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23D-124 (15) 176 FEDERAL ST BP-2017-0137 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 124 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit 4 BP-2017-0137 Project# JS-2017-000221 Est. Cost: $6800.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Cta(s:, Contractor: License: Use Group: JAMES O'SULLIVAN 66335 Lot Size(sq,ft): 20952.36 Owner: TRINIDADE BRUNO fl1001/ Applicant: JAMES O'SULLIVAN AT: 176 FEDERAL ST Applicant Address: Phone: Insurance: 264 BUCK POND RD (413) 532-1312 WESTFIELDMA01065 ISSUED ON:811/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ENCLOSE PORCH TO MUDROOM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector f 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: FceTvpe: Date Paid: Amount: Building 8/1/20160:0400 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0137 APPLICANT/CONTACT PERSON JAMES O'SULLIVAN ADDRESS/PHONE 264 BUCK POND RD WESTFIELD01085(413)532-1312 PROPERTY LOCATION 176 FEDERAL ST MAP 23D PARCEL 124 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT „y� Fee Paid / V #41 Building Permit Filled out Fee Paid Typeof Construction: ENCLOSE PORCH TO MUDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 66335 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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 Demolition Delay / tVi Signa re . :uil n 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. RECEIVED Deparbnent use only • City of Northampton Status of Permit: A - 12016 Building Department Curb CullDmlewey Permit 212 Main Street Sewer/Septic Availability .OF BUILDING INSPECTORS Room 100 Water/Well Availability NORTHAMPTON.MA O.00 Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-5B7-1272 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 -4 S m Map Lot Una (S NC t lM rA Zone Overlay District T Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Al A-CrEe euub vht' nix -t-EZ>LR-dpi- Sr Name(Print) Current Mailing Address: sNle LG�tL- lol� SLS Telephone l�7z_V Signature 2.2 Authorized Agent: W1N 24 V3nR01\,� 4 wLc5T Name(Print Current Mailing Address: (�10s� `_\\J 413— S32-I 3)2— Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building L/Q c 0 CO (a)Building Permit Fee 2. Electrical s^ o,CO (b)Estimated Total Cost of o Construction fmm(6) I Plumbing Building Permit Fee 4 Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) ( qU( OOCS Check Number "*, This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissionerflnspectar of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information t Existing Proposed Required by Zoning This column to be filled in by Building Department t 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) R of Parking Spaces Fill: polume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO NT KNO YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands?(NO5 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES C IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradin• excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check an aputicabie) New House Addition Replacement Windows AlteratIonfa) Roofing Or Doors Accessory Bldg. Demolition New Signs [ ] Decks [ ] S{dlng[� Other[ [ Brief Description of Proposed 71 a Cor SNS+ciffi._. Work. 4iUl L7? MCD C'Cr`idA ON FA (Sri Ai fo€4,6, '1.7411/41I5+ 7r nitro it, 5 irvj Alteration of existing bedroom Yes ?C No Adding new bedroom Yes v`No Attached Narrative Renovating unfinished basement , Yes )( ,No Plans Attached Roll -Sheet at it New house end or addition to existing housing.Oomolete the following: a. Use of building-:One Family 1111'— Two Family Other b. Number of rooms in each family unit: 7 Number of Bathrooms —2-- c c. Is there a garage attached? Nb 5.r 7 C Coi d. Proposed Square footage of new construction. Ho- Dimensions e. Number of stories? r �� f. Method of heating? `Gly/- Y�?inlF1(sI H Fireplaces or Woodstoves Lab Number of each g. Energy Conservation Compliance. Maascheck Energy Compliance form attached? h. Type of construction WmTD i. Is construction within 100 ft.of wetlands? Yes PC.,No. Is construction within 109 yr, floodplain Yes OC,No I. Depth of basement or cellar'loot bebw finished grade v— k. Will building conform to the Building and Zoning regulations? QC Yes No. I. Septic Tank City Sewer 1-- Private well City water Supply ."-- SECTION SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t A/i ti 1},- f--Cre ,as Owner of the subject property ]67%)‘56/0 A /� ,..,� hereby authorize J°ITT7)q /0 { \ S/O-UC-f (C�e"') to act on my behalf, I a matters rotative to work authorized by this building permit application. rLMA. �-- &'—(-14 Signature of Owner Date 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 the pains and penalties of perjury. > S aSet NAN Print Na Cq v ( /� 4 ay\F\Orme 1 Y Signature r/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructionn Supervisor: Not Applicable ❑ tame of license Holder' C1 Pt'ME—S OSUIIt VJ1✓J 'VC2 33 S License Nu .2-Ce4 �ilc K�.r e.11 CLIA Z1 )7 Atltli�a �Sr�t�.ti� Vv,A- (31o)S5 Eiwiraeen Date 4-N3 -S3z- 1.3t Signature Telephone R Rsaistered Home Improvement Contractor: Not Applicable ❑ NV) K1)Is� N 6 �sce (Oev 1456 'fO Company Name Registration Number 7 La 4 3 Y-')Ots'i Z—/(o Address Expiration Date W cST('cl_� M Y - C 16(f'S Telephone 4 13 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.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 yv� No ❑ 11. – Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow 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 1083.5.1. 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 fans 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. 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 ycu 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 Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts tt�� :m== Department of Industrial Accidents ly=L_j1= L Office of Investigations _ el— 1 Congress Street,Suite 100 —_"� • '- Boston, MA 02114-2017 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiodlndividual): ONf:1)1 CCv1 CCN CSTP 1107OIK) _ Address: 2LR (f -(43CIL R bed h R- City/State/Zip: W ES,TcleF\> 6M0- Phone#: 'S32- r-\3 12— Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P t3'' 9. ❑Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 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 1g❑Roof repairs insurance required.] ' c.152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *My 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 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. lie. #: 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 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 cce fy and the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 6 " —I 0 Phone#: et)3-5-i1-431z 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#: 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 150k Address of the work: VVI •;?—A-t— S\ c(A25NCE_ Y \ The debris will be transported by: t Y y-i---)(s3N CON STR_oc'i o� The debris will be received by: \34*L--\J R&cs1LL r' Building permit number: 11 1 Name of Permit Applicant OrnES Ati f( ia � Date Signature of Permit Applicant I AffoJ y'4ot &hart_ Astu.J Jiunaw I 7'X L,' ', d 'y yr ,-;-: M1>'_ J�J � „, cic .1. 1 TELA li erit_ Ntv- Z74Lc v.✓,L - 'i'l I -'77Z7-77),.._- �X Z 21 of ____.._.,-'- AJ2L.i ire. .., .:,r. 7--X1`.;7Aar ✓ i;-- 12 X -2_X ld P7r: '[A;t ,ti c. I I /2/61 (-1„77/1( 4 �I � r U Eia fr City of Northampton Building Department Plan Review 212 Main Street Northampton, MA 01060 fe,massDOT Sign Up for E-ZPass MA Thank youl You have successfully submitted your application) Your Account Number is 2145898. Please print this page for future reference and also record your 4 digit PIN. Your transponder(s)and information packet will be mailed to you in 7 business days. The following charge will be made' Your credit card number ending in 6499 will be charged$20.00. If you have any questions regarding your application please contact the Customer Service Center 1-877-627-7745. Program Information