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17A-260 (4) 89 OAK ST BP-2018-1319 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-260 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category ADD BATH BUILDING PERMIT Permit# BP-2018-1319 Project# JS-2018-002345 Est.Cost$10500.00 Fee $68.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group Homeowner as Contractor_ Lot Size(sq.ft.): 10890.00 Owner: GERYK JOHN A&DARLENE SEDLAK zoning: URB(100)/ APPUcant: GERYK JOHN A & DARLENE SEDLAK AT. 89 OAK ST Applicant Address: Phone: Insurance: 20 JACKSON ST (413) 727-3057 () NORTHAMPTONMA01060 ISSUED ON.6/1412018 0:00:00 TO PERFORM THE FOLLOWING WORK:ADDING A BATH TO 2ND FLOOR BY MAKING BEDROOMS SMALLER 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 p Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 011: 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 6/142018 0:00:00 $68.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1319 APPLICANT/CONTACT PERSON GERYK JOHN A&DARLENE SEDLAK ADDRESS/PHONE 20 JACKSON ST NORTHAMP ON (413)727-3057 Q PROPERTY LOCATION 89 OAK ST MAP 17A PARCEL 260 001 ZONE URB j 1001/ THIS SEC'I'ON FOR OFFICIAL USE ONLY. PERMIT APPLICATION CHECKLIST CLO-59REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstruction ADDING A BATH TO 2ND FL AKING BEDROOMS SMALLER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _Approved_Additional permits required(see below) i PLANNING BOARD PERMIT REQUIRED UtIIDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site PlamAND/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 :molrbon Delay r � Sig a of m ¢ al Date Note: Issuance a Zoning permit doesnot 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 Pem* Building Department Curb CuUDnveaay,Paring 212 Main Street Sews llSepuc Avallability '.t { Room 100 WaNnrNJell Availabllity t� Northampton, MA 01060 Tao Beta OfStructealf Pimm phone 413587-1240 Fax 413- 7Plastai china - o9010vvI NOldw p� esra 9mml APPLICATION TO CONSTRUCT,ALTER, PAI ,RENOVATE OR DEMOLI H A I NE OR TWO FAMILY DWELLING SECTION f -SITE INFORMATION 9(OZ z L Nnr 1.1 Property Address: Thij sect on to be completed by office 91 o&V- Sf. a flyte,_�fL _ucil irtorCncl i mAr Ot0(6a Zone Overlay District Elm St.Dis rict CB Distric SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3a lA + �. Fi )(-- 4 $9 Oa1L 5t Vloy I'Lx_ MA DlOG.' Name(ori Cunent Mailing Adtlress: / Nt3 7d7-305'7 !i1 Telephone Signator 2.2 Authorized Agent: Name Ione) Cunent Mailing Adtlress'. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only cpm leled bv mi applicant 1. Building G coo (a)Building Permit Fee 2. Electrical )/�0 0- (b)Estimated Total Cost of -7 ConsWGion from fi 3. Plumbing ,7j bOv Building Permit Fee gq 4. Mechanical(HVAC) �� p 5.Fire Protection 6. Total=(1 +2+3+4i 5) /01660 Check Number This Section FgrORcial Use Only Date Building Permit Nu r: Issued: Signa re: Building o misslonerllnspector of Buildings 54e!4k- 1q_VA6I'XR Col EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To roomplete In formation Existing Proposed Required by Zoning This column a be filled In by Building Department Lot Size ao1.5 �awv3 Frontage Setbacks Front Side L:'-. R _. L: R: Rear Building Height Bldg.Square Footage 1100 Pv Open Space Footage % (l.ot uree minus bldg&paved ,kin H of Parking Spaces Fill: (volume&Location? A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW ® YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O Date Issued: C. Do any signs exist on the property? YES O NO 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 0 IF YES, describe size, type and location: E. Will the construcdon activity disturb(dearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 ane? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 51 DESCRIPTION OF PROPOSED WORK(check all anplicadel New House ❑ Addition ❑ Replacement Windows I Alteration(s) Q Rooting Or Doora, 1ia Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding 1171 Other[m Brief Descdp%ofproppsetl n Work: A � Alteration of existing bedroom k Yes No Adding new bedroom k Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 8a. If New house and or addition to"iatina housing.ctanolete the followlna: a. Use of building :One Family 1A Two Family Other In. Number of rooms in each family unit Number of Bathrooms VV, c. Is there a garage attachetl? 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 S.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. Septic Tank_ City Sewer Privanewell City water Supply_ SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, (�E�""'—�' k—) _,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 OvmerDate 1, 7�-tA-- 1 , C x " k— ,as Owner/Authorized Agent hereby declare that the staternalrel 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. Pont ame Irl ��O Signature of ner/Agen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Consbruceon Supervisor: Not Applicable No..M Lt...Hold.r License Number Address Expiration Date Signature Telephone 9.R"Istered Home Inipmenrsnt Contnetor• - Not Applicable Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.162,§26C(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 Wilding permit Signed Affidavit Attached Yes....... i No...... ! City of Northampton Massachusetts $si. o` A z \ I n212 H&IENT OF NNZZDZNG INSPECTIONS i M 212 Main Stvee[ a Nwicipal Building JF CD \ NoctheO,Oton, em 01060 X1.,0 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 performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must 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-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'be done by registered contractors. Note:[f the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: _ Est. Cost: Address of Work: Date of Permit Application: _____-- 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 owner-occupied 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: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building pe he ow h ve property: y 1120 11 Date Owner Name and Si nature City of Northampton Massachusetts wzSs sus! c ' DEPARTMENT OF BUILDING INSPECTIONS y 232 nein the a ....,aleuilding \\\V��Y// cm Nori'CT�ton, !p 01010 60 Massachusetts Residential Building Code Section I I O.R5.1.2 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. Section 11 O.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 1 I O.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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 persons) you hire to perform work for you under this permit. City of Northampton Massachusetts 1 I DEPART T OF BUILDING INSPECTIONS 5 l 212 Mein tr •Municipal auilCing `� xor[heupton, ea 01060 abr i s Di s pos al 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: COGS (Please print house number and street name) Is to be disposed of at: (PI se print n me location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4S,,nate Pe it pplicant kor Owner Date If, for any reason, the debris 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. n x X I N Bodroom Bedroom 2nd Floor 25.0' 8R Oc, k Sf Bedroo s ' n k 1 � � N k Bedroom Bedroom 2nd Floor 25.0'