14 Garfield St demo 2018-07-26.pdfFile# BP-2019-0102
APPLICANT/CONT ACT PERSON NU-WAY HOMES !NC
ADDRESS/PHONE 10 WHITE A VE EAST LONGMEADovr ( 413) 563-0085
PROPERTY LOCATION 14 GARFIELD ST
MAP 17D PARCEL 064 001 ZONE URBU 00)/
THIS SEC)JON FOR OFFJClAL USE ONLY:
PERMJT APPLICA TIO. ..J' CHF.;CKLIST
ENCLOSED REQUIRED DA TE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
Typeof Construction: TO RAZE EXISTING HOUSE AT 14 GARFIELD ST
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
INFORMATION PRESENTED:
__ Approved-----¥ Additional permits requ
1
ir~d (see bel?w)
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
V: Demolition Delay
LilAJ
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 ofMGL 40A. Contact Office of
Planning & Development for more information.
RECEIVED
JUL 2 4 City of Northamp n
Building Departm nt
212 Main Stree
Room 100 DEPT OF BUILDING Northampton, MA O 060 NORTHAMPTON
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 PropertyAddress: This section to be completed by office / c; {::f olFt'e !cf' ~-r, Map __.f ........ 7 ___ Q_ Lot Cf.J2c:/ Unit. ___ _
Zone------Overlay District,..._ ____ _
~----------------------E-,lm St District _______ CB District. ____ _
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
Name (Pri
Signature Telephone g.
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Official Use Only
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 + 2 + 3 + 4 + 5)
(a) Building Permit Fee
(b) Estimated Total Cost of
Construction from 6
Building Permit Fee
Check Number
This Section For Official Use Onl
Date Building Permit Number: ___________ _ Issued: _________________ _
Signature: ------------------
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK {check all applicable)
Replacement Windows Alteration(s)
Or Doors D D Roofing D New House D Addition
Accessory Bldg. D Demolition New Signs [D] Decks (0 Siding [DI Other [DI
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.
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
I, _.i..::iV:....:V'----Cc.,..:::.....:...n..:..,,.~q..· ~M .... ~=Llirt. ..... ,';;>.........::~~..-+-/<-0~""',f)_~' .,,__~ ...... ·: '-.'--. ~""'--·· ~-~-"""K,.,,..•L...,.-~§,c__' _____ , as Owner of the subject
property ~ I c:::'" ~
hereby authorize -----------------------------------------to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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.
jl Ji) -(,.»411/4'/ C \ Z:.,'? ( •
Print Name '\
Date
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street• Municipal Building
Northampton, MA 01060
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: ____________________ Est. Cost: _______ _
Address of Work: _____________________________ _
Date of Permit Application: ___________________________ _
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 FORAND 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 as the agent of the owner:
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
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:
l'l {i M' I /J r•··-,:'4£, :'It' l(J/ ~,~
(Please print house number and street name)
Is to be disposed of at:
(Please print name and cation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Addrs)
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.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as " ... every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house havii;ig not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office oflnvestigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in ___ (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
Revised 02-23-15
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass.gov/dia