17A-154 (5) 66 FOX FARMS RD BP-2017-0126
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: I 7- 154 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit# BP-2017-0126
Project# JS-2017-000210
Est. Cost: $6500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KUEL MCQUAID 051394
Lot Size(sq. ft.): 19994.04 Owner: MCSHERRY MICHAEL&FRANCES
Zoning: URA(IOOY Applicant: KUEL MCQUAID
AT: 66 FOX FARMS RD
Applicant Address: Phone: Insurance:
131 FERRY ST (413) 537-5063 0
EASTHAMPTONMA01027 ISSUED ON:8/4/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:EXTEND DECK & REPAIR
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: OI: 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 8/4/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-0126
. 0/J1/5 P_
APPLICANT/CONTACT PERSON KUEL MCQUAID (
ADDRESS/PHONE 131 FERRY ST EASTHAMPTON01027(413)537-5063 0
e
PROPERTY LOCATION 66 FOX FARMS RD
MAP 17A PARCEL 154 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT _,y/
Fee Paid o 3O $�FJJ
Buildin Permit Filled out
Fee Paid
Tyoeof Construction: EXTEND DECK&REPAIR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051394
3 sets of Plans/Plot Plan ATLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INATION 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
Si W.':ui .mgifficial 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
Lii 2 8 2016
Department dee onbi
r Mort i3 Dr 'n Stet. of Permit
QVIIcer - D a mel'( Our50u Driveway P-e mit
OF BUILDING N6XQpW 212 Main Street Save poc Avaea6ni9
• MOR 10N'�010°0 Room 100Aater rr
n ^ elFvall o ty _
Northampton, MA 01052 Tno!S_ts o Ctruceu al Pions
phone 413-587-1240 Fax 4 3587-1872 IPlocSit Pars
1 Other Specify -
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOL4sH A ONE OR TWO FAMILY DWELLING
SECTION 9 -SITE INFORMATION
-
`( 1.1 Property Address This section to be completed by office
64) 'Cry �A ��� —r 117ap Lot Unit
FtoenJee. y�/ "
f a ' • 0 106 ` Zone -Ove-rlayDis rice
2
Em St Dstrct - - Ce Osfrct -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
4.- 2,1 Owner of Record: Pic
< ,,
91`
PG/cbwLe �/Y�f..)/..eA /'/�I�'cS� l2o� ,i ) �vc I��dz.V-4 /K� n✓zeivt.Q
Name(Pent) Curren!Meiling Adar..ss.
/ „ani:I•�/>%'Ai' If Teleohcne
sisn,wre • • y13-531 i771
2.2 Authorized Aaenl:
I t,&l mc at/u', ) 13 Ier- ��"/ SA L Mid
Name(Peet) Cur Ent Mailing,Scorers:/ QfOZ�`j
P L
140( A 413 K37 So 6 3
Sioncillre -Eisohone
SECTION 3-ESTIMATED CONSTRUCTION COSTS 1
Item Estimated Ccst(Doltars)to be J Official Use Only
ccmyoleted by permit eopiicant I. I
1. Bui!tllnc
1 G S (a)Building Permit Fee
O6
2 Electrical (b)Estimated Total Cost of •9
Construction from(6)
3�
3 Plumbing Building Permit Fee t5
4 Mechanical (HVAC) /C[/ j� .
e
5. TFiot ttflProtection- `Alfia'
6. Tatel= (1 +2+3+4+5) � �,Check Number
This Section For Official Use Only
Date
Buiidina Permit Number: i Issued:
Signature'. F
rd
9uildingConmis�eonsrrinspectorof3uildings Date I
•
Erdal ) • /1✓e( Mc- Qua;a( P) circa c-\-es- Ne--+-
1
Section 4. ZONING I AIL Infer-dation Dust Se Completed bebnit an be Denied Due du lucampleteinforbabon
Exdsbng Proposed Required b} udni t J
Buildingir to berrt
Lot Size .____ ....
Frontage ._ _—.
Setbacks -I-
T-- _..-
Front
Side _ ____
_— r__. —
Rear
Building Height _
Bldg Square Footage % I _ __
Open Space Footage 1 ______
F= em
.Suis flag& r _ __.
ner4 )
4ofParkind5caces e - - I --
Rah
(voume&Lowson`
A. Has a Special Permit/Varance/Findin ever been issued for/on the site?
NO 0 DONT KNOWrb
YES
ED
IF YES, date issued:.
IF YES: Was the permit recorded az the Rei -My of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Paget and/or Document u
B. Does the site contain a brook, body of water or wetlands? NOq(1111 DONT KNOW 0 YES 0
!F YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tube obtained Obtained Cate Is Sed J m
C. Do any signs exist on the property? YES : NO W _
IF YES, describe size, type and Location: !
D. Are there any proposed changes to or addltions of igns intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. WJI the construction activity d_turb tdearIng, grading, e ovation, or Eling)over 1 acre or is it pad of a common plan
that will disturb°vet 1 acreb YES 0 NO
IF YES,then a NoChampton Storm Water Management Permit from the DPW is req uired.
x
tt
SECTION 5-DDSCR,IFTION Or PROPOSED WORK tcnxk all applicable)
I
Poen.,blouse 7 Addition ❑ Replacement Windows Alteration/' ❑ 1 R.co,'ing
Or Doors El I
Accessory Bldg. Ti Demolition ❑ New Signs [71 Decks [ Siding ID] Other[D] I
Brief Description okkoposed
Work 2LK 2eec..:f }' 0.06I 4-:0 v.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa ff Haw house and or addl±ion to ezis [no hotisd7s corerpfet=the fohowirra:
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 Wocdstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
n. 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
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this budding permit application.
Signature of Owner /,r Date
Priest 44.( ' '&ea� . . . Y. as Owner/Authorized
Agent hereby declare that the statements and information on the foregotno application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
kuzl Ac Duo
Print Name
,%,/ �lG_ Q 7/zs ,
Signature a, Owner/Agent Date
SECTION 6.CONS-RUCTIOIC S_RACES
8.i Licensed Censerur ion Su(peen�risor: /Y� Not Applicable E
Name of License Holder /W Q-( A{��S L O VGItce C S - C S I J� l
/,� ��JJ,�� ps/n� nn� 17Dense_ NNumb e
Add 4S ccw.Co'�ov\ 6(02_ t 7 c ,bnDa / 2v1
t (n
9/3 -5317- So4E
Signature Telephone
9. Registered Nome Improvement Contractor:A Not Applicabie £
K.)e.e htc au o i K 106700
Company Name Registration Number
13 ( tests-1—kruA.piesv._ MA- 7/24/ 20 IR
Address Expir non Dtte
Telapno Ee3 g37- SOHO?
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)l
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 _
ii. - 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 108.35.1.
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,cuing 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 Building Code, City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
''-, The COM mwlH'✓ .e r' V✓t age 1'usattz
= _..' mc✓r 'i O hind 5grial Acclaims&
of r w s g ..fwrrs
v
Fes- „et
600 CS'esrt.mg was 5�r2Wt
'r o- 3ffi 'c=^9 MA 02111
66`r' wwa'mtarassegav/wde
VI?skims' Compensation insuranceR 3az> 1 darer ant.ac,,s,t Z'C_eri germs/i i eirthere
r_nDlican: Troiernr�i,aLen Hesse Print L,e iaLb
Name (Business/Organizarior✓mdividual): Y1V2�� M L 4 Vet
Address: r3 .(//''
City/State/Zip: c&911v&U{ 4a& clow
A Phone k: 413— $ 37- S6)63
Are you an employer? Check the approsriate her:
Type of project(required):
am ageneral contractor and I
1.n I am a employer with 4. ❑ I 6. ❑ New construction
employees (full and/or part-tune).' have hired the sub-contractors
2. am a sole proprietor orpartner-
listed on the attached sheet, 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance
surance.t 9. (i Building addition
comp.
required.] 5. We are a corporation and its 10.❑Electrical repairs or additions
3.n I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself [No workers' comm right of exemption per MGL
t C. 152, §1(4 ), and wehave no 12.0 Roof repairs
insurance required.] 13.n Other
employees. [No workers'
comp. insurance required.]
"Any applicant that checks box it must also fill out the section below showing their workers'compensation policy information.
I Ho meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-conractors and stare 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 policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. f: 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 DLA for insurance coverage verification.
I do hereby certify under ire pains and penalties ofperjuly that the information provided above is true and correct
Signature: C / GI:Lde/ Date: 7/Zg
Phoned: 4637
i3E - So63
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 ,:
V ru off rT® 7S sur 3?, -----•,
C\ T z
.`.:- z s. n Street 0 Municipal Bpildiflg
.c. n, MA 01060 tee:"�
NS ECO
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOIVE OWNER E n03TION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends to be, a one or two family dtvelferg, 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 home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footinas (before backfill). sonotube holes (before pour), a rouch buildinc inspection
(before work is concealed). insulation inspection (if reouired) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing &gas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
Cite of Northampton 212 Main Street, Northa`pton_, MA 01063
Sold 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 fac iity, as defined by MGL c111, S 150A
Address of the work: 647 fox fasv'S (1tcev,4._ AlA
The deoris will be transported by: hue-( Mc QvaOC
he debris will be received by: jo u se-0-0 g_e ..( A.
Building permit number: �f
Name of Permit Applicant G<v2.A /Uid Qva �C
7/2q , 12
Date Signature of Permit Applicant
l�p�OU
as � wry ?r/6'
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City of Northampton - \!' f-.
Building Department
Plan Review r.,r
212 Main Street r
Northampton, MA 01060 ! ,
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