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30A-032 (31) 320 RIVERSIDE DR BP-2019-1389 GIS#: COMMONWEALTH OF MASSACHUSETTS MW BImk:30A-032 CITY OF NORTHAMPTON Lot-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildino DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: REPAIR DECK FLOORING BUILDING PERMIT Permit# BP-2019-1389 Project# JS-2019-002231 Est.Cost:$3500.00 Fee $65.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: RICHARD T WEST 086947 Lm Size(sa.R.), OWner: CUMMINGS ROBERT Zoning: SI(108)IWP(38V Applicant: RICHARD T WEST AT: 320 RIVERSIDE DR Applicant Address: Phone: Insurance: 10 BARSTOW LN (413) 584-8528 SOLE PROPRIETOR HADLEYMA01035 ISSUED ON.61612019 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR 4X10 DECK 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 61620190:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File q BP-2019-1389 APPLICANT/CONTACT PERSON RICHARD T WEST ADDRESS/PHONE 10 BARSTOW LN HADLEY (413)584-8528 PROPERTY LOCATION 320 RIVERSIDE DR MAP 30A PARCEL 032 000 ZONE SI(108VWP(38U THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid .06 Building Permit Filled out Fee Paid TvoeofConstruction: REPAIR4XIODECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine Plans Included: Owner/Statement or License 086947 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKENON 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 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. Version l.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb CuuDriveway,Permit 212 Main Street Sevier/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PIOVSit APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHAN E T R OCCUPANCY 4F,04 DEMOLISH ANY BUILDING OTHER THAN A ONE O TW FAMILY DWELLING JUN - 3 201 SECTION i-SITE INFORMATION 1.1 PIOoartr Address: co pletwdbyofflm - NORTHPMPTON.MA01090 SQOtea``:11 d1R 74 pt 0 Unit Z �Or^�.f1CA. t MO t«.f Z Zone Overlay District ...._...... _-_.....-... Etrrt at District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: o�E2"T C"&k" -Nq% �i O�ou 120c'1 Name(Pnm) Current Mailing Address�:}-T 'e 1 1 Signature Telephone 2.2 Authorize nt: Name(Pont) Current Mailing Address. Signature Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by perrit applicant 1. Building j 35w (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) l-fcS Uv 5. Fire Protection 6. Total=0 -2+3+4+5) n�� Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: GCw19 Building CodilitasionarlAnspector of Buildings Date Versimi Commercial Building Permit May 15,2000 SECTION a.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition Rei Additions ❑ Accessory Building[I Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: / / / / ��p tires / _X� .C�� . O'Y6-1�t'«/Z•ti C/jF��m.o SECTION 5-USE GROUP AND CONSTRUCTION TYPE ,USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly13A;1 '❑ - _ A-2 ❑ A3 ❑ 1A 1:1 Aa ❑. 'A-5 1B ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 13 ❑ 38 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R3 ❑ 5A0 S Storage 13S-1 ❑ S-2 1:15B ❑ U Utility ❑ Si M Mixed Use ❑ Specify S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: ...._. Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 3m 3,e 4in 4r, Total Area(st) Total Proposed New Constmction(sq Total Height(h) Total Height it 7.Webr Supply(M.G.L.c.40,$54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zone❑ MunicipalK On site disposal system❑ Vcmionl.7 Commercial Building Permit May 15,2000 B. NORTHAMPTON ZONING Existing Proposed Required by Zoning Thu robe filled e M B„ilding ne Dcpim,w Lot Sia Frontage --_ ---_. -- — Setbacks Front -— -- Rear Building Height Bldg.Square Footage '7 Open Space Footage (Id w mivue 6118 a pv 1 ) #ofparldng spaces Fill: vo &Laurpnl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW ® YES O 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 ® NO Q 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. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that vdll disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 9.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 730 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Dale Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Tekphore Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale 9.3 General Contractor -/)10X,l(l / /ys�s71— Not Applicable [I Company Name /?114-4 4/"/– Responsible Responsible In Change of Construction /O tea ✓ .�n c , / c��t /ylr�®/off Adtl�ress/Jj. //�. c Si nature � Tebphone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No SECTION 11 -OWNER AUTHORIZATION-TO BECOMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, t � _ (� /v/r/%/7�/i%/ as Owner of the subject property hereby authorize _..yG�LAI� � Y/�-%� to act on my behalf, In all matters relative to work authorized by this building permit application. Sgnalureo Owner Dale as Owner/Author¢ed 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 penahties�of p rlury. _.. Print Name _/ _— Signature of Owner/Agent J Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ / �- Name ofLicense Holdar'. �y/6/rN/1_',/ ...� �� 65 -00(G/ /Y— License Number /0 -���� �4 e / / C4/, IV,a Atltlres Z Empidlfioni !3 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) 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 O City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 3aa /.ice. S/i�P -, The debris will be transported by: y�c�.�� /�drif The debris will be received by: !/ � 11, Building permit number: �7 / Name of Permit Applicant . Date Signature of Permit Applicant The Commonweafth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.goP/dia Ulkorkers'Compenstation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business OrgmizatioNlndivldua0: Address: City/State/Zip: Phone M Are you an empoyert Check,me appropriate hos: Type of project(required): LE]l am a employer with emNoysss(full andNm pan-time).' 7. ❑New construction 2.nt lemasolepmprietorarpmmmhipandhavemempmyeeswo&mg formem 8. ❑Remodeling any mpomty.[No worker'comp.mummotce retained] 1F I am o homeowner doing all work myself(No wodxrs'comp.urswancerequa rd.l' 9. ❑Demolition 4.❑I mo a homcowver and will be hours contranons to condtot all won on my pcoperry. I will 10❑Building addition oe amt A conttamoo either haus workers'eompematimi ..orare tole 11.❑Electrical repairs or additions pmpneron with m employee. 12.[]Plumbing repairs or additions 5,[3 1 oma general emartwtor and 1 have hoed the tub-coormoom listed on theaaachcd athirst. 13.❑Roof repairs nksas subtio arwu s have enmloy«s and have worker'comp.mossamer.: h.❑we area em Borman and to mins.have a tecixd their right ofexemgion per MOL c. 14.❑Other 152,§114),and we have tw employees.Mo utaumnce slurred.] 'Any applicant that checks box#1 must also fill out the section below showutg their workers contpemetion policy Nf tion. ,Homeowners who submit this attidavit indieming they me,doing all work and then her outside contractors most submit a new affidavit urheaung such. :Cmu eavers that check due Not must attached an wi fitiunal sheet slowing the name of the sub-contractors and some whether or not those entities have employees. If the subcummetun have empiuvm,they most mvide dwir workers compwhev number. lam an employer that is providing workers'compensadon insurance far my employers. Below is rhe polity and job she information. Insurance Company Name: Policy#or Self-ins.Lic.If: 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,p25A 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. /do hereby certify un erthep ns autdpenalfiesalpperjury that the informationprovided above istrueand correct Sienature�7 ���/'V Date: 1,1411 Plume ii' r,r2 7 r 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): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Peron: Phone#: 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 of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustce of an individual,partnership,association or other legal entity,employing employees. However the owner of a 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 shat l not because of such employment be deemed to be an employer." MGL chapter 152,k25C(6)also states that"every state or local licensing agency shag 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)nates"Neither the commonwealth our any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to 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-contractor(s)models),addresses)and phone number(s)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 to carry workers'compensation insurance. If an 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 of insurance coverage. Alan be sure to sign and date the affidavit The affidavit should be resumed to the city or town the the application for the pemdt 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 Office 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 the must 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 the has been officially stamped or marked by the city or town may be provided to the applicant as proof the a valid affidavit is on file for future permits or licenses. A new affidavit mug be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn 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 I 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