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NEW WATER
i I
GAS SERVICE EXISTING
GARAGE
NEW
ADDITION i )
t-- , bb > r
O STUDIO /RECREAT1ON
o EXISTING 1 ROOM IN GARAGE
HOUSE l NEW ROOF *
4 WINDOWS; REPLACE
y j GARAGE DOOR WITH
DOOR AND WINDOW;
FRAMED FLOOR W/
PLYWOOD SUBFLOOR;
VINYL FLOORING j
_s Ae_arzt
I j APPROXIMATE
14\ PROPERTY LINE
t N
S -S8'
STREET
SITE PLAN
62 M 1 D D LE STREET
CONTRACTOR: STEPHEN YOSHEN
FLORENCE, MA 0 1 062 LICENSE #: CS 88490
OWNER: DANIEL TRENNER tut
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 pieessmoires 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
---- - - - - - pennits - conjunction_.to_theh ' 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 me.
— Date
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
_7 = Office of Investigations
_° r�Y®I= 600 Washington Street
[.f Boston, MA 02111
....... _ www.maz ovv/dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):
- Address: -
City /State /Zip: Phone. #:
Are you an employer? Check the appropriate box: Type of project (required): /'
1. I am a employer with 4., [] I am a general contractor and I
employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction
2. 0 I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
ship and have. no P' 10 gees These sub - contractors have. 8. ❑ Demolition
working for me in any capacity. employees and have workers'
Y P t3' $ 9. 0 Building addition
[No workers' comp. insurance
comp.- ;nsurance.
required:] 5. [-_-_] We are a corporation and its 10.0 Electrical repairs or additions
3. Q I am a-homeowner -doin -allwork — offer ,s_have xtzcise_d weir —14 [I Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 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 information_
t Homeowners who submit this affidavit: 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 sheet showing the name of the sub - contractors and state 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
_Lt ft ormation
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 under Section 25A of MGL c. 152 can lead to the imposition of criminal 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
of up to $250.00 a day against the violator. 13e advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
_ I do hereby certify under the pains andpena/tios of petjury that the infornmation provided abov_e_is_true and_correct._.__
Signature: Date: .
Phone #:
t - Official use only: Do not write in this area, tto - be completed by city or lown officiaL
City or Town: Perrmt(License #
Issuing Authority (circle one):
I. Board of Health 2. Buiidi -ng. Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _
6. Other
Contact Person: Phone #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
— License - Number
Address Expiration Date
Signature Telephone
9':::Registered>Home Im proverrient:Confiactor „ ,.. ,. = . -n,,, z .,F .« Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
_ 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" wasextended 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 l:iable 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
1 611 ampton • r e mane- , a e an' :- . . ° . • • i +: - . • - -its-General-Laws-Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House 0 Addition Replacement Windows Alteration(s) ❑ Roofing n
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I:2] Siding [0] Other [0]
Brief Description of Proposed
Work: t T PI v.) AcLi Td C xACif" .
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes N o✓
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a_ If New` house snd:6r..addi#lon'to existing hooustnq - 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?
i 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, /`.-- \ ` 1 ' ' ..* , as Owner of the subject
property f ,, r�
hereby authorize aXte 1 \ ^. L -\
to act • - y be - f ' • • rs relative to work authorized by this building permit appli -tion.
Si atureofO, -r � �ufm, Date
1, , 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.
i
Signed under the pains and penalties of perjury.
I
Print Name
Signature of Owner /Agent Date
5£E a 246I0v R-t,, Pet/0 R'
J
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 i ,; '" S"
Side L:1
. Fa R. .„ L:.�? Q._ R: 1. ?.; _._
Rear 2Z � ._
Building Height
Bldg. Square Footage r -
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces -•• -
Fi11: I
(volume & Location) --• ,.._ ---• __ ._
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 40 YES
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW i,�� 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 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the preperty? YES 0 NO 9)
IF YES, describe size, type and location:
D. Are there any proposed Changes to or additions oTsiins intended for he property ? YES 0 NO
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 p
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. A r A- Bp---0-$(),1
City of Northampton S of Pertlt 4 M
Building Department �C s�yPerttt
212 Main Street e tiS e c�a rlabrt
Room 100 a 4 y et 4 Or� � ' At� �I �_
— — —No thampt�AVIA111_060 , " y '1 4� t i s, - ' �i. :is ,,,A
phone 413 - 587 -1240 Fax 413 - 587 -1272 Pl ,_ � 1 -( a n s � t. r �t�k a
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE ORDEM.QUSI-[A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
a
6" t k)C J 1 "Map " Lo d Unit
Zone Overlay District
FrN t M
Elrn St District CB District
SECTION 2;- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
)ty � I c
Name (- C Mailing A�Idr s:_ _ D- 0 S
#. /y /
Ilia Telephone ir r
- - thoriz- • • gent:
5 66� , Name (Print) Current Mailing Address:
of Signature Telephone
SECTION 3 - ESTIMATED .CONSTRUCTIO COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
- _,_3, 1. Building ACM oDco 4 ! 00 (a) Building Permit Fee
2. Electrical (b).Estirnated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) A t�+nl�NR €0 1.0 Q
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Only
Date
Building Permit Number: .Issued:
Signature:
1 Building Commissioner/Inspector of Buildings::' Date
. •
•
•
File # BP- 2008 -0901
APPLICANT /CONTACT PERSON STEPHEN YOSHEN
ADDRESS /PHONE P O BOX 41 CUMMINGTON (413) 634 -5431
PROPERTY LOCATION 62 MIDDLE ST
MAP 23A PARCEL 057 001 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 O
Typeof Construction: CONSTRUCT 6 X 9 MUDROOM ADDITION, RENO KITCH /LAUNDRY, FINISH
ATTIC W /BATH, ENCLOSE & INSULATE GARAGE ' ig1) pom, : YwAY,
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 88490
3 sets of Plans / Plot Plan
THE Fe LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF '.' 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
Demolition Delay
/t 2A. J 0
Signature of Building fficial Date
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
.
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6 152 MIDDLE ST 11 BP- 2008 -0901
GIS #: COMMONWEALTH OF MASSACHUSETTS
ap:Biock: -057 gi CITY OF NORTHAMPTON
Lot; - 001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit # BP- 2008 -0901
Project # JS- 2008 - 001360
Est. Cost: $67000.00
Fee: $336.00 PERMISSION IS HEREBY GRANTED TO:
Coast. Class: Contractor: License:
Use Group: STEPHEN YOSHEN 88490
Lot Size(sq. ft.): 6795.36 Owner: TRENNER DANIEL & NOREEN
Zoning. URB(100)/ Applicant: STEPHEN YOSHEN
AT: 62 MIDDLE ST
Applicant Address: Phone: Insurance:
P O BOX 41 (413) 634 - 5431
CUMMINGTONMAO1026 ISSUED ON:4/22/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 6 X 9 MUDROOM ADDITION,
RENO KITCH /LAUNDRY, FINISH ATTIC W /BATH,ENCLOSE & INSULATE GARAGE,AMENDED
- ADD ENTRYWAY TO GARAGE
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 4/22/2008 0:00:00 $336.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo