Loading...
29-101 (5) I 15 BRIERWOOD DR ! BP-2020-0247 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block:29- 101 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2020-0247 Proiect# JS-2020-000424 i Est.Cost: $8000.00_ { Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: I Use Group: MATT MAYNARD 112584 Lot Size(sq. ft.): 12066.12 Owner: ROVITHIS ADAM ! Zoning: Applicant: MATT MAYNARD AT: 15 BRIERWOOD DR Applicant Address: Phone: Insurance: 1209 SPRINGFIELD ST ' (413) 262-7676 WC FEEDING HILLSMA01030 ISSUED ON:8/28/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.VI NYL SIDING I POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Servicer Meter: Footings: . Rough: Rough: House# Foundation: Driveway Final: Final: Final: ! Rough Frame: Gas: Fire Department r Fireplace/Chimney: i Rough: Oil: Insulation: I I 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 i Signature: I FeeTvpe: I Date Paid: Amount: Building 8/28/2019 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner I Department use only ; City of Noll amp �=/Vslusof ermit. t ti, Budding De artm nt Cur .Cut/ riveway Permit f -` L 212 Main St t AUG 2 7 2019 se er/S tic Availability. ROOM 00 W ter/W II Availability Northampton MA T Set of Structural Plans phone 413-587-1240 Fax° �,T4��p R��2rsPECT 'Site Plans TON.MA 0106 ther S ecify —.._ APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR-DEMOLISH A ONE OR TWO FAMILY DWELLING I SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office /te t M q I Map . Lot CJ Unit ✓V V7 Zone Overlay District j Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT i 2.1 Owner of Record: =hn ,�oV�th�s (91�L( / - ;/� .1-�5�Lcr t� _/t'I (09 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: rcl Ho vn r _ 711Ave— G.% a., ota?f Name(Print) Current Mailing Address: Zia- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildingi� 00,a^ (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 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only i Building Permit Number: DateIssued: pf Signature: f 2 g-201 Building Comm issio ner/Inspector of Buildings Date i I. EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) I I i I I 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:0 L:0 R:0 0 0 Rear 0 i Building Height Bldg.Square Footage j0110 Open Space Footage % j (Lot area minus bldg&paved parking) #of Parking Spaces 0 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOWjj�, YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES I IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NOse --DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the,property? YES ® Nd— IF YES, describe size, type and location: i E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1'acre? YES ® NO kj IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I S j I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) I New House ❑ Addition ❑ Replacement Windows Alteration(s), Roofing ❑ Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs [[ ] Decks [Q Siding ] Other[0] I ' \ Brief Description of Propoed Work: CJ nN� S I Alteration of existing bedroom YesPlo Adding new bedroom Yes �'Z 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 J II b. Number of rooms in each family unit: Number of Bathrooms i a� c. Is there a garage attached? �� j I d. Proposed Square footage of new construction. AAA= Dimensions e. Number of stories? Q f. Method of heating? 6t�5 �ur�' �— Fireplaces or Woodstoves umber of each g. Energy Conservation Compliance: Masscheck Energy Compliance form attached? I h. Type of construction EKrA, j I. Is construction within 100 ft.of wetlands? YesAlo. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade A/0— k. Will building conform to the Building and Zo ' 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 I, as Owner of the subject property _ hereby authorize ,Jcurd mo!-- /dllr7 to act o�ehalf,in a afters re tive to work authorized by his building permit application. I I i I Signature of Owner Date I ` I as Owner/Authorized Agent hereby declare that the statements and information o the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature o ner j Date i I � . City of Northampton r Massachusetts t3 i z LO DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building yv`y fib.r 4M a 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: Or- house number and street name) Is to be disposed of at: I ' , V (Please print name and.location of facility) I I I Or will be disposed of in a dumpster onsite rented or leased from: (Company Name add Address) G Sign ermit Applicant or Owner Dat I 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. � I i i � i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: � Not Applicable ❑ Name of License Holder � 1 �1a Licenseumber Address Expiration Date aro '1\ -r)G c)• Si ature1 le hone i9.Registered Home Improv(e__ment Contract Not Applicab7le ❑ ���'�c✓�s �t�l ��5� �� 67 O� Company Name RegistTc lumber )aoq Address Ekpiration Dat Telephone L{{ fP�7Pn7_� i 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...... ❑ i i I I , I I i I I I I , I I I WL The Commonwealth of Massachusetts u Department of Industrial Accidents M a 1 Congress Street,Suite 100 Boston, MA 02114-2017 I www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WiTH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):kitchens by prestige/matt maynard I Address:1209 springfield st City/State/Zip:feeding hills;ma 01030 Phone#:413-262-7676 Are you an employer?Check the app Ir•opriate box: Type of project(required): 1.E]i am a employer with 2 employees(full and/or part-time).* 7.1 ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. ❑Remodeling any capacity.[No workers'comp:insurance required.] 9.' El Demolition 3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will I ensure that all contractors either have workers'compensation insurance or arc sole I .❑Electrical repairs or additions proprietors with no employees. 12.n 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.* 1 6.❑We are a corporation and its officers have exercised theirright of exemption per MGL c. 14,'OOthervinyl siding 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. fi 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 I ane an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:remillard insurance Policy#or Self-ins.Lic.#:mpt5'1555v W GcI�y�9�� Expiration iDate:1/22/20 Job Site Address:15 brierwood'dr City/State/Zip:northampton ma 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 certifj nder t pai d pen 'es of perjury that the information providedi above is tr a and correct. i Si nature' �' Date: fit Phone#:413-262-7676 Official use only. Do not write in this area,to be completed by city or town official. I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Buildiing Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: