32C-281 (12) 100 WILLIAMS ST BP-2020-0529
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-281 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2020-0529
Proiect# JS-2020-000912
Est.Cost: $6000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CARL WOODRUFF 109983
Lot Size(sg. ft.): 5532.12 Owner: MALZONE WESLEY
Zoning: URC(100)/ Apt)ficant: CARL WOODRUFF
AT: 100 WILLIAMS ST
Applicant Address: Phone: Insurance:
122 PLEASANT ST#109 (315) 854-4024 WC
EASTHAMPTONMA01027 ISSUED ON.10/29/2019 0.00:00
TO PERFORM THE FOLLOWING WORK.-ADD 8X8 PARTITION WALL
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 Sig(nature:
FeeType: Date Paid: Amount:
Building 10/2/2019 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
tt A 212 Main Street Sewer/Septic Availability
l•
A • Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
lop
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE ILY DWELLING
SECTION 1 -SITE INFORMATION rT Z-0
1.1 Property Address: Tj) jse;ti�n tbf$co plet d by office
Map 3c� C Lot Unit
DEPT OF BUILDING INSPFCTIONS
100 Williams Street Zone- NOnTHAmrTON.00p'14gyDistric
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Wesley Malzone 100 Williams Street,Northampton
Name(Print) , , Current Mailing Address: 413-270-2970
�S ���
Telephone
Signature
2.2 Authorized Agent:
413-527-9000 413-527-9000
Name(Print) Current Mailing Address:
- 413-527-9000
Sign Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 6000 (a) Building Permit Fee
2- Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee (�
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2 + 3 +4+ 5) Check Number 1
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: 1 1
Building Commissioner/Inspector of Buildings Date
Carl @ oxbowdesignbuild.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
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW e 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 NO
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 ® NO Q
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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [[J] Other[m]
Brief Description of Proposed Construct 8'x 8'partition wall with integrated built-ins.
Work:
Alteration of existing bedroom Yes " No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housina, complete the following:
a. Use of building : One Family Two Family Other _V0000—
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. 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 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
Carl Woodruff
hereby authorize
to act on my behalf, in all ma a to work authorized by this building permit application.
/u '-i<r 1 .
Signature of Owner Date
yAd✓v as Owner/Authorized
Agent ereby 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 penalties of perjury.
ovo�
Print Name
Signa er ge Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Carl Woodruff
License Number
122 Pleasant Street, Suite 109, Easthampton, MA 01027 CS-109983
Address Expiration Date
03/04/2020
Signature Telephone
413-527-9000
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Oxbow Design Build 186013
Address Expiration Date
122 Pleasant Street, Suite 109, Easthampton, MA 01027 Telephone 413-527-9000 09/20/2020
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...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 f ��
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note: If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Installation of builtins Est. Cost: $6,000
Address of Work: 100 Williams Street,Northampton,MA 01060
Date of Permit Application: Oct 25,2019
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
_ Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit/ass the gent of the owner:
tow- 1 Udall rgpp-- 186013
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
'ntrh Massachusetts
j a F r DEPARTMENT OF BUILDING INSPECTIONS ;
# 212 Main Street •Municipal Building
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:
100 Williams Street
(Please print house number and street name)
Is to be disposed of at:
Valley Recycling
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Si ature of P6rmff 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.
C—\ The Comnwnwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
www mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aaolicaut Information Please Print Legibly
Name (Business/Organization/Individual): Oxbow Design Build
Address: 122 Pleasant Street, Suite 109
City/State/Zip: Easthampton, MA 01027 Phone #:413-527-9000
Areyou an employer?Check the appropriate boa: Type of project(required):
1.❑✓ I am a employer with 5 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.]
3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition
10E]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions
proprietors with no employees. 12.[:]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These subcontractors have employees and have workers'comp.insurance.t
14. Other Installation of builtins
6.F1We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#I 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.
=Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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 workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:Liberty Mutual
Policy#or Self-ins.Lic.#:XWO(20) 57 41 28 82 Expiration Date:07/27/2020
Job Site Address: 100 Williams Street City/State/Zip:Northampton MA01060
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 certify under the pains an penalties of perjury that the information provided above is true and correct
Si ature: Date: OC t
Phone#:413-527-9000
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#:
1
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Oxbnw
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122 Pleasant street
Easthampton, MA 01027
T-0 T-W V-7 i
PROPOSED PARTITION WALL AND BUILT-IN
fV
GENERAL PURPOSE RECEPTACLES ON
BOTH SIDES OF WALL
m
SECTION
�a
in
io
1PY GYP WALL BOARD,TYP.
1/2'PLYWOOD,TYP.
2"X 4"FRAMING,TYP.
314"SOUTHERN YELLOW PINE
MILLWORK,TYP.
314"PAINTED POPLAR
MILLWORK,TYP.
�Existing �Pronosed
114"=p-0" SLOT FOR PLUG-IN 12V'LED' 3/4"PAINTED MOO MILLWORK,TYP.
DESK LAMP.LAMP TO BE
PLUGGED INTO SWITCHED SWITCHED RECEPTACLE
RECEPTACLE. LOCATED ABOVE DESK FOR
'LED"DESK LAMP
314"SOUTHERN
YELLOW PINE DESK
GENERAL PURPOSE RECEPTACLE
LOCATED ON BOTH SIDES OF WALL
100 Williams Street
Permit Plan
Date Oct 29,2019
3 La I Section Drawn by Carl Woodruff
''1"=1-� Checked by
OX-2.1
Scale