31A-200 BP- 2011 -0329
GIS #: • COMMONWEALTH OF MASSACHUSETTS
liA - 200 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP-2011-0329
Project # JS- 2011- 000540
Est. Cost: $75600.00
Fee: $453.90 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11238.48 Owner: POSTEL ROBERT J
Zoning: URB(100)/ Applicant: POSTEL ROBERT J
AT: 44 WASHINGTON AVE
Applicant Address: Phone: Insurance:
44 WASHINGTON AVE (617) 669 - 3680 0
NORTHAMPTONMA01060 ISSUED ON:10/13/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN,REMOVE
WALLS,REPLACE BEDRM W /2ND FLR BATH, REMODEL BATH
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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/13/2010 0:00:00 $453.90
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0329
APPLICANT /CONTACT PERSON POSTEL ROBERT J
ADDRESS/PHONE 44 WASHINGTON AVE NORTHAMPTON (617) 669 -3680 Q
PROPERTY LOCATION 44 WASHINGTON AVE
MAP 31A PARCEL 200 001 ZONE URB(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 NO V ∎3 , b 0
'�' ■3
Typeof Construction: REMODEL KITCHEN,REMOVE WALLS,REPLACE BEDRM W /2ND FLR BATH,
REMODEL BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
iti , n Dela
Se 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.
City of Northampton � ,�
Building Department T. $� li , 41 _ .
212 Main Street
Room 100
Northampton, MA 01060
- phone 413 -587 -1240 Fax 413 -587 -1272 •
` ' � k
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
41F \,� / � \ , n QJ \ k\142- Map Lot Chit
W V r `f"
Zone " Overlay Distr c
Elm St District - GB. Dtstrict
SECTION 2 -PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 1 (1_
Rn'Jev ?QJif'_1 _ " YV�J'1 /1 ��
Name (Print) a Current Mailing Address:
y Telephone / ` 1 ) — L 6 e, 0
Signature t )
2.2 Authorized Anent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION C OSTS
Item Estimated Cost (Dollars) to be Official. Use Only
completed by permit applicant
1. Building 4 2 ( (.).Building Permit Fee
2. Electrical C (b) Estimated Total Cost of
C� (3 �> Construction from (6)
3. Plumbing U b Building! Permit Fee
4. Mechanical (HVAC) t Li s
5. Fire Protection 1 } J
6. Total = (1 + 2 + 3 + 4 + 5) ' S I (� C� f� Check Number • to
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissionerllnspector:of Buildings Date
/ _
4
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 l 1 1 ! 1
Frontage ! 11 I I F
Setbacks Front 1 1 ) I I I
I
Side L:= R:I I L:I _. R I I i
Rear 11 ( 1 1
Building Height € I I
Bldg. Square Footage 1 I I I% I I I =
Open Space Footage �--� % ,
(Lot area minus bldg & paved F J 1 I
Pig)
# of Parking Spaces
1 ( f 4
Fill: r - _'
(volume & Location) -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book 1 I Pagel and /or Document #1
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued: ; i
C. Do any signs exist on the property? YES 0 NO i)
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location: E
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,
SECTION.5 -. DESCRIPTION OF PROPOSED . WORK (checkatlatiblcabte)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [1:31 Decks [C] Siding [CI] Other [GI
Brief Desciiption of Proposed r
Work e l o ( c.tc. r" 1 ` bvc4,1 t } -e.■� L" � �L be ��`C c, c� `re-m c , k k e t`1
Alteration o emsti b room —I Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes -4 No
Plans Attached Roll - Sheet
s �ti� a a y ,�>r�-.... ..- 3 * � k '� ^ - �, r � s _.�• -"T.�c Y � •t _
S i ". ei.� Q �r and` Or Vft�} iWifotI i tilreetit efti OiiIf :
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,' UT ORIZATION TO BE COMPLETED WHEN r
OWNERS AGENT OR CONTRACTOR APPLIES: FOR' BUILDINGPERMIT
I• , 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
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.
go S
Print me
ignature of Owner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
e air# e� �nme: �tr�vei�ert'btiicfOriaES.a..a ,;IS Z,.,�ti_ ...,. _ ::. �u�
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-.WORKERS' COMPENSATiON INSURANCE AFFIDAVIT (MG .L. c. 152 § 2
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 'IEf No ❑
The current exemption for "homeowners" was extended to include Owner- occupied Dwellines of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature V... 01\ Q
,
• - 7
• , ,
The Commonwealth of Massachusetts •
Department of Industrial Accidents •
Office of Investigations
600 Washington Street
1...,S1111i1=e e's? .
t •=t;:gr=r, 4 Boston, MA 02111
.,.....
; -=
: .
www.mass.gov/dia .
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
‘ i
Name (Business/Organization/InclividnAl): \.., C. CA" V R
Address: 1 4 ‘--4 \A/ c,c\A` A
1 I , < 1
City/State/Zip:W 0 1- , N\ \ i\ - W\ 0 u f J 6ePhone.#: 1 — I 6L-7. -
Are you an employer? Check the appropriate box: •Type of project (required): i
1. 0 I am a employer with 4. 0 I am a general contractor and I
6. D New construction
have hired the -con ors
enTloyees (fall and/or part-time).*
listed on the attached sheet 7. 0 Remodeling
2. 0 I am a sole proprietor or partner-
These sub-contractors have
ship and have no e These 1:=1 Demolition
employees and have workers'
working for me in any capacity. 9. Q Building additiOn
# "
[o workers' comp. insurance
5 0 We e a corpoiation and 10.0 Electrical repairs or additions
. ar its
3. 8, I am a homeowner doing all work officers have .exercised their .
11.0 Plumbing repairs or additions
right of exemption per MGL
myself [No workers' comp. 12E Roof repairs . •
insurance required.] t C. 152, §1(4), and we have no
employees. [No workers' 13.0 Other_
comp. insurance required] .
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnzttion.
t Homeownera who submit this affidavit indicating they are doing all work and than 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. lithe 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:
• •
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 bilker Section 25A 'OfMGL c. 152 can lead to the imposition of ciiminaj penalties of a
fine up to S1300.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $25000 a day against the violator. Be advised that a copy of this statement may be forwarded to the Of6ce of
EV �f the DIA for insurance coverage iraifiCtiiik. i -------- . ,7:17. - 77
filo hereby certify under the gains and penolfiPs of perjraythat the infermationproviiiiaboveiiiid.TiOiTert.
•
Si. ..ture: \t ----- If , a .ii- 1 6 Q 0
Phone #:
-
Official use only Do not write in this area, to be completed by city or town'OfficiaL
• City or Town:
Issuing Authority (circle one): •
.- Permit/License #
,........______ . .
:1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical _Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #: ' .
•
• 5
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
jermits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
? C;1 understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to
Date 1101Q/ 0
Address of work
location 4-1 '1 4 \'V G. �� \ "�v\ S� - ✓ � -
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