30A-023 (11) 48 LEXINGTON AVE BP-2020-1257
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30A-023 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate og a:replacement windows/siding BUILDING PERMIT
Permit# BP-2020-1257
Proiect# JS-2020-002115
Est.Cost:$10640.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor: License:
Use Group: Kevin R. Schnell DBA Live Well Home Improvement LLC 109600
Lot Size(sg ft.): 11194.92 Owner: MESCON CORY&BEN BAUMER
Zoning: URB(100) Applicant. Kevin R. Schnell DBA Live Well Home Improvement LLC
AT. 48 LEXINGTON AVE
Applicant Address: Phone: Insurance:
33 LAUREL MOUNTAIN RD (413)887-8482 Workers
Compensation
WEST WHATELYMA01039 ISSUED ON.6/18/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-SIDING, DOOR AND WINDOW REPLACEMENT
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:
FeeTyipe: Date Paid: Amount:
Building 6/18/2020 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 Nodhampton Status of Permit:
Buildin De urb C Drivewa Permit
, � Dep y
r., 212 Main retic Availability
! Roomraax
ater ell Availability
Northampton, MO� a �2?O wo S is of Structural Plans
phone 413-587-1240413-587-12 +� IoUS'a Plans
her pecify
PFT APPLICATION TO CONSTRUCT,ALTER? k,�wWM0wb1MO ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: } This section to be completed by office
`?a Lex h I(ltl'1 A v-e• Map �Q A Lot Q/ Unit
5 Zone Overlay District
Fl,rjrre%ce Ma O1D62
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ,�
COV-4J�'ES CoV% I&V% 3C.VyAr-V- yB Lex)v►�le). Av- Fiorevt cy nA
Na Priho CurrentAl a.i.linAddre
3�} 310 /363 (41;) 21S-39C.0
Telephone
Sign
2.2 Authorized Agent: /�
LIvc%-e-11 ow.t gym, Lt`C• tr.&C to N% 33 L&Vre) K+. wh6we14 NUS
Name(Print) Ste+rrent Mailing Address:
(L13) Lfo4 - 2929
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building .00
0O (a)Building Permit Fee
2. Electrical Q (b)Estimated Total Cost of
Construction from 6
3. Plumbing 0 Building Permit Fee r
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Numbe Issued:
: Date
Signature: (o"lB&ZO
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
s
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to he tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage % e� �t
(Lot area minus bldg R paved ! i
parking) cJ
#of Parking Spaces
Fill:
(volume&IAcation) �` Q' ist
A. Has a Special Permit/Variance/Finding ever been issued for/on the site? w �
r-NO) DON'T KNOW YES
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? �NOr, DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES �VO
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 (NO—11
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
Accessory Bldg. Demolition New Signs [ ] Decks ( J Siding[--] Other[ ]
Brief Description of Proposedct
Work: I�'c.j I�� C�: Sf C l C:v `-� LZ C C C >�,,✓I '9"J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _V No
Plans Attached Roll -Sheet
6a.If New house and or addition to existina housina,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 7 WNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject
property 1 f
hereby autho ize 1
to act o ,in all matters relative to work authori ed by this building ermit appli ion.
Signature of Ov4er Date
I, as Owner/Authorized
Agent h b at the statements and information on the foregoing application are true and accurate,to the best of my kngwledge
and b
Sign a pains and penaltie of perjury.
Print
d
Sig re of gent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: CC Not Applicable ❑
Name of License Holder: key I h �,�+CN lrti e' loci 00
License Number
L0.Vtr?A MA—lo- 101 - a0-11
Address Expiration Date
4I3 8k'7 - y �sa.
S
ignatylst4jm4proyement
Telephone
R Contractor: Not Applicable ❑
I$ It46
O"paj&Name umber
V L
Address Expiration Date
' elephone - *�
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. �t
Signed Affidavit Attached Yes....... Kf No...... ❑ A Q ►^ I I1[,
City of Northampton
L Massachusetts
l` � W 's
l DEPARTMffiVT OF BUILDING INSPECTIONS y x
M
212 Main Street • Municipal Building Jti a
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: �tSICk9- 1I'CIPIaCt- 'v'Adow tc6ftV Est.Cost: t 1 Cyt G4*. GO
Address of Work: l $ LtAi Wgtdh AVL', HartnGe, MA o loci
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 RESPONSIBILITES 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 ase gent of the owner:
G S. 1 g 11 q6
Date Co actor Name HIC Registr• ion 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
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
s
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:
LI( N
Z 1-1x I ng:172l� AV I (ortw%� � 1 to
(Please print house nurnGer and street name)
Is to be disposed of at:
VC06 1 lr_u R c w ca►rca C�rteY'
(Please p ' t name and locbtion cility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit icant 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
Department of Industrial Accidents Oh
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 ''11 r Please Print Legibly
Name(Business/Organization/individual): LI_►Z� yye-11 A er,,. Ln pronyKed LUC
Address: 33 l,ourtl M'} 1' J W. wkatt A MA.
City/State/Zip: NA 010Phone#: C413� Yost- 2Gzq
Are you an employer?Check the appropriate box: Type of project(required):
1,[�I am a employer with 5 employees(full and/or part-time).* 7. F�New construction
2.R 1 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.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.►'
10 Q Building addition
4.[:]l am a homeowner and will he hiring contractors to conduct all work on my properly. 1 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.❑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$t�lttn� t W If7
152,Q 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 employees. Below is the policy and* site
information,
Insurance Company Name: C
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: 411T n City/State/Zip: Q O4�,Q_
Attach a copy of the workers'compensa on 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 impri: ent,al well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the viol or. coy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificat'
Ido hereby cert' der ais nd penalties of perjury that the information provided above is true and correct.
Signature: Date: 0
Phone#: 9
Offici e or 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#: