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24D-202 (10) o�� 5 File#BP-2019-0814 APPLICANT/CONTACT PERSON JASON HEILMAN ADDRESS/PHONE 26 SOUTH RD HEATH (413)345-9048 p �- PROPERTY LOCATION 43 FINN ST MAP 241)PARCEL 202 001 ZONE URCO 00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ti� USEU'.nREQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TyReof Construction: DEMO BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 187368 3 sets of Plans/Plot Plan THE FOLLOWING CTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION)=SENTED: �AFFroved,_ 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 13T011tC— C11"Y141141&Q to t44,� -O j l fg If 9 Signature of Bui ding 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. Ycrsion1.7 Commezcial Building Permit Ma 15,2000 Department use only City of Northampton stag of P"ft: JAN 16 2019 Builing Department CUfb.CtltJJlrive "4wfnit— 2 2 Mein Stivet Room 100 Wa*NVel!Avaltabillty j DEPT OFOUR-DING rNCPECroWth pton, MA 01460 TWO, ol` r:#PwM* TJGRTHAA4P?ON t O - -- - -, -1240 Fax 413.587-1272 plot sifo?lans O?her - APPLICATION TO CONSTRUCT,REPA1k aENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR Q&66R79 ANY BItR DING OTHER THAN A ONE OR TWO FAMILY DWELLING --� SECTION 1-SITE INFORfAATMU 11 1.1 g am; This i to be compl�e6od by*Moo 149 Mair e2! Co! �r/i+ Un 43 010 W v Zone Ebn St.Distdat CS Did" SECTION 2-PROPERTY OWNERSHIPIAUTHORMED AGENT fal- !A t A r I'd1,5 NWm(Pt" Si�atrrre L2—e Telephone 7-2 gdmd Acent: _ LZ 4 - xq fir? s Telephone SECTION 3- 119ATED ttam Estimated Cost(Dollars)to be ofllclal Use only cornotated ern*applicant 1. Building .. _ (a)Bu2dft PwmitFee 00 2. Electrical (b)F.stifna*d Total Caast of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.l=ire Protsc bon 6. Total=(1+2+3+4+5 2 S { Check Number This Seddon For Ot[ictal Use Only 6adtlinp PermW Number Dade Issued BuUd Corn of DOW rn el Casi2)j PYx bu.t Id . ci rr\ a C3 DLLs�c�l ' SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ® Addition ❑ Replacement Windows Alterations) Roofing Or Doors 0 77 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [O] Other[o] Brief Description of Proposed Work: 71F(66ri-2 Q� F. SF. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. If New 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: 7 Number of Bathrooms c. Is there a garage attached? v'L> kQ V d. Proposed Square footage of new construction. ` S dC>F Dimensions 3g x g 7 e. Number of stories? I�o fQ�acL f. Method of heating? L tn nce 'tcrrJ ljc� Fireplaces or Woodstoves � '�Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? �v KERS QtihnS h. Type of construction r� 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 7 i k. Will building conform to the Building and Zoning regulations? , Yes No . I. Septic Tank City Sewer�_ Private well City water Supply K — SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. as Owner of the subject property hereby authorize ��N �i 1,l��ftc Inc to act on m>be alf, inall, atter elativeto work authorized by this building permit application. Signature of Owner Date - as Owner/Authorized Agent hereby decta e that the statements and information on the forego' g application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties perj7,"") / -- 17 Print Namw Signat4r6 of Owner/Agent Date ............. VersioE1.7 Commercial ftlding Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE I Interior Alterations D Existing Wall Signs P Demolition 0 Repairs 0 Additions El Aecaosery Building El Exterior Alteration 0 Existing Ground Sign 0 Now Signs 0 Roofing 0 Change of Use 0 Other C) Brief Description Of 445 Finn Proposed Work: ACA A-Tr SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 p A-2 C] A-3 0 1A 1:1 A-4 ❑ A-5 ❑ 18 0 8 Business ❑ 2A ❑ E Educational 2S ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C 0 Z I MsUtutionat 1-2 0 1-3 0 36 0 M Mercantile ❑ 4 0 R Residential fff R-1 El R-2 R-3 0 SA Rr S Storage 0 8-1 0 S-2 0 58 ❑ U Uunty ❑ Spear. Al Wired Use 0 Spear S Special Use ❑ specify. COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS.ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Tn hQ-acmu-CL or,%ON - 1p,L Proposed Use Group: Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34); SECTION 6 BUILDING HEIGHT AND AREA T BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) lot mi� U t. 2Ad P1 Ii.zq& 3rd Total Area(sf) q0.it 4 Total Proposed NOWN 920lb-COM(I&--- L Total Height(ft) ToW Height ft T.Water§upply(M.G.L r-40,§54) TA Flood Zon*Information: 7.3 Sewage Disposal System: Public 0 Private [] Zone Outside Flood Zoneo Municipal 0 On site disposal systemE] Versioul.7 Commercial Building Permit May 15,2000 8 NoRTH&mrwxzmwG Existing Proposed Required by Zoning nb columna to be filled in by Bn�dia8 D+epara�mt Lot Sizer tV-10l Setbacks Sic L RE%21 I=•R,= '_"OU a Building Heigbt Bldg.Square Footage % Open Space Footage % t { �. (Lot area minas bldg&paved 10$61 tl CF l #of Parking Spaces h j VOtllli7e IIC I.008ti0Il .....-._..___. ._... _. __._ A. Has a Special Perrnit/Varlanee/Finding+ever been issued for/on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW a YES 0 IF YES: enter Book _# Page�� and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW a YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained a , Date issued: C. Do any signs exist on the property? YES 0 NO e( IF YES, describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO or IF YES, describe size, type and location: E. Will the oonsfmction activity disturb(clearing,grading,exg1v81lon,or Ifing)over 1 acre or is it part of a common pian that will disturb over 1 acre? YES 4 NO nt IF YES,then a Northampton Storm Water Management Pemtit from tate DPW is required. Veruioul.7 CommmvW BnIft Pewit May 15,2000 S S'C�"11�i 4,-'�tJ�c ff!'l f . t Sds i C 1�6u'1'Ht�C1'JCAii '$ 'fit � NNUMMUCTUM VOISMUM COMMUCT"CONTROL PUMMW TO 780 CUR 146(CM TA Ii M tIOM THM 35,{#80 C.F.OF S CLO9W SPACE) 9.1 Roostered Architect: SIEfrFRf�A f'� t+SotAppGcatde 0 Name(>3eg�rant). (3 1 mmbw ErJwr Diu 9.2 R9qkftr&d Prc&sriona!' s E ! E Narm Area of Rosp"mgffily Adftw PAO*a*a fJtetlbw 5ignauxe TolWmo EMpitaeon Data Name _ Ams of ReopmmWfty Sil Ore 7eMph** >*aha Dole N1lsl! Arm of ResWWblity - i Ad*on Rag3slr2 w Plumber S nehrre Temptppm ExpirBlit n Date "Illmie Agee of RasponsiMW 111AlMMR Roosbuban Nwnber siwmwm T ExSirartion Date 9_3 General C-*retractor I I dlNotAppecome 13 Compeny Name: u Response in Charge at C.anstrualion Address f. ..y. -aJ"'�C� 3 a T Vaaionl.7 Comnat W Building Pa mk May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW f780 CMR lial1J Ind ndml Structurai En ine&Mg Bbwtu ai Peer Review Required Yes No 0 $M 11-OWNER AWTHORIZATION-TOMC.OPKETED:WHEN, OWIMW AGENT'OR COWRd CTOR APPLi�I�?tt!Rlf �,PEwtI !, _ nc . �_.:_ rse.•_• •_ _. _.... __._. .as Q►ar ofi ftre eubJed PIr tu�by M. fir %%VA. W,'oy trtfkft _�.. `•+ .lr 2.x`1 L`� 77, as OwnerfAuttnortad Agent hereby declare that On statements and Inilormation an the foregoing application are tno,and accurate,to the best of my kn Medge and b h: PrIM N 9lgeuhne.A0wrwWA0wd Date TF ON 12-CONSTRUCTION SERVICES i i liLl j,ymmmcl- - Not Applic9bte ❑ MM of Licsoiss Holdw f Lic", umber �_. MIR 11 X311 G Ila � T SECTION 13-WORKERS'COMPEL+UTION,INSURANCE AMDAYIT(M.G.L.c.1 52,S 25C(6)} Workers Compensation Insurance MTkievit must be oompieted and submitted with this application-Failure to provide this affidavit wiU result in the denial of the issuance of tiro baikfing permit Signed Affidavit Attached Yes N,0 From: ?JJ 6n ra(9--n tharn . llS -g,h ,l.i q To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street lNorthamption, 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,i request that you grant a modification to waive the requirement for construction control of the project at because the work Is of a minor 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, Cf�.- DATE pIrMlDarrrYl CERTIFICATE OF LIABILITY INSURANCE 01/15J2019 THO'CERTIFYCATE IS ISSUED AS A MATTER OF INFORMA71ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlNCate holder Is an ADDITIONAL INSURED,the ptorcy(les)must be endorsed. N SUBROGATION IS WAIVED,subject to the tarns;and cot>dtfions of the po icy,ce taln pokles may require an enclorsemertt. A statement on this cerdficate does not Confer rights to the cerdfkate holder In Neu of such s. PRODUCER NAME: Bats Wholey-Qsell BLACKMER INSURANCE AGENCY INC "HONE (413)625-W27 No); k. hetwyww*MftM-=n- 11 1147MOHAWKTRAIL -- - +>SuR,�fsRnLR6COVERAG,E PICS EL SHELBURNE MA 01370 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 IN __ INSURER 8: HEILMAN JASON P DBA JPH BUILDING ft"ERC: INSURER D: 9 WILLIAM ST STUDIO 6 u4suRER E-. SHELBURNE FALLS MA 01370 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 356749 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAima S" ADM TYPE,CF INSURANCE POLICY NUMBER EFF POLICY EXP t.IMns COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-AIAUE OCCUR PREMISES Ea_ _ MED EXP one peason S NIA PERWNAI A ADV IWURY s GEn AGGREGATE t GAIT APPLES PER: GENERAL AGGREGATE S POLICY❑JE ❑LOC PRODUCTS-C OMPIOP AGG s oTrleR: s AUTOMOBILE LIABILITY (Es accnied) _ s ANY AUTO BODILY INAIRY(Per penton) S ALL O8 AUTOS NIAWNED BODILY UKXJRY(Por soc brit) S �y PROPERTY DAMAGE s HIRED AUTOS AUTOS (Per aackwo) S URIBRBAALIAb OCCUR EACH OCCURRENCE I S EXCESS LAD a AarB{IgpE NIA AGGREGATE I�S _ DED 1 1 RETENTION 5 S WORKERS COMPENSATION X D AND EMLOVERV L.0 ML" Y t N A a T 6414- ANYPRDPRMSER XCW IRA NSA WA 7PJU87HM21818 0311 W2018 10311012019 ORIPARTNERIEXECUrIWE E�EACH AccIDENT !s 1.U00.000 (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 Syes under DESCRIPTION OF OPERATXNI$bebw E.L.DISEASE-POUCY L"T I S 10o0'000 NIA 1 DESCMPTION OF OPOtATNNIS t LOCATIONS t VONCLEB OWWIW IIK AdMw d Rerrhrb beheddr,mer be admiod Noon space to m4uker3 Worksm'C•ampenseiion benefits ws be paid to Messachuseft enoloyteas only.Purmmdlo Endorsement WC 20 0308 B.no authorization is given to Pay dskm for benefits to empiayses in states other than Messachusetts If the khsunxi hires,or has hired time employees Dutskia of Massachusetts. This Caardfieate of kwianee shows the policy In force on the Hats that this certificate was Issued(unless the expiration dots on the above policy precedee the ice"date of this certificate of lnw rsncs. The status of this coverage can be monitored daily try accessing Ute Proof of Coverage-Coverage Verification Search tool at WWW.fM= Sole pwpnef r has not elects coverage. CERTIMATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VM.L BE DELIVERED IN Town of Northampton Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 07080 �M.Ca y CPCU,Vice President-Residual Market-WCRIBMA Q 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD(lame and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Indrrs#rial Accidents D,Bice of Investigations 690 Washington Street Boston,MA 42111 www.mass govldia Workers' Compensation Insurance Affidavit., BuiidersiContractors/Electri+cians/Plumbers Apnlcant Information Please Print I.,dbly Name(Businesslthmnization/individual): s�tt"I t 9 i L t1 C2 A city/state/Zip: -tft&UoE. �-A }R (} WPhone#: �!S-43 5 - � 5 Are you an emp1oye� r Vned*k the appropAstebox: i- Type of project(required); 1.® I am a employer with (A2 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. 10 Demolition working for me in any capacity. employees and have workers' _ 9. E3Building addition [No workers'comp.insurance 'comp.ice. required.] 5. ❑ Weare a corporation and its 10.®Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof insurance required.]t c. 152,§1(4),and we have no ❑ repair employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 mit also fill out the section below shriving their wogs'dation policy fi formation. t Homeowners wbo submit this affidavit indicating they are doing all wwk and then hire outside cannactors must submit a new affidavit indicating such. hC'mtractors that check this box must attached an additional sheet showing the us=of the sub-contractors and state whether or not those entities have employees. If the sub-oontract ors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for mp eirydayan Below is the policy and job site infermation. Insumce Company Name: j3i('1s 1 tf C Policy#or Self-ins.Lic.#: Expiration Job Site A : 1u City/StaWZip:_ N NIA C5 6 d Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 Clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 5 I do hereby cell nder ,pains nasties ofperjury jury that the Information provided above is true and correct i tore: Date: 11 i5l kel E' Phone#: ., 1-45 - ?205 OjWdd use only. Do not write in this area,to he compked by city or town offwkL City or Town: PermlMicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Peraom: Phone M