24D-173 (8) 204 STATE ST BP-2021-1090
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 173 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit# BP-2021-1090
Project# JS-2021-001840
Est.Cost: $10000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL K DACRI 105989
Lot Size(sq.ft.): Owner: DANIELL DEBORAH
Zoning: URC(100)/ Applicant: DANIEL K DACRI
AT: 204 STATE ST
Applicant Address: Phone: Insurance:
247 RIVERSIDE DR (617) 543-2843 Workers Compensation
FLORENCEMA01062 ISSUED ON:4/2/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:EXTEND EXISTING DECK 5 FT
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. I j
• r • 5r''1 •
Certificate of Occupancy Signatu'e:
FeeType: Date Paid: Amount:
Building 4/2/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Z-0K
File#BP-2021-1090
APPLICANT/CONTACT PERSON DANIEL K DACR1
ADDRESS/PHONE 247 RIVERSIDE DR FLORENCE (617)543-2843
PROPERTY LOCATION 204 STATE ST
MAP 24D PARCEL 173 000 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: EXTEND EXISTING DECK 5 FT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105989
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
itgAll\es., , 7 /
Sign ure of Building Official 11 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.
' .
,, , �,
41d ` ..)
ga The Commonwealth of Massachusetts . 3 0 FOR
W
Board of Building Regulations and Standards <0497 7MUNICIPALITY
Massachusetts State Building Code, 780-0 1
' USE
Building Permit Application To Construct, Repair, Renovate.00001iski Revised Mar 2011
One-or Two-Family Dwelling ,„ ;,_;T./o,v,
This Section For Official Use Only
Building Permit Number: 4 ZI - 1 0 Date Applied:
ii ,•
oZ
Building Official(Print Name) Signature 1 to
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
how it, Sb , Nor p ad-ID - ns-03.-
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
ong District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
/� i /0 /0 ' // ,i 11 off ' 60''
1.6 Wate Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public Private El Checkif yes❑ Municipal E(On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.)4e0 0(l of � �4!J /7,��04,/l-00) /i'4 v,%a.6G�
Name(Print) City,State,ZIP
4I S-Mk 54 iil 3-'/5S Ny6 DEB,L. ;.d o, �l
No.and Street Telephone Email Address ,con
SECTION 3: DESCRIPTION OF PROPOSED7ORK2(check all that apply)
New Construction 0 Existing Building I2TI Owner-Occupied Repairs(s) 0 Alteration(s) Gel/Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units a, Other 0 Specify:
Brief Description of Proposed Work2: EX1-er,e1 'ii�f i, deck cif rcx i 1-or
e.dy. o ex� 1 j ho . Rec.r sic&, J /''
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /d 000 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier/9 a0D x 6;SO
3. Plumbing $ s 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression)
$ -- Total All Fees: $ 6 j de
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ )0} (XD 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS /act -4—a -
MN, 4C C) License Number 1 Expiration Date
Name of CSL Holder i /
a.q 3 p)iv j1L 1)r List CSL Type(see below) CJ
No.and Street Type Description
10 Y.eLiCE' ^^� O�Od�. U Unrestricted(Buildings up to 35,000 Cu.ft.)
V 1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
614-913•ag 13 7ANbAtQ•l & .-1A461,1.GOle\ I Insulation
Telephone Email address D Demolition
5.2 Registe d Home Improvement Contractor(HIC) I r p)-9 fir a
Dvt R L () HIC Registration Number xpir ion Date
C Compan Name orI�IC strant Name
0-Y i)/rs? `4. r do I4 r. '! Ma, .eao^
Nu.j�ttr _ ��/� !� L 6)^ , ,A 2-.)- 3 Er�ai ddress
City/Town,State,ZIP Telephone
SECTION 6: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 Issuan of the building permit.
Signed Affidavit Attached? Yes No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorizer q. 1)q( r I
ito act on m�behalf,in all matters relative to work authorizedtby this building permit application.
-betOrl art•\,L aUtiCiAititAi 3/2i01
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Dc- `'--J Oic.>;, 3 �� 1/
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK� PLAN
MAP:a j1b LOT: ) 3
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD 1/41
SIDE YARD /0 < ,. •444ccij- SIDE YARD /1�
FRONT SETBACK b
FRONTAGE
City of Northampton
o0.YH MPo ,� 15 � SI
?Y' Massachusetts ��?s
r ! ocAl�' / DEPARTMENT OF BUILDING INSPECTIONS
+'►_ ' •
212 Main Street • Municipal Building vd.., Ca
r y Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of :Facilit � 7c5
Y
The debris will be transported by:
Name of Hauler:
3a)
Signature of Applicant: Date:
, The Commonwealth of Massachusetts
n Department of Industrial Accidents
=i 01 tt I Congress Street,Suite 100
r �
s; , ��.= Boston, MA 02114-2017
`t."� www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansrPlumbers.
TO BE FILED WITH THE PI RMIITINC;AtlTHORlTl.
ttnlicant Information Please Print 1 t ihly
'J}
Nanit I Business Or unwtuon,tndtviduuil __. �C _ ___
Address: 1-44 E)AV5iiA, TY
CityfStatefZip:fM'►1 iVi OP•bv Phone#: )i-"rj L/z✓-_-)44-3
Are yen employer°Cheek the appropriate ton:
0 Type of project(required):
1. 1 am a employer withemployees(full aed'or pert tirt>r i.• 7. Q New construction
".0 I am a uric proprietor or partnership and have no employees working tar me in l. remodeling
any capacity.[Nu workers'comp.insurance required" GJ
30 I am a homeowner doing all work myself.[No workers'comp-iimran uce mowed.]'
9. El Demolition
4.0 tam a homeowner and Will be hiring contrac1urs to conduct all w ork on my property. I wdl 10 Building addition
enure that all t:rturartun,either halite wrrken'compensation insurance or are mule I la Electrical repairs or additions
proprietors with no employeea-
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hind the sub-contractors listed on the attached sheet. 13.EIRoof repairs
These sob-contractors have employees and have workers'comp.insurance.;
6.0 We are a corporation and its officers have exercised their nght of exemption per Mid_c. I 4. Oilier
152,f 1(41.and we have no employees.[No workers'comp.insurance required]
•
•Any applicant that checks hot al mist also till uut the section below show ing their workers'compensation policy information.
.Homeowners Homeowners who submit this affidavit indicating_they aredoing all work and then hire outside contractors must submit a new affidavit indicating sic h.
ICuntractors that check this boa must attached an additional sheet show in;;the name oldie sub-contractors and state whether or nut those entities have
employees. If the sub-contractors have employ Les.they must pro.,idc the it workers'comp policy number
I am an employer that is providing workers'compensation insurance for my employees. Below is de policy andfob stile
information.Insurance Company Name: EIA(tt 1 h5 C o, —
Policy#or Self ma.Lic.4: C. 1)•1 j 3� Expiration Date: ''/, ' l C3/1101
Job Site Address: aoci City;State;Zip: , ,/ t7� )
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required u L c. 152,*25A is a criminal violation punishable by a tine up to SI.500.(X)
andlor one-year imprisonment,as well civil 'naltics in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the vio . copy f s state nt may be forwarded to the Office of Investigations of the DiA for insurance
coverage ire lion.
I do her .y certify under r I nv dill rnrrlties of utyi that the information provided a ore is rue and correct.
Signature: Dale. 5 Z� )/
Phoned: 6/ ' 541 -— i'93
r
• Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License k
Issuing Authoriti (circle one):
I. Board of Health 2. Building Department 3.('it}il ossn Clerk 4. Electrical Inspector 5. Plumbing Inspector
(. Other
Contact Person: Phone 4:
3/28/2021 CkPl 't 9.--'
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1 REPORT THAT THE PROPERTY LINES SHOWN
HEREON ARE THE LINES DIVIDING EXISTING
OWNERSHIPS,AND THE LINES OF STREETS AND
WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE
STREETS OR WAYS ALREADY ESTABUSHED,AND • • N i5Y]E'• MAO'
THAT NO NEW LINES FOR DIVISION OF EXISTING • • r Y •
' 0 NAGryEiIC aE
OWNERSHIP OR FOR NEW WAYS ARE O' SHOWN. \\,\.\\\-• \\'\ \\\\\• .\ \\ , i. z
SURVEYOR:
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2 ETdI[f UNIT 3
BUILDING B VUNIT 1 - 2 PARKING SPACES
I i 0 \\ \ UNIT 3 - 12PARKING PARKINGSPACES SPACES
•
101UNI{ \ /
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LEGEND // /. /. \\ ,/ / / 7,
0 FOUND IRON PIN —6OCM'2YE SITE PLAN
• IRON PIN TO BE SET FENCE I STATE STREET CONDOMINIUM
PLAN LAND IN
A UNMARKED POINT
NORTHAMPTON,aF MASSACHUSETTS
PREPARED FOR
STATE STREET BABBOTT—BRYAN, LLC &
. .• ,•• NEW HARMONY PROPERTIES, LLC.
mr SCALE:I.010' JULY 7,200E
HARCID L EATON AND ASSOCIA EIC.
I REPORT THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY RRUSSEELL D REETESSIONAL LAND
0 235 RUSSELL STREET—H564-7999 ADLEY—MASSACHUSETTSIso)
WITH THE 197E RULES AND REGULATORS OF THE REGISTERS A1} Arndt hl.atanOaal.�nn 76(MA)
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