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35-266 (10) • v 21 WEST PARSONS LN BP-2020-0640 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-266 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2020-0640 Project# JS-2020-001083 Est.Cost: $23000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sa.ft.): 39988.08 Owner: MANGIONE LORRAINE zoning: Applicant. ROBERT WALKER AT. 21 WEST PARSONS LN Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:11/18/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-MASTER BATH RENO 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 11/18/20190:00:00 $150.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner rvcaa*"— Of r� K,cKU Department use only City of Northampt n Status of Permit: ..� Building Departm nt _. �, ' ` �; ay Permit 212 Main Stre eptic vailability '(. Room 100 NovWater ell A ilability Northampton, MA 106 5 Se s of ructural Plans phone 413-587-1240 Fa 413 -1272 Plot/si Pla s f+Fat CSF Full. Peci P1A n APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA LISH ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6 to—,A 0 ' � ct,40 1.1 Property Address: This section to be completed by office zl ��, Q,q.Q�u r, Map Lot Unit PALUV O-Ncf, O L, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: tvti SG!{'j kNAf_'16 toa••r� l 1�cX� PSA—rL v�s cwt Name int) `+d} Current Mailing Address: u1+.9 Telephone Signature 2.2 Authorized Agent: 1 �^ `uc VL- S P (L�i lC�r L IZ N Name(Print) Current Mailing Address: 4-t3 — � — �-t z�► 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) OL_ 5. Fire Protection 6. Total = 0 +2+3+4+5) Z�j Uj Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: EAT I Building Commissioner/Inspector of Buildings Date 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 fill by Building Depart t Lot Size Frontage Setbacks Front L� Side L: R: L: Rear r Building Height Bldg. Square Footage r % J 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 U DON'T KNOW ® YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,ex vation, 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [Q Siding [Ell Other[D] Brief Description of Proposed Work: AhI z(Z S AM4RCOW 'RF-�JGVPy-11 GM Alteration of existing bedroom Yes___�/No Adding new bedroom Yes ✓No Attached Narrative Renovating unfinished basement Yes /No Plans Attached Roll - heet 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 A- c. Is there a garage attached? ,. Lv d. Proposed Square footage of new construction. Dimensio N e. Number of stories? f. Method of heating? v Fiv laces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. � ands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement9rcellar floor below finished grade y k. Will buildi g-Gronform 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 I, (� C Mill, --e o riQ as Owner of the subject property hereby authorize to act n my behalf, in all atters relative to work authorized by this building permit application. Sign re—ol Owner A Date I, ``c '3�" 1 L--- - 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. J?`U'15. 2, Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8-I.Licensed Construction Supervisor: Not Applicable 0 Name of License Holder C-r- 1P 4- R-4 License Number 2 SE a-V X CX C V- t7a 0 T--T*A 10 1 to 7-07- t Address ---A Expiration Date 4- 1 Signature Telephone Not Applicable 0 Company Name Registration Number 3 G s-1 17, 1 7,0 r-0 Address Expiration Date -Telephone±11-�4-�12- 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....... Er' No... The Commonwealth of Massachusetts Department of Industrial Accidents A 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): Address: City/State/Zip: Phone #: Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with mployees(full and/or part-time).* 7. N construction 2.[:]1 am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E] Building addition 4.❑1 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 5.M I 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.: 6.❑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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //�� Insurance Company Name: 0 � M Policy#or Self-ins.Lic.#: W M Z V oD UO -7Tt;7 Z c 19 A Expiration Date: -7 o a 00 2-e, Job Site Address: 2) Pr+e$ori 5 u A,\_y, City/State/Zip: (-�l()a ,&-%z e t t'lAR U "'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 ceJ;l fy under the pains and penalties of perjury that the information provided above is true and correct. Signature• O� Date: j L 1 t I ei Phone#: 4 2 4- 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#: _ City of Northampton Massachusetts (. - c DEPARTMENT OF BUILDING INSPECTIONS i 2121Northampton, MA*Municipalet Building 01060 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: (Please print house number and street name) Is to be disposed of at: (Please print name and locatiorf of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) [ t I SCI 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. PRE-FAB RECESS, 14"W x 18"H LOCATION TBD 6'-7" HAND-HELD WAND 30"GRAB BAR W/SUPPLY UNION SCOPE OF WORK REMOVE EXISTING TUB AND DECK o U M w BUILD NEW SHOWER WITH BENCH °o SEAT AS SHOWN ON PLAN w Z F- wSUPPLY AND INSTALL NEW 36"WIDE I : < C? VANITY CABINET WITH STONE COUNT- ;n ERTOP AND UNDERMOUNT SINK 2-2 2'-3' 2'-2" INSTALL NEW TILE FLOORS, SHOWER ENCLOSURE INSTALL NEW TOILET MASTER NEW 36" BATHROOM VANITY ih -v OL M 2 PROPOSED MASTER BATHROOM PLAN 1/2" = 1'-0" SCHUMACH FR BATH 21 WEST PARSONS LANE, FLORENCE MA 01062