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32A-227 (12) 58 POMEROY TERR BP-2020-0652 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-227 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-0652 Project# JS-2020-001109 Est.Cost: $10000.00 Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO: Const. Class: Contractor: License: Use Group: RICK LIGHT 056457 Lot Size(sq.ft.): 56148.84 Owner: COLLEGE CHURCH INC THE Zoninj4: URC(99)/SC(I)/ Applicant: RICK LIGHT AT. 58 POMEROY TERR Applicant Address: Phone: Insurance: 25 BOYDEN RD (413) 253-9492 PELHAMMA01002 ISSUED ON.1112212019 0:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector i 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 signature: FeeType: Date Paid: Amount: Building 11/22/2019 0:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner I no Versionl.7 Commercial Build' Permit May 15,2000 f. I'- i ., Department use only ity of Northampton Status of Permit NOV2o S uilding Department Curt ;Cut/DrivewayPermit 201g 212 Main Street Sewer/Septic Availability i Room 100 WateNWell Availability E orthampton, MA 01060 Two Sets of,Structural'Plans °, Fete 4 3-587-1240 Fax 413-587-1272 PlotlSite Plans O,therSpecify APPLICATION TO CONSTRUCT,,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY,OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWEL ING ,SECTION 1 -SITE INFORMATION --Q Cates 1.1 Property Address: This section to be completed by office �Ct p01`�I,(� ' Map 3a Lot Unit' i MQ o t ov O Zone OveHay District i —�----- — ,,:Elm St.,',Districts CB Dlstnct.A SECTION,2 PROPERTY OWNERSHIPlAUTHORIZED AGENT 2.1 Owner of Record: �PG+J 1 ��` I� P bob �/�i-� _�f/�I[-7!//v� A?14 0 Name(Print) Current Mailing Address: L�Lill 3 -s--K&- Signature Telephone 2.2 Authorized Agent: Name(Print) p Y Current Mailing Addresses Signature Telephone ( Y13- '07-32-9' SECTION 3-ESTIMATED CONSTRUC ON COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1(0 OL (a)Buildings Permit Fee �� 2. Electrical (b).Estimated Total Cost of � Construction from 6 3. Plumbing Building Pennit Fee` 4. Mechanical(HVAC) A-�dbr 5. Fire Protection E -� 6. Total=(1 +2+3+4+5) . 00 Check Number This Section for Official Use•Onl "Building Permit Number //r�� Date j�j�'° v" VJ✓C/t Issued . Signature: Build g Commissionedlnspector of Bu gs Date. �� ®IA4 �t*ul 60", Versionl.7 Commercial Building Permit May 15,2000 8`";NORTHAMPTON,ZONING v. 3 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 L '+-� --- Building Height Bldg.Square Footage % Open Space Footage % �-----� (Lot area minus bldg&paved parking) #of Parking Spaces �--� —� ---� Fill: volume&Location i— A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ';$L YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW YES 0 IF YES: enter Book Page— --1 and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW @ YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 , Date Issued: E C. Do any signs exist on the property? YES NO 0 +L IF YES, describe size, type and location: GJ.�tI, St �„� a'ry lk D. Are there any proposed changes to or additions of signs intended for the property? YESQ NO Y' 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 0 NO 1 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I i Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS:.LESS THAN 35,000 ,.. CUBIC FEET OE'ENCLOSED SPACE Interior Alterations Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Brief Description E,,�n�ter?a brie desc�' tion here. �p�� - +c �C t �^ a :L �^ Of Proposed Work: caq�Vffs tz 6(y- SECTION'.5•-USE GROUP..AND,CONSTRUGTION�TY•PE , USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 113 ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A Q S Storage ❑ S-1 ❑ S-2 ❑ 5B H U utility ❑ i Specify: -��- MMixed Use ❑ Specify: S Special Use ❑ Specify COMPLETE THIS'SECTION IF-EXISTING BUILDING UNDERGOING.RENOVATIONS;ADDITIONS AND/OR CHANGE IN USE• . �. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): � Proposed Hazard Index 780 CMR 34): SECTION:6IBUILDING HEIGHT AND AREA` BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY3 Floor Area per Floor(sf) a 181 ,.T— ...._��,_. 18S �__.._. .__..._._ 2nd 2nd �� — J > 3rd aro 4t' f Total Area(sf) Total Proposed New Construction(sf) h Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 1 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private❑ Zone Outside Flood Zone[] Municipal On site disposal system I Versionl.7 Commercial Building Permit May 15,2000 SECTION,9-PROFESSIONAL DESIGN ANI)`CONSTRUCTION SERVICES R; FOBUILDINGS ANDSTRUCTURES'SUBJECT TO. ' CONSTRUCTION CONTROL PURSUANTTO 780"CMR 116:(CONTAINING. MORE,THAN,'35,000;C.F:D ENCLOSED SPACE), 9.1 Registered Architect: ��'1Not Applicable ❑ Name(Registrant): - -- -�-w_—.• Registration Number Address �Y _� Expiration Date =0�.. � I Signature , Telephone _�j i 9.2 Registered Professional Engineer(s): Name Area of Responsibility _ Address i' _ Registration Number Signature Telephone Expiration Date Name r Area of Responsibility Address ! Registration Number __--- Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor l._� �J(Y 1- �' �� ----•---a Not Applicable ❑ Company Name: Responsible In Ch rge of Construction _ ;d&gnature Telephone Off31 19.7-3' Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEER'RE1/IEW(780 CMR'110'11) Independent Structural Engineering Structural Peer Review Required Yes © No SECTION 11: OWNER AUTHORIZATION=TO BE COMPLETED'WHEN OWNERS .AGENT:OR CONTRACTOR'APPLIESeFOR BUILDING PERMIT �. ° I, 1.. �JGL✓l_ J r1"P,��l�l�__... � �V��w._� as Owner of the subject property P � n herebyauthorize � ..C�(( — �_ _ _ _ -- _ _ __ �to i act on y behalf,in all matters relative,to work authorized by this building permit application. Signature of Owner Date as OwnedAuthorized Agent hereby declare that the statements and information on the foregoing application are true and,accurate,to the best of my knowledge and belief. Signed ridertains and penalties of perjury. Print ame ` Signature of Owner/Agent Da SECTION12;CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: _ __ Not Applicable ❑ Name of License Holder: It[W License Number Address _ Exp __ iration Date Signature Telephone A �� 11 SECTION 13'-WORKERS CO ENSATION'INSURANCE=AFFID`AVIT(M.O L c:.152,§25C(6)) i} . � - •,, 1. 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 0 I I 1 I i V I I i 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 governediby this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL.c 111, S 150A. Address of the work: Sm & —V- r i The debris will be transported by: SJ o! wkel f The debris will be received by: Building permit number: Name of Permit Applicant c" Ithsh Date Signature of Permit Applicant i I I I i i I I The Commonwealth of Massachusetts Department of Industrial Accidents 1 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. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 4 KCL - l� � lot 0222= City/State/Zip: Phone#: I (If e711124' Are you an employer?Check the appropriate box: Type of project(required): 1.Q 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 4.[:]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition 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.❑ repairs re airs 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. $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 ant an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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 verification. I do hereby certify under the pains/hand penalties of perjury that the information provided above is true and correct. Si ature: 6— Date: Ilk Phone#: I — 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#: I Initial Construction Control Document H To be submitted with the building permit application by a W Registered Design Professional for work per the 9a'edition of the •1 SAO � Massachusetts State Building Code, 780 CMR, Section 107 Project Title: K-House Renovations Date: November 18,2019 .Property Address: 58 Pomeroy Terrace,Northampton,MA 01060 Project: Check(x) one or both as applicable: ❑ New construction Existing Construction Project description: Interior Renovations I, Curtis A. Edgin ,MA Registration Number: 7352 Expiration date: August 31,2020,am a registered design professional, and-I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Entire Project ❑ Architectural ❑ Structural ❑ Mechanical ❑ Fire Protection ❑ Electrical ❑ Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17; as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3'.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: Phone number: (413)594-2800 Email: cedgin@cbaarchitects.net Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. ' I Version 06 11 2013