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38A-006 (4) 56 LAUREL ST BP-2020-1221 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38A-006 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-2020-1221 Proiect# JS-2020-002056 Est.Cost: $10000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: . JOHN B OTIS 002688 Lot Size(sg.ft.): 6882.48 Owner: DUDA JACQUELYN Zoning B(100)/ Applicant: JOHN B OTIS AT: 56 LAUREL ST Applicant Address: Phone: Insurance: 612 EAST ST (413) 268-7106 WILLIAMSBURGMA01096 ISSUED ON.6/11/20200:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE FLOOR IN 1 ST FLOOR LIVING ROOM 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 MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeTyne: Date Paid: Amount: Building 6/11/2020 0:00:00 $65:00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit b A r t 212 Main Street Sewer/Septic Availability ' Room 100 WaterNVell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: QThis section to be completed y office p,,�J tZE L Map �U Lot Unit ��"` Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: fA-c© uEIy J k-kbA P(D 600tz(4cc 01062 N e(Print) Current Mailing Address: X15 - Sg(c-- S� 7 Telephone Sign re 2.2 Authorized Agent: John 13. Utis 612 East 6t. , Williamsburg, 14A 0109 Name(Print) Current Mailing Address: 2b6-71o6 & 695-4679 (cell) Signa a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 410,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �T I 5. Fire Protection VVV 6. Total=(1 +2+3+4+5) 10,560 Check Number r' / This Section For Official Use Only BuildingPermit Number: do J 1 I Date GP- Issued: Signature: Building Commissioner/Inspector of Buildings Date ., „ f. i - SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) ff7Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[E--3] Other)d Brief Description of Proposed Work: i,,eulace floor in 1st floor living room (see attached) 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 New house and or addition to existinhousing. comlete the followincomplete 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 I, y�\�\ Vq U�L��, as Owner of the subject property hereby authorize John 13. Otis to act on my behalf, in all matters relative to work authorized by this building permit application. as LO z0 Sign )Sign5A)ie of Owher J Date I John B. U t i s as Owne4�nowl,, Agen hereby declare that the statements and information on the foregoing application are true and accurate,to the best of ge 4rrTbelief. Signed under the pains and penalties of perjury. John B. Utis Print Name 6/2/2020 :Signat of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: John u. Otis 002688 License Number 612 East Street, Williatnsburg, NIA 01096 10/13/21 Address Expiration Date (413) 695-4879 Sign re Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ John L. Utis 102687 Company Name Registration Number 612 East Street 7/1/2020 Address Expiration Date Williainsburgy NIA 01096 Teleph�413)695-4879 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....... IX No...... ❑ City of Northampton �• Massachusetts •x � DEPARTMENT OF BUILDING INSPECTIONS ®1 212 Main Street *Municipal Building >� Northampton, MA 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: 56 Laurei street (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: ;,iark aic.i%v in Inc ./Wiiiiau:sbui, (Company Name and Address) ,�Qdk/—9 & SiqXature 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. The Commonwealth of Massachusetts i Department of IndustrialAecidents 1 Congress Street,Suite 100 Y 4 Boston,MA 02114-2017 A www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/orgmization/Individual): J o hn 13. U t i s Address: 612 East Street City/State/Zip:Williamsburg, MA 01096 phone #: (413) 268-7106 Are you an employer?Check the appropriate box: Type of project(required): I.❑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 $. Remodeling any capacity.[No workers'comp.insurance required.] 3.[:]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 ❑Demolition 10 Q 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 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.= Repair 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: 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 6/2/2020 Phone#: (413) 268-7106 Official use only. Do not write in this area,to he completed fit,city or town ofjicial. 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#: JOHN B. OTIS STATEMENT 612 East Street, Williamsburg, MA 01096 cell: 413-695-4879 home: 413-268-7106 jotisrestoration.com Date: 6/2/2020 STRUCTURAL REPAIR & RESTORATION OF ANTIQUE BUILDINGS Submitted to: :vortiianpton 13uiluing Dept . Submitted for: Proposed floor replacement in 1 room u56 Laurel St. Description: Replace 122 (span) X 251 living room floor in 1st floor of house, using PT floor ,foists and 3/4" Advantech sub-flooring. Finish flooring, propably 3/4" wood, to be installed by others. There is a tight crawl space with a dirt floor underneath. I rebuilt the floor in an adjacent room about 15 years ago and was able to pour a concrete floor to seal off the dirt. Space was limited by ductwork, so I used 6X6 PT joists. This room looks to be about the same. There is termite dawage which may require replacement of adjacent beams or sill. If you want, I can send you a drawing or have you take a look, once I have it opened up. City of Northampton Massachusetts DEPARTI, PT OF BUILDING ZHSMCTICiS ; 212 Main Street • Municipal Building North, ton, 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 he registered Type of Work: Carpentry repair Est.Cost: "P1 O,"O Address of Work: 56 Laurel Street Date of permit Application: 6/2/2020 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 the penalties of perjury: 4?*4&� I hereby apply for a building permit as the agent of the owner: 6/2/2020 John L. Utis lo2687 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 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 DONT KNOW VY YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT 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 ® DONT KNOW O YES 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required.