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17A-203 (4) BP-2022-1413 23 POWELL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-203-001 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-2022-1413 PERMISSION IS HEREBY GRANTED TO: Project# ADD BATH/RENO INT Contractor: License: Est. Cost: 23000 RICHARD DENNO 066189 Const.Class: Exp.Date: 10/20/2023 HERSKOVITZ REBECCA A&CAOLAN P Use Group: Owner: LOUGHLIN Lot Size (sq.ft.) Zoning: URB Applicant: RICHARD DENNO Applicant Address Phone: Insurance: 551 FLORENCE RD (413)584-0852 FLORENCE, MA 01062 ISSUED ON: 11/01/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATIONS/ADD 1/2 BATH 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I I �� Fees Paid: $150.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner i:" , d,_,:,' `-Department use only City of Northampton ocr Status or unit: Building Depart ent / 3 J rb Cut/ rivew y Permit 212 Main Str et (_ r/5 tic Availability DF�- Room 10 - r op, Water ell Av4ilability Uzi C;/AJc Northampton, MA 01060 �r'�Atia°1�h F ro of S uctural Plans phone 413-587-1240 Fax 413-587-1272 �'—= 86tslt"eSPlar Other Speci4 APPLICATION 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 23 -PO f. ct\l Map 1 7A Lot 203 unit FlOr ev/14 e Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Gaal& r, 0) 1ov� h► h 23Fe teal ( 1 5+ ortri.kot, Name(Print) Current Z! Address�� Telephone Signature 2.2 Authorized Agent: GA alerjVe ZA.c Sal / JD-Ji 'ki"R./A wn ,,, A/CSS Name(Print) Current Mailing Address _ 1 s75 /- ©867 Signs ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building l0/_T7T0 (a) Building Permit Fee 2. Electrical I�-,P) (b) Estimated Total Cost of t ;. Construction from (6) 3. Plumbing pi. ov D Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+ 3+4+5) 3,O0 0. - ' ) Check Number o2 3 ,47 This Section For Official Use Only /2-/,1/) Date Building Permit Number: G1 l7 Issued: Signature: ./7 //- /-ZOZZ Building Commissioner/Inspector of Buildings Date it c„,14. It lino co�, . CI-M, @./Cal'il h cas Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Fxistinii Proposed Required by Zoning This column to be lilted in h1\ Building_Department Lot Size • Frontage Setbacks Front Side L: R: 1 R: - Rear Building Height Bldg. Square Footage 00 Open Space Footage 00 (Lot area mints hide&na\ed parking) #of Parking Spaces Fill: (volume R Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 YES O IF YES: enter Book Page and/or Document • B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO O 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 ex IF YES. then a Northampton Storm Water Management Permit from the DPW is required. 7 • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors l] Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [Q Siding [CI] IDther[CI] Brief Description of Proposed T / 1 Work: C✓4 Lti L!k 1 11 1 n l a l►t ), �i Mr ► l/z. 13g 4 /. 11}Lr(✓� l o Al Alteration of existing bedroom Yes " No Adding new bedroom Yes 4:1No Attached Narrative Renovating unfinished basement 75 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 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, st GQ G /e d 2 o pjA 64 . as OvYner of the subject property hereby authorize to act on m half, all m er relative to work authorized by this building permit application �•s T Signature o wner Date d `2 ' I, chi 77j 44 . as�0'/nSY/Authorized Agent hereby dec are 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. Jr) d L. Print Name lid✓ ) Zat 7 Signature o Glwgpr/Agent Date SECTION 8-CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: Not Applicable ID Name of License Holder: [�Gf �Y�l�y J1 G� 046 f 1 g License Number Address Expiration Date Signature Telephone .r►J/— O eg 5 9.Registered Home Improvement Contractor: Not Applicable 0 ch i- hh j2660.t Company Name Registration Number 1?,1 r�b/�L�lilr. /�/.tcr !'/"4" 2 J-trJ Address Expiration Date Telephone_. ?/ cif* 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 _. 0 11. - Home Owner Exemption The current exemption for"homeowners-NA,as extended to include Owner-occupied Dwellings of one(1 or two(2)families and to allow such homeowner to engage an indi\idual for hire who does not possess a license. rovided t at the owner acts as supervisor.CNIR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s)who own a parcel of land on which he she resides or intends to resi.e.on which there is.or is intended to be.a one or two family dwelling.attached or detached structures accessory to such us.and/or farm structures. A Berson who constructs more than one home in a two-year eriod shall not be considere' a homeowner. Such"homeowner'shall submit to the Building Official.on a form acceptable to the Building Official th t he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time.duri ,g and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated.you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner" certifies and assumes responsibility for compliance with the State Buildin Code.City of Northampton Ordinances. State and Local Zoning Lays and State of Massachusetts General Laws Annota ed. Homeowner Signature The Commonwealth of Massachusetts Department of Industrial Accidents ' i_- Office of Investigations . T''n y 600 Washington Street Boston,MA 02111 �'Z`..` www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 64 )2)0 7.4 c, Address: ,5-37 F1 cl_".4F,,c >1 City/State/Zip: , ,,, css e3/66.z. Phone.#: - „ „� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* haVe hired the sub-contractors 6. ❑New constnlction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. , emodeling1 ship and have no employees These sub-contactors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. 0 Building ad 'lion required.) 5'We are a corporation and its 10.0 Electrical r airs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing r airs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repai insurance required.)t c. 152, §](4),and we have no employees.[No workers' 13.0 Other comp.insurance required.) Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Contractors 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 poll 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 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 RDER and a fine of up to S250.00 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 certift under the pains and penalties of perjury that the information provided above is true an correct mature: .-4Z Date, //// /L02.7- Phone#: ..5 / ' O g6 7 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: / r N Oc"--. v VN _________. ...,___, 0 j 3 ...r) ' 1=. s- '11 D Ol=")r �Q1 _ ,7>\\ o� r e----• J ,r �1 1\1 J 3 � 4J% d� c'•