31B-286 (14) 129 MAIN ST-FIRST CHURCH BP-2020-0531
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31 B-286 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2020-0531
Project# JS-2020-000914
Est.Cost: $3000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: D P CARNEY INC 99798
'Lot Size(sg. ft.): 31755.24 Owner: FIRST CONGREGATIONAL CHURCH OF NORTHAMPTON
Zoning:CB(100)/ Applicant. D P CARNEY INC
AT. 129 MAIN ST - FIRST CHURCH
Applicant Address: Phone: Insurance:
34 HORSE SHOE CIRCLE (413)967-7124 O WC
WAREMA01082 ISSUED ON:1012812019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR REGLET FLASHING
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:
FeeType: Date Paid: Amount:
Building 10/28/2019 0:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Version 1.7 Commercial Building Pcrmit MaN 15,2000
I` /��-y` Department use only
U City of Northampton Status of Permit:
l Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
OCT 5 2019
ROOM 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
D_PT OF GUILDING INSPECTIP
_ ne 13-587-1240 Fax 413-587-1272 Plot/Site Plans
NORTHA"r'TON.MAOi(w
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office 129 Main Street Map L Lot 2 U Q
Unit
Northampton, MA 01062
Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
First Church of Christ in Northampton 129 Main Street,Northampton, MA 01060
Name(Print) Current Mailing Address:
(413) 584-9392
Signature r Telephone
2.2 Authorized Agent:
D.P. Carney Construction, Inc. 34 Horseshoe Circle
Name(Print) Current Mailing Address:
(413) 967-7124
Signature Telephone
SECTION 3 -E TIMA CO UC COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $3,000.00 (a) Building Permit Fee $100.00
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee f�
4. Mechanical(HVAC) v v
5. Fire Protection
6. Total =0 +2 +3 +4+5) ULD, Cr0- Check Number o2( ?j
This Section For Official Use Only
Building Permit Number Date
Issued
Signtures
►o�as,)
Buil g Commissioner/Inspector of Buildinglu Date
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑� Change of Use❑ Other ❑
Brief Description Repair reglet flashing by re-seating into wall, re-solder vertical seams in wall flashing and one
Of Proposed Work: patch.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify: Church p
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1 St 1 St
2nd 2nd
3rd
3rd
44th
�'
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
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 0 DONT KNOW Q YES C)
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q 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 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained i , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location: Name of Church, Front right of stairs
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
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 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
NSA Not Applicable El
Name(Registrant):
NSA Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
N/A
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
D.P. Carney Construction, Inc. Not Applicable ❑
Company Name:
Daniel P. Carney
Responsible In Charge of Construction
34 Horseshoe Circle, W
Addres
(413) 967-7124
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No IS
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
First Church of Christ In Northampton as Owner of the subject property
hereby authorize D.P. Carney Construction, Inc. to
act on my behalf, in all matters relative to work authorized b this building permit application.
r �, �b 24 1 a1�
Signature of Owner t Date
D.P. Carney Construction, Inc. 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 er the p ' and all'�ipenury.
4
Print N
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Daniel P. Carney CS-099798
License Number
34 Horseshoe Circle, Ware, MA 01082 08/19/2021
Address Expiration Date
(413) 967-7124
Signatur Telephone
SECTION - ORKERS' C ENSATION 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 O No O
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work:
The debris will be transported by: N I
The debris will be received by:
Building permit number:
Name of Permit Applicant -Loc ,
Date Signature of Permit Ap
The Commonwealth of Massachusetts
Department of IndustrialAccidents
e I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):D.P. Carney Construction, Inc.
Address:34 Horseshoe Circle
City/State/Zip:Ware, MA 01082 Phone#:413-967-7124
Are you an employer?Check the appropriate box:
Type of project(required):
1. ✓❑I am a employer with 20 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
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 E]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.❑Plumbing repairs or additions
❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ repairs
re airs
These sub-contractors have employees and have workers'comp.insurance.:
6.Q 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.
: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:Guard Insurance Company
Policy#or Self-ins.Lic.#:R2WC991807 Expiration Date:11/15/2019
Job Site Address:129 Main Street City/State/Zip:Northampton, MA
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 the pains and pen of perjury that the information provided above is true and correct.
Si nature: Date:
Phone#:41 - 124
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#:
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building RegulatAons and Standards
-OnstruCtiOn SUPervisor
CS-484798 Expires: 08119/2021
DANIEL P CARNEY
34 HORSESHOE CIRCLE',
WARE MA 01082
Commissioner
Cansttuction stipervlsor
Unrestnctrc! Butlduigs at any use group which Contain
Hiss Ihan 35,690 Cuttic feel f991 cubic awtersf nt enclosed
space.
i
Failure to possess A current edition at the Massachusetts
state abiding Code is cause tot revocation of this license.
For ntorntation about this license
Call 1617)727.3209 or visit www.rnass.govldpl
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
D.P.CARNEY CONSTRUCTION,INC. Registration: 078 4/111//22
020
34 HORSESHOE CIRCLE Expiration: 04/
WARE,MA 01082
Update Address and Return Card.
SCA 1 20M-05117
�'Tv Fnrri»r�srinroll� 1r�lor�ri.0/%t 1�
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only v! 1lJ pt L J
TYPE:Comoration before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation in
121178 04/11/2020 One Ashburton Place-Suite 1301
D.P.CARNEY CONSTRUCTION,INC. Boston,MA 02108
DANIEL P.CARNEY
34 HORSESHOE CIRCLE
WARE,MA 01082 re
Undersecretary Not Id t sign