32A-034 68 CHERRY ST BP-2017-1219
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-034 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: EXTERIOR RENO BUILDING PERMIT
Permit# BP-2017-1219
Project# JS-2017-002053
Est. Cost: $2200.00
Fee: 565.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SARAH STULL 071711
Lot Size(sq. ft.): 4486.68 Owner: ROSENBLATT KENDRA&ALIDA ENGEL
Zoning: URC(100)/ Applicant: SARAH STULL
AT: 68 CHERRY ST
Applicant Address: Phone: Insurance:
P O BOX 48 (413) 634-5013 0
PLAI N F I ELDMA01070 ISSUED ON:S/I/20I7 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT SMALL AWNING OVER FRONT
DOOR
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 5/1/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
ii'
File# BP-2017-1219 ? fl,.._ pjDf j -
APPLICANT/CONTACT PERSON SARAH STULL �N1 I S 06 Z6 Q-
Q ii
ADDRESS/PHONE P O BOX 48 PLAINFIELD (413)634-5013 { (S (to
PROPERTY LOCATION 68 CHERRY ST 1414213VA
MAP 32A PARCEL 034 001 ZONE URC(I00)/ K c
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM AILED OUT
Fee Paid p
Building Permit Filled out 14 Di5/
Fee Paid
Typeof Construction;: CONSTRUCT SMALL AWNING OVER FRONT DOOR
New Construction
Non Structural Interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 071711
3 sets of Plans Plot Plan
THE FLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION 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 PermitVariance*
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 Co 0 I ili Pe s•2 DPW Storm Water Management
Demolition Delay
i{- nP/ '
�f
OF 4tJ2.1/17 _-
SignatureofBuilding official 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 40k Contact Office of
Planning& Development for more information,
City of Northampton
Building Department
I s�etpn 2 6 212 Main Street
MrRoom 100
_ - - Northampton, MA 01060
--` - phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: Thi&stctii nio be completeti?*of tUe
68 (C/her
: r .Lot U+tt
`\ _moi /_ _ -tw• -r }Y Cal(Dis'frlcZ,s�
vu'r`�'��.�'V�9- \ .Di34ii! .CB.Dietrf t..
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
KPv1cka R3Sthj-A&* 6S Eke ct 9- Oa c,n,rdon 1111tc�IDtf
Name(Pdn Current Mailing Addrest 'J ,, I
1{.� Telephone {�
Signe re � - /Cmo,f: I1(!i SG rC �F,N 1Zu'a , 17<4-
2.2 Authorized Agent:
SaELt8� , it,t4 01x20
Name(Prin Current Mailing Address:
Signature Telephone
SECTIONS ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
,(�ompleted by permit applicant
4
1. Building 2.00 0 > 0 J (a)Building Permit Fee
2. Electrical /4 20O z (b)Estimated Total Cost of
COW Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
/ �1 l
6. Total=(1 +2+3+4+5) L// U, �1,--�atw Check Number �71j-3D .
This Section For Official Use Only
Building Permit Number: Date
.Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
,s
Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
l / Existing Proposed Required by Zoning
� This column to be filled in by
�h)� Building Department
Lot Size
Frontage l
Setbacks Front 1 1 I
Side L: R: L: R:
Rear l
Building Height
Bldg.Square Footage — % , [ i
Open Space Footage %
(Lot area minus bldg&paved I
parking)
#of Parking Spaces
Fill: F I
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW josg YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
c
IF YES: enter Book Page ,,��(( and/or Document ft
B. Does the site contain a brook, body of water or wetlands? NO
so DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O ,,tDaatte issued:
C. Do any signs exist on the property? YES O NO Qt.
IF YES, describe size, type and location: �c
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location: '
E. Will the construction activity disturb(clearing, grading,e vation, or filling)over 1 acre or is it part of a common plan
that will 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(checkall applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) g! Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [q Siding[CO Other[CO
Brief Description of Proposed /�
Work: CONMTTZU CT- SMA-Li. AwN Qv-EA, rRAINI( Duo R
Alteration of existing bedroom Yes Jc No Adding new bedroom Yes K N
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll aniti
k ,t :
a. Use of building:One Family Two Family Other
b. Number of roams 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 Woodstoves Number of each
g. Energy Conservation Compliance, Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 ftof 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
I
I, V4'1 tt
.,^cc \�SCh1 hi as Owner of the subject
property
hereby authorize aC'l , CS-h)I
to act on i. b€half,in all matters relati e to work authorized by this building permit application.
A/P y//7
Signa e of Owner . ate
I, Savzcc'h e. Ely •( / .as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best omyf knowledge
and belief.
Signed under the pains and penalties of perjury.
kaL F.
Print Name
—18 - 17
Signature Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: � 11 Not Applicable 0 �r
Name of License Holder: C`� � �� I / II
License Number
HO, O3C)C 'E ' 63 4- ,Matot Xf 'i *I -26 - i8
Addre ( /",OW Expiration Date
L5_ . c4(e)(0341 —szir3
ignature Te hone
Not Applicable 0
S'avzt-L Glut( 13 , SCC
Company Name Registration Number
Pt() . QC/>c 4g / 4Plaivvi e,s2 3 2/7' _ 18
Address Q1L// // Expiration Date
Telephone l( ){q S I—S7(.
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 ng permit.
Signed Affidavit Attached Yes No 0
The current exemption for"homeavners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an inditidual 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.
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 tie State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
I
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: to 6 Ctgr✓ t Sf. / N.04'tto✓ J 1
The debris will be transported by: ,cu e-A-. Siva Car
I
The debris will be received by: Y l--akArkt,It / t. p`
Ls
Building permit number:
Name of Permit Applicant j4Avzt ?o`;;,,-, I. Jdt
Itel/17
Date r Signature of Permit Applicant
The Commonwealth of Massachusetts
/ �c t Department of Industrial Accidents
�a=', kh Office of Investigations
- 1 Congress Street,Suite 100
1. -''r` a�
— Boston,MA 02114-2017
%Zvwww.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� Please Print Legibly
Name (Business/Organization/Individual): ga.vz„- `(l ,vne
Address: pok,,'1Jt1 63 ,ley 84, rp (12Q'cS' 6 oi0 '�C�
City/State/Zip: . Phone#: (q ( 4 34i - so (3
Are you an employer? Check the appropriate box:
Type of project(required):
I.❑ 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. Iain a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
hip and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P ty 9. ❑ Building addition
[No workers' comp. insurance comp.insurances
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 I L❑Plumbing repairs or additions
myself..[No workers' comp. right of exemption per MGL
12.E Roof repairs
insurance required.]f c. 152, §1(4),and we have no
employees. [No workers' I3.❑ Other
comp. insurance required.]
'Any applicant that checks box tlt 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.
teontractors 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.
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.#: Expiration Date:
lob 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$250.00 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 certify u er thepains and p n lues of perjury that the information provided above is true and correct
Signature: /l / i1 Date: 11— le — I
( /jPhone#: 3) (O3-I — So 4
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#:
4101r?`PbYedas a44w4 aiv /Voce V-a?-17
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,i, City of Northampton
Sending Department
I - Plan Review
1 _ PPPf 212 Main Street
I r t , I 1 - Northampton. MA01060
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Invoice
Sarah Stull Carpentry
P.O. Box 48
Plainfield, MA, 01070
(413)-634-5013
CSL-071711
Bill To: Date:
Discreption Rate Price
Total
Total Due
d