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25C-175 (8) 81 PARSONS ST BP-2019-0512 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 175 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-2019-0512 Proiect# JS-2019-000833 )est.Cost: $5500.Q0 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES O'SULLIVAN 66335 hot Size(sq_ft.): 5227.20 Owner- FEENEY PAMELA C&CLAIRE ALLEN C/O WENDY B ROBINSON Zoning:URC000)/ Applicant: JAMES O'SULLIVAN AT. 81 PARSONS ST Applicant Address: Phone: Insurance: 264 BUCK POND RD (413) 532-1312 WESTFIELDMA01085 ISSUED ON.•10/30/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR ROTTEN SILLS,POSTS POUR 8 FOOTINGS AND PIER FOR BARN 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 Dej!grtMgnt Fireplace/Chimney: Rough: Ails' Insulation: Final: oke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sisnature: FeeTvpe: Date Paid: Amount: Building 10/30/2018 0:00:00 $65.00 212 Main.Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2019-0512 APPLICANT/CONTACT PERSON JAMES O'SULLIVAti ADDRESS/PHONE 264 BUCK POND RE, WESTFIELD (!13)532-'312 PROPERTY LOCATION 81 PARSONS ST MAP 25C PARCEL 175 001 ZONE URC000V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST EN OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: REPAIR ROTTEN SILLS OSTS AgJR 8 FOOTINGS AND PIER FOR BARN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 66335 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFF ATION PRESENTED: vy Approved Additional permits required(see below) PLANNING BOARD PERMIT RfQUIRED;UN�ER,,§ _ 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 Signature of Building Official 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. C I 018 Department use only City f Northampton Status of Permit: ° or G INSPECTIONguild g Department Curb Cut/Driveway Permit RT N.MA01060 Main Street Sewer/Septic Availability 1 tl, Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other 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 ( fl C)�� �� Map Lot / 7(5 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: P-�1.1 M�►���si�'� Name(Print)W�Tj n9-C)b,N SON Current Mailing Addre s: K`V'tL'J 1 -11 v'K 5Ucm Teleph no e Signature 2.2 Authorized Agent: NameCurrent Mailing Address: Ll'-- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION CQKrS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ©O o CD (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) qV) 5.Fire Protection 6. Total=(1 +2+3+4+5) Q Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date '6 AOS�j 06 MAC EMAIL ADDRESS (REQUIREQ; EITHER HOMEOWNER OR CONTRACTOR) 4OA }- � 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 in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q 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 Q 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 IF YES, describe size, type and location: E. Will 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 acre? 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 Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ([] Siding[[3] Other(� WoerfkDescription of Proposed \ , \ ���S ,11'�sl S b ��1� 1�0511yoj—T—((? Alteration of existing bedroom Yes 1- No Adding new bedroom Yes YC No �jiif Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existina housing- , complete the foll win : a. Use of building:One Family Two Family Other :54 b. Number of rooms in each family unit: Number of Bathrooms d c. Is there a garage attached?_ V D 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 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 Zoo b o � k V`U—) p1,4~1 as Owner of the subject property 1 ,` hereby authorize 'I V`�1] (�d ,y 0-6`v to act n my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, "P"me's> 1� J`S 1���1f l� as 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 un er the pains and penalties of erju Print e Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder: ..�4'Mn LS 1'� 1 O�U� I1 Y 4� 0 6& License Number Ad ress Expiration Date —}4ZB Signature Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ mgr i�� tJ C IySi Ric �o� tcks cs 410 Company Name Registration Number 711 �V 1�U�1� K-�� ������i�L" ) /'_4, _/9 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....... No...... ❑ .C�\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WTTH THE PERMI'T'TING AUTHORITY. Anplicant Information Please Print Legibly Name(Business/Organization/Individual): n � \ Address: 2Zo-�- ?t)gNN (t City/State/Zip: Phone#: �f]3^ 200-7�4E Are you an employer?Check the appropriate boa: Type of project(required): 1.[J I am a employer with employees(full and/or part-time).' 7. New construction 2%am a sole proprietor or partnership and have no employees working for me in $.> Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.; 6.[:] 14.0Other ��l'.)t We are a corporation and its officers have exercised their right of exemption per MGL c. T- 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.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.Lic.#: 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$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 certi,�t under a pains and penalties of perjury that the information provided above is true and correct. Sianature: y\ 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 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts G DEPART OF BUILDING INSPECTIONS �. 212 Main Street •Municipal Building yvd. OD` Northampton, MA 01060 ssbw 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: (Please print house number and street name) Is to be disposed of at: (Plealse print name afnd location-W facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) jc�-� 10 -Z� Signature of 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. h 43 so u+ NG' m . 06 ' J da Al ., ^. if -7 . 10 (wit. . 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