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38D-027 (4) 14 HAMPDEN ST BP-2016-1211 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-027 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ELECTRICAL BUILDING PERMIT Permit# BP-2016-1211 Project# JS-2016-002051 Est. Cost: $25014.00 Fee: $163.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KITCHENS OF DISTINCTION 081778 Lot Size(sq. ft.): 5619.24 Owner: BENT APRIL zoning: URB(100)/ Applicant: KITCHENS OF DISTINCTION AT. 14 HAMPDEN ST Applicant Address: Phone: Insurance: P O BOX 1225 (413) 569-1100 WC SOUTHWICKMA01077 ISSUED ON:4/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN 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: FeeType: Date Paid: Amount: Building 4/21/2016 0:00:00 $163.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1211 APPLICANT/CONTACT PERSON KITCHENS OF DISTINCTION ADDRESS/PHONE P O BOX 1225 SOUTHWICK01077(413)569-1100 PROPERTY LOCATION 14 HAMPDEN ST MAP 38D PARCEL 027 001 ZONE URB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: KITCHEN&DINING ROOM ADD RECEPTACLES AT COUNTERS �G New Construction Akt!:� t Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 081778 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFF03A+ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan 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 of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management olition elay Sig o uil ing O ficial 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 who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: _ Telephone Signature 2.2 Authorized Agent: Ole-�,bjj1SJ1J?G4*h) 4 6qX 1!�e� *y Na Current Mailing Address: eo Signature Telephone SECTION 3-ESTIMATED CONST TION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building O d ' to 3 (a)Building Permit Fee 2. Electrical f Of (b)Estimated Total Cost of a Ub Q Construction from 6 3. Plumbing y . Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2 +3+4 +5) Z j U `�, la 3 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 O DON'T KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES O 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 Q 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) 7 New House [] Addition Replacement Windows Alterations) Roofing Or Doors D N I Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[01 Other[tom] Brief Description of Proposed l+cA m� Work: K �/ Alteration of existing bedroom Yes No Adding new bedroom Yes !\ No Attached Narrative 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 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 c s u do 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 1, _ as Owner of the subject property hereby authorize (( j (J Q to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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. Print N Signature of Owner/Agent Date / SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �F Q �� ���►!� ` ! I W 1 t �C[L!i/ I LicenseCS 0 e9 r/ �,11179 Address Q/03� Expiration Date 9464W 9 �64'SignatureTelephone 5 2—(j // 9. Registered Home Improvement Contractor: / -(k(, Not Applicable ❑ k4thow Companv NameRegistration Number sq � Ca/� � cSd� Address fir Expiration Date = Telephone A113 SM / 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...... ❑ 11. - Home Owner Exemption /U/4 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to 1110w such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 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 reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that 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,during and upon completion of the work for which this permit is issued. / Iso be Avised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to 1,mployees for inj uries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perforin work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homemi ner Signature The Commonwealth of Massachusetts } Department o f Industrial Accidents Office o f Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: A City/State/Zip. O �r Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with -7 4. ❑ I am a general contractor and I employees (fall and/or part-time).* have hired the sub-contractors 6. r_1 New construction 2.❑ 1 am a sole nroprietor or partner- listed on the attached sheet. 7. remodeling shipand have no employees These sub-contractors have g ' ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. 1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] + c. 152, §1(4), and we have no 13.E] Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#I 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 mist attached an additional sheet showing;the name of the sub-contractors and state whether or not those entities have employees. It 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:_�JISJ)9 CWlCO if Policy# or Sell-ins. Lic. #: 67 Y 060 5D -7 //4C Expiration Date: r 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 sccurc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 statemenj may be forwarded to,the Office of Investigations of the DIA for insurance coverage verification. 0�(,It/ I /s/(I Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. �( Signature: _ Date: 1� Phone#: Mz (6�z� LgL— , — Official use onk'v. Dv 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#: 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: 0')e o W �' The debris will be received by: Building permit number: Name of Permit Applicant �j 2 doI (a Z� Date ignature of Permit Applicant Kitchens of Distinction 599 College Highway Southwick, NSA, 01077 Bill TO: Bent Resi� Ship To: Same As Bill-To: Date: 2/17/2016 14 Hampden Street Northampton,Mass,01060 Phone: 413-335-9746 /413-575-2295 Designer: Ryan Ha 530-9172 Cell Office Use DESCRIPTION PRICE Kitchen B-ti hton Cabinetry-AIIPlywood Construction $9,107.00 0,) ac)AuWood.•Maple Paint.•Shade Door Style: Meadowview Raised Panel Semi Overlay DrawerFront. Matching Slab Dining Room Dining Room in Cherry Inset $2,967.00 Finish:Bourbon Door Style:Hr bland Raised Panel-MatcAh2g Slab Drawer Carpentry includes the folio . Take Doom Half mall $3,560.00 Frame and Sheetrock new half wall. Install all new .kitchen cabinets, hardware, toekick, ..fillers Plumbing Estimate includes disconnect and $2,910.00 reconnect of sink, faucet, G.D, Dishwasher, move `✓�� Q67�' Gas line -Install new sinkin Dining Room ro (Cut and Cap Lines -Provide new Shutoffs) Labor Total $6,470.00 Materials Total $12,074.00 �Io'". Sales Tax $754.63 Terms 40%Down-40% On Start oflnstall Total: $19,298.63 Balance on Completion Deposit: 47,700.00 Approval: - RN Balance- $11,598.63 tA-� i'_O_ ,, �� lac c2ak — � s