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit# BP-2020-0256
Project# J8-2020-000441
Est. Cost: $11000.00
Fee: $72.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SAM LAKAS 103997
Lot Size(sq.ft.): 16465.68 Owner: GRIFFIN JILL A
Zoning:URA(100)/ Applicant: SAM LAKAS
AT: 16 TAYLOR ST
Applicant Address: Phone: Insurance:
5C SOUTH ST (413) 230-6699
WILLIAMSBURGMA01096 ISSUED ON.8/30/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-BUILDING NEW GROUND LEVEL DECK ON
BACK 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:
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THIS PERMIT MAY BE RE�OKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy I Signature:
FeeType: ate Paid: Amount:
Building 8/30/2019 0:00:00 $72.00
21,2 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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File#BP-2020-0256
APPLICANT/CONTACT PERSON SAM LAKAS O I c—
ADDRESS/PHONE 338A AMITY ST AMHERST (413)230-6699 i L
PROPERTY LOCATION 16 TAYLOR ST
MAP 24A PARCEL 172 001 ZONE URA(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED . REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tyneof Construction•_BUILDING NEW GROUND LEVEL DECK ON BACK OF HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
AccessoKy Structure
Building Plans Included:
Owner/Statement or License 103997
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
Approved Additional permits required(see below)
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PLANNING BOARD PERMIT REQUIRED UNDER:§
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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 DPIN Water Availability Sewer Availability
Septic Approval Bard 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.
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Department use only
City of Nott n F`\jE tatu of Permit:
Building epa Orb ut/Driveway Permit
212 Ma St et eWer epi-,Availability �
=� r Roo 100 9 Z� afer , ell Availability. "
a 4 ,
.K..r
Northampton MA 10 T o Se of`Structural F'Ians..
phone 413-587=1240 Fax 13-587�- Ec $YSite lams
DDpT.OF('AhhPTON MA010 rSpecify
APPLICATION TO CONSTRUCT,ALTEZ,7REPrIR,RENQVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION '
This se��tion to he corn` ltd by office
1.1 Prooertv Address: i p ee
Map Lot lUnit
T
Zone Drstrrct
j Elm SftlDrstnctCRDistnct.
....
SECTION•2.PROPERTY,OWNERSHIP�AUTHORIZED AGENT.
2.1 Owner of Record:
Name(Print) Curr nt Mailing A dr ss: ':C O
• Telephone 1
gna
2.2 A&Aorized Agent:
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 �� O 0 0 (a)Building Permit-Fee`
2. Electrical0 (b)Esfimafetl.Total Cost:of
Construction from 6
3. Plumbing "Building�Permit Fee 1'
4. Mechanical(HVAC) (2f
5. Fire Protection _
6. Total=0 +2+3 +4+5) 0 O Check Number
This Section.,ForOfficialaVse-Onl
Building.Permit.Number: ate
Issued:,
Signature: -Z9:ZO)q
Building`-Coma i"ssio6ei/Inspector of.Buildings ',Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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y
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: L. I R:
1
Rear M t
Building Height 9C
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
#of-Parking Spaces
Fill:
(volume&Location) � 4
A. Has ORy' l Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOWYES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES 0
IF YES: enter Book _ Page= and/or Document# �
B. Does the site contain a brook, body of water or wetlands? . NO DONT KNOW YES
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 0 NO
IF YES, describe size, type and location:
D. Are there any.proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,ex avation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 5-:DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ;❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [g Siding M Other[C]]
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Brief Des ription f roposed
Work: V
Alteration of existing bedroom Ye No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a''If'New pause and.or'addit o"n to°existing housina,.complete.'ttie.foll `.
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
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c. Is there a garage attached?
d. Proposed Square footage of new construction. 9"7c Dimensions
e. Number of stories? 0
f. Method of heating? N / Fireplaces or Woodstoves Number of each
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g. Energy Conservation Compliance.. i Masscheck Energy Compliance!form attached?
Wy
h. Type of construction AI
i. Is construction within 100 ft. of wetlaInds? Yes No. Is construction within'100 yr.flfloodplain-Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? )c Yes No.
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I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION:-TG BE COMPLETED WHEN
OWNERS AGENT OR,CONTRACTOR:APPLIESfQR BUILDING-PERMIT •, .
I, 47l �r( 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.
z � 4
-Signature f Owner Date
acaner thorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the s of my knowledge
and belief.
Signed under the pains and enalties of,perjury.
Print Name
AMC vi -IX119
i
ignature caner/Agent Date j
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ d(�
Name of License Holder: �L��yy f CS
LicenseNu ber
01
e -3z;_0—
Address' Expiration Date
44
Signature Telephone
,9.Re''"istered•Home lm Not Applicable ❑
SaW% 2-
Company Name Registration Number
15 C S 0A Igg"
Address
\ �rb 6 Expl Da
Date
V(WV M Telephone413'P
SECTION 10 WORKERS'COMPENSATION INSURANCE.AFFIDAUIT(M.G,C.c.152,§Milli
.
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...... ❑
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City of Northampton
Massachusetts '
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t ti DEPARTMENT OF BUILDING INSPECTIONS
J rbc
212 Main Street • Municipal Building
Northampton, MA 01060 �' s
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the'i 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 four dwelling units....or to structures which are adjacent to such residence or buildin j'be
done by registered contractors)
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
0.
Type of Work: Aqq
Est. Cost: 1( 4 Q A
Address of Work: 6 (LI S AA
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Date of Permit Application: : pro
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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(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 NO HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUAKANTY FUND
UNDER M.G.L.Chapter 142A.ISUCH OWNERS ALSO ASSUME THE RESPONSIB LITES 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:
Notwithstanding the above notice,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
' Massachusetts 5 sI4�
x's DEPARTMENT OF BUILDING INSPECTIONS p z
o 212 Main Street • Municipal Building
Northampton, MA 0106011
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 1 l O.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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City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
Northampton, MA 01060 j�14 i
Debris Disposal .Affildavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting fro 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:
(Please print house number and street name)
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Is to be disposed of at:
Va OeccA93q
(Pleasb print name and locatio of facility)
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Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
SignigFure 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.
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information // Please Print Legibly
Name(Business/Organization/Individual): sakIA- bi,/V�
Address: G Ol/
City/State/Zip: W l S Phone#: �'V� 3 � a'3 p
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. ❑New construction
2.[<I am a sole proprietor or partnership and have no employees working for me.in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
1[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 ❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. repairs'
E]Roof
These sub-contractors have employees and have workers'comp.insurance.t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.KOther n pAIV &R C V-
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.
:Contractors 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 sub-contractors 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 certify under el fainnss and penalties of perjury that the information provided above is true a d correct
Signature: Date:
Phone#: q1 1 0
Official use only. Do not write in this area,to be completed by city or town official.
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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 In§pector
6.Other
Contact Person: Phone#:
=r
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"anindividual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased'employer,or the
receiver or trustee of an 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,§25C(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 contracting 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)name(s),address(es)and phone number(s)along with their certificate(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 returned 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 necessa )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 must 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 bum leaves etc.)said person is NOT required to complete this affidavit.
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The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
T 1. # 617-727-4900 ext. 7406 or 1-877-MASSAF
Fax#617-727-7749
Revised 02-23-15 www.ma§s.gov/dia
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NEW ENGLAND LAND SURVEY IMORTGAGE INSPECTION PLAN
Professional Land Surveyors NAME JILL- GRIFFIN j
5 Wheelock Street�'
Oxford, MA 01540 LOCATION 16 TAYLOR STREET E
PHONE: (508) 987-0025 NORTHAMPTON, MA
FAX: (508) 234-7723 -
SCALE 1"=40' DATE 12/7/2010
REGISTRY HAMPSHIRE
BASED UPON DOCUMENTATION PROVIDED, REQUIRED MEASUREMENTS WERE LENDER:Merrimack
MADE OF THE FRONTAGE AND BUILDING(S) SHOWN ON',7HIS MORTGAGE OF c�
INSPECTION PLAN. IN OUR JUDGEMENT ALL VISIBLE EASEMENTS ARE "Q! DEED BOOK/PAGE 9372
SHOWN AND THERE ARE ND VIOLA71DNS OF ZDNING REQUIREMENTS U / 52
REGARDING STRUCTURES TO PROPERTY UNE OFFSETS (UNLESS OTHERWISE
NOTED IN DRAWING BELOW). NOTE: NOT DEFINED ARE ABDVEGROUND PA CK PLAN 900K/PIAN _ 47 / 29
POOLS, DRIVEWAYS, OR SHEDS WITH NO FOUNDATIONS I THIS 5 A
MORTGAGE INSPECTION PLAN; NOT AN 1NSIRUMENT SURVEY. DD NOT USE N0. 51 WE CERT�iTY THAT THE BUILDINGS)ARE NOT WON THE SPECW.
TO ERECT FENCES. OTHER BOUNDARY STRUCTURES, OR TO PLANT p FLOOD HAZARD AREA SEE HUD LAP;
COMPLLANCE WITHNLOCAL ZONING FOREPRDPLWOWN LINEFFSET �in �F�STE���
REQUIREMENTS, OR IS EXEMPT FROM VIOMDN ENFORCOUM ACTION D 2501670002A om 04/03/1978
UNDER MASS. G.L.TRLE VU. CHAP. 40A, SEC. 7, UNLESS OTHERWISE NqL LAtm FLOOD HAZARD ZONE HAS BEAT DETERIWO BY SCALE AND 5
'NOTED. THIS CERRFICAIMN'IS NON—TRANSFERABLE THE ABOVE NOT NECESSARILY ACCURATE UNTIL DUMM PLANS ARE ISSUIZD
cERTIFlCATIONS ARE MADE WITH THE PROVISIDN'THAT THE LNFORM47I11N BY HUD AND/OR A YERi&CONTROL SURVEY IS PMRMED,
PROVIDED IS ACCURATE AND THAT ME MEASUREMEIM(USED ARE PRECISE ELEVATIONS CANNOT BE DEIERYBU
ACCURATELY LOCATED IN RELATION TO THE PROPERTY LINES.
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#16
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�Sh 22, 23 & 25
0. 20; 40' W Bo' ,2p'
REQUESTED BY: MB
DRAWN BY: SPP
CHECKED BY BY: GES SCALE: 1'=40' File: IOMIPS574
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