Loading...
38B-105 15 MUNROE ST BP- 2012 -0052 GIS #: COMMONWEALTH OF MASSACHUSETTS Map-Bloc 38B - 105 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: EXTERIOR STAIRS BUILDING PERMIT Permit # BP- 2012 -0052 Protect # JS- 2012 - 000079 Est. Cost: $1500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WILLIAM CONZ 13783 Lot Size(sq. ft.): 12022.56 Owner: CONZ GLORIA M Zoning: URB(100)/ Applicant: WILLIAM CONZ AT. 15 MUNROE ST Applicant Address: Phone: Insurance: 30 OUM DR (413 ) 265 -4920 HOLYOKEMA01040 ISSUED ON. 7115120110:00:00 TO PERFORM THE FOLLOWING WORK.- Install rear exit stairs (2nd means of egress, 2nd floor apartment) 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 7/15/20110:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 f OOM pgg phone 413 - 587 -1240 Fax 413 - 587 -1272 s APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DE MOLI A IL DWELLING _SECTION ' -1 - SITE INFORMATION JUL Thk section to be comple ed k V office 1.1 Property Address WR ©FSUILO NG iNERnOTIoNS -7 orr raat3toen / /K1� Map - Unit ,, /a r Zone Overlay /�'� Distnct q Efrn it District CB- District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Current Mailing Address: Telephon Si a ure / 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS S t? a Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building PennitFee 4. Mechanical (HVAC) 5. Fire 4 4eciion c7 O 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Onl Date Building`, Permit Number: Issued Signature: 7 �/ Building Commissioner /Inspector of Buildings Date s Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side R L R Rear I -- — •• -••p — — Building Height r Bldg. Square Footage % , t Open Space Footage % (Lot area minus bldg & paved _. p arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW 0 YES IF YES, date issued: z IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book = Page$ and /or Document #. 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 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 Q 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 E3 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [O] Other [�] Brief Description of Proposed / W ork: _AL - h r ')"4' �n C: 17 YJlsi -�i�r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. .if,New h�ti §e an 16 i�`aidditiorl�istmg4'a - nte�e, re..�oltc Wirii[: 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, , ► CA 4, ft ( 4 Z as Owner of the subject property ,_, 1, hereby authorize . ' 12, VA _y ( p o -7 to act on my behalf 'n matters lative to wort c uaua thorized by this building permit application. ig atu o Owner Date I, , 1 Lq LAI 4 7� 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. On Print Name /l Signature of Owner ge Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder : ��� j � License Number Address Expiration D to ignat a Telephone 9 Rectsfeyed=Elc�me Irinrorretrfent Ciantractor . r .. _. .:.s x _.. Not Applicable ❑ Co p ny a Registration �� N tuber Address Expir tion Date `' Telephone c�b� 7 /Q 0 SECTION 10- 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 issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 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 Signatur f r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston, MA 02111 ,• ' www.mass gov/dia -Workers' Compensation Insurance Affidavit: Builders/ Cont ractors/Electricians/Piumb.ers Applicant Information Please Print Legi Name ( Business / gmiiation/Individual): I �,1Nj O 1� e Address: 5 d t >y Y1 D f u/-P City /StateJZip: Z lol P ' IV&4 Phone. #: 01 `7 y Are you an employer?. Check the appropriate'boz: . -Type of project (require];:ons 1. I am a employer with 4 .. E] I am'a general contractor and I employees (full and/or part time). have hired the sub- contractors 6. Q New construction I am a sole proprietor or partacr- listed on the attached. sheet. 7. ❑ Remodeling ship and have no. a loyees These sub - contractors Isave .8. Demolition worlang for -me in any �?loyees and have workers' ���'. _ ..9(No e�orkers'..comp i�tnaact El requirea hod ] meowner doing all work 5. Q. We are a corpoiation and its 10. ❑ repairs or officers have ercised their Plumb' mg r epairs or 3 I am f : x 11. myself [No work orkers' comp. right 6f exemptlori per MGL I2 E.Roofrepairs insurance required.] f c: 152 §1(4); and'wehave no employees. (No '- . 13.0 Other comp. insurance required.}. 'Any appGeanE Shat checla box l must,also fill out the section below showing d cirworl=' corapensatian Policy i�armatiom t Homeowners who submit this affidavit.indicating they are doing all work and then hire outside contractors must submit a mw affidavit indicating such. IConvactors that check this box must.=,ched an additional sbed showing the name of the sub - contractors and state whether ownot +those entities have employees. If the sub - contractors have employees, diey must Provide their. workers' eomp..policy number. f am an employer that tsprovidixg workers' compensation insurance for. pry employees Below is thepolicy and job •site information Insurance Company Name: . Policy # or Self-ins. Lic. A Fxpiration Date: Job Site Address: City /StafelZip: r Attach a copy of the workers' :compensation policy. declaration page (showing the p 9h number and uatton date . Farqure. to secure covers -: "" - ge. as recltrtred under $echvn °25A ofMGL e: T52 can lead to ffie iuiposrtiori of cririinI penalties of a fine up to $1, 500.00 and/or one.- year as well as civil penalties in the form of a STOP'T9 ORD£R and- a fine of up to $250.00 a day against the violator. Be advised that a copy of thus statement may be forwarded to t ,0ffi ce:of Tnvestieatrons ofthe bIA firr insurance `coy eras*e werifrcafion I do hereby certify under the p and enalties o periray :that the in ermattox rovrded av rr true _aaiLcurreat Si tune: ate• ✓. /'�' Phone#: 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): J. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #• 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 homeowner." 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 your), 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 ermits 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 tame: Date Address of work location A` °R ° CERTIFICATE OF LIABILITY INSURANCE /8 /2011YYY' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificat holder in lieu of such endorsemen PRODUCER CONMTACT Christine Sullivan NA E: Aquadro & Associates PHONE (413)586 -7373 'FAX. 'a E.&P - Exit), AIC Nol: (113)584 -0859 355 Bridge St., P. 0. Box 357 INSURER (S) AFFORDING COVERAGE NAIL tl Northampton MA 01061 INSURER A:Pref erred Mutual Insurance Co 15024 INSURED INSURERS: William Cone INSURERC: 30 Quinn Dr INSURER D : INSURER E: , Holyoke MA 01040 INSURER F : COVERAGES CERTIFICATE NUMBER:CL11780314 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF I POLICY NUMBER 1D IYY Y MJ IY YY GENERAL LIABILITY EACH OCCURRENCE $ 300,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES [Ea occurrence $ 100 ,000 A CLAIMS -MADE aOCCUR cPP0100595753 9/17/2010 9117/2011 MEDEXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 n GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 600,000 X POLICY PRO LOG $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ MIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION T R I STATU- O R - AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPAR7NERIEXECU7IVE F7 NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory to NH) E L, DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF NORTHAMPTON NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE C Sullivan /CMS ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD 0 N a O a N .. m E o � a I C7 Vol o -- -- - -- — - - - - - -- - -- - - _ _, 71 w !D Jl� 3 rntn N V 3 p A P -7- OP p _ ° � D m n � P 7 I A. DO r I - -�- -- I - -- -- - - - -- - = -- ��_ - - - I -LL -- 1 I f' j Jl :saznivaa IeuonlppV .5uzliama :snlulS ) /jlQmQ/IuVaun AV :Xj ililn/SjlligtxisaQ/uoil,ipuoD :uot�euzxOul uo!l!ppv owes :xoixa�xgJxoixalur pooO :uoilipUOD PaisAtId If :aprlt) Xlgvno HO :adfZ Iona 10MAk IOH : uzals/CS 2u11 aislag : D/v IuxluaDAP914 :s2uiuodO /sjmjS £ $ s� 6 £ 0/0 aauldaxia IulpW z G s e 6 e e £ I/ I : sBuivadO /slou1S GL oogdo u,4 �uivangpoom 0 X 0 :taxy uotlUaxaa-a Iuouiasvg v 0 X 0 BUTAI - I I u auxasug pausiu 3 36 se 171 t1£ :EaJV OuiAY'I IeIo.L LOL I TOW x oola punoi J � 0 :uaxV patlszuUun 3 L� soisagsy : sjjv,�A xoixalxg : su;tg lIn3 dJ 88 8 d e S : suzooxpag a oG I I :suzoo-d ItjoZ 17 i 1 Iln3 :�uauzasug ugun :ail�'d z :IgWiaH AJO S 0061 :1I1ng .iooA fgUO!TUQAUOD . gala�iS �uiplmg UOTIvuuojul OuillannQ ;I oL 9£L :91ud paaQ 501 - ld rpling ZZS i =Moog paaQ £ :sIiun 2 UiAi'I# :puuZ 01 :poouxoq�?pM IS WdNI1W S :uoilBao - zssass'v :OuiuoZ I00 :Io ) [oolg - dLW IuowssassV 5uiuoZ - uoil Vao - 1 - Iaand 1 I` pxe� aauazala�i apo� uo�ua�!ssul� ,J, a oad 4-310S WON D PJOaa� �jjad:O -ld PlO u.ap!Sa- :V `uOl w ���7 pelo(I lilxadoxd VW `uojduzvxoK uoTlt ou uoiltuTZojuT ou znd aotad # �.tuTaad a�uQ �ipilu� aolad add 1, a��Q OJuI ituzlad ojul saiuS uOIJLUTIOJuT uopmuuojuT ou ou i © an � sazo add peo�aax�s ad�iZ a5ea.zoV OOb 0 0�6 T � i rJ2T P�J ZaziS I aziS aua� � ad�.L a }iS u OTILUZZOJuT OOL 09 T Z i 0 Z i auT11d ou �OS adtZ sat�ti ?�fl adXjL food arenbS ojul Buiplinglnp u173Q Puu'I :(N/A) PaiapouzD - U Tug I tl ojo,immij uadp :(N/A) palapoWO -d uagaliN TTozod ourei j uadp 0 :palopouza2l Juak TTo.Tod ouipil uadp :UiuQ oullopownd an aurea3 f.TOls aup L OTS Quo ! 0 X 0 :Luljl, auois —11 `LTols PuZ l is I 15morl 0 X 0 :uzTJ,L �lai�g Z 3O Z Ar(I ploCl Xlzadoxd VIN `uoTdtuugpON REQUEST FOR MODIFICATION FROM BUILDING CODE I, William J. Conz, hereby request a modification from the building code as allowed by section 104.10. I am asking that the City of Northampton waive the requirement for control construction at the premises located at 15 -17 Munroe Street, Northampton because the work being performed (construction of second floor egress) is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Date: July 14, 2011 William J n OF -