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34-003 (20) 267 TURKEY HILL RD BP-2019-0221 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:34-003 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:Porch Repair BUILDING PERMIT Permit# BP-2019-0221 Project# JS-2019-000361 Es[ Cost,$18515.00 Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO: Const.Class; Contractor: License: Use Group QUINLAN BUILDERS 011289 Lot Size(so.ft.): 178247 52 Owner: PINNEY JAMES Zooms; Applicant: QUINLAN BUILDERS AT. 267 TURKEY HILL RD Applicant Address: Phone: Insurance: 9 HILLSIDE DR (413) 549-5474 0 HADLEYMA01035 ISSUED ON:8/24/2078 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING FLOORING TO PORCH & INSTALL NEW FLOORING, BUILD 18" KNEE WALL W/ HARVEY SIDING & STORM WINDOWS ABOVE 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 Deuartmen[ 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 Shmature, FeeTvpe: Date Paid: Amount: Building 8/24/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0221 APPLICANT/CONTACT PERSON QUINLAN BUILDERS ADDRESS/PHONE 9 HILLSIDE DR HADLEY (413)549-5474 Q PROPERTY LOCATION 267 TURKEY HILL RD MAP 34 PARCEL 003 001 ZONE TIES SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST rrIIENCLOSED REQUIRED DATE ZONING FORM FILLED OUT A S¢./sUD/-Q. Fee Paid Building Permit Filled out Fee Paid TweofConstruction: REMOVE EXISTING FLOORING TO PORCH&INSTALL NEW FLOORING BUILD 18"KNEE WALL W/HARVEY SIDING&STORM WINDOWS ABOVE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 011289 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Demolition Delay �-�--- /I /� Signature of Building Oficial Date .Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 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 DMog � Status of Permit: Ir(`I Curb CutlDrivewey Permit USewer/Septic Availablit,y WatanWetl AVSII I' 'Two Sets of structural Plans 58 1272 Plot/Site Plans Elod.a,Plumbing 8 Gas Irspxlione - NU,Ibem Ion.MAC n Qalef Specify — APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 6Tyrl/�.e 1,� I-A0I R00.d Map Lot W� Unit (! r ( J Zone Overlay District Elm St.District CB District_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r ° .1G7 -r *rig Name(Print) Current MailinyA r 71, s cNNE - 9i6- �iysG � L S Telephone Signature .2 Authorized A e�[ T n lXislNlAn Sr- `/4 I-lwl'�T`nc.�-e+ �a� �/ Name(Print) Current Mil Mailing Add Signature Telephone SECTION 3-ESTIM TED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building D `I S•O b (a)Building Permit Fee 2. Electrical V J (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ob 5. Fire Protection 6. Total=(1 +2+3+4+5) 1 00 1 Check Number lU This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 rT This column to be filled in by GBuilding Department Lot Size Frontage Setbacks Front Side L: R U R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arkin ) 4 of Parking Spaces Fill: (volume&Locali,m A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Je YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW YES O IF YES: enter Book cc Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW 0 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 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. WII the constmctionactivitydisturb(clearing, grading, cavation,or filing)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 b DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteralion(s) ❑ Roofing ❑ Or Doors � Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [M Siding [O] Other[O] Brief Descri n of Proposed rFw rR Work: LMOv 7 &—XIS{vha Klop4.0 POrCl, a"d raS IJ N<L.? Fr + oOrrk Alteration of existing bedroom_Yes_No Adding new bedroom_Yes No Sr;1d 1L" �aa ue Attached Narrative Renovating unfinished basement Yes No 0t 1At,%)4y Plans Attached Roll -Sheet Sa. If New house and or addition to existing housing, complete the following: W 140u7 ct(;oIilf 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 stories? f. Method of heating? Fireplaces or Wcodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? K Type of construction i. Is construction within 100 ft.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. 1, Septic Tank_ City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, -� _h :7 C (7j/V '{ (�JWGN�� U as Owner of the subject property � I hereby authorize o/m �yl� l�✓) to act on my ben If, in all matters relative to work authorized b/9�his building permit ap lication. Juk b /6 Signature off Own r /� �1 Dale I, for" �t/r tnas 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 perjury. 0 M Print ame a / " Signature of Owner/Age Date SECTION 6-CONSTRUCTION SERVICES 6.1 Licensed Constructions-Suup'ervisor: �^ Not Applicable ❑ Name of License Holder: / O/r'L u,Y IUs 10 07 License Number Address Expiration Date sgrunuh,, Tesphone S. Realstered Home Improvement Contractor: Not Applicable ❑ /0/70 7 Company Name Registration Number Atld�rgeslsr l' /rl }� Expiration Date -/ �L I�V� � ', ✓ter 111 41 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....... No...... ❑ �\ The Commonwealth of Massachusetts Ulkirkers' Department of Industrial Accidents 1 Congress Street,Suite 100Boston,MA 02114-20177www.massgov/dia Compensation Insurance Affidavit:Builders/Contractors/Electriciuns/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information C Please PrintLe ' 1 Name Basi...//(hgarm,wior✓ladividua0: OM ( l7✓t 41rL, JW Address: / y pun V`519 pon 00ar� _ t City/State/Zip: RodIdly, MA 6tv75Phone#:_L/t3 - 364 - 77$ 3 Are you an employe/1 Check tLe.pprmpriate isms, Type of project(required): I-E]I am a ent'i'cnvith employees(full amber pori-time) 7- ❑ New construction 21mvw4e propricua or wane+xhiv vavcwumployc4's wanking lanln 8. E] Remodeling f�-`Irnc y capacityu�n .[No workers cony.in , requitI 9, ❑Demolition 3D I em v M1mmmwmer aping all wink myself INo workers'camp.insurance regnh M_I' 4.❑I am a hammwner aha will M Nang cnnuacmrs m condne(all work on my propeay. I will 10E]Building addition crium that all em or cmrsellher have workers, nnnpememlom immaance or arescie I L❑Electrical repairs or additions prapficmrs vnth no omtplaycex- 12.❑Plumbing repairs or additions i7lamagenialremor,ba and lltavmhircathe.se vokeW ey linea,mthe atmcned rhea These sub-contmcmn nave empinytts arW have werken'comp.in,umme_t 13.[]Roof repairs 6.0 We area empommic and its officers have exercised lhe@ right ofexemptimm pet MGL c 14.[]Other 152,§lro,mad we have.employs,,.INovmkmi cemp.immame requhM) Any applicant that checks box#1 must alit)fill cau he ach.hebw,hewing their warkept',omperaboic Imlicy infmarinon_ `Homeowner,who saMmh this andovit indicating they are doing all work and Ihw hue umxide eoalracmrs airs(submit a mew ulfifi linm,xm,,.sh. tCommaaclnrs root check(las box must attached an additional afim omiamg the mnme of the,ubmnhactem mad nam wi edte,m sou roic omnia,have empleyecs_lithe smbeommctoms have enmplayees,they most provide then workers comppolicy mmnbca I am an employer that is providing workers'compensation insurance for a0,employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lia#: Expiration Date'_i 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 e. 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 forth ofa STOP WORK ORDER and a fine of up to$250,00 a day against the violator.A copy ofthis statement may be forwarded to the Office ofhavestigations ofthe DIA for insurance coverage verification. I do hereby certify under thepains a/Jnd penalties ofperjuy,that the irtiormadon provided above is true and comet XSi n tut� [� Date' k1d 0 �(F 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 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives ofa deceased employer,or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However the owner of dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence ofcompliance with the insurance requirements ofthis chapter have been presented in the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)morels),address(es)and phone numbers)along with their certificate(s)of insurance- Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required N carry workers'compensation insurance. Iran LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Once of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that most submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under`Job Site Address"the applicant should write"all locations in (city or town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related many business or commercial venture (ix,a dog license or permit to bum leaves etc-)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia