17C-038 (4) 24 HILLCREST DR BP-2020-0948
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-038 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2020-0948
Proiect# JS-2020-001613_
Est.Cost: $130900.00
Fee: $851.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THAYER STREET ASSOC INC 045159
Lot Size(ssg. 1): 34281.72 Owner: KELLY EDWARD
Zonine: URA(68)/URB(33)/ Applicant. THAYER STREET ASSOC INC
AT: 24 HILLCREST DR
Applicant Address: Phone: Insurance:
8A COATES AVE (416) 665-4018 Workers Compensation
SOUTH DEERFIELDMA013731SSUED ON:2/21/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENO BASEMENT, MASTER BED AND 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 Signature:
FeeTvpe: Date Paid: Amount:
Building 2/21/2020 0:00:00 $851.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
��� 'rist,rl City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
pe
Room 100 ', � i Water/Well Availability
Northampton, MA 01060 *�'`� . Two Sets of Structural Plans
phone 413-587-1240 Fax 5�7-1272 _ ! -Plot/Ste Plans
j Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVXTE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
00
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
//
a y EA t I(c res+ `�E• Map RIC Lot Q clZZ
y Unit
Zone Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
7cresc &. Aej,/t and 44.4d ke.11y 14_ AtUeres+ •D I:
NFIoreptI «
e(Print Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent: 1 ,/
r ? II Cd4T�s �7 YC
Name(Print) /moi 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 Da (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
4/ O 0 a 0 Construction from 6
3. Plumbing 4 Building Permit Fee
/7 aoo � ?5). .SCJ
4. Mechanical (HVAC) ,t
5. Fire Protection d 7, QQz)
6. Total= (1 +2+3+4+5) /3 pD Check Number �01 17
This Section For Official Use Only
g p,, qqf Date
Building Permit Number: Issued:
Signature: Wa)Lac)
Building Commissioner/Inspector of Buildings Date
d rcw @ -�-�,a.Y crs {-rccTQssoc �4f� s.cD�l
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
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 O DON'T KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ® YES 0
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? YESO NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YESO 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
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 EQ
Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [❑ Siding 0::1] Other[M
Brief Description of Proposed
Work: Aeno va te- ehArr}v;Amro/- Qtcp &,4reoh+ aAI 40 Al-00
Alteration of existing bedroom_ Yes No Adding new bedroom Yes No
Attached Narrative-' Renovating unfinished basement Yes No
Plans Attached Roll - Sheetl�Cj•�v QJ&"
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
1, TetGSG /bio Aeele and Edward kelly as Owner of the subject
property
hereby authorize V 108 k Qr r%KJ 0 h
to ct on ;Jy1f, in all matters relative t work authorized W this building permit application.
b 1 125
Signature of Owner Date
I, _ vf r Kd o !A a r r ;A oil as Owner/ uthorized
Agent hereby declare that threstatements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties perjury.
llerKoti 14 a r f',L
Print Name
Signature 4-6wneNAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑[—
Name of License Holder: VCr^0 ti l I u«i A�i 0 m C—� U y S )J q
License Number
Cgle3 avuS, Wccf;elj M4. 01.373 0?-63 - 0)0a 0
Addr Expiration Date
7�wil411 .3
Si nature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
7-X4ytr —. f rcc� 4ss6c; 7leS IrcG. /2/03S
Comp ny Name Registration Number
$ C ve Zt t 'c(d of37 3 a - /G - a 7
Addre Expiration Date
�. Telephone y/344S-Vol
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....... W No...... ❑
J - Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
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("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 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: je eAW U a f i on_S Est. Cost: 4� 436,000
Address of Work: a 44 14 0 1C r e s f 1D r i v G ., f-to r eh G e,40
Date of Permit Application: o�// /o10a 0
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 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 a penalties of perjury:
01
I her ply for a permit s e agent of the own r:
���
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
- . A/.
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS y ;}
212 Main Street *Municipal Building
Northampton, MA 01060 �J,
t 3
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:
a H Rill Ctcs+ Z r ve . Fforot Cc
(Please print house number and street name)
Is to be disposed of at:
UWM Auld Kas 6Z6 rha► h Li.
(Please print ntrme and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
AL,s � ,� 5 goo mus bihaleIV
(Company Name and Address)
Sigr4ture of Permit Applic t or-Avanel, 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
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):_r 4 f S }('C G"i- 4 5 So C l d l c S
Address: �'Qc�►fe S 'A'C
City/State/Zip: S.J)ee r if t' e(d/19 . 0117 3 Phone #: S- y0/8
Are you an employer?Check the appropriate box: Type of project(required):
I ®I am a employer with 4a 9employees(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.]
3.❑I am a homeowner doingall work myself 9. Demolition
ildi
y [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
5F I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]ROOf re airs
These sub-contractors have employees and have workers'comp.insurance? p
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
en ployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
/am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:AVS/!j
Policy#or Self-ins.Lic.#:_(i IP1 a 80 0 Q 66 7V5 f—Q 0/9/4_ Expiration Date: S -3l- a ox o
Job Site Address:_ ,a 1l J71 Wer eS It Dr i V G City/State/Zip: kl0/to t C /#/� 0/0 6 O
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 violato .A copy of this s atement may be rwarded to the Office of Investigations of the DIA for insurance
coverage verificatio .
1 do herebyunder the p nd penalt' perjury that the information provided abo s iue and correct.
Si ature: Date:
Phone#: - 4 S-
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#:
Thayer Street Associates
• 8 Coates Ave
South Deerfield MA. 01373
Renovations at 24 Hillcrest Drive Florence
Terese Hammerle and Edward Kelly, Owners
Entertainment room renovation
The current basement entertainment area will have existing counter and sink removed, the
tiled ceiling will be removed, new lights installed and drywalled.
New wall built dividing off back of stairs and utilities with door for access.
Concrete wall to be insulated and drywall installed.
Luxury vinyl plank to be installed over existing flooring.
New countertop to be installed on framed and sheathed base.
New sink and range hood installed.
Master bedroom renovation
We are taking two bedrooms and one bathroom and making a master suite from that space.
Demo existing bathroom, select walls and plaster in those areas.
Rework floor plan to incorporate new bathroom new laundry area and new bedroom.
Install new rough plumbing for bathroom and laundry.
Frame new walls for the new areas.
Reinsulate exterior walls in areas that plaster is removed.
Remove and replace old windows.
Drywall and finish.
Bathroom gets tiled, fixtures installed.