The URL can be used to link to this page

23D-077 117 WARNER ST BP-2020-1247 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-.077 CITY OF NORTHAMPTON Lot:-001 PERSONS CO TRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACC ESS TO THE GUARANTY FUND (MGL C.142A) Category: ADDITION BUILDING P E RM I T Permit# BP-2020-1247 Proiect# JS-2020-002104 Est.Cost: $210000.00 Fee: $1365.00 PERMISS ON IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: JASON GRAVER 103229 Lot Size(sg. (t.): 35501.40 Owner: ECK JUSTIN R&CHRISTINE D Zoning_URB(100)/ Applicant. JASON GRAVER AT. 117 WA NER ST Applicant Address: Phone: Insurance: 118 HAWLEY ST 413 320-6427 WC NORTHAMPTONMA01060 ISSUED ON.-612212020 0:00:00 TO PERFORM THE FOLLOWINGWORK.-ADD 20X23 2 STORY ADDITION TO EXISTING BUILDING 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: Feer e: Date Paid: mount: Building 6/22/2020 0:00:00 $1365.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasb ouck—Building Commissioner File#BP-2020-1247 z d�� APPLICANT/CONTACT PERSON JASON GRAVE R ADDRESS/PHONE 118 HAWLEY ST NORTHAMPTON (413)320-6427 ( �LbFz PROPERTY LOCATION 117 WARNER ST MAP 23D PARCEL 077 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED ED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: ADD 20X23 2 STORY ADDITION TO EXIS UILDINC New Construction Non Structural interior renovations Addition to Existiniz Accesso Structure Buildiny,Plans Included: Owner/Statement or License 103229 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRE UNDER:§ Intermediate Project: Site Plan AND OR Special Permit With Site Plan Major Project: Site Plan AN /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED I NDER: § Finding Special Permit Variance* Received&Recorded at Registry o Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commissi n Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Sig ture of Building Official LIJ Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants whc meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. M_ ZP Department use only C City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit c� 212 Main Street Sewer/Septic Availability '3 ` Room 100 WaterlVVell Availability Northampton, MA 0106b Two Sets of Structural Plans tt phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans N Other Specify TION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office //7 � )QfA�t, Map�� Lot 07 Unit W ;=%n4e p�o6� Zone Overlay District �A Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 7 Gt/�rnl� f�. /rr 'r�tP Name(Print)_ — urrent Mailing Address: c one q/.3 d,? A106 Sign re 2.2 Authorized Agent: / r"S15 //6 Name(Print) Current Mails Address: L;;; 3d� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /?S 0040 (a)Building Permit Fee 2. Electrical � 4/0949 (b)Estimated Total Cost of Construction from 6 3. Plumbing d 6490 Building Permit Fee O 4. Mechanical(HVAC) 3(6 51 O 5. Fire Protection /oi Poe 6. Total=(1 +2+3+4+5) glo 00 Check Number AP—Q 1 This Se tion For Official Use Only ABuilding Permit Number: — QV IDat ed: Signature: Building Commissioner/Inspector of�uildings 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 filled in by Building Department Lot Size •el t 3a$34/�e Frontage Setbacks Front 35 75 Side L:31 ' R. �. 7S L: 7' ' RFV�75— / Rear ? �DD 0 {�— Building Height ,..._.. Bldg.Square Footage 3N % �7.7 5 Open Space Footage 13 � % 3i o 5 (Lot area minus bldg&paved a�6,1 el parking) #of Parking Spaces Fill: / (volume&Location) - - A. Hasa Special. Permit/Variance/Finding ever been issued for/on the site? NO J6 DONT KNOW O 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 (X1 DONT KNOW O YES O 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? YEE O NO X 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 A Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs ED] Decks Siding p] Other[p] Brief Description of Proposed r Work: glad aD oc ot3 fu/D fr<irc� af)d�d'cw � P/c,s�i/t9 buy/yrxj, Alteration of existing bedroom ( Yes No Adding new bedroom X Yes No Attached Narrativek Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family)C_ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached?AD d. Proposed Square footage of new construction. 60 Dimensions 00 / X t22,3 / Hors e. Number of stories? 19J f. Method of heating? /hiQ� SPP' Aod OIr W Fireplaces or Woodstoves X Number of each t6+*p k/410-g. Energy Conservation Compliance. /nMasscheck Energy Compliance form attached? In. Type of construction u1sod tufo 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? X Yes No . I. Septic Tank City Sewer_ Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE C MPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, CAllisllne Q,- 364s'trrl C� as Owner of the subject property hereby authorize544 ager - r prewou� e 0 F Lr�PiltPrtlzt� �G�S��kCA�O✓r• to act on m alf, in all matters relative to work authorized by this buildin p mit ication. Signatur of wner Date I, �erSdn (t/ddr- 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. on 0(rxlel— Print Name Signatur of Owner/Agent r Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable�❑ Name of License Holder: �Qf011 � �03ao7 License Number //8' `law(ey S� A&A�i.Addn MA 6ro`o 61,;V;4 Address / Expiration Dat Sig ature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 NeMet/aIf (_Rt rI Con5frNCroel 1/IC. /77196 6 Company Name I r Registration Number I!B 11l�failty Sf• ndni,o�rH �A Ql0611 Address 1-117, Expirati n ate PlPntp (Cp./y�Q�I 4 .✓t►lt��•&41 Telephone 30tO.6yd� 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.... ❑ _ City of Northampton s> Massachusetts t1 �, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building i3 s .9r 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"recons t uction, 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 orto structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted w*h a cgrporation or LLC,that entity must be registered Type of Work: NdIJ6a4 Est.Cost: 1 00 Address of Work: re 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(explai ): Building not owner-ocpupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOF 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 LSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMI .SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the kgentof the owner: ??% v Dfi to Contractor m HIC Registration No. OR: Notwithstanding the above notice,I hereby appl for a building permit as the owner of the above property: Date Owner Name and Signature The Comm wealth of Massachusetts DepdWmeti t of Industrial Accidents Office of Investigations 4 600 Washington Street B Ston,MA 02111 w w.mass.gov/dia Workers' Compensation Insurance A davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): P/lPV u on chC Address: // +ale S�< City/State/Zip: ArAan pirm MA Dld b Phone#: Z-//3- 3d 0_b yd 7 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 67 4. ❑ I ar i a general contractor and I employees(full and/or part-time).* ha a hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- list A on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. em loyees and have workers' Y9.;KBuilding addition [No workers'comp.insurance col ip.insurance.# required.] 5. ❑ W are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work off vers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. rig it of exemption per MGL 12.❑Roof repairs insurance required.]t ti c. 152,§1(4),and we have no em loyees. [No workers' 13.0 Other cor ip.insurance required.] *Any applicant that checks box#1 must also fill out the section belom 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: x&l rS Policy#or Self-ins.Lic.#: 98' ^ 3 Expiration Date: 070 Job Site Address: tpl't r 9, City/State/Zip: 6,114m , A& d�Dba- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25 A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as ivell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the ains and penalties of pe jury that the information provided above is true and correct Si nature: f Date: 6 /Sap Phone#: 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.Ci /Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: l ® DATE(MM/DD/YYYY) ASR" CERTIFICATE OF LIABILITY INSURANCE 10/15/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Denise Sawicki NAME: Amherst Insurance Agency Inc A/CNN Ext): (413)253-5555 A C No): (413)256-8354 20 Gatehouse Rd. E-MAIL dsawicki@nathanagencies.com ADDRESS: P.O.BOX 48 INSURER(S)AFFORDING COVERAGE NAIC# Amherst MA 01002 INSURERA: Travelers Casualty Ins.Co.ofAmerica 19046 INSURED INSURER B: Travelers Indemnity Co.of Connecticut 25682 Elemental Carpentry&Construction Inc k INSURER C: 118 Hawley St INSURER D: INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: CL19101503067 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDPOLICY/YYYY MEFF M/D//YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 300000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A 6802C687310 09/01/2019 09/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-1 JECT PRO F]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE t AGGREGATE $ DED RETENTION $ PER - T $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? � NIA UB4J619853 09/01/2019 09/01/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE fvlz�Ucml ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton • # Massachusetts DEPARTMENT OF BUILDING INSPECTIONS k ` 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: /n 6"I f of ' 44 F/�"AC e /ha drOda (Please print house number and street name) Is to be disposed of at: lb A, C�/� — UIrl r MA ( leas print namb and cation o acility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) z26 /r .70 Signat re of Per r pplicant or Owndr Da e 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. k