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31A-113 1 4 - 1 ' .• I I < , ! _. ez 7 42" ,,-; i 2 , { " _. 24 1 , 50" . . , 1 , , 14 . 1,, 70 , I/ 1 , /1 .._. ..... 4) „,„..., 11 1 1 W2418BD WI 536-R W4236BD ---t- I ---- ---AV640 i _...... ---- . --„ BEP032 .- 24ANGE ! 41.)E321 SB24E3D 24.D1:Lz31-IVY 4CDB24 1----1 . 1 1 I cut BFP3 to 2 1/2” extend stile on SRB24 1.5" on right All dimensions size designations 2 0 This is an original design and must Designed: 8/16/2011 given are subject to verification on i ECHNOLO3IE5 ,,,,ei not be released or copied unless Printed: 9/16/2011 • , , 1 y_ \ job site and adjustment to fit job applicable fee has been paid or job ,i ,,,, conditions, order placed. - . 7 ,{, ; IL,/ i ' . [ eb d n tn bgs res 8--1 All Drawing #: 1 LNo Scale. ola baroig161 1 L,' ti. .c, 1 G C, / - ,k- 44 11 ( , an_ i / ( 1:-Z / ' -- / ", ...- ":A....L: k` -- • ___ _ --=-1 --• ' 1 \ — 1 1 1 ■ , ' ! 1 I MI 'L.. Or— 1 ---- D 1) 0 1) CID c- _ _..... \\ -Clii-3 — ---------- - 1........... --------------------- mil I I n E ma ,----, 1 . 1 ' 1 / 1 -=-_-_=. , - --:-.7- --- , --------- ' 1 tlil 7 , e,-_,n ' I i F___ _ _ 1 . ------___ ---- Note: This drawing is an artistic 20 i Designed: 8/16/2011 interpretation of the general TE,AOLOGIES ,,A Printed: 9/16/2011 . appearance of the design. It is not meant to be an exact rendition. eb dolan barton biggs res 8-16-11 i All Drawing #: 1 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 p_ro_cess 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 permits- in- -conjunction_to_the..build Termit issued,_and_ 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 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. n� +o Address of work location • • The Commonwealth of Massachusetts Department of Industrial Accidents = i - ' fl Office of Investigations ., w.�,... - rte t. 600 Washington Street . Boston, MA 02111 www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 7 m 2}o,( X4'1 G -e✓1 ea A � on iiiiic7Fe) Address: 2 0, 00,/ 45-7 City /State/Zip: G lit z ) /off A. 0 /O /z Phone #: '//3-- 297- 5'6q Are ou an employer? Check the appropriate box: Type of project (required): i` 1. [ I am a employer with / 4.. 0 I am a general contractor and I 6. D ew construction employees (full and/or part- time).* have hired the sub-contractors L - " , i( 2. El I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have. no P^Tloyees These sub - contractors have. g. 0 Demol on_ working for me in any capacity. employees and have workers' Y P ty 9. 0_ Budding addition [No workers' comp: insurance comp- rasurance= required ] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am-a homeowner- doing - ll- work 9 cer _ha ex ercised their_ —l-1:0 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. 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 information. Insurance Company Name: A/ 4l4 /21 ✓ / ✓u / ,..-/ . Policy # or Self -ins. Lic. #: 6✓ 2 - 3/5- 3`Z /q? 0 // Expiration Date Nu y 2 6 Zo/ , Job Site Address: ¶0 VP4 hDn f7". City /State/Zip : - itAv le i,„ ,4lG o 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 $1500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fmQ of up to $250.00 a day against the violator. lie 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 acid penalft s ofperjury that the information provided above_isirue_and_corr-ect S ignature: Date: Phone #: f Off/cirri use only. Do not write in this area, to be completed by city or t official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical _Inspector 5. Plumbing Inspector _ 6. Other Contact Person: Phone #: s SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : , /D N'1 4 5 --- 00A. --- 00A. Mvt/ e5 3 ` Gj c2 S �j License Number ?0. 0 OJ 021 6Ataste (tA /e4i A. oioi2. _ /02-8-/1 Address Expiration Date cam* #10-- I��'� � `//3- d91-576N Signature Telephone 9..,Registered Home lnrproveementCdn #ra or . t,,. , Not Applicable ❑ 10i14 Dort a,,v 6 ne A t!oh 14, c-_ /019 o 0 Company Name Registration Number 7. v, •vx al- 9.- 21 - /2- Address Expiration Date GhPvet fte // 0. 0 /O!? Telephone `// SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL. 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 buii ' g permit. Signed Affidavit Attached Yes No ❑ Ii -, i31C1 e , 8 1 - etein 4, ` hon The_current_exemption for "homeowners" was extended to include Owner 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 ort amp on it ■ tna c - , ` .te >✓5cal` _ . . � _ - s General taws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [D] Other [ !r Brief Description of Proposed Work: ??,• ,e1le4 6thvi671 lisinld L°X /v9ky Xoly" Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a If New house and or. adciitronfio'exisfi. lci housrnq, complefie, #tie owing: 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 , 1 a as Owner of the subject property OVA hereby authorize to act o If, in all matters re - ' work - • •rized by this building permit application. Signature of Owner Date — .— / I , d /Y1 D•1 K/ 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 Na e Signatu e of Owner /Agent Date P 4 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inco Information Existing Proposed Require by Zoni o, This co n to be fill i 4 , !1 Buildin epartment r r ' Lot Size Frontage _ . Setbacks Front " Side L: ___ R:____ ___ L ____ R:__ Rear Building Height Bldg. Square Footage -" € Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces ------- °` Fill:_ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page 1 and /or Document #AFµ__ _ ... 3 B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 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 property? YES 0 NO 0 IF YES, describe size, type and location: - " - --- y 3 — D. "� re ty re any proposed c anges to or a rtions o signs inten ed-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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t D • ,v ity of Northampton uilding Department Ga�reway Feri% 212 Main Street Sew er1Sept 6,iii l�ab�l + ' �� i .a x� Room 100 ate ; eta-vats t i fix; h t F R`,A4� . ort ampton, MA 01060 tee+ r. - :7 - 1240 Fax 413- 587 -1272 A TtJ l s a IO i- 4 C�ti1P Sped+ V* 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 So "'enon s r Map Lot Unit A/o g N^/i tOv1 Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 • _ er of Re ord: 4144' igr _ _ hy, 1"- P__ Llnq V\A-- N. ) Current Mailing Addres / V • , , (6— Telephone _ G e Signature (/// 2.2 Authorized Agent: Owt �o <Mt.) Giag t og 4 /07k, 7O• ?Ox o`1 GA '5A i/e /J Name (Print) Current Mailing Address: C ✓ // ? - 2 97 — 5 z / 7 Sign / r e Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building "Permit Fee 2. Electrical fP w (b) Estimated Total Cost of qd (9 Construction from (6) 3. Plumbing Building P Fee 6 4. Mechanical (HVAC) 5. Fire Protection. 7677 6. Total (1+2 +3+4+5) 89 77 ° ‘ 1 Check Number 7 / gq L6 This Section ForOfficial Use Only Date Building Permit Number. Issued: Signature: Budding Commissionerlinspector of Buildings;= Date File # BP- 2012 -0476 APPLICANT /CONTACT PERSON THOMAS DOLAN ADDRESS/PHONE P 0 BOX 297 CHESTERFIELD (413) 585 -0612 0 PROPERTY LOCATION 50 VERNON ST MAP 31A PARCEL 113 001 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 �`J Fee Paid ` � 7 5- Typeof Construction:_REPLACE KITCHEN CABINETS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 039281 3 sets of Plans / Plot Plan THE FOL : ` NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON .: 0 '. 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 I)PW 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 . gnature 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. 50 VERNON ST BP- 2012 -0476 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 113 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0476 Project # JS- 2012- 000789 Est. Cost: $8877.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS DOLAN 039281 Lot Size(sq. ft.): 1 1238.48 Owner: BYG BARTON & JAN WHITAKER Zoning: URB(100)/ Applicant: THOMAS DOLAN AT: 50 VERNON ST Applicant Address: Phone: Insurance: P 0 BOX 297 (413) 585 -0612 0 Workers Compensation CHESTERFI ELDMA01012 ISSUED ON :11 /15/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE KITCHEN CABINETS 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 11/15/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner f