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17A-302 (8) J �C<cr5-oma,�. �olahs 115 HILLCREST DR BP-2019-1414 GIs#, COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17A-302 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateeorv:Deck BUILDING PERMIT Permit a BP-2019-1414 Proiect a JS-2019-002286 Est.Cost:$12500.00 Fee:$81.25 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grow SACKREY CONSTRUCTION 079384 Lot Size(w. ft.): 21867.12 Owner, TURNER DAVID S&MELODIE P Zonimr URA(100 Applicant. SACKREY CONSTRUCTION AT. 115 HILLCREST DR Applicant Address: Phone. Insurance: 83 SOUTH MAIN ST (413)665-9995 O SUNDERLANDMA01375 ISSUED ON.611712019 0:00:00 TO PERFORM THE FOLLOWING WORK REPLACE EXISTING WOODEN DECK WITHIN SAME FOOTPRINT 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 Occuoancv signature: FeeTvpe: Date Paid: Amount: Building 6/1720190:00:00 $81.25 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2019-1414 APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLAND (413)665-9995 Q PROPERTY LOCATION 115 HILLCREST DR MAP 17A PARCEL 302 001 ZONE URA000Y THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OU �� Fee Paid 11 .2 Building Permit Filled o Fee Paid Typeof Construction: REPLACE EXISTING WOODEN DECK WITHIN SAME FOOTPRINT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 079384 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIEMATION 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 Si ature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all inning 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 , City of Northampton Status of Permit: 4 i Building Department Curb CuuodvewayPermit 212 Main Street Sewer/Septic Availability 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 O VEWDAMI DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: hi&yh*JohtIbkW66mpI ted office NS + iLLc- s-r W . ISA- 3oz— Map Unit OE Wn1HaMPI ON.MH� VO , t 1AAA D 10 b'L zone strict Elm SL District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGEitT 2.1 Owner of Record: Mft,,u,Dil -tuK+[n.Pr-- Name(Prim) Current Meiling Addreas: yl a - S 2T— 7yS 3 Tebphone Signature 2.2 Authorized Agent: (' ,10* -k III , S AL� b-6 S . luAir Q �C, JlA cA"+RIAuD Name(Pdnt) Current Melling Address: V17 - 5'63 . 1. 639 Slgre Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed brmltapplicant 1. Building )� S db b (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) I ' 5.Fire Protection 1 1 6. Total=(1 +2+3+4+5) 12 V" Check Number (-12, This Section For Official Use Only Building Permit Number: Date Issued: Signature: 6- 13-261 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 5T ��zu4wf �X � ST�r1l> �Z fl���T ' Section 4. ZONING All Information MusFWtompleted. permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 1 N N Buie Building Zgmm�entto be ad in by 1111 Building pepmnenr Lot Sim Frontage _- Setbacks .Front O Side L: R L: R: Rear Building eight Bldg.Square Footage % .I Open Space Footage , (W use minus bldg&paved .J #ofParking Spaces Fill: (volume&Lowrion A. Has a�Spe/cial Permit/Variance/Finding ever been issued for/on the site? L`7 NO DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT 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 G 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 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavalb.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 Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition 0 Replacement Windows Axeration(s) 0 Roofing O Or Doors 0 Accessory Bldg. ❑ Demolition 0 New Signs [o) Decks [INK Siding[pj Other[r_0 Brief Description of Proposed Work, A¢PEAOTlu.IL/fr wdbID" DBclIc !Wifiks 5A-Kkk �TPkILI�• Alteration of existing bedroom_Yes�No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ss.H Now house and or addition to existing housing,complete the following. a. Use of building :One Family ✓/ Two Family Other_, _ b. Number of rooms in each family unit: Number of Bathrooms c. Is mere a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. 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 fl.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 To-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this Wilding permit application. Signature of Owner 11 f Date I, " C) K*A ,as Owner/Authorized Agent hereby declare that the statements and information n the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalb of perjury. O J( � Print Name Signature of Owner/Age Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:,, Not Applicable ❑ Name of Ucense Holder: 1�0 VkV4 df—S-0-7 9 3 S V c Ucenx Number wr,,.l �7i)nlDlFvec aa� �D 10% Y/zo Address Esq Date n J �. 43 - s (e3 - 66. 31 Signature Telsoano 8.Registered Home Improvement Contractor: Not Applicable D SA,cAs-s.�-, CAA-6e . Co - I (0`74 b9 Company Name r Registration Number S 2) S . Va h.�Q Sur+UlewLc ea/ CD o zo Address Expiration ate Telephpne 'l l 3. 563'4 4'r'� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.182,§25C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this appiicabon. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... W' No...... ❑ City of Northampton Q'7— Massachusetts DBPAR2'IIINT OF BUILDING INSPECTIONS212 Hain Stink 01n iclpal Buil,UngNoxtAton, HA 01060 emp 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 Ibe disposed of at: /4111 f2 n �rzL! t U ,dry (r— V�dY�744}}k P (Pleaselprint name a d location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) El� Signature o I 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. x 9 LIN The Commonwealth ofMassaehusetts Department ss Street,Indust Suit ccidents 1 Congress Sdeey Suite 100 Boston,MA 02114-1017 wwnsmassgov/dia U,krkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WHO THE PERMITTING AUTHORITY. Applicant Information Please Print Leeihlv Name (Business/Organization/Individual): S car col t S'T Address:—5 3 5 , " A-y.Q City/State/Zip: PIW Phone#: kf1 1, 5-6 3 G G 3 t An you an employer?chars the appropriate laps: Type of project(required): 1.�am a employer with q employces(fell emberpmt-time).' 7. ❑Newconstmction 2. 1mnaaxleproprietorwI> mhipmrdhavememployeesworking f«mein 8. r]Remodeling any capacity.[No workers'camp.insurance required.] 3.❑I em a homeowner doing all work mymlf.[No wodmrs'camp.insurance requimd.l r 9. El Demolition 4.❑l mn a Immmwnm and will be hiring eontmemrs m mndmt all work m my property. I will 10❑Building addition amore that all contactors either have woreers'emaga etion insurance or are sole 11.❑Electrical repairs or additions proprietors with no employes. 12.[]Plumbing repairs or additions 501ama genemlcontm;have a plohaveeiredthave w. .'eirspin ont6eattached sheet. 13.E]Rpof airs These subcontractors have employes and have workers'comp.insurarme.r � 6.❑We area corporation m,d its officers have exercised theirright ofexerwhon per MGL c. 14.❑Other 152,g1(4),and we have m employees.[No workers'comp,inamenn required.] 'Any applicant that checks box 41 most also fill out the section below showing their workers'compesimmon polity inforreatim. I Homcowmers who submit this affidavit indicating they are doing all work and the hire outside contractors must submit a new affidavit indicating such. lCummetors that check this box must attached an additional sheet showing the rmmc of the sub-contractors and state whether or not those entities have employees. If the subeomracum have employees,they most 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 injormation �t ,I Insurance Company Name: 1 A W Policy#or Self-ins.Lic.#: lrlilgtSflrt 't 1. Expiration Date: 2 Zp Job Site Address: I �� �L(-•C"V, ACOAX*XCK City/State/Zip: Attach a copy of the workers'compensation pailicy 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 fore 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 ceT= n thepoins and ena/ties ofperjury that the information provided above is hue and correct Simature: Date 64/o Phori Official use only. Do not write in this area,to be completed by city or town o,OFciot City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CBy/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: