23D-066 170 FEDERAL ST BP-2020-1199
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.-Block:23D-066 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:demolition BUILDING P E RM I T
Permit.# BP-2020-1199
Proiect# JS-2020-001956
Est.Cost: $2750.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NU-WAY HOMES INC 013693
Lot Size(sg. ft.): 24742.08 Owner: John Handzel
Zoning: URB(100)/ Applicant. NU-WAY HOMES INC
AT. 170 FEDERAL ST
Applicant Address: Phone: Insurance:
10 WHITE AVE (413) 563-0085
EAST LONGMEADOWMA01028 ISSUED ON.61512020 0.00:00
TO PERFORM THE FOLLOWING WORK.-RAZE THE GARAGE AND EXISTING OUT
BUILDING
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:
Rouhh 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 6/5/2020 0:00:00 $75.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2020-1199
APPLICANT/CONTACT PERSON NU-WAY HOMES INC
ADDRESS/PHONE 10 WHITE AVE EAST LONGMEADOW (413)563-0085
PROPERTY LOCATION 170 FEDERAL ST
MAP 23D PARCEL 066 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
REQUIRED DATE
ZONING FORM FILLED OUT EN
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RAZE THE GARAGE AND EXIST UT BUILDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 013693
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFqRMATION PRESENTED:
Approved 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
Signature of Building 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.
/ Department use only
City of Northampt n �1. Status of Permit:
�. \
Building Depart ,ent ��I' Curb Cut/Driveway Permit
212 Main Street N ewer/Septic Availability
Room �,n titer/Well Availability
Northampton, N � 60 tao wo Spis of Structural Plans
-"" phone 413-587-1240 F /4�� -1272 Plot/Site Plans
"�✓,'�'cc� Ogler Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RE AOR PtMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: C This section to be completed by office
170 tri-dv l �✓�' Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name t) c2as!!��� irf Current Mailing Address
�2Cn 5L-4-9C Telephone
Signatu
2.2 Authorized Anent:
S"o tip. 04, `re rove, /. LN�•��a
Nam (Print) Current Mailing Address: VD/oaf'
( y 3]57G3-VOF�
Signa r Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by permit applicant
1. Building/rvv (a) Building Permit Fee
2. Electdcal (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) U Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
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 S aces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW X YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Re istry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, vation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
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 Alterations) Roofing ❑
j Or Doors 0
Accessory Bldg. ❑ Demolition IBJ New Signs [[3] Decks f0 Siding [0] Other[a
Brief Description of Proposed ,
Work: U I e G X l �7'� O"
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes 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
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 .
1. 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,----A)L) —11/G4,Y / /c��S Ci as Owner of the subject
property L/
hereby authorize : J 'V
to act on my behalf. in all matters relativ to work authorized by this building permit application.
Signature of Ownet- Date
I, as Owner/Authorized
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 under the pains and penalties of perjury.
Print Name
z,�44z&l Signature of Owner/Agent Dater
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 0i" 1y
License Number
Address Expiration Da e
Signa ` Telephone
9. Resaistered 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.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
`31GT_.�Llir�
i- Massachusetts
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:
/17c / j t,,� � ----,7—,
(Please print house number and street name)
Is to be disposed of at:
(PI a print naniVand locati&h of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and-Address)
Signat a I Per it App cant or Owner Da e
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.
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.
Aimlicant Information Please Print Legibly
Name (Business/Organization/Individual): N U l SCS ci
Address:_Jig GJL,,`�`c )qVe .
City/State/Zip: �W .e44 l t44Phone#: �V/
Are you an employer?Check the appropriate box: Type of project(required):
1.[J 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.]
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 �Duilding a
10 �Building addition
4.[:]1 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
sese sub-contractors have employees and have workers'comp.insurance.
6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
52,§l(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 workers'compensation insurance for my employees. Beloit,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 verification.
I do hereb ify under the pains �enalties of perjury that the information provided above is true and correct.
i n re' #//' " Da :
Phone#: � —
Official use only. Do not write in this area,to be completed by city or town offtciaL
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#: