Loading...
23D-064 (9) 40 NUTTING AVE BP-2019-0175 G1s#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:23D-064 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: GARAGE BUILDING PERMIT Permit# BP-2019-0175 Project# JS-2019-000291 Est.Cost: $16000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group, Homeowner as Contractor_ Lot Size(sp.ft.): 12980.88 Owner., KAJKA JARED A Zoning:URB(100)/ Applicant. KAJKA JARED A AT. 40 NUTTING AVE ApplicantAddress: Phone: Insurance: 40 NUTTING AVE (413) 584-6440 0 FLORENCEMA01062 ISSUED ON.•8/23/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:GARAGE ADDITION 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: git 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 8/23/2018 0:00:00 $65.00 212 Main Sweet,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 'd M City of Northampton Permit ® I'! 0 Building Department rl 212 Main Street 1` -4- Room 100 a 'A Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 `­APPUCATI N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ON SECTION 1.1 Property Address This section to be completed by office yoAye- Map 2 Lot .. 'roc—a� Unit Zone Overlay District Elm St.Distinct Cis District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: is) [-,-j !�Al kill ii PA-1 Ave- Name(Print) current M41 Address:say- 5ss Telephone sigi-mure � 1 2.2 Authorized Anent, Name(Print) Current Mailing Address Signature Tal.phimr. SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 00o (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Lvo Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical I10 41&�1 5. Fire Protection 6. Total=(l -2-3+4+5) 1)00 Check Number .4'A 00 This Section For Official Use Only Building Permit q, Date Issued: Signature: Building Comrmssi. MZIrl Buildings Date @ c611(A61, N,!-r EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alterations) Q Roofing Or Doors O 1 .� Accessory Bldg. ElDemolition ❑ New Signs [01 Decks [M Siding`�, Other[C7) Brief Description of/Proposed � ((1 Work: (TArQYC A'XJ'�ib^J Alteration of existing bedroom Yes V" No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes �GNo Plans Attached Roll -Sheet ba It Now, and or addition to a Mogo housing,complete the following: a. Use of building: One Family V" Two Family Other b. Number of rooms in each family unit, 6 Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. 1,7;LDimensions e. Number of stories? 0 1 f. Method of heating? GAS hai wMf r Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ft.of wetlands? Yes V 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 . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR ICONTRACTOR APPLIES FOR BUILDING PERMIT I, TAre d hal kA as Owner of the subject properly hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. ZV Signature of 0.plar L Date I, as Owner/Authorized Agent hyddgare ,MKtements 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. Jn/e,J kRl A-P, Print Name S,gn.tu.,O DwnWA m Data Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled m by Building Department Lot Size Frontage Setbacks Front Side L:-R.;... . L:. R: . Rear Building Height -,.. Bldg. Square Footage Open Space Footage (Lm area minus bldg&paved din q of Parking Spaces Fill: _. . volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 1' DONT KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 Gr DONT KNOW O YES 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 (D-- IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,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 Storrs Water Management Permit from the DPW is required. City of Northampton 1 4 Massachusetts `s ' DEPARTMENT OF BUILDING INSPECTIONS ' 212 Nein Street • Municipal Building Northampton, MA 01060 spa Fee Calculator for Residential Properties LocationAve- Square Footage Amount Basement @ .20 1sT Floor @ .50 2nd Floor @ .50 '/2 Floors, Finish Attic, Garage @ .20 39�L �• y0 Deck / Porches @ .20 Total City of Northampton Massachusetts/; assachuaetts i i DEPARTMENT OF BUILDING INB NS S 'm 212 Nein Street n ipal Buildiuildi� NorNamptonon, eex 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: yo Mjf/Nr Are (Please print house numbik and street name) Is to be disposed of at: y VAIk. R'x rL H -A �Hc J RJ ( ease pri t name nd location of facility) Or will be disposed of in a dumpsler onsite rented or leased from: (Company Name and Address) � Signature df Permit Applicant or 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. City of Northampton a MassachusettsDEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building BortTae ton, MP 01060 Massachusetts Residential Building Code Section 110.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. City of Northampton Massachusetts c ' DEPARTMENT OF BUILDING INSPECTIONS n 212 Hain Stcaet 0 Municipal Building �JFti Cs NocNampton, HA 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("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 pm-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 buildin j'be done by registered contractors. Note:If 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 permit as the owner of the above property: a-lam la 69rej J<A1KA j Date Owner Name and Siga4ure The Commonwealth of Massachusetts Department of industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia 911,orkers'Conquenscation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lealbly Nme (Businem/OrganfzatioMndividual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): I_[]I am a employer with employees(ficl end/or pan time).* 7. ❑New construction 2 lama sole propnemrurpartnership and have no employees working fcrmein No workers colo ed S. Remodeling any eapneiry.[ p.ivsmavice regmr ] 3 l am a homeowner doing all workmyse If L No workers come insurance d 9. El Demolition .❑ ger pin ec rcquirc ]' 4.Etsm a homeowner and wdl be hiringtractors m conduct all work on 10❑Building addition rescon r progeny. i cele me that all ronvnoma either have workers'compensation insurance or are sole IL❑Electrical repass or additions proprictors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general cuntreaor and l have hired the subvntracters listed on The attached sheet. I3 Roof repairs These sub-coreactors have employees and have workerscomp.iwarri on We are a somomlion and its offcry have exercised their right of exemption per MGL c 14.❑Other 152,Lila).and we have no employers.Mo weders'comp_insurance required] Any appiicanuhat checks box dl must also fill out the section below sbow and farm workers'compensation pol ley information. t Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such o(omractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'romp.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.Lie.#: 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 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 5250.00 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 certif/y y/gd�er thepains andpena/lies of perjury that the information provided above is true and correct Signature' Date: Phone#: 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 7.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 6-CONSTRUCTION SERVICES 9.1 Licensed Construction Supervisor: Not Applicable D Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Reeteedre Achile Imorawment GarHrector. Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 building permit. Signed Affidavit Attached Yes....... D No...... ❑