32A-239 (4) 2 POMEROY TER-UNIT 5 BP-2018-1208
GIS N: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-239 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:Bath ren p BUILDING PERMIT
Perrot4 BP-2019-1208
Proiect N JS-2019-001960
Est.Cost:$13000.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HANS DALHANS 101628
Lot Size(w.ft.): Owner: O NEILL WILLIAM CHARLES&PATRICIA FORMANT
Zoning: URC(71VSC(29V Applicant: HANS DALHANS
AT. 2 POMEROY TER - UNIT 5
ApakantAddress: Phone., Insurance:
11 CHERRY ST (413)977-6094
EASTHAMPTONMA01027 ISSUED ON:4/30/1019 0:00.00
TO PERFORM THE FOLLOWING WORK:BATHROOM RENO
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: Noun Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: QJla Insulation:
Final: Smola: Find:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeTvoe: Date Paid: Amount:
Building 4/3020190:00:00 $100.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File k BP-2019.1208
APPLICANT/CONTACT PERSON HANS DALHANS
ADDRESS/PHONE I1 CHERRY ST EASTHAMPTON (413)977-6094
PROPERTY LOCATION 2 POMEROY TER-UNIT 5
MAP 32A PARCEL 239 000 ZONE URC(71VSC(29V
- THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled
Fee Paid
Tvoeof Construction BATHROOM RENO
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 101628
3 sets of Plans/Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFATION PRESENTED:
Approved_Additional permits required(sea 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 Smrm Water Management
Demolition Delay
170�-7 1-2g-;ol9
Siffoure of uil g Official Date
Note:Issuance of 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.
(��o MA -iiK Ci/��
Department use only
City of lortECEIVED St lus of Permit:
Buildin De Ct rb CuVDdveway Permit
212 ain treat SE wer/Septic Availability
Rc Dirt loo APR 2 9 2019 W iterNVell Availabiliiry
Northam on, A01060 Tv o Sets of Structural Plans
phone 413-587-1 40 ,-i Tions Ph it/Site Plans
NQgiY4!APIOM1'.IAP Q105001 er Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
� 1.1 Proosrty Address:
This section to be completed by office
Map Loi Unit
/Vor✓l.Iq / {a✓I/ /'�yV ; bloloo zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner o1 Record:
o-�leie:o_ �lz n.a,.'�' b/,Il,cw. CN✓•✓1 BS�/4L'rl�� ( 3 k-1124— C`F-OSSIN� �Y IVC
Name(Print _ Current Mailin rags'
w.c- � Cy� ceti :�v °3 StYiais4 �e_ca.-F�R , !�
�' N a• Telephone ''
Sneuro 7o03(J
f V�
Nsme tPri Current Maung Addr ss:
�IS fl-7
neturo Telephone
SECTION 3.ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be OMdal Use Only
completed by permit applicant
1. Building /vl/ 00U (e)Building Permit Fee
2. Electrical ,� Vh (b)Estimated Total Cost of
Construction from 8
3. Plumbing .{./) 00 a w Building Permit Fss
4. Mechanical(HVAC) ��
5.Fire Protection
6, Total=(1 +2+3+4+5) OW . ... Check Number
This Section For Offlclel Use Only
Building Pam h NU r: Date. ssued
Signature: 74 e * - w)_I
Building Commissioner/Inspector of SuiWings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION e•DESCRIPTION OF PROPOSED WORK Ich ick all applicable)
New House ❑ Addition c� Or Ooprc ReplacementM
Alteration(s) Rooflng
Accessory Bldg. ❑ Demolition roy New Signe lo) Decks (I3 Siding[p] Other[pJ
Brief pyscnption o6Propoged 1 j A 1 �
Work. 1\OJ Irv, 'lY IWW�d �l d. V�J, �]Gn `1�t1Q,j' YyP.�14 C-Q, w
Alteration of existing bedroom_Yes No Adding new bedroom Yes _ ,� No
nem
Attached Narrative Renovating unfinished basemen) Yes _,_/_No
Plans Attached Roll -Sheet DO
ea.N New houaa and or addition to existina housina.complete the tollowina:
a. Use of building:One Family Two Family Other
b. Number of roams 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?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
In 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.
I. 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 y�
I, PA-f ici / iY�+nh� q U/1"'. / UC'I as Owner of the subjed
property
hereby authomm q r Y1
to ad on my behe , all matters relative to work furthorized by is building permit application.
S nature of Own r L., �► Date
LTD C,- Ir� as Owner/Authorized
Agent hereby declare that the statements and inw1111o,�„�1 m 1 me roregoing appaca ion are two rid.-.rate,to the best of my knowledge
and belief.
tinned under me mins and penaeies of perjury.
Prrint Name /� C
Sig Wm of Owmrf aM �-
Section 4. ZONING Au Information Most Be completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This.tomo tr br filled in by
Building Npamnenk
Lot Size
Frontage
Setbacks Front
Side L'= R:� LCL R:I
Rear
Building Height O O O
Bldg.Square Footage
Open Space Footage O % O C
lark arta minus bldg a Rived
,arkiiiii)
#of Parkin S aces 0
Fill:
vdumc&lurarian
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:EL:__ J
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book , � Pagi and/or Document#L___
B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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. WIII the construction activity disturb(Gearing, grading, excavation,or filling)over 1 acre or is it pan 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.
I I . I
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder Y\<, `IG` ,IS cs— li
License Number
11 ag a^ phi/2Dao
�lil
Address E�xpi n Date
eture Telephone
.Re Istered Home Im ovemerd Contractor: Not Applicable ❑
G� gJS ( ( In✓�S 1 1GI�[.JS I ����
Com n Name Registraton Number
�I ( fdyu S�• �gs� w��M
Address � ly Ezp a8o Date
Telephone I e
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,g 25C(5))
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
Massachusetts
s
DEPANTMENT OF BUILDING INSPECTIONS
212 Main Street •
Municipal Builei� mpC�
ia aorthampton,n, !A 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 preexisting owner-occupied building containing
at least one but not more than tour dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with o corporation or LLC,that entity most be registered
Type of Work: nn (7�r�(v-� P 1{,..x,1 r."C'sv� Est.Cost: �� ()� ()t7
Address of Work:��! I_O�1 1'P iCV t..'C_S i o-!(X T%1r-.M,o Y� A
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 ownervoccupied
_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 AL LSSUME
RESPONSUNLITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT NE PAG FOR MORE INFORMATION.
Signed under the penalties of ped-19
I hereby appl for a building permit as the agent of the owner:
/ s ag"L JW
Date ontractor r
e HIC Regis tion 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
c
� OF BUILDING INSPECTIONS
212 Main 9tr • Municipal Huildinq
NoxtTampton, MA OlOfiO
Massachusetts Residential Building Code
Section I IO 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
J
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal a ilL ng Cs
Northampton, MA 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:
(Please print house n tuber and street name)
Is to be disposed of at:
-&M -b, A- )Y-,
(Please print ryme and location of cility)
Or will be disposed of in a dumpster onsite rented or leased from:
." tiA e�
(Company ame and Address)
re Pe 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.
Fx The Commonwealth of Massachusetts
Department of IndigstrialAccidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
w lowmassgov/dia
Wilivitkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lmibly
Name (Bnsiness/orff mindion/1 dividua0:
Addressl ( C�f`I S� • q
City/State/Zip: /r� o,y�,p MW Phone#: 1�
An you on employer?Check the approprlah boa:
Type of project(required):
LC]I an aemployer with employees(full it/.,p n-time)a 7, Q New construction
2.rl 1 ann.sole proprietor or partnership and have no employers working for are in g. ®Remodeling
any capacity.[No workers'comp.insurance required.]
7.E]1 am a home.,doing all work myself[No workers'comp.insurance required]t 9. f Demolition
4.11 stn a hormowncr and will be hiring contraction to conduct all work on my pmpert5'. I will 10❑Building addition
,mare that all maractres either have workers'mmpersam.imormce or are sole I LIM Electrical repairs or additions
propriemrs with no employes. 12.®Plumbing repairs or additions
5.[]]am is general cono-anor and I have hired the sub<oraaukars listed on Ne arcaded sheet 13.�ROOf repairs
These sub-contr
actors have employees and have workers'corp.mutanre.:
6,1&,ere a coryomthm and its officers have exercised their right mfex,mption per MGL c. 14.❑Gfher
152,g1(4),and we have no employees.Mo workers'comp insurance required.)
'Any applicant that checks box 41 most also fill out the rection below showing their workers'compereation policy information.
I Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors thin check Nis box must mtadvit an additional shat showing the time of the sub-contractors and arm whether or not Nose entities have
employees. Ifthe subrontracmrshave employees,they must provide their workers'comp.policy number.
!am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/Stateizip:
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 time 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.
!do hereby cerli un a paitt and pe allies of perjury that the information provided above is true and correct
Snot e: Dale:
Phone;t
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Pernait/License q
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
F=rom: � ( 1 \
�u5 �T�h
c
�70 5� � ��vh J\A,� c) oaf
To:
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code,section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10,1 request that you
grant a modification to waive the requirement for construction control of the project at
MA
because the work is of a Jinor nature,will not affect structural elements, health,accessibility,life or fire
safety,and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,