25C-016 (5) 174- 176 NORTH ST BP-2021-0980
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-016 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2021-0980
Project# JS-2021-001681
Est.Cost: $13503.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENAISSANCE BUILDERS 013302
Lot Size(sq.ft.): 11891.88 Owner: HELMUS DENNIS
Zoning: URB(100)/ Applicant: RENAISSANCE BUILDERS
AT: 174 - 176 NORTH ST
Applicant Address: Phone: Insurance:
P 0 Box 272 (413) 863-8316 Workers Compensation
TURNERS FALLSMA01376 ISSUED ON:3/8/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE SIDING ON 2ND FLOOR WEST SIDE,
REPLACE PORCH FASCIA
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.
o 1 ' X1 - '1 •
Certificate of Occupancy Signatur:
FeeType: Date Paid: Amount:
Building 3/8/20210:00:00 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
rilsi� City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
ill it :� 212 Main Street Sewer/Septic Availability_
P� i r f Room 100 Water/Well Availability_
f.
,« '�� Northampton, MA 01060 Two Sets of Structural Plans
.E` phone 413-587-1240 Fax 413-587-1272 Plot'Site Plans
;Other Specify
rAPPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
4$E TI ="�SI O 1. N
1'�. z4�. try. 4 1:')C4t :-_
1.1 Property Address: '� This r4 p
t�
11 —�� 1�+D� Q� Map i X, ,1 -. Lot h( Unit'
y �-In S-we A-
t D`1 15.vh p v\ M1ot 01 0(St 0 Zone_ Overlay District
C t
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
De-VW\\5 4e1 vvt,u S 1-1 Lt Nor S.I No(-4-hav►1?it)el
Name(Print) Current Mailing Address
?Veal Gte. -I�d ti 1 a- sell- 54Q18
e Telephone
Signature
2.2 Authorized Agent:
r Po Q,aX 212_ Turners �f;,.Us M%' I.
Name rin Current Mailing Address: I f 0tai(.
4f3- 8621- 83tLit
Sign Telephone
SECTION 3- Official Use Only
P'ESTIMATED CONSTRUCTION COSTS
_Item Estimated Cost(Dollars)to be � ' ,,�
completed by permit applicant
1. Building 13 9 O Q (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee 4. Mechanical(HVAC) (_2
C5.Fire ProtectionLL
6. Total 1 +2+3+4+5 15 t 503 OO Check Number -
This Section For Official Use Only
<) -s f - Date .
Building Permit Number: r"7 "1 s' r` AIssued:_
1. l v
Signature. t }„�. V
Building Commissioner/Inspector of Buildings Date iitliUl
.
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
RECEI\'`ED
MAR -
5 2021
DEPT.OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060
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 I
Frontage I
Setbacks Front I
Side L:I R: I L: R: I
Rear I I I I
Building Height
Bldg.Square Footage I I I I % I I I I
Open Space Footage I I % I
(Lot area minus bldgpaved aved i
parking)
#of Parking Spaces I I I I
Fill: I ( I
(volume&Location)
A. Has a Special Permit/Variance/Finding e er been issued for/on the site?
NO 0 DON'T KNOW 0 YES
IF YES,date issued:
IF YES: Was the permit recorded a the Registry of Deeds?
NO 0 DON'T OW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a br•,ok, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit •een or need to be obtained from the Conservation Commission?
Needs to be obt• ned O Obtained 0 Date Issued:
C. Do any signs e st on the property? YES O NO O
IF YES, d- cribe size, type and location: r
D. Are the - any proposed changes to or additions of signs intended for the property? YES 0 NO
1
IF ES, describe size, type and location: F
E. ll the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
hat will disturb over 1 acre? YES O NO O
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) n Roofing n
Or Doors D
Accessory Bldg. El Demolition ❑ New Signs [DI Decks [Q Siding[r] Other[D]
Brief De cription of Proposed
V Work: -ee\act. S‘a:vm O secov.d - oor ciC 'J&r Sic12 • Qtp\ace cere.k, krASuc
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Is 0 ° 'I o., F''S ji nb ;Co.0 0 a ¢ i
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. Di • sions
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 • wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of baseme .r cellar floor below finished grade
k. Will bull.'•. conform to the Building and Zoning regulations? Yes No.
I. -ptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT1 ORO CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �1>!a per_ e. ,as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1, J V Gret€X AS WLCs. ,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.
C-‘e _vvv1a3.A.
Print Na
3(t (2t
Signatur er/Ag t Date
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: #S' \AQA(‘ C X\v CAA CS " O 133 0 2
License Number
3a�4pMIRY, �� , G► 11 µ a►3sti oa f t 12024
Addres Expiration Date
Signa• ems- Telephone
; Not Applicable0
\� Q7uilc�ihq &(P. N)(P114 2..Cr\AA55&nCe. %ui1de2rS 1 ct 11409
Company Name ) Registration Number
Bo` 2I2 14 0l'b 1 (4 08/23/2O2 2
A re t ryy�,l f Expiration Date
Telephone YG-$(23-83I to
l< AtEWK. +, a A;.,e i ,b-:a+�`
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 )111 No 0
RENAISSANCE
(_BUILDERS
PO BOX 272, TURNERS FALLS, MA 01376,413.863.8316
INFO@RENBUILD.NET, WWW.RENBUILD.NET
January 13, 2021
Dennis Helmus
176 North Street
Northampton MA, 01060
Work list for Exterior Repairs to Home at Above Address.
Scope to include the following:
• Replace fascia on West side of front second story porch.
• Replace siding on second floor of the West side.
1000 GENERAL CONDITIONS
1520 Temporary Facilities
A. Provide portable toilet for workers.
1530 Temporary Protection
A. Provide protection against the spread of lead dust to surrounding work areas.
1730 Cleanup & Trash Disposal
A. Clean up all debris and leave the job site broom clean at completion of all work.
B. Legally dispose of all debris.
C. All work to be performed per the EPA Safe Lead-Based Paint Regulations.
1950 Owner Responsibilities
A. Cost of electricity and water during construction.
B. All other phases not specifically outlined in this Proposal.
2000 SITE WORK
2220 Demolition, Exterior
A. Remove and legally dispose of sidewall shingles on second floor of the West side
of house.
B. Remove and legally dispose of fascia on West side of second story front porch.
6000 WOOD & PLASTICS
6710 Soffit & Fascia
A. Install new fascia at porch to match existing using Boral composite lumber.
7000 THERMAL & MOISTURE PROTECTION
7200 Insulation, Vapor Barrier
A. Install Tyvek® DrainWrap wind barrier on exterior walls.
B. Tape all seams with Tyvek tape. Repair all tears in Tyvek with Tyvek tape prior
to start of installation of siding.
Helmus Proposal Page 2
7460 Siding
A. Siding to be clear 18" red cedar sidewall shingles, installed to match existing
coursing exposure.
B. All wood siding to be nailed with ring shank stainless steel nails.
9000 FINISHES
9910 Paint, Exterior
A. New siding and fascia to receive two coats Benjamin Moore, Sherwin Williams,
or equivalent latex based paint or stain, or equal.
END WORK LIST
Renaissance Builders, PO Box 272,Turners Falls, MA 01376 License#013302, Registration#199409
3/1/2021
Helmus Proposal Page 4
ACCEPTANCE OF PROPOSAL:
Agreement between:
Dennis Helmus, 176 North Street, Northampton MA, 01060
And
Renaissance Builders, PO Box 272, Turners Falls, MA 01376
The prices, specifications, and conditions are satisfactory and are hereby accepted.
Please send a contract for the following work, as specified in the Proposal dated
January 13, 2021:
�— Siding & Fascia Repair $ 13,503.00
Fascia Repair Only $ 1,841.00
Please make the following changes or clarifications:
!^ • tla['n /rt..n/ -f'�'�S��l� -to -t��v�'/ Ov4
�
q� o
//4‘ Vna(/ C�h-t7r/n<r7rnel . 62-1.1 tl'LL.ji 4.4,
1.4t, t d/ .ill-v . s4cc.N.,r-A/i/,Afrn/ a'/ ncfe?..t' 41 /7
nI -7'("L s,J4'/'4 •7ri fyirrrt Jt .lr I.� �sy/ r,41/ /'t'/iif/Wf. _..
Payment will be made as outlined below: (l
Deposit on signed acceptance of Proposal: $ 500.00
A payment schedule for the balance will be included with the contract.
i authorize you to apply for a building permit, if required, on my behalf.
/ //26 l/2 /
'41)./221). .1L1,-"
Customer—Signature l Date
e424)...s. /4: 11..) -
Please print legal name for Contract Documents
Customer Signature Date
Please print legal name for Contract Documents
All individuals listed as Owners of Record for a property are required to sign Contract Agreements.
Please note any corrections to your name or address. Also, please give us your phone
number(s) and the best times to reach you so we can keep you posted regarding our schedule.
You may also provide an email address if that is a good way to contact you.
Note: Please return only this signed acceptance sheet along with deposit.
Retain the Proposal for your records.
Renaissance Builders, PO Box 272, Turners Falls, MA 01376 License#013302, Registration#199409
1/13/2021
The Commonwealth of Massachusetts
Department of Industrial Accidents
_ Office of Investigations
- = 1= 600 Washington Street
'� Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): RENAISSANCE BUILDERS
Address: PO BOX 272
City/State/Zip: TURNERS FALLS, MA 01376 Phone #: 413-863-8316
Are you an employer? Check the appropriate box: Type of project(required):
1.a I am a employer with 22 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees . These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13. X❑ Other siding replacement
comp. insurance required.]
*Any applicant that checks box#l 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 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. Below is the policy and job site
information.
Insurance Company Name: AIM MUTUAL INSURANCE CO.
Policy#or Self-ins. Lic. #: MCC20020004972021A Expiration Date: 01/01/2022
Job Site Address: 174-176 North Street City/state/zip:Northampton, MA 01060
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 and penalties of perjury that the information provided above is true and correct.
Signature: Date:3/1/21
Phone#: 413-863-8316
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#:
•
AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS
Supplement to Permit Application
As a result Of the provisions of NIGL c. 40, s54, I acknowledge that as a condition of the
issuance of a 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 NIGL c. 111, s l 50A.
I certify that debris resulting from this demolition will be disposed of as listed below:
Job Site Location: nil- N o,(4-1n kl s,r'-4‘awy NA1-0\0(s2 0
Name of Permit Applicant: Renaissance Builders
Disposal Facility: F & G Recycling
Address of Facility: 15 Mullen Rd., Enfield, Ct 06082
IF SAID FACILITY IS OTHER THAN WHAT I HAVE LIS FED, I CERTIFY THAT
I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF
THE SOLID WAS FE DISPOSAL FACILITY WITHIN TWO MONTHS OF THE
DA 1'E OF THIS APPLICATION.
41027.711.0. 514--$49--"-"-fr;(.
v 3JLII
Signature of Applicant te
1ZN
RENAISSANCE
fLBUILDERS
PO BOX 272, TURNERS FALLS, MA 01376,413.863.8316
INFO@RENBUILD.NET, WWW.RENBUILD.NET
March 1, 2021
Jonathan Flagg, Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
Jonathan,
Enclosed is a permit application to replace the siding and fascia on the West side,
second story of 176 North Street, Northampton. Stephen is the project manager.
His cell phone number is 772-9430 if you have questions or concerns.
Also included is:
❑ A scope of the work
❑ An Owner Authorization signature page
❑ A Worker's Compensation Insurance Affidavit
❑ Demolition Affidavit
❑ A check for $60.00 for residential siding.
Please call Stephen if you have any questions.
Th n you,
atasha Olany
Administrative Assistant
natasha[a renbuild.net