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29-463 (2)
39 CRESTVIEW DR BP- 2011 -0264 GIS #: COMMONWEALTH OF MASSACHUSETTS 4vlll );Olpekc. 29-461 « 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 -0264 Project # JS- 2011- 000437 Est. Cost: $7000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HEARTWOOD CONSTRUCTION 043443 Lot Size(sq. ft.): 10018.80 Owner: STEIN LESLIE B Zoning: URA(100) //WSP Applicant: HEARTWOOD CONSTRUCTION AT: 39 CRESTVIEW DR Applicant Address: Phone: Insurance: P 0 Box 993 (413) 268 - 7484 0 WILLIAMSBURGMA01096 ISSUED ON:9/23/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL 1ST FLR 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 9/23/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck – Building Commissioner File # BP- 2011 -0264 APPLICANT /CONTACT PERSON HEARTWOOD CONSTRUCTION ADDRESS/PHONE P 0 Box 993 WILLIAMSBURG (413) 268 -7484 0 PROPERTY LOCATION 39 CRESTVIEW DR MAP 29 PARCEL 463 001 ZONE URA(100) //WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /J('3 A 5-67— Tvpeof Construction: REMODEL 1ST FLR BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 043443 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 9/231CC) Signa e of Building / ial 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 a a Building Department r= > SEP 2 2 29)OMain Street Room 100 Northampt 1, M f 01060 „ phone 413- 587 -1240 Fa413- 587 -1272 0 ° °.* 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 Map Lot Unit CEE E3 1>�l \/ Zone J E_ x � fJverla District 3 Elm $t. District . CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 3 5741a3 0L. CG Name;(P T Cu t M 'ling ddress� " �-4 a 1l M1 Tel hbfie / .n. ure p� 2.2 Authorized Agent: t/Lj� >r `►etil 6 Si l 4E76 0 iociG Name (Print) Current Mailing Address: 7i-143+ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 1.--/ (, d / (a) Building Permit Fee 2. Electrical ' S-00 (b) Estimated Total Cost of 1 Construction from (6) 3. Plumbing I { 4 Building Permit Fee 4. Mechanical (HVAC) I W f 5. Fire Protection 6. Total = (1 +2 +3 +4 +5) `"7 C��. Che ck Number l��P This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date , 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 — i n Lot Size r Frontage : ' _. I ? Setbacks Front i 1 """ Side L: i R:` L:' R:?_ .,._: , Rear Building Height i i i Bldg. Square Footage 1 "--- 1 % I i I Open Space Footage t ; % , (Lot area minus bldg & paved S i i s parking) # of Parking Spaces Fill: I 1, $ (volume & Location) t S s , 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:I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book P age; and /or Document #: N FW B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: 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 0 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) Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition El New Signs [0] Decks [C] Siding [0] Other [0] Brief Des n of Propo " �jL' 1u • - � /�1� uG" i _9 \ T Work: L �� -- li/ [_ � L w ! � Alteration of existing bedroom Yes 1/No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 1,/ No Plans Attached Roll - Sheet 6 a„ t e`ii for seWatac w. alifa -t dad ►ifii p a pi+ i..t ki Ic w ha: 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, /L-75-..L./y- ' .. / , as Owner of the subject property hereby authorize A S Cwt �-- to act on m half, in e tive to orized by this building permit application. .�. L �('Tw��Sr,tZ� ,`?910 Sig . ture .f Owner �-_ Date I, AP--111 ( . 3 t, {a-_ , 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 O lb.. li t ( N ors l Z2— / 2 a Signature o Owne • ent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction uper i : r ( � Not Applicable ❑ Name of License Holder : . i'^ Stu! k p f1 It l-� IZD 1 ©. ! ! 3 w i A Q1 C 16 License 45 Address Expiration Date al s...-.4.1t,- 413 1 -rzt-821- -3 q£4. , -ao 1 I Signatureephone 9; a ulster i d fait e. Jii a6feTti 8t11r ;1Ril ct{' 1'µ' ' it 'rz - u Dom .Srirc Nv l coo 56 Compan Name Registration Number r�z c---, _S~I LEI E 6 f gl ' 12 Address Expiration Date L : 1 _ .dV C,, Telephone — SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M,G.L. c. 152, § 25 C( 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 buildi permit. Signed Affidavit Attached Yes No ❑ � >r r� I ton The current exemption for "homeowners" was extended to include Owner occupied Dwellings 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 7 . , . The Commonwealth opfassachusetts Department of Industrial Accidents Office of Investigations • • 600 Washington Street i• ME. -# . Boston, MA 02111 • - , www.mass.gov/dia --. -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A • • licant Information . Please Print L • 11 On/Indivi al. ' r (nay Name (Business/Organizatirinap: I 1 I a__ G u ;_5 Address: Oct NI As . t - C - 81. LA— 12131, T•C) , GO1Ct93 - A_C109b 3 t 26 g -7 City/State/Zip:VO ILLA.0\1'15ZUVrec:::511/1$ Phone.#: 1 1 . 1 , v • i ttri l— Are you an employer? Check the appropriate box: S Type of project (required): " 1. 0 I am a employer with 4• 0 I am a general contractor and I 6. 0 New construction have hired the sub-contractors ___ employees (full ancVor part-time).* listed on the attached sheet 7• 0 Remodeling 2.1.N I am a sole proprietor or partner- These sub-contractors have ship and have no e.wloyees 8. 0 Demolition engi and have workers' - . working for me in any capacity. 9. Er Building addition [1\To workers' comp. insurance required.] 5. cl We are a corporation and its 10.0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have 4xercised their . 11.0 Plumbing repairs or additions myself [No workers' comp. Hen of exemption per MGL 12.0 Roof repairs . insurance required.] t c. 152, § 1(4), and we have no 13.C1 employees. [No workers' other comp. insurance required.] • *Any applicant that checks box #1 mist also fill out the section below showing their workers' compensation policy information. - - t Homeowners who submit this afridaVit 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 sited showing the name of the sub-contractors and stain 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: • - Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City/Stafe/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 Sectiiiii 'ofMGL c. 152 can lead to the iiigiosition of Criminal penalties of a fine up to S1,500.00 and/or one-year impnsonxnenl as well as civil penalties in the form of a STOP woia_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 Office of Investigations of the DIA for insurance cOveraie - viiiliCiniciii - I do hereby certify under , e P ;:" and penalties of perjury that the informaion providetrithcive_iii I 0 , Signature: i-- -- , . i Phone ii: . • Official use only. Do not write in this ai ta 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 , S S f- • • Contact Person: Phone #: S. 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 iermits 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 I, 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 Address of work location HEARTWOOD CONSTRUCTION BcKtLf.)e---ex3(11-65101\1-c_.. -sarrENAGe.J., ;0 c ■---c or Noi T z c i I -+mot otL i=wc-6/Qc-c..„ 1 tadi-oGS REPLAQ/u t& k i Pct., T loth ),"lrs'ANI . T E /5tbw �t2 54 \0 1,t L 5t\aw ,. - V - AZ DR" k\ 1 T3‘ 1... 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