25C-140 (2) 51 ORCHARD ST BP-2017-1238
GIS#: COMMONWEALTH OF MASSACHUSETTS
May:Block:25C- 140 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category S'dinr_ BUILDING PERMIT
Permit# BP-2017-1238
Project# JS-2017-002074
Est.Cost: $15000.00
Fee:$105.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID SCHOEN 077835
Lot Size(sq. ft.): 10280.16 Owner: BELL THOMAS R&DIANE M
Zoning:ORB(/001( Applicant: DAVID SCHOEN
AT: 51 ORCHARD ST
Applicant Address: Phone: Insurance:
14 GLENDALE WOODS DR _... (413) 527-3788 Workers
Compensation
SOUTHAMPTONMA01073 ISSUED ON:5/J5/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:VI NYL SIDE HOUSE
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 f3 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:
FeeType: Date Paid: Amount:
Building 515/2017 0:00:00 $105.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck-- Building Commissioner
Versionl.7 Commercial Buildin&Permit May 15,2000
D•p&bnenf 1St ank
City of Northampton Status of Permit
Building Department Curb CUHDrblwwey.P nt
212 Main Street Seww/SepticAvaHebify
APR 21 Room 100 WawVetla "
Northampton, MA 01060 Two Sated Simons*Plans
L L -phone 113-587-1240 Fax 413-587-1272 Plot/SitoPiana
Olfie SpecHy
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ✓ / 7/aza j7
This section to be completed by office
1.1 Property Address: //''/�
Si LRCIkC� � jT, Map (36e, Lot `lie Unit
N o �L{'l�0 ry fy ,-+ .�n_ . Zone Overlay District
r
_.. _.. .... _ . EIm St District CB DIstdct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
7' tim,n.A � 13 C.( [. . hl, l3Ca.,sDen .. denlArid ma
Name(Print) JJ - Current Mailing Address:
-+�- l2 l_) _� i 3 3 5 1 A 3 3
Signature Telephone
2.2 Authorized Aoent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building U-f coo — (a)Building Permit Fee
1
2. Electrical ✓' (b)Estimated Total Cost of
COO Construction from(6) ..
3. Plumbing `-- Building Permit Fee /
4. Mechanical(HVAC) / OS
5. Fire Protection A /
6. Total=(1 +2+3+4+5) 1 Sl 000 Check Number
This Section For Official Use Only
Building Permit Number Date
/f Issued r',17/7
� //�J
Signature: p7 t7e N ',17//
Bui• .. . _-Ionians r of Buildings Date G
Versionl 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
Exterior Alteration Existing Ground Sign New Signs Roofing Change of Use Other
Brief Description Enter a brief description here.
Of Proposed Work: Si d� 1 . (AA L_ . . _
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 0 A-3 0 1A I ❑
A-4 0 A-5 0 1B 0
B Business 0 2A 0
E Educational 0 2B ❑
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
I Institutional ❑ I-1 0 1-2 0 1-3 0 38 0
M Mercantile ❑ 4 0
R Residential 0 R-1 0 R-2 ❑ R-3 0 5A 0
S Storage 0 5-1 0 S-2 0 5B l ❑
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' 1°
2nd
3ra 3,d
4th 4th
Total Area(sf) Total Proposed New Construction(0)
Total Height(ft)
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 0 Zone Outside Flood Zone Municipal 0 On site disposal system
Versionl.7 Commercial Building Permit May 15,2000
B. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: I.: R:
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved _
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ONT KNOW 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 p
B. Does the site contain a brook, body of water or wetlands? JO 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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES t0
IF YES, describe size, type and location:
E. WIl the construction activity disturb(clearing,gr mg,excavation,Of filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
VersionL7 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
Not Applicable 0
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version!.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
SECTION/1 -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: Not Applicable
Name of l Inman Hnldq:
License Number
we,e, oohs 372.. 6«o}3,w,,eic+v. „ C - 077e.,5-
Address
8 3rAddress Expiration Date
'VA- oso7 3 c//3—r/t— tonn
Signet i0 Telephone t3/I
(c l S
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,g 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 No
sC k000G %d v , 144.1 • edo
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: .5 I D 2 c1-L n„ A S I ,
The debris will be transported by:
Dorn p "t---A
13
The debris will be received by: LDse0 Thz .'c
Building permit number:
Name of Permit Applicant I Lori , et 5 IZ: H e_ 11
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
a=—_ Department of Industrial Accidents
Is__'= /.
5=4•=41,-
=Ilk=
_ Office of Investigations
_I ;e 1 Congress Sired,Suite 100
e '–�'�c`= ' Boston,MA 02114-2017
+� ` wwwmass.gav/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 6 \ Please Print Legibly
Name(Business//Organization/Individual): ` r.I V Ib LYtTcJ�
1
Address: I'-( 6 t�Mr.QL,,ci._ INCaSSL�--
City/State/Zip: 5Gt-- etc, . wtyl.. Phone#: 7/f— 39/5- -COS-,
Are you an employer?Check the appropriate box:
I am a general contractor and I Type of project(required):
4.
1.❑ Iamaemployer with ❑
employees(full and/or part-time).' have hired the sub-contractors 6. ❑Ne construction2.[AI am a sole proprietor or partner- listed on the attached sheet. 7. odeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
P ty 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 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs
insurance required.]r c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy thfomation.
t Homeowners who submit this affidavit indicatmg 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.
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:
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations o le DIA for insurance coverage verification.
I do hereb certify der t e .'in*,adpe hies of perjury that the information provided above is true and correct
D. : e Z7 7
Phone#. tit — 3c - 00 5)
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#:
.,.... ECt?OEN ELECTRHC
14 Glendale Woods Drive
Southampton, MA 01073
413-345-0053
MA Master Lic. #A11333
CS-077835
Commissioner Hasbrouck May 14, 2017
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the vinyl
siding for house of Thomas Bell at 51-53 Orchard Street in Northampton because the work is of a minor
nature,will not affect health,accessibility, life and fire safety, or structural requirements and is
impractical in that the cost of control construction is considerable when compared to the cost of the
proposed work. All work will be completed within the prescriptive requirements of 780 CMR. Thank you
for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
David Schoen
D.A. Schoen Electric
14 Glendale Woods Drive
Southampton, MA 01073