Loading...
13-007 44 COLES MEADOW RD BP- 2010 -0944 GIS #: COMMONWEALTH OF MASSACHUSETTS MV 13 - 007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: B UILDING PERMIT Permit # BP- 2010 -0944 Project # JS- 2010- 001403 Est. Cost: $1000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin MICHAEL HOLDEN 03687 Lot Size(sq. ft.): 40772.16 Owner: KIPP FRANCES R & PETER 7 Zoning: SR(100)//Pd Applicant: MICHAEL HOLDEN AT, 44 COI -ES M_ EADOW_R_D Applicant Address: Phone: Insurance: P O BOX 721 (413 ) 634 -0200 NORTHAMPTONMA01061 ISSUED ON. 4/29/2010 0.00:00 TO PERFORM THE FOLLOWING WORK.- RENOVATE BATH /LAUNDRY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: �1 Footings: Rough: 5- I _ j L+ ough: '� / C�" / c. House # Foundation: Driveway Final: Final: � � � 0 ( Final: ' \ p Rough Frame: 6 V Z1 �° �� t �l o� ' �d Gas: Fire Department Fireplace /Chimney: r Rough: Oil: Insulation: W Qq I D Final: Smoke: Final: ok b - /6 _ /Q C - ArAl— THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REG LATI S 0 444 #a Certificate of Occu anc i nature FeeType: Date Paid: Amount: Building 4/29/2010 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0944 APPLICANT /CONTACT PERSON MICHAEL HOLDEN ADDRESS /PHONE P O BOX 721 NORTHAMPTON (413) 634 -0200 PROPERTY LOCATION 44 COLES MEADOW RD MAP 13 PARCEL 007 001 ZONE SR(100)//RI 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: RENOVATE BATH /LAUNDRY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 03687 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 ,�.c.. + 2, 60 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 of MGL 40A. Contact Office of Planning & Development for more information. City of Northampton Building Department` APr� n 2 1 2 010 212 Main Street` Room 100 Northampton, MA 01060 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 Property Address This section to be completed by office L�`t - Unit /1�a ,yL�a..� r � , '04e;.' Za o DYerlay pistrict EkirSt Dlstilct CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record J Name (Print) Current Mailing Address: i ✓,,* - A w . -1 Ake.'- bir, Cto 1 %22 kg" Telephone Signatu 2.2 Authorized Aaent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed b ermit applicant 1. Building (a) Building Permit Fee S'ooa 2. Electrical �' /aoa (b) Estimated Total Cost of Construction from 6 3. Plumbing ,�(� Building Permit Fee � aao 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5 ) /a Check Number 91 7 0 This Section For Official Use Onl Building Permit Number. Date 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 Lot Size Frontage 4 Setbacks Front Side L: 'L6. rA R: i L: R: - -�-- -- Rear i Building Height -- t Bldg. Square Footage % �-- — Open Space Footage (Lot area minus bldg & paved v _p -kin g) # of Parking S aces Fill: volume & Location A. Has a Special Permit /Variance /Finding e r been issued for /on the site? NO 0 DONT KNO YES Q IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW YES 0 IF YES: enter Book f PageF 1 and /or Document # " B. Does the site contain a brook, body of water or wetlands? NO k*) DONT KNOW 0 YES 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 NO 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 IF YES, describe size, type and location:__ 8 E. Will the construction activity disturb (clearing, grading, exca tion, 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 (check ail applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [0) Other [CA Brief Description of Proposed [[ /� ) Work: � " s,,,ti G ; A L t3 .44 A / �(� G r,G./r ti / '11011 / 7 i Sr K Alteration of existing bedroom Yes V" No Adding new bedroom Yes � No Attached Narrative Renovating unfinished basement Yes _Z Plans Attached Roll - Sheet /' -s Gs ; d bM / A Ara/r: 1 / es .r ��: /t r.. / dr , 77. Yn 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:, OMPLETEV WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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. Print Name Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION 'SERVICES 8.1 Licensed Construction / Supervisor , : n - � � Not Applicable ❑ Name of License Holder �� (� YC y 1 r /� r " ) `✓ 7 License Number Add s i ( l i Expiration Date Signature Telephone 9 ReaIsfr�tt�otr�nr Not Applicable ❑ Company Name Registration Number K Cl/y- G 1 06 t 2 - 1 - 1 2- Address r Expiration Date Telephone V 3 0 2L SECTION 10- W ©RK6RS' 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 buildi g 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 Signature The Commonwealth of Massachusetts Depa of Industrial Accidents - Office of Investigations _ 600 Washington Street Boston, MA 02111 ' www massgov/dr'a -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumb.ers Applicant Information Pleas Print LegjbIy Name ( Business /organization/Individual): Address: City /Sta&zip: "9-` " Pone. #: Are you an employer?. Check the appropriate - box: Type of project (required):_ // 1. [] I am a employer with 4.. [] I ama general contractor and I layees (fan and/or part time). have hired the sub - contractors 6. [] New construction 2..E I am a sole proprietor or partner- I one.axtached sheet 7• 2'lmodeling ship snd Have no =4ployees These sub -contr ctors have. .8. ❑ Demolition wor ' for me in an employees workers' - y �P�3'• 9 Q Buili� [No workers' Comp. insurance required.] 5. E We are a corpoiation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers havexercised their 11.[] Plumbing repaizs or additions myself jNo workers' comp. right of exemption per MGL 12.[3.Roofrepairs m5urance required j t c. 152, § 1(4), and we have no 13.[] Other employees. [No workers' comp. insurance required j. 'Any applicant dtat checks box 911must.also fill out the section beiawshowing tbeirworkas'. compeasatim policy infwmafiot: t Homeowners who subnut this afftdavitindicating they arc doing all work and then hire outside contractors must subtait a new affidavit indicating such. :Conteactors that check this box must attar hed an additional sbeet showing the name of the subcontractors and state wheel= or not those entities have employees. If th e s ub - contractors have employees, they must provide their wmia s' comp. policy uumbar. Aram an employer that isproviding workers' compensation insurance for my einplgpees Below is the policy and job site information. Insurance Company Name: Policy # or Self =ins. Lic. #: Expiration Date: Job Site Address: CitylStafe/Zip: Attach a copy of the workers' - compensation pol cy deelarafion page - (showing the policy number and ezpiraizon date). Failure . to secure coverage;as regaiTed'unsler. Section 23A'ofMGL "c 152 can lead to Sze imposition of crimir I penalties of a fine up to $1,500.00 and/or one -year imprisonment;' as well as civil penalties in the form of a STOP WORK ,ORDER and a f m copy of this statement zna of up to $250.00 a day against the violator. Be advised that a y be forwarded to t31e Office of __ -_- InvesttPations of the brA foi insurance' coverage yerifzcation I du. hereby, reify `under the and enallies o . -_ —.— P P... fPerJur}' thatthecnformatwnrravuiedstbovP _rs�rur- andcnrre.__ Signature- Date Phone Offjcial use only. Do not write in this area, to be comp . d by Ci or town official City or Town: -- PermitUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City own Clerk .4. Electrical Inspector 5. Plumbing Inspector 6. Other F Contact Person: Phone #: s s r 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 awn 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 backfdl), 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 permits 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