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24D-220
19 PERKINS AVE BP-2017-0039 GIS 9: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-220 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:REPAIR BUILDING PERMIT Permit BP-2017-0039 Project JS-2017-000063 Est. Cost: S 16000.00 Fee: SI12.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JEREMY DILLENSNEIDER 094249 Lot Size(sq. ft.): 6359.76 Owner: FITZGERALD REALTY CORPORATION Zonine: URC(100)9 Applicant: JEREMY DILLENSNEIDER AT: 19 PERKINS AVE Applicant Address: Phone: Insurance: MILLERS FALLS RD (413) 774-0863 WC TURNERS FALLSMA01376 ISSUED ON:7/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACING STAIR PANS ON EXTERIOR REAR PORCH 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: FeeTvpe: Date Paid: Amount: Building 7/21/2016 0:00:00 $112.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0039 APPLICANT/CONTACT PERSON JEREMY DILLENSNEIDER ADDRESS/PHONE MILLERS FALLS RD TURNERS FALLS (413)774-0863 Pa-a3 PROPERTY LOCATION 19&21 PERKINS AVE MAP 24D PARCEL 220 001 ZONE URC(100)1 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid CJS' •2<- q W /a Building Permit Filled out Fee Paid TvpeofConstruction: REPLACING STAIR PANS ON EXTERIOR REAR PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 094249 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: Approved 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 Pernit 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 Demolition Delay Sign. ure . Build g £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. ��-e.5)1 Version!.7 Commercial Building Permit May 15,2000 !' \% VG �rl� it .f Northampton Status of Permit: Department use only P v 1 : ilding Department Curb Cut/Driveway Permit '-t 212 Main Street Sewer/Septic Availability QSS�`' Room 100 Water/Well Availability o`'ttr Northampton, MA 01060 Two Sets of Structural Plans ot1 ‘'O.hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING iCS OTHER THAN A ONE OR TWO FAMILY DWELLING 1 SECTION 1 -SITE INFORMATION 1.1 Property Address: R f a ( This section to be completed by office I. • 19-23 Perkins Ave of rIC Map Lot Unit hi Northampton MA 01060 i� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Fitzgerald Realty Corp 37 Mary Jane Lane Florence MA 01062 Name(Print) Current Mailing Address. (413) 835-5689 Signature Telephone 2.2 Authorized Agent: Theodore Boyer 22 Buckland Rd Ashfield MA 01330 Name(Print) Current Mailing Address: (413) 835-5689 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building // 710 (a)Building Permit Fee • 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) "7j(j2/v( �p Check Number 25-a This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version 1.7 Commercial Building Permit May 15.2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building El Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other E Brief Description Replacing Stair Pans on Exterior Rear Porch Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 El A-2 IDA-3 El1A 1 ❑ A-4 0 A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B 1 ❑ F Factory 0 F-1 0 F-2 ❑ 2C I ❑ H High Hazard 0 3A 0 I Institutional 0 I-1 0 1-2 0 k3 0 38 0 M Mercantile 0 4 ❑ R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage 0 S-1 ❑ S-2 0 5B 0 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 2e 2c 3,d 3rd 4° 4m. Total Area(sf) Total Proposed New Construction(sf) Total Height(0) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal systemO Version) 7 Commercial Building Permit May 15,2000 R. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be num in by But)ding Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage ,o • Open Space Footage (Lot area minus bldg&paved parkine) ft of Parking Spaces File. Isolume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , 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 O 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • Version l 7 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 Registered Architect: Not Applicable 0 Name(Registrant). Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Deerfield Valley Re-Fab, Inc. Not Applicable ❑ Company Name: Steven Phillips Responsible In Charge of Construction 8 North Street South Deerfield MA 01373 Atldr .(\/�Y/�h (413) 665-7059 Signature Telephone D f7vc% F COrc« • N Veisonl 7 Commercial Building Permit May 15.2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,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 ,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 penury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Nat Applicable 0 Name of License Holtler: Saitem4y Dluas, s aNac CS - u-lg24a1 License Number n L-1.1 Ct nu,SittTuts ett_ renicS ma or-376 711(47 Addn ss t Expiration Date _ (413) r14-oe 03 g .tura Telephone SECTION 13-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 O No O 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: 19- 25 PeekiN," n.ie N/0411rct-+Prtxv MH Oioc0O The debris will be transported by: DEE'LFa t, RE-MS./NC The debris will be received by: oeecflt-t vrtu.ey ft-Frh5, INC. Building permit number: Name of Permit Applicant 5i&VET Pm,y pS Date Signature of Permit Applicant �� The Commonwealth of Massachusetts �3— Department of Industrial Accidents M_, - Office of Investigations l; _ ='`= I Congress Street, Suite 100 Boston, MA 021]4-20]7 ' ^:5 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): maiviauul)f Deerfield Valley Re-Fab, Inc. Address: 8 North Street City/State/Zip:South Deerfield MA 01373 phone #:413-665-7059 Are you an employer? Check the appropriate box: Type of project(required): I.ID I am a employer with 6 4. ❑ I am a general contractor and I— 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition workingfor in anycapacity. employees and have workers' p' 9. ❑ Building addition [No workers' comp. insurance comp. ins'urance.= required.] 5. ❑ We aro a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.111 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 Repair Stair Pans employees. [No workers' 13.© Other P comp. insurance required.] *Any applicant that checks box a I must also till out the section below showing their workers'compensation policy information- `Iiomcowners who submit this affidavit indicating they arc 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 or die sub-contractors and stare whether or not those cudtics 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: Selective Insurance Co Policy 4 or Self-ins. Lie #: WC 7993913 Expiration Date:06/15/2017 Job Site Address: 19-23 Perkins Ave City/State/Zip:Northampton MA 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 cer ' and the pai - p nalties of perjury that the information provided above is true and correct. X Signature: - Date: 07/06/16 Phone 4: 413-665-7059 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#: ELEIO flat'angina. rams' mans rap/ 9 °rc' 9r fj-aa/ hmo2 Q7nfDDaa ae7arfran,Q low-naO r 'hypt fradrDX _*awned sly e4 r°7r°rnrr°° peewee ,rw9 rnra7°n Yb el saran* not swum 'nNDMeNDN/)/ nrry/, •r°lnaepr°° mesh #4 vah ran, •ysoa ear°d°ad pr 90 rru° ayr n earthing DDy°r a79r'fae7rroa n r°7r°rnfro° lawn p° pro' ay; ;op n 7rimWdrn n err nraxraynbaa 7WrnrDry a '4rD9ur °n9 esu '*7 Af,,,y7rra„o ,'Mtny ra4 9.' r°��r""""mos 'Drmw #OWTS, PO n 3 Pp Wing g rn"d�r","r""y�rl"°A/ r7 NV ",rq"t et-61 7r rrrwa7lr)S nndaa ay; Dog r°p°wgno° 7wrro° el 7NDwsnrnpva ay; enrol at rnrr°I9re°,r r nova W0 pry; mirbn a • 9LOZ 'EL kr(/ 999 t099-599-516 6502-599-nE�1.h 52510 'tilt/ Wilma roc" JDDnS row 9 ,