32C-284 zpa File#BP-2020-0365
APPLICANT/CONTACT PERSON ADAM BELCHER
ADDRESS/PHONE P O BOX 1354 NORTHAMPTON (413)539-4937
PROPERTY LOCATION 3 MONTVIEW AVE
MAP 32C PARCEL 284 001 ZONE URC(92)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIS
ENCLOSED REQUIRE DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
T3Teof Construction: EXTEND LANDING ON FRONT ENTRY ST
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 104221
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.
Department use only
. —:�... City ofortp ����`v _ tus ermit:
BuildingDe rtm n b Cu Driveway Permit
212 Main Streel Se er/S ptic Availability
_ Room 1 0SEP 9 , w er/W 11 Availability
Northampton, A 0 060 2d Tw Set of Structural Plans
phone 413-587-1240 F ax 4 3-587-1272 PIc YSite tans
DEPT_OF BUILDING IN'PFC,i0ther S clfy
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 comp ed by office
VM.e Ma d� Lot 16 Unit
� 'A P
�m r�t�.y r� O\ 6 ► Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r'C1Mr'-
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
��w'l✓k- o C i
Name(Print) Current Mailing Address:
413,53y .y93 }
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 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3+4 +5) `L $"c o ,G o Check Number
This Section For Official Use Only
Building Permit Number: DateIssued:
Signature:
Building Commissioner/Inspector of Buildings Date
(Cllee- ww 6? r'l "Z' @
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 9 35'C
Frontage
Setbacks Front cL 7
Side L: u R: z- L: 0 R: 32
Rear f Z t
Building Height & Z d
Bldg. Square Footage /SoG % ICGL
Open Space Footage %
(Lot area minus bldg&paved 3�Z r 3YZ�
parking)
� Z
#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 recorded at the Registry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Gr- DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , 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
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 a
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [-1 Addition Replacement Windows Alteration(s) Roofing
Or Doors 1:1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[a
Brief Descri tion of Proposed
Work: rial-en�` la,.dl',,,� a— ar' 'nA ,r
Alteration of existing bedroom 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 family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is 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 well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l�117Y as Owner of the subject
property VV
hereby authorize Z/L 4L
to act on my behalf, in all matters relative to work authorized by this building permit application.
n
Signature of O ner D to 41
I, i-F .N- 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 pains and penalties of perjury.
A4L,
Print Name
,,4,
Signature Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: c S kV,-k 2--2 t
License Number
Address Expiration Date
Q�,k/aL-- Y/3- S,3 9 -Y 9
Sign re Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
M4Lv-- 14 TZ 3 1
Company Name Registration Number
Co ` a-o 0 16 /27 12.0
Address Expiration Date
Telephone `1�3 S3gy93}
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....... Q"- No...... ❑
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Uip www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Belcher Woodworking
Address: P.O. box 1354
City/State/Zip: Northampton, MA 01061 Phone #:413-539-4937
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 1 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [2 Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• 9. E] Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#I 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: Traveler's
Policy#or Self-ins. Lic. #:7PJUB9F74883718 Expiration Date:6/15/2020
Job Site Address: 1'"t64 64 Nu-' lloa- City/State/Zip: /cap L., c l vG U
Attach a copy of the workers' compensation policy declaration page(showing the policy number ani expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA insurance coverage verification.
I do hereby certifyder hep ns and penalties of perjury that the information provided above is true and correct
Signature: Date: 9//,// ,
Phone#: `// 53i_11934
Official use only. Do not write in this area,to be completed by city or town offkiaL
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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City of Northampton
��'J•�lie' .w. d
Massachusetts
'fS . DEPARTMENT OF BUILDING INSPECTIONS y
212 Main street •Municipal Building
"46-
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Northampton, MA 01060 -Psbry
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:
'3 ?-\. 'jr", Ay�'
(Please print house number and street name)
Is to be disposed of at:
(Ple se printtiame ald location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
(2/t qk�
Signa
t a 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.
LANDING LANDING
4-0" DN
❑ 01 1
I 3-4 1/2" L1'-10" L 3-0 1/4" �1'-10" I
G
P.O. Boz 1354
CLIENTJCB DESCRIPTION DATE Northwrt—W1, 01061
Page 1 CAROLYN OPPENHIEM ENTRY STAIR LANDING EXTENSION EXISTING LAYOUT SEPTEMBER 12, 2019 ni�n�lne9�om
El
LANDING
a'-0" DN
LANDING
10
3-9 1/2"
P.O. Box 1354
CLIENT JCB DESCRIPTION DATE Nor Chanpbon!W, 01061
Page 2 CAROLYN OPPENHIEM ENTRY STAIR LANDING EXTENSION PROPOSED LAYOUT SEPTEMBER 12, 2019 blcher-ogmil icon
EXISTING CONCRETE FOOTINGS
NEW DIAMOND PIER DP-55
MATCH EXISTING FRES. TREAT. FRA7ANDNG-
-2X8 @16O.C.-5/4 PT DECKING-4X4 POST AND 2X4 TOP/BOTTOM R-2X2 PT BALUSTERS
LEDGER ANCHORED TO CONCRETE FOU
-SLEEVE ANCHOR 3/8^ X 5" 2@16^ 0.C.
�/aaduar.�uz9
P.O. Boz 1354
CLIENT JCB DESCRIPTION DATE Northampton MA, 01061
Page 3 CAROLYN OPPENHIEM ENTRY STAIR LANDING EXTENSION ELEVATION SEPTEMBER 12, 2019 belchr3w@g3 I.-m
MONTVIEW AVE
72'-11"
SIDEWALK.
7'-3 1/4" 18•_9"
DRIVEWAY
ADDITI� 13-2 1/2'
2'_0'
_0.
54'-8"
62'-2"
80'-4"
�J�1C1
P.O. Boz 1354
CLIENT JCB DESCRIPTION DATE N_thszpton MA, 01061
Page 4 CAROLYN OPPENHIEM ENTRY STAIR LANDING EXTENSION PLOT PLAN SEPTEMBER 12, 2019 b1 (413.) 539 l97