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16B-001 (52)
5 MARK WARNER DR BP-2017-0880 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16B-001 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-2017-0880 Project a JS-2017-001495 Est.Cost: $23400.00 Fee:$152.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sa.ft.): Owner: MASSY WILLIAM Zoning: SR/URA/WSP Applicant: ROBERT WALKER AT: 5 MARK WARNER DR Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Liability NORTHAMPTONMA01060 ISSUED ON:1/23/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:MOVE LAUNDRY, FRAME OFFICE ROOM, ALTER MASTER CLOSET 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 ft 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 Occu a anc si•nature: FeeType: Date Paid: Amount: Building 1/23/2017 0:00:00 $152.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-. Building Commissioner File#BP-2017-0880 APPLICANT/CONTACT PERSON ROBERT WALKER ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 5 MARK WARNER DR MAP 16B PARCEL 001 001 ZONE SR/URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT '\ �� Fee Paid W\ Building Permit Filled out Fee Paid Typeof Construction: MOVE LA DRY •ME OFFICE ROOM,ALTER MASTER CLOSET New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/StatementorLicense 034783 d im- 1 (O? / 3 sets of Plans!Plot Plan G ti'g7 f` THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: ',proved 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 , �✓/ 1( /-a3-/y Si_ 1,111.5f Buil.' g bfficial 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 V212 Main Street Sewer/Septic Availability Room 100 Water/Well Avaliabeity 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 Properly Address: This section to be completed by office 20 (3(24o6t ST. t' 5 Map Lot Unit tUttCt4-'C-&. \ Zone Overlay District O tioCc Z- Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT a.1 Owner of Record: tuit .,.,k. r-vt? cUZat-x-'E AAA-51 Zo 50-Ioe* St ,9i c-C°11tat Name(Print) Current Mailing Address: 44.21 - TolL _ 7-41 2-S Telephone Signature 2.2 Authorised Anent: I Lo 9a -t --r \J-' tz 36 Stc-c.A L Cgs- - n cYLfl4,r-t4,(xr ) Name(P nt) Current Mailing Address: ZZ't 41r/1474i f t /W5 M2) S84 tLz4 Signature Telephone RECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use On& completed by pernSt applicant 1. Building I (a)Building Permit Fee r D'� 2. Electrical 3, t UV (b)Estimated Total Cost of I Construction from(6) 3. Plumbing ,I'UJ. Building Permit Fee 4. Mechanical(FIVAC) 5.Fire Protection S. Total=(1 +2+3+4+5) 2.-2?) 4-03. Check Number /307 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Frosting Proposed Required by Zoning This column to be filled y Building Departm �tiy Lot Size Frontage N Setbacks Front �kV Side L: R: v>,.� Reay Pe‘i Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg es paced Parking) #of Parking S ces Fi . Plume Br Location) A. Has a Sp al Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NODONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO gp 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex vatbn.or filling)over 1 acre or is it part of a common plan that vvill disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all angiicablel New House n Addition ❑ Replacement Windows Alteration(s) Roofmg 0 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding(0I Other[al Brief Description of Proposed Work: M5'0 i-1a-Vt.,-ow1y Gt wa of-=ICXt 2tx-t� 1 Ki1. -nrA-- ais ' 2� CLOSET-- i/ Alteration of existing bedroom Yes No Adding new bedroom Yes N✓ o Attached Narrative Renovating unfinished basement Yes No Plans Attached Ro - es Ba. 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 construction. qvv L Dimensi••- W e. Number of stories? , 0N f. Method of heating? C"a4 ' ;places of dstoves Number of each g. Energy Conservation Compliance. Energy Compliance form attached? h. Type of construction �'Y� i. Is construction within 100 ft. o , ands? Yes No. Is construction within 100 yr. floodplain Yes�No j. Depth of basement • -liar floor below finished grade k. Wilt buil..., conform to the Building and Zoning regulations? Yes No . I. c-ptic Tank City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLt I tD WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject Property hereby authorize F-o454-era- t^-00/1....a,0 to act on myalf.in all �'a-livvettoowork authorized by this building permit application. Signature ofrnOwner Date L fit 5¢r-4a— '-V,„,. it 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. 'Win,K frier W -v-r-et_ Print Name Signature of(Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed ConstructjOn Stumm/MT Not Applicable 0 Name of LICRnse Holder: 'Vire it-ttti S ' €c.41- CS ...... OS 4 7 `t' 3 License Number ..• _oat . (ri ^V- (�-.G'W'4(� - Iii k) / 1e( 7-C1I ...... Address Expiration Date 'it Signature Telephone 9.Reaflmd Nome lmororremem Contractor: Not Applicable 0 . 4.' '1-AL-47K Z) 1 E pompano Name Registration Number e--x2Lnuu) s t A ! art S) Address Expiration Date Telephone 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 0 No ( o"" AP`10 11, - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occuoied Develhaps of one(I) 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 v supervisor.CMR 780. Sixth Edition Section 1084,5.1, 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 Iwo-vear 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 lid' ;.1 ch woe, nos erthe b_:n'i• srmi . As acting Construction Supervisor your presence on the job site will be required foam 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,von 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 City of Northampton 212 Main Street, Northampton, MA I Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge th. a condition of the building permit all debris resulting from the constru+ activity governed by this Building Permit shall be disposed of in a prof licensed solid waste disposal facility, as defined by MGL c 111, S 150 Address of the work: g 4- t-^-"^^ndL & The debris will be transported by: C' "a-"a'2 The debris will be received by: V L R 60"jcut vca Building permit number: Name ofnPermit Applicant 17-6 Date S-1'31 I lir Signature of Permit Applicant Departai ent oflndustrla1Accidents -4 - Office of Invesfigations ".-t c 1 Congress Street,Suite 100 Boston,MA 02114-2017 www ntassgov/dia Workers' Compensation InslranceAffidavit: Builders(Contractors'ElectridansiPlumbers Aoolicant Information Please Print Legibly Name (Business/organization/Individual): ' : • " _.. .0 S .t_ . it . 'C Address: 3 C PctVV4 ( 6j—t`Ca- i Ci /State/Zi o" tY P fCM A✓PTDr , hone #: LI-42, CS a 1 l Z Are y an employer? Check the appropriate box: Type of project(required): 1. 1 am a employ¢ with (� 4. ❑ I am a general contractor and F 6. ❑New construction employees(full and/or pan-time)." have hired the sub-contractors listed on the attached sheet 7. 0 Remodeling 2.© 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have K. 0 Deotion working for me in any capacity. eV oyeas aid have workers' 9. ll— ml addition [No workers' comp.Instance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees [No workers' 13.❑ Other comp. insurance required.] •Any applies*that ctaksbox et must Sw fi It out theaseaon MON ageing thar serials'mmpert0impolicy'Mauritian, t Homewners who submit this affidavit indicating they arc doing an work and then hire outside contractors must submit a new affidavit indicting such. =Contractors that check this box must auachcA an additional sheet showing the name of the sub•contncaors and stats whether or not those auities have employees. If the sub-caartorshareempo/®a t mutt pro idetheir wakes'eat.polio/numbs. I am an employer that isproWcing workerd oampansation i net:ranee tor my employees Belavisthe policyand job site information. Insurance Company Name: .,41/4 OW Irlai Policy# or Self-ins.Lic. #: /71 Z 260 `E'6 V,yO /Zs' Expiration Date: 17/1/4 O/7 Job Site Address: City/State/Zip: Attach a copy of the workers' ccmpetadionpolicy declaration page(Slowing the policy number and spiratiai 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 terrify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: phoneT #• fficiul use only. Do not write in this area,to be completed by city or town official. �O City or Town: Permit/License# . Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone#: