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17A-248 (10)
98 LAKE ST BP-2019-0034 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mam:Block: 17A-248 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:REPAIR BUILDING PERMIT Permit# BP-2019-0034 Proiect# JS-2019-000047 Est.Cost:$6000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License: Use Group: TIM STOKES 083602 Lot Size(sg.h.): 16552.80 Owner: BROWN MAREN T&PATRICIA ANN MORRISON zoning: URB(100 Applicant. TIM STOKES AT. 98 LAKE ST Applicant Address: Phone: Insurance: 20 TURKEY HILL RD (413) 203-3046 O WESTHAMPTONMA01027 ISSUED ON.7/9/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVAL & REPLACEMENT OF DRYWALL & TRIM , MOVE HOT WATER RADIATOR 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: FeeType: Date Paid: Amount: Building 7/9/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0034 APPLICANT/CONTACT PERSON TIM STOKES ADDRESS/PHONE 20 TURKEY HILL RD WESTHAMPTON (413)203-3046 Q PROPERTY LOCATION 98 LAKE ST MAP 17A PARCEL 248 001 ZONE URB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST EN SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Constructiom REMOVAL&REPLACEMENT OF DRYWALL&TRIM MOVE HOT WATER RADIATOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 083602 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) 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 t tition Delay / 47 jgnatme of Building-OT, uildingOffi ' 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 fe r�;Pt ' . 212 Main Street Sewer/Septic Availability "' k Room 100 Water/Well Availability �- Northampton, MA 01060 Two Sets of Structural Plans f" phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans APPLICATION TO CONSTRUCT,ALTER,REPAIR, ENO ATEOR DEMOLISH A qNE C I TWO FAMILY DWELLING SECTION 1 -SRE INFORMATION AUL - 2018 619_ jq- 34 1.1 Property Address: DFPT OF BUILDING ITrig n Irxlan to ''�gzcJompleted/byyfoffice NOnTHAMPTON.Mq O,WD /( l Unit 98 Lake Street, Florence, MA Zone Oveday District Elm SL District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Maren T. Bro atricia A. orr' on 98 Lake Street, Florence, MA 01062 Name(Pring Current Mailing Address. 413-586-0901 Telephone Signature 2.2 Authorized Agent: W� Y=E S J.1 Alt-k- Name(Pnn', CWyr�Gn OaYlo¢6A4�s 1 IM� Q� Q T S S' ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of QO O Construction from 6 3. Plumbing 500 Building Permit Fee 0 0 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: IDssued: Signat Building CongsioneninsiPdor of Buildings Dale < �D,F hl Ic&rs @�l�Iail + EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing proposed Required by Zoning This mlumn m be filled in by Build.,Ibpannient Lot Size Frontage Setbacks Front Side L: 'R: L: R: Rear Building Height Bldg. Square Footage Open Space Foulage (Lot area minus bldg&paved parking) 4 ofPsrking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O 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 O 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 O 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 O IF YES, describe size, type and location: E. Nil the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acrel YES O NO O 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 Atteration(s) Roofing ❑ Or Doors Q 't"' Accessory Bldg. ❑ Demolition ❑ New Signs [pl Decks [[:3 Siding p;']] Other[a Brief De iptian of Pr posed Work'. //�,�d' KA �5�� Alteraflon ezisbn be2521 room� eY s No 1 � A g new bedroom j�� Yes t��Nom Attached Narrative Renovating unfinished basement - sNo Plans Attached Roll -Sheet sit.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. Dimensions e. Number of stones? f. Method of healing? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masser 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 I. 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 t�BUIILLDINNG.�PERMIT /1 I, �'q J /({/� / (7/J//[7T/// ///DAs�XJfwV -, ars Owner of the subject property Tim Stokes hereby autho ct on my h -n all matters ati to rk t oozed by this building permit split ice on. a i8 signature o ner Date I, ( � as Owner/Authorized Agent he by 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. � 1G� Print N -a 6 A to Signature of er/Agent 4ste SECTION a•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �^ Not Applicable 0 /1 Nems of Ucense boiler SSD S� 6V �. License Num er 4 Ex irati&Date G 5 6at Telephone �rIwasrowernent Contractor, Not Applicable ❑ In k—(S617- 5 Company Name 1 Registration Num r Address A Expir ion D atli ©� 6 7-7 Telephone 13 0-5 SECTION 16 WORUAKE�RS'1COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.1S425C(S)) 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...... ❑ City of Northampton r�rMassachusettslYYlNT1gNT 08 BGWL G IH C=msk 212 Nair Btmat a Municipal Building -. �r North vg n, M 01060 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 110.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 110.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 person(s) you hire to perform work for you under this permit. r ,r City of Northampton yy[ St,w Massachusetts 1 r�yf y DEPART T OF BUILDING INSPECTIONS �i siY 212 Main stzeet a Municipal Building p- Northampton, MA 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 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("IHC). 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 owneroccupied building containing at least one but not more than four dwelling units.._or to structures which are adjacent to such residence"building"be done by registered contractors. Note.Ifthe homeowner has contracted with N corporation or LLC,that entity must be registered I ypc 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 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: a. 1:JSol 2 Hate Contractor Name HIU 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 �� fifk D ARTNENTt or BrIIWMGO IHPECEr s Hortba too, !9 01060 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:15' Int 10 -i , Fi..'a vWl5- (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: -Awa(. p.ny . Ir r.� e (Company Nam-antl Atltlress) f Permit Applicant or Owner Day 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. -' The Commonwealth ofMossachwells Department of IndustrialAccidents _ 1 Congress Stree4 Suite 100 - Boston, MA 02114-2017 www.macs gav/dia Rmieers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �? Please Print Leeibly Nagle (Dusiness/OrgmimlioMndividuap: A 'r- Address: ZO I w a City/State/Zip: \ hone#: ZZ An you an employer?Check roe appropriate boa: Type of protect(required): 1.❑lama employer with employees(lou md/or paaaime) 7. New construction 2 a.ttdn proprmar,or parmcrsNp and have no enrplay«s working for me un g. ❑Remodeling y capacity.[No workers'wmp.hsu arce mquired.l 3. l am a M1rmxmwner doing all work myself plc workers'wmp.imurmce mquved.]` 9. ❑Demolition 4.❑I am a homeowner mui will In laving contractors to conduct all work on an, no ax,. 1 will 10❑Building addition .that all emrtramom eimm have workers'.,wraation immumea,n me sole 11.❑Electrical repays or additions propricton Wim rm employers. 12.❑Plumbing repairs or additions s❑1 am agereral contras or and I have hired the subcontractors listed on the allwhW sheet an13.�Roofrepairs These subcontractors h.,employees and!have workers wmp.insurance i 6.owe am a wrpoodam and its officers have rx rvicedthev right ofaxemption per MGL, 14.[]Other 152,§I(4),and we have rat employees.Mo workers'comp.irrsurence required.) eAnY aPPlicant that checks box kl must also fill m t the sectionbelow showing Nev workers'compeusaaon policy mfmmarem I llomeowners wlm submit this affidavit indicating Nay are doing all wait and dm love onside contrscrors must submit a new amd ,indicting such =Conuemon Nat check Nis box must amehed an additional sheet showing de name of the sul,mxramon and state whether or not those entities have employees Ifthe sub-wntractors have employws,Ney must provide their workers' omp.policy number. Tom an employer that b providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lia#: 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 seem coverage as required under MGI.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 cent er penahim ofperjurythou the information provided abov it five�d correct. Suture r Date, 6 7I D Phone#: \ 7i "1 7 Z Z Offwial use only. Do not write in this area,to be completed by city or town official City or Town: PermittLicense# Issuing Authority(circle one): 1.Hoard of Health 2.Building Depart l ent 3.CityITown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: