Loading...
06-064 (28) 63 CHESTNUT AV EXT BP-2020-1274 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:06-064 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2020-1274 Project# JS-2020-002130 Est.Cost: $8000.00 Fee: $65.00 PERMIS,�IONIS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: ED JAZAB 050099 Lot Size(sq.ft.): Owner: Joshua Birk Zoning. Applicant: ED JAZAB AT: 63 CHESTNUT AV EXT Applicant Address: Phone: Insurance: 9 SHEPHERDS HOLLOW (413) 222-4910 0 LEEDSMA01053 ISSUED ON.612312020 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADD EGRESS WINDOW TO BASEMENT CONVERT ROOM TO BEDROOM 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 I'aid: Amount: Building 6/23/2020 0:00:00 $E5.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Building Department 212 Main Street «& A' .€ Room 100 SUNW sr d(A,bi ility 1 Northampton, MA 010 0 9 2Nm 5 sof$tructuraloIansuj . phone 413-587-1240 Fax 4 f' 72 Plod PI s c APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVAT ,q _V EM&US A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 0 C'(A E57 Q v T (�v �x I � � Map Lot 06 Unit Ln�C� S ["V /� © , Zone Overlay District �- i t Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3bsN u N 'i3�Py, 63 GA'CS-nK(UT (\V. Name(Print) Current Mailing Address: Telephone Sig ature 2.2 Authorized Agent: q [ 1 ID �P��"3 t N (Print Current Mailing Address: 413- 222-LA91 b Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 500o (a)Building Permit Fee 2. Electrical 000 (b)Estimated Total Cost of G. Construction from 6 3. Plumbing 2010 Building Permit Fee 4. Mechanical (HVAC) 0 5. Fire Protection 1p 00 6. Total = (1 + 2+ 3+4+ 5) gPPo-X B000 Check Number j ! n /� 7 •-7 This Section For Official Use Only Building Permit Number POA 47'4 / Date Issued: Signature: G-Z5- zwo Building Commissioner/Inspector of Buildings Date ru w 11 w�MM� IMS 0%1 nr%rM_ r1T1 IrM w�M% SECTION 5-DESCRIPTION OF PROPOSED WORK(check all awlicablel New House ❑ Addition Replacement Windows Alteration(s) Roofing Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[C7J Brief De tion of Proposed Work: (�l,D EcR-L;5 w 1 N Do-vi i o 8()St )t-'1QT . C-r3►J U uZT 1.7\m `-0 13' tl)Ro c'lvl J 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 followin 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. CD Dimensions e. Number of stories? f. Method of heating? F0q-2_C.9D x o T w^Tfv"', Fireplaces or Woodstoves Q Number of each g. Energy Conservation Compliance_ Masscheck Energy Compliance form attached? h. Type of construction ',40-0U 'K(Z VW)6 i. Is construction within 100 ft. of wetlands? Yes No_ Is construction within 100 yr. floodplain Yes No I j. Depth of basement or cellar floor below finished grade 1 k. Will building conform to the Building and Zoning regulations? Yes No/. I. Septic Tank City Sewer �/ Private well City water Supply V SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT U P" as Owner of the subject property hereby authorize to act n my beha�11� rs relative to work authorized by this building permit application. Q6 03 2020 Sig ure of Owner Date I, �D �AZAB 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 r t ains and penalties of perjury. JA72-6 Print Name ab 103 � 2_020 Signature of Owner/Agent Date The Commonwealth of Massachusetts _ Department of Industrial Accidents -y .. 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.meas&gov1&a NVorken' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbet-s. TO HE FILED WITH THE PERMITTING AUTHORITY. AnulicantInformation Please Print Legibly Name (Business/Organization/Individual): ED jo,7rij Address: 9 �H1}C.RDS FtOu"a Y� City/State/Zip: LE-cv vw_572, Phone#: 4 l3 -222- 4910 Are you an employer?Cheep the appropriate hoz: Type of project(mquimd): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2IR I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'cone.insurance required.] 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.l t 9. El Demolition 4.F1I am a homeowner and will be hiring conAraclors to conduct all work on my property. I will 10 p Building addition ensure that all contractors either have workers'compensation Iinsurance or are sok I LED Electrical repairs or additions proprietors with no employees_ 12.®Plumbing repairs or additions 5.❑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. 1contractors that check this box must attached an additional sheet showing the name of the sub-comb-actors and state whether or not those entities have employees. If the sub-contractors have employees,they mast provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor 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 firle 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 Investigatiorts of the DIA for insurance coverage verification. 1 do hereby cerrtlyunger rnepasns ana pennies of perjury inai ine information provtaea above is true ana correcT. Signature:SMDale: Tut,) -5Zo 20 Phone#: IN 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.Cit iTownClerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Penon: Phone#: City of Northampton Massachusetts DEPARIMNT OF BUILDING INSPECTIONS ` 212 Main Street •Municipal Building �- Northampton, MA 010603`� y a Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, 1 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 debfriis�from construction work being performed at: 63 +�T� )V UT I . t=X i 1J . (Please print house number and street name) Is to be disposed of at: VALLE )e (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 51 Q � L 13 1 202D Sign ure f Permit Appli ant 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. City of Northampton r Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �.. � 212 Hain Street • Municipal Building Northampton, MA 01060 r'° tri 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: Est. Cost: Address of Work: Date of Permit Application: 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 RESPONSIBH.ITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: CI -312-02-0 ��fW�IC Li9c,:Z1TE 5IF,811 © 511312- 1 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 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: F-12 V r,'z/4o License Number C) s t4cyi� N I EM Address Expiration ate q CA� 413 - 222- l4g1�o _ Signature Telephone /� 9.Registered Home Improvement Contractor: Not Applicable ❑ LP,0CRTC- 3U)�-DCR5 '5k6 B 110 Company Name �Arj) Registration Number 1� Mo-ZVj)� (;-TU-rla L-N 105 � l 3 � 20 2 Address / p Expiration Date Telephone Ll 13-x;95 �Sl 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....... ❑ No...... ❑ 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 Nariance/Fi ndi ng ever been issued for/on the site? NO (D DONT KNOW Q YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from���the Conservation Commission? Needs to be obtained � 01_htained � r>aYP Iscuorl C. Do any signs exist on the property. YES 0 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 0 IF YES, describe size, type and location: E. Will the construction activity disturb(c�le�aring,grading,excavation,or filling)over 1 acre or is it part of a common plan ) that will disturb over 1 acre? YES I; NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. (03 GESTNUT U �K� ► W � N p a v�/ 11ovLD L\1<� C�NVT t�1ar'1��W fJ R)7D {� ►3F�D�{pov.^ �tiD To S 'AGZpT TD f,iJ it Cr 5 bf J N �2or`^ i 0-L- A6 Icy ZcA -� z LU 12� D�� �I (��CE F o R, �/�S L�f3 0(�PD �T- ? ��►v� ra►�� w �� B c c�w, i✓�L�J BY ►cH VST N� �v w�G3 r�E- L A►J� � -T 1�I CA1. W L 1- T tiC , L �N3D �D9 smo ►4cc /C0 �r N-L�-bCo_ hrzt ►� I €tN�va�J�� CN C-L K \f:�tiD cv A I< tr (a tiY N M L) nn J nT F I GIA i 1 a — S P 6Z1 N K E 1AcY WILL. CE T 'C�-t qt-�ZM\,T- (-N%,j ID UYTDZ a a�-�v C �c Iz�tL �`1 T D R,le, . W I T c 1\ 4U P vin ) w ► l l �V ' i � ► a.1 S"�� t✓���S Lv►h1 D o ►�.) , rJ� w �� wt ► r�(r, �+'"� � w V,-\V4 p DRYS, ,AitL . l�J 11..1_.. cC � �►�� pNP �p�S i gay Sv5 P �-w� i✓� ,-T(Azov Lt 5T ►Jct P, s W QDO--tj N�W W A L L-- A1� E-A 15-1 ING LAy A 6ZCA `EYZ VvA LLS A L R $ ULAT� �n��.. � Fz � a