17C-055 (6) 168 CHESTNUT ST BP-2018-1300
GIs#: COMMONWEALTH OF MASSACHUSETTS
May�Block: 17C-055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:GARAGE BUILDING PERMIT
Permit# BP-2018-1300
Project# JS-2018-002317
Est Cost$41000.0
Fee, $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: CRAIG MARNEY 057159
Lot Size(sp. ft.7 16509.24 Owner: GILLETTE DANA
zoning,URA(100y Applicant: CRAIG MARNEY
AT: 168 CHESTNUTS
Applicant Address: Phone: Insurance:
P O Box 128 (413) 586-5512 WC
LEEDSMA01053 ISSUED ON.6/12/2018 0.00.00
TO PERFORM THE FOLLOWING WORK:DEMO AND REPLACE 20X20 GARAGE AND ADD
10X15 ADDITION ONTO GARAGE
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 Occuoancv Signature:
FeeTvoe: Date Paid: Amount:
Building 6/12/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 0 BP-2018-1300
APPLICANT/CONTACT PERSON CRAIG MARNEY
ADDRESSIPHONE P O Box 128 LEEDS (413)586-5512
PROPERTY LOCATION 168 CHESTNUT ST
MAP 17C PARCEL 055 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: DEMO AND REPLACE 20X20 N&RAIVAND ADD I OX 15 ADDITION ONTO
GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
B ldine Plans Included
Owner/Statement or License 057159
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO&IC7ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Pmject: 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
De olition Delay
e ofBm ding Dat
Note: Issuance of a Zoning permit does no[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.
,3*--
partmem use only
-- City of Northampton Status of permit
Building Department Cum CuuDdvewsy Permit
212 Main Street Saver/Septic Availability
Room 100 Water/WellAvailability
Northampton, MA 01060 Two Sets of Structural Plane
phone 413-587-1240 Fax 413-587-1272 PlottSite Plans.
— Other Spedfy
APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 PropertyAddms: This section to be completed by off-ice
Map I Z G -
Let 0- ,5 unit
68 GK�ST UcaT S T
Zone Overlay District
Elm St District CB District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.t Comer of Record:
i-. s.w -
Name'(PriMj Current Mailing Address'.
Telephone
S'gratou 9 C-3 - 9 so 7 la
2.2 Authorized Atiewl
d szs a NN A.tsaa rs tis lab Lars �z Kxra olcca
Name(Print) Current Moiling Address:
41 3 , Cr 4 - sr 1 1
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building '4d Ob0 (a)Building Permit Fee
2. Elecaical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee- y
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) I 00 Check Number 37dy
This Section For Official Use Only
Date
Building Pamtlt Number: Issued:
Signature:
Buildng mmissionertlnspeclor of Buildings Date
&.\42uG4.2 .42- @ cower
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING ALL Information Must M Completed. Pent Can Be Denied Due To Iwomplete Information
Existing Proposed Required by Zoning
Thi,colmon to be filled in by
Bwlding Dwartnamt
Lot Size . 379 4 . 37 9 4
Frontage 20e.. 3' 84.81 Pae—S /Sc•8,
Setbacks Font CoRA1BQ l..o — SrS� SrT�
7.—AuS
Si L: R:_ L:,R'.
Rear
Building Height
Bldg. Square Footage % :Soo F
Open Space Footage
(Lot area minus bldg&pav
#of Parking Spaces
Fill.
volwne&Incanm,
A. Has a Special Permit/Variance/Finding e r been issued for/on the site?
NO O DONTKNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT 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 L/
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 actMty disturb(dearing,grading,exc on,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(check all applicable
New House ❑ Addition Replacement Windows Alterations) 0 Roofing
Or Doors ❑
Accessory Bldg. El-� Demolition LJ New Signs [OI Decks [p Siding [C3] Other[
Brief Description of Proposed
Worka:,M\O AaMLiz aexzo G^sAcm- Cee • enx.a: dimsamQs
AJteretion of existi etlroom_VesJL No Adding now bedroomYes ✓ No
Renovating unfinished basement _Ves ✓ No
lana Attached R -Sheet
sa.If New house and or addition to exlstlnD 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 constmction. Dimensions
e. Number of stories?
I. Method of heating? Fireplaces or Weodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
It. Type of construction
i. Is construction within 100 R of wetlands?_Yes _No. Is construction Wthin 100 yr. floodplain-—Yes_No
I. Depth of basement or cellar floor below finished grade
k. Will bulling conform to the Building and Zoning regulations? Yes_No.
I. Septic Tank_ City Sewer_ Private well_ City water Supply_
SECTION 7a-OWNER AUTHORIZAT10N-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject
property
hereby authod e G R.A G 1a C e N ♦13 V
to act on
my b a in all matters relative to tW authorized by this building permit application.
Signature of er Date
I, t=A es '�45"Asc•? as Owner/Authorized
Agent hereby dedare lhatthe 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.
G Asy A\A� • zU
Prim Name
Slgnatur f Owner em Date
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder G QA.a 4 Cas.ta... Ey
License Number
ao a x z• `�� s ..a erosa o57ts9
Address Expiration Date
� -Ag I / 1131
Signature Telephone
413 •
ItReptstered Hom Innor ement Cornreotor Not Applicable
Company Name Registration Number
s.\dRU LT. 13.a r"MAX-5 C/e/ww4L I O t ll Z
Address Expira0on Date
P.D,85o% G /L9/Zv
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,;25C(8))
Workers Compensation Insurance affidavit must be completed and submitted vith this application. Failure to provide this affidavit vdll result
in the denial of the issuance o1 the building permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
-" Massachusetts
mat
z
212 N i"S OS anIL Ct Z bslldI q
21z OYia zthw • NuM 010 auilaivg C°
Northavpton, ]m. 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors perforating improvements or renovations on detached one to fora family homes.Prior to
performing work on such homes, a contractor most be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the`reconstruction, alteration, renovation, repair, modernization,conversion,
improvement, removal,demolition, or construction of an addition to any pre-9xisfing owner-occupied building containing
at least one but not more then/our dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered
Type of Work: c /6C LE psu.a..o GAw-^ eta Est. Cost: ova VO In,
Address of Work: IGA Gu =sT we Sri G' tacos �c—
Date of Permit Application: Cu l e- a 6
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owneroccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR.SUBCONTRACTORS FOR APPLICABLE.HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
; �el lrA ( rLi //,Z IC,L HZ
Date EontraeName HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts F? <<
1 TaLPAR10ffilT OF BOILDING ZNSPECTIWta 2
212 Main Strwt •tNnicipal HullG g
\" Northavpton, MA 01060 t0�`
Debris 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.
The debris from construction work being performed at:
IG2a Gwa.ae w»z Sr.
(Please print house number and street name)
Is to be disposed of at:
(Please pant name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and A rens)
�y�G�c�r�
Signatu of it Applicant or Owner Date
If,for any reason, the tlebris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
'\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www massgov/ttta
IV,, Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORfrV.
Applicant Information Please Print Leaibl
Name (Business/Orgmi=i n/lndMdmel): •$
Address: ,.5 7 &sir R&acs. I+Z a
City/State/Zip. to Phone 4: -I 13 • ® _.
Are you v eye
mplor?Cheri Ne eppmprtate bar: Type of project(required):
1. lnneasploycrwiN 7. 3-9ewcnrtstfuctlon
2.F1 l em a role Mprieir in pertoerslnip sad lave on employees working fm ra in g. E]Remodeling
any raga nINo wnrom,camp.vrammrce.required] P/
J.❑Inure Mmawna doing all work myself lNo wo�kms'comp.ineumroe regird.lr 9. LJ liemolition
4.�1 em a Mmawar eM will be hhir�g coonactmsto aductell work onmy property. I will l0❑Building addition
me Net ell convactmseiNerheve workers'compeusetiw vamnra or are sole I I.QElectrical repairs oradditions
pmprieim wimno employers. 12.Q Plumbing repairs or additions
5.rl 1 ran a general conuactv,and 1 have Muni Ne sub-runrn ir,road on the anachd shat. 13.�Roof repairs
These sub-contrecron loveemplmm and have werlim'emnp.vvnowant
6.Q We ern a aworetlonarrl its offiam have exorcised Neh right ofexempaon per MGL c. 14.❑Other
152.$1(4),erd we Inve no employees.[No svodm%ramp.insmana rtWvd.]
*Am epphtdsto1ie&s1xx#1 mustalso folout Neinnum below slrowirgl their workers'compm, fico policy Wormetion.
t Homw«mers vrfio submit flus affidavit indicating they ere doing all vvrk end Nenhire owside commmms must submit a raw afdavit indicatmg such
tCmn ton Natcheck Ninboxmustanacledmddiaoralshat showma Nename of Ne sub-antrecmrseM smi whedarm not Nose wades Imve
employee. Ifam sub-conheGorsheve employes,they mustproviie Nev workers'comp.policy vmnber.
I am m emptayw that is providing workm''e&nW=atioa insaraacefor my employees. Below is thepotuy and job site
inf-mation.
Insurance Company Name: I, a R..G A.,,v Z?—% e—"
Policy#or Self-ins.Lic.#:42,7 t OR Expiration Date'.
Job Site City/Smte/Zip:C. vxaus..G i" e%s i
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date),
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify un der the pa' mdpenaaies ofperjurythat the iaformadmprovided above is trueandcorrea
Sianatwe' Nnz Date' GllG .118
Phone# — 5St2
Offtcfaluse only. Do not write in this seen,to be completed by city or town egiciat
City or Town: Permit/License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/fo"Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
QZMassachusetts i
D6 PANT OF BUILDING INBF IONS S r
312 Main St t • Munloi,u Hui1dJ¢
North ton, MA 01060
Fee Calculator for Residential Properties
Location : ig. a 4=.b4= .a, Sr
Square Footage Amount
Basement @ .20
1 sT Floor @ .50
2nd Floor @ .50
Y Floors, Finish Attic, Garage @ .20 35CD 70,"
Deck I Porches @ .20
Total :
-1- OF-K\O FE¢ 3
t O O o0