64 North BP 201864 NORTH ST
GIS #:
Map:Block: 240 -089
BP-2019-0030
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
~P,~,m~it~, --~B~u~ild~in-"'g DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category; ADDITION BUILDING PERMIT
Pennit # BP-2019-0030
Prnject # JS-2019-000037
Est. Cost;
Fee, $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class:
Use Group:
Lot Size(sq. ft.), 7100.28
Zoning: URC( 100)/
Contractor: License:
Homeowner as Contractor_
Owner: HARRINGTON MICHAEL L
Applicant: HARRINGTON MICHAEL L
AT: 64 NORTH ST
Applicant Address: Phone: Insurance:
POBOX393
NORTHAMPTONMA01061 ISSUED ON:9/512018 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 3/4 BATH IN EXISTING LOFT, ADD 3/4 BATH
BETWEEN SUNROOM AND HOUSE, ADD SPIRAL STAIRCASE FOR 2ND FLOOR APMT, ADD
CARPORT
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: 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 Paid: Amount:
Building 91512018 0,00,00 $100.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck -Building Commissioner
File# BP-2019-0030
APPLICANT/CONT ACT PERSON HARRI
ADDRESS/PHONE PO BOX 393 NOR
PROPERTY LOCATION 64 NORTH ST
MAP 240 PARCEL 089 001 ZONE URC
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
GTON MICHAEL L
IAMPTON
TypeofConstruction: ADD 3/4 BATH IN EXISTING LOFT, ADD 3/4 BATH BETWEEN SUNROOM AND
HOUSE, ADD SPIRAL STAIRCASE FOR 2ND FLOOR APMT, ADD CARPORT
New Construction
Non Structural interior renovations
Addition to Existin
Accesso Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFJ)RMA TION PRESENTED: _V_ JApproved __ Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§----------
Intermediate Project., ____ Site Plari_ AND/OR ____ Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:§ _________ _
Finding~-----Special Permit _______ _ Variance* ___ _
~-~_Received & Recorded at Registry of Deeds Proof Enclosed. ____ _
___ Other Permits Required:
___ Curb Cut from DPW ____ Water Availability ____ Sewer Availability
___ Septic Approval Board of Health ____ Well Water Potability Board ofHealth
___ Permit from Conservation Commission ___ Permit from CB Architecture Committee
___ Permit from Elm Street Commission
___ Demolition Delay
Signature of Building Official
____ Permit DPW Storm Water Management
Date
Note: Issuance of a Zoning permit does not relieve a applicant'~ 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 who meet the strict standards ofMGL 40A. Contact Office of
Planning & Development for more information.
Versionl.7 Commercial Buildin
JUL -2 2018
City of Northampton
Buil ing Department
2 2 Main Street
Room 100
DEPT oi= ou11n1Nr.1NSPEcT1 rth mpton, MA 01060
. NOPTHAW'TO blne 13-58 -1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ! 'f?-{'1-?0
1.1 Prol,'.!e~ Address: This section to be completed by office
- --------I{ RM__. ..... Lot Unit ~o'i-.t°r/i[;d~ /1,\A-rJ/O{RO Zone Overlay District
----------------. ---.. --------Elm SL District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ----Jv., ---fA llJ :-!__PtlcJif iJG -iJ 1,l)f-?,.'[3 --
Nam, (Poot)JC:A 1/ '-____ J:0-__ -Current Mailing Address:
!J.Pli=[!fll~fJWfr_ tj/-f {)/()6/
Signatur· L.HJ r f./ ~ / Telephoce lf/_ 0 (0 -~
2.2 ll ul~'"'riZ~d Anent: I
/'f,Yi~ ....... --- -fj1nf-' ••ss• • •
Name (Print) Cui:r_ent Maili g ~-dress·
-
Signature Telephone
SE£TION 3 -§~TIMATE!;! CON~TRYCTIQN CQST§ I
Item Estimated Cost {Dollars) to be Official Use Only
comoleted bv oermit aodicant
1. Building 11i---------------
--~.~ (a) Building Permit Fee
I! 1 -----~-2. Electrical "?cl:'.) . q;) (b) Estimated Total Cost of . I)~ Construction from 15, . " ...
3. Plumbing -:J,.00(). ere> Building Permit Fee
'-il1o0 4. Mechanical {HVAC) _j_ {)CJ() • orj 5. Fire Protection -
6. Total-(1+2+3+4+5) Check Number JC,,.,, .
This Section For Official Use Onlv
Building Permit Number Date
Issued
Signature:
Building Commissionerttnspector of Buildings Date
.
Versionl.7 Commercial Building Pennit May 15, 2000
SECTION+ CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 ' CUBIC FEET OF ENCLOSED SPACE I '
Interior Alterations ~xisting Wall Signs D Demolition D Repairs D Additions O ~ccessory B~ilding D ' .,
Exterior Alteration Existing Ground Sign D New Signs D RoofingO Change of Use'D Other 0
:':~:::::::,., ,fr~fefd:;;;;;he:~~; :;,l-l-~;~u;:::t:: \ . ........ .... .. .. .. ......... .. ········· .. 'i ..... . .. . ~
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE I \_, ,,,
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 D A-2 D A-3 D 1A D D A4 D A-5 D 1B D
B Business D 2A D
E Educational D 2B I D
F Factory D F-1 D F-2 D 2C D
H Hinh Hazard D 3A D
I Institutional D 1-1 D 1-2 D 1-3 D 38 D
M Mercantile D -/ 4 D
R Residential "' R-1 D R-2 I?! R-3 D SA ~ S Storage D S-1 D S-2 D SB
-- -. -. ---U Utility D Specify:
M Mixed Use D Specify·.
... .................• . .................• . . ·-·· .. -..
"" . S Special Use D Specify:
. . ---
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA I
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 " ·(J:Clo-L. .. 1" r;;:.'l!v
2" . 'C() ~ ··-
2'' -it> . {?L. ..
3" '(JcJtJO 3" ··rw .. 20 ····-····
•• ·~ •• ···-~r;--··
Total Area (sf) :}@ Tota! Proposed N~=l~@tio~_Lsf}
Total Height (ft) ,;}-5 23 Total Height ft .
7. Water Supply (M.G.L c. 40, § 54) 7.1 Fh;!,o~ Z:~me Information: 7.3 Sewage Disposal System:
Public O Private D Zone Outside Flood ZoneQ Municipal D On site disposal system D
Versionl 7 Commercial Building Permit May 15 2000 ' & NOR _ .ON ZONING I
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
=-rtt/0········ ----· ------' ----·-
Lot Size -----.
.... . ---. ---' --------~IJ,r Fronta~e ---•---· . ---... . --__ ,__ --~ .
Setbacks Front .tV . . .
L~f. Side ff JJT L._. _._ R._. _ .. ·-··
JJ{ Rear
... Building Height p(J.
Bldg. Square Footage /'Jlf7 l?-3 % .. ....
.. ..
Open Space Footage #.51. ?[1 %
(Lot area mums bldg & paved
nark.in!>\ ...... J;_· # of Parkin12 Snaces .. -· .. .. .a
Fill:
rvolume & Location) ..
A. Has a Special Permit/Var1ance/Fin~ver been issued for/on the site?
NO O OONT KNOW It'.) YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
No O DONT KNow._O YES_ 0
IF YES: enter Book Page-
B. Does the site contain a brook, body of water or wetlands?
and/or Document#
NO er'ooNT KNOW O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
C. Do any signs exist on the property? YES
IF YES, describe size, type and location:
0
0 , Date Issued:
NO
D. Are there any proposed changes to or additions of signs intended for the property? YES Q
IF YES, describe size, type and location:
YES 0
NO~
E Will the construction activity disturb {clearing, grading, e~ca~or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO CEJ'
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
..
Version!.? Commercial Building Permit May 15, 2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES • FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Re,.,istered Architect:
--------.. ------. ~?t Aep(i~ble D
----------------------------------··-------Name (Registrant): •. _ -" ---.. .. -----
Registration_ Numb~r ----------------------. -------. .. ..
Address ... ---------... ------------. Expiration Date
.. -
Signature Telephone
9.2 Registered Professional Englneer(s):
..... -----------------
Name Area of Responsibility
--.. .....
Address Re~~~;ration_ Number
.. ----. ---------
Signature Telephone Expiration Date ----------
---.. . .. .. . ------------. Name ----------Area of Responsibility
----.. ... ----. . . ----.. ---------Address ~§!_gistra_t_i()_~ Num!)_~r
---..
Signature Telephone Expiration Date . . ..
Name Area of Responsibility
Address Registration Number
-------.. ... . .. -Signature Telephone Expiration Date ....... ------. ----------. --------. ------------.. -"' ......
..... . .... ----------------------Name Area of Responsibility -
. ----------... ---------Address Registration Number -
' Signature Telephone Expiration Date
9.3 General Contractor
... Not Applicable D
Compar_iy Name:
... .. ...
R-~-s~onsible In Charge of Construction
------.. ------.. .. .. . ...
Address
----------..
Signature Telephone
,
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11) I
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
''' -· ----------,,, -, -
I, -~ I --------. -. ---' .. ---... if,~" -------. , as Owner of the subject property
---------·--------- -·---.. -
hereby authorize ' ------. ---to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
-------------
I, a·~·-~==-~==~=~=======~=======--~-~-=---' 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.
Date
SECTION 12 • CONSTRUCTION SERVICES
Not Applicable 0
License Number
Telephone
Expiration Date
"}.017 :rl~f,q
OMPENSATION 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 resutt
in the denial of the issuance of the building pem,it.
Signed Affidavit Attached Yes O No 0
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work:
The debris will be transported by: (Vl!C1-t1l{l-L.-. \~rtJ~ToJ
The debris will be received by: __ IJ,._(-!-""[,,""Le""--'y_'_(-2£'--"';c/,'----''r..:::e-_L(_,__,l.t_~ __
Building permit number: -------------
Name of Permit Applica
Date re of Permit Applicant
...
"
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses.
TO BE FILED \\'lTH THE PERMTITING AUTHORITY,
Applicant Information Please Print Legibly
Business/Organization Name:. __________________________ _
Address.:_--------------------------------
City/State/Zip· Phone#·
Are you an employer? Check the appropriate box: Business Type (required):
I.~ a employe, with employees (full and/ 5. D Retail
part-time).* 6. 0RestauranUBar/Eating Establishment
2. I am a sole proprietor or partnership and have no 7. D Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity.
8. D Non-profit [No workers' comp. insurance required]
3 r::l We are a corporation and it~ officers have exercised 9. D Entertainment
their right of exemption per c. 152, § 1 ( 4), and we have 10.D Manufacturing
4.0 no employees. [No workers' comp. insurance required]*' 11.0HealthCare We are a non-profit organization, staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.0 Other
• Any applicant that checks box # I must also fill out the section below showing their workers' compensatrnn policy mformauon.
**!fthe corporate officers have exempted themselves, hut the CO'l'oration has other employees, a workers' compensation po hey is required and such an
wganizauon should check box #1.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information.
Insurance Company Name:._-----------------------------------
Insurer's Address: ·------------------------------------
City/State/Zip:-------------------------------------
Policy # or Self-ins. Lie.# Expiration Date.,_----------
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 fonn of a STOP WORK ORDER and a fine
of up to $250.00 a day ·. st the violato . Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the i r insurance verage verification.
Si ature:
nalties of perjury that the information provided abol'e is true and co"ect
Date: ~~ -<o'
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. Cityffown Clerk 4. Licensing Board 5. Selectmen's Office
6. Other ____________ _
Contact Person: Phone#:
www.mass.gov/dia
Information and Instructions
Massachusetts Genera[ Laws chapter 152 requires a!! employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as " ... every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee ofan individual, partnership, association or other legal entity, employing employees. However, the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who bas not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements ofthis chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply your insurance company's name, address and phone number along with a certificate of insurance.
Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members
or partners, are not required to carry workers' compensation insurance. Ifan LLC or LLP does have employees, a policy
is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of
insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town
that the application for the pennit or license is being requested, not the Department of Industrial Accidents. Should you
have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the
Department at the number listed below. Self-insured companies should enter their self-insurance license number on the
appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that
must submit multiple pennit/license applications in any given year, need only submit one affidavit indicating current
policy infonnation (if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town
may be provided to the applicant as proofthat a valid affidavit is on file for future pennits or licenses. A new affidavit
must be filled out each year. Where a home owner or citizen is obtaining a license or pennit not related to any business
or commercial venture {i.e. a dog license or pennit to burn leaves etc.) said person is NOT required to complete this
affidavit.
The Department's address, telephone and fax number:
Form Revised02-23-!5
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA02114-2017
Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass.gov/dia
'
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' !..---
\
NORTH STREET
PLAN OF LAND IN
I
\ I
' ' ' ' \
ORTHAMPTON, MASSACHUSETIS
PREPARED FOR
MICHAEL HARRINGTON