24D-276 (2) BP-2022-1092
157 CRESCENT ST COMMONWEALTH- OF MASSACHUSETTS
Map:Block:Lot:
24D-276-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1092 PERMISSIONISHEREBYGRANT I TO:
Project# RAILING Contractor: License:
HAYDENVILLE WOODWORKING &
Est. Cost: 15180 DESIGN INC 116208
Const.Class: Exp.Date:04/13/2025
Use Group: Owner: AMY ROSEN SUSAN E&DOUGLAS
Lot Size (sq.ft.)
Zoning: URB Applicant: HAYDENVILLE WOODWORKING & !DESIGN INC
Applicant Address Phone: Insurance:
35'CONZ ST (413)665-7402 WMZ-800-8007423-2021A
NORTHAMPTON, MA 01060
ISSUED ON:09/02/2022
TO PERFORM THE FOLLOWING WORK:
RAILING
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
4 • ir )2 • si
Fees Paid: $97.50
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Department use only
"N M Cityof Northam tones Status of Permit:
of.'
Building Departttnen /1
Cut/Driveway Permit
212 Main Street SFP Availability
A: Room 'O0 Wa ell Mailability
Northampton/MA 9_ '.0 1 ?O Two ets o /Structural Plans
phone 413-587-1240 Pax, T 5In��in 272 Pio Site ans
` Ty
O er S city
�4oRCT /
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOV'� ' MOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map s'`'If, Lot cP. 7I Unit
157 Crescent St Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Douglas Amy 157 Crescent St
Name(Print) 4.7 Current Mailing Address:
Ott3 3e3-- 7344f Telephone
Signature
2.2 Authorized Agent:
Haydenville Woodworking&Design, Inc./Zinnia Stetson 35 Conz Street,Northampton,MA 01060
Name(Print) Current Mailing Address:
413-665-7402
Signs re Telephone
ON 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 15,180 (a)Building Permit Fee
2. Electrical 0 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 0 Building Permit Fee �(9 "�
4. Mechanical (HVAC) "
5. Fire Protection 0
6. Total=(1 +2+3+4+5) 15,180 Check Number a3'?3
This Section For Official Use Only
«
Building Permit Number:6!f_ o ioqA DateIssued:
Signature: / -1• /-ZOZZ
Building Commissioner/Inspector of Buildings Date
Zinnia a HaydenvilleWD.com
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 0 DONT KNOW Q YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO O
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 0
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 0
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 n Addition ❑ Replacement Windows Alteration(s) n Roofing E
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding[El] Other[CI]
Brief Description of Proposed Paint deck, replace railing
Work:
Alteration of existing bedroom Yes x No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
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
Douglas Amy
I, , as Owner of the subject
property
Haydenville Woodworking & Design, Inc./Zinnia Stetson
hereby authorize
to a t�y behalf, in all •.tters r tive to work authorized by this building permit application.ap
Signature of•' r Date
of 3 I+ ZZ
Zinnia Stetson / Haydenville Woodworking & Design
I, , 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.
Zinnia Stetson
Print Name
ignatffre if Ow�}er/ '-nt Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Zinnia Wu Stetson
License Number
35 Conz Street, Northampton, MA 01060 116208
Address Expiration Date
413-665-7402 04/13/2025
Signatu e Telephone
9.R tared a Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Haydenville Woodworking & Design, Inc./ Zirylta S is 110732
Address ( Expiration Date
35 Conz Street, Northampton, MA 01060 Telap r 65-7402 11/2/2022
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
�<PrPrO -n.-
j. Massachusetts �;S 1
'' ` ` ' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J P*
Northampton, MA 01060 i`j~~ '�g
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: Paint deck,replace railing Est Cost: 15,180
Address of Work: 157 Crescent St
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 as the agent of the owner:
Haydenville Woodworking & Design, Inc./Zinnia Ste 110732
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above prop rty:
Date Owner Name and Signature
City of Northampton
{[� •
� "• Massachusetts CHU� DEPARTMENT OF BUILDING INSPECTIONS
'r212 Main Street •Municipal BuildingNorthampton, 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:
157 Crescent St
(Please print house number and street name)
Is to be disposed of at:
Valley Recycling, Northampton
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signatur of Per it pplicant 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
AT
_ 1]1►= t Office of Investigations
G.._ i�_ 600 Washington Street
Boston,MA 02111
.Y �= www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lesibly
Name (Business/Organization/Individual): Haydenville Woodworking & Design, Inc./Zinnia Sth
Address: 35 Conz Street, Northampton, MA 01060
City/State/Zip: Phone #: 413-665-7402
Are you an employer?Check the appropriate box: Type of project(req ,fired):
1. I am a employer with ' 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7•VI Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. workers' comp.insurance. 9. 0 Building additikn
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers'
comp.insurance required.] 13.0 Other
*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 their workers'comp.police information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
A.I.M. Mutual Insurance
WMZ-800-8007423-2021 A 12/1/2022
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address:157 Crescent St City/state/ziJorthampton, A 01060
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 25A 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 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. Be advised that 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 pain and penalties of perjury that the information provided above is true and co'rect.
Signature: Date: 731I7Z
Phone#: 41 -66 -740
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#: