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30A-052 (8) 61 LIBERTY ST BP-2020-0345 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-052 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Building BUILDING PERMIT Permit# BP-2020-0345 Project# JS-2019-002158 Est.Cost: $4700.00 Fee: $130.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sci. ft.): 15594.48 Owner: WATSON DAMIAN A Zoning: URB(100)/ Applicant: CARLIN DEBORAH AT: 61 LIBERTY ST Applicant Address: Phone: Insurance: 61 LIBERTY ST (413) 584-51010 FLORENCEMA01062 ISSUED ON: TO PERFORM THE FOLLOWING WORK:REMOVE WALL ON 1ST FLOOR, INSTALL HEADER BEAMS, REROUTING OF ELECTRIC AND PLUMBING 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: Z %� 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 $130.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only T City of N Irthampton ' i— : Status of Permit: Building epartment Crb C Driveway Permit 212 M n Street Sewer/ eptic Availability, b y Ro[n, 00 J UN 1 2019 Water ell Availability . NorthamptMA 01060 Two Se s of Structural Plans phone 413-587-12 i� ,'� fi r� aFP A Sit Pians N01-37HA%1r'Oy."AA oi> Other ecify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION b OIL 0— 3 1.1 Property Address: This section to be completed by office Map -��o/4 — Lot O�5')- Unit 61 Liberty Street zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Damian Watson 61 Liberty Street,Florence,MA 01062 Name(Print) Current Mailing Address: ($57)919-9623 Telephone Signature 2.2 Authorized Agent: None None Name(Print) Current Mailing Address: None Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complete by permit applicant 1. Building $3,000 (a)Building Permit Fee 2. Electrical S1,200 (b)Estimated Total Cost of Construction from 6 3. Plumbing $500 Building Permit Fee 4. Mechanical(HVAC) $0 ow 5. Fire Protection 6. Total=(1 +2+3+4+5) $4,700 Check Number This Section For Official Use Only Building Permit Number: Date {ssued: Signature: ' _ q"1Ua "ZUj9 Building Commissionerlinspector of Buildings Date damian.watson@gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 # w i w Side L: ---J R= L: R Rear Building Height; Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&pave parking) #of Parking Spaces i i Fill: (volume&Location) j A. Has a Special!Permit/Variance/Finding ever been issued orlon the site? NO 0 DON'T KNO f YES IF YES, date issued: j IF YES: Was the permit re orded t the Registry of eeds? NO 0 D TK OW 0 YES IF YES: enter Book Page and/or Document# � � B. Does the site conain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a pl�rmit been or need to be obtained from the Conservation Commission? Needs to be optained Obtained Date issued: + , 71 C. Do any signs exist on the property? YES 0 NO 0 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 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 will disturb over 1 acre? YES U NO 0 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 F-1Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [[I] Decks [Q Siding[C3] Other[O] Brief Description of Proposed Removal of load bearing wall on the Ist floor,installation of header beams,rerouting of electric and plumbing Work. Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes a No Plans Attached Roll -Sheet 6a. 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: Number of Bathrooms i c. Is there a garage attached? d. Proposed Square footage of ne construction. A Dimensions e. Number of stories? / f. Method of heating? ( it places or Woodstoves Number of each d g. Energy Conservation Compliange. ', Maischeck Energy Compliance form attached? i h. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Not applicable hereby authorize to act on my behalf, in all matters relative to work hoz th s building permit application. Signature of O Y Date as Owner/Authorized Agent herkby de are that the sta ments and information on the foregoing application are true and accurate, to the best of my knowledge and behiii, Signed under the pains and p nalties of perjury. Gml � tir� Print Name 1 Signature of OwnerlAg� Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: None License Number Address Expiration Date Signature Telephone Reaiistared Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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. 1 Signed Affidavit Attached Yes....... ❑ No...... ❑ �i r` The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 J� www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avvilcant Information I i Please Print Le ibl Name (Business/Orfganization/Individuaall): 1 Cin W47JUVI) Address: City/State/Zip: tl eti( e Old C--�— Phone#: R , 9'1 ~ -/6Z? Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. &Remodeling any capacity.[No workers'comp.insurance required.] 9. [--]Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition am a homeowner and will be hiring contractors to conduct all work on my property. I will nsure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.[:]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 am an employer that is providing w rkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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, §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 veria n. I do hereby under the pains and penalties of perjury that the information provided ahove is true and correct. Si ature: Date: Phone#: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 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 , Sn 150A. Address of the work: L► The debris will be transported by: � The debris will be received by: ej Pc I c Building permit number: Name of Permit APP lica t �1117f)[5 Date Signature of Permit Applicant