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18C-117 (4) 8 Allison St. Basement Main Suopart Beam UP IC04 g LIVING AREA 1018 sq ft 38 Allison St, Second Floor Bath pliteo pHank Bc, 2 Bedroom 3 22) (15' _J L 2 I I UP Under Eave Storage LIVING AREA 1018 sq ft 38 Aillson ist Hoor Ktchen BaTh Bedroom 1 e ('? ng L R ri" co , PC UP - LIVING AREA 1015 sq ft The Commonwealth of Massachusetts . _ Department of Industrial Accidents ' a ,- Office of Investigations • _ � -,- 600 Washington Street �=1= Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information n /� ( Please Print Legibly Name ( Business /Organization/Individual): MA r k a V'1 /� +" 1'1� Address: 46g 4 Rol. City /State /Zip: eel cl c 4 o�•:n j PI I) 01007 Phone #: 6/13) 2S 1- ..50J3 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 1 employees (full and /or part - time).* have hired the sub - contractors 6. ❑New construction 2.' I am a sole proprietor or partner- listed on the attached sheet. 7. Ig Remodeling ship and have no employees These sub - contractors have 8. ['Demolition working for me in capacity. employees and have workers' g any P Y 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 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 information. 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 fine of up to $250.00 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 coverage verification. s 4i; 4erePy Cori* is r the - - --: W no •es f oriury that the information provided ah ve is true and correct. /X_ . j) 4 1 11..,, s /g to Phone #: C/1 3) Z - SO 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: . ` SECTION 0- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I Not Applicable ill Name of License Holder ricirk GI Albcc,I,\+ cs 79413 1 162 A f^k C(31 PS) - B4(. (4'W in ( 4 / /2-3 /2 Address Fx pi Date 4.{ ( I/ 3 25 - j NS 9. Re•istered Home Imerovement Contractor: Not Applicable Li Company Name Registratiop NuTher Address Expiration Date giC NA Telephone 613) 23 SVC SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (11/I.G.L. c. 152. § 25C(6)) I 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 I Signed Affidavit Attached Yes Ell Nc.. . El i / . 11. - Home Owner Exemption and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts Definition of Homeowner: Person (mw�m�o�m:|oUm�vowhi���^�U�m�md,mm��vnvN�/�� structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. responsible for all such ork Perfornled under the building permit completion v[ the work for which this puni/ is issued. Employees for injuries not resulting in Death) o the Massachusetts General Laws Annotated, you may be liable for person(s) The undersigned ^homcovner''conilio, and assumes responsibility for compliance with the State Building Code, City ^[ Northampton Ordinances, State and Local Zoning LAWS and State of Massachusetts General Laws Annotated. Homeowner Signature - ^ . 1 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) I New House 7 1 Addition in i ReplacementRindows , Alteration(s) 15(1 ; Accessory Bldg Li 1 Demolition 1 I New Signs )01 Decks {El Siding [0) Other [01 I I Alteration of existing bedroom y Yes No Adding new bedroom Yes X N 1 6a. if New house and or addition to existing housin corA 1 0 Number of rooms in each family unit: Number of Batniooms I i rt. Is there a garage attached? 1 e Number of stories? 1 f. Method of heating? Fireplaces or Woodsloves Number of eac h i I g. Energy Conservanon Compliance Masschoct. Energy C)tripionce fowl .,:ltiached? 1 1 h. Type of construction ii I i. is construction within 100 ft. of we,tlancis? d'es No. Is construction within 100 yr. floodplain Yes No I j. Depth of basement or cellar floor below finished grade k. Will building conform m the Building ^nd Zoning wgukoicrw _____�. 11. Septic. Tank City Sewer Ptivate well CO water Suppiy , 1 SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN i I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I I, / (/ / l tO A.A i -I . as Owner of the subject 1 property ! 111,,k Alho t-d i, hereby authorize . 1 to act on my i half, in all matters r lative e wo! authorized by this building permit application. 1 C----1 -3A3/./D 1 Signature of Owner Oarc; PIONEMBEIMEMIMMEIMIMERIEt 1 1; , as Owner/Authorized 1 Adent hereby declare that the statements and information, on thc forrc application are tuta and accurate. to the best at illy knowledge 1 and belief. 1 Signed under the ut ins and penalties of pep rv. , / LA. i / 'e -P7",e74/P ,57 9/70 I Signature of O erlAoent . . I Section 4, ZONING 1 Aff Information Mit,: Be Crarnocted Permit Can Be Denied Para f rr; Incornocte Informt.tran Etc:I:Prod 1 toning Soil Front 1 3C 30 Roar A. Has a Speoat Perrnit/Vaiiance/Fin ever been issued for/on the site /\ �� /\ NO \_/ DON'T KNOW \�� YES `.� IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds': ,-� /� r"-',. ND DON'T KNOW YES �� �� \.) IF YES: enter Book Page and/or Document4 B. Does the site contain a brook, body of water or wetlands? NO X` e l YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained U 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 / \ NO IF YES, describe size, type and location: - =� ' `.. '`'� .�..' .= _ ` .` ..�, ,." ``�' . � that will disturb over 1 acre? YES / \ NO �x3 �� �� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. � ^ . ___ ___-- Building Department !Curb Cut/Driveway Permit f Northampton, MA 01060 ,, iwo bets of Structural Plans i I • , phone 413-587-1240 Fax 413-587-1272 iOtber Specify I I APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i This section to be completed by office 1 1,1 Property Address: ,, 3g Alli5on s-1. IVIap Lot Unit Eim St. District CB District . 1 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT , i 2.1 Owner of Record: 1 Name. (Price j ( l',1:itl;ng Acidrss . I i 2.2 Authorized Agent: 1 ... 4 04, ( 259 — 3-0/.5--- , 1 SECTION 3 - ESTIMATED CONSTRUCTION COSTS 1 !tern Estimated Cost (Dollars) to be Official Use Only I i completed by permit applicant 1 (a) Building Permit Fee j 22 060 1 2. Electrical I 2000 1-11- - 1 7- bt Estimated Total Cost of I 3 Plumbing 1 Building Permit Fee 1 5. Fire Protection . 1 -1 r i This Section For Official Use Only_ 1 Building Permit Number: 1 issued. File if BP- 2010 -1030 • APPLICANT /CONTACT PERSON MARK ALBRIGHT ADDRESS /PHONE 468 AMHERST RD BELCHERTOWN (413) 256 -1436 PROPERTY LOCATION 38 ALLISON ST ag59 / MAP 18C PARCEL 117 001 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 t � y� 7 �� ` 0 Fee Paid / y� (2 Typeof Construction: CONSTRUCT 14 X 30 DORMER (ADD 2ND FLR BATHROOM) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 079655 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 y l Signal of Building 0 Vial 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. • BP- 2010 -1030 GIS #: COMMONWEALTH OF MASSACHUSETTS 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- 2010 -1030 Project # JS- 2010- 001521 Est. Cost: $29600.00 Fee: $177.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARK ALBRIGHT 079655 Lot Size(sq. ft.): 9452.52 Owner: REDSTONE PAUL Zoning: URB(100)/ Applicant: MARK ALBRIGHT AT: 38 ALLISON ST Applicant Address: Phone: Insurance: 468 AMHERST RD (413) 256 -1436 BELCHERTOWNMA01007 ISSUED ON:5/25/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 14 X 30 DORMER (ADD 2ND FLR BATHROOM) 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 5/25/2010 0:00:00 $177.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 38 ALLISON ST BP- 2010 -0709 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 117 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- 2010 -0709 Project # JS- 2010 - 001054 Est. Cost: $17400.00 Fee: $104.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEPHEN M POWER 072399. Lot Size(sq. ft): 9452.52 Owner: REDSTONE PAUL Zoning: URB(10017 Applicant: STEPHEN M POWER AT 38 ALLISON ST f## rcztn Address: Phone: Insurance: 311 BRATTLEBORO RD (413) 648 - 9545 BERNARDSTONMA01337 ISSUED ON :2/8/2010 0 :00 :00 T9 PERFORM THE FOLLOWING WORK: ENCLOSE BREEZEWAY & REMODEL KITCHEN 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: j I ri/ P House # Foundation: „VP' Driveway Final: Final: Final: j `� /8 / • 1 Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: ©I< 6 2.3 1 to L.0(..‘ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy 61 - lilignature: t FeeType: Date Paid: Amount: Building 2/8/2010 0:00:00 $104.40 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo Version: 2.0 Designed on: July 2G, 2010 Beams /Joists Analysis and Design wwpn.org '� At How to -....../ @Trlflrr�fb Il y ��� Enter Data W • �°SefU Girde t Joist or Rafter , l'iii : Member # B -1 Member Beam or at 1 =�aqr r Location : Floor 1, Area A Repetitive Use 7 .r�5 Nominal Size : ( 2) 2 x 10 Incised f or nt PT : No gy a Species = Spruce Pine Fir (South) Flat use ; No _..DI,men3.. -- -nb r " Grade = No.2 Moisture Coent : � � „95::, Span (L) = 8 ft 6 in Temperature (° F) <0 � ; Tributary Width (B) = 6 ft 0 in Unsupported Length (lu) = 0 ft - 12 in tram [ ;w Cantileiier.' i t ' w ith Point Load(s �_ I ,r. with Sloped Loatl(s) L 1 (pressed - d own buttons are selected) • w •sf IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHIIIII LOADING Load Type ��, Max. Span = 8 ft 11 in Dead Load Uniform w (psf) = 10 R1 R2 1275 lb 1275 lb Stress and /or Deflection Check --► OK A c t u a l Allow a b l e Ratio Floor Live Uniform w (psf) = 40 Max fv (psi) & V (lb) 56 1044 135 2498 42% CD = 1.00 Max fb (psi) & M (lb-ft) 760 2709 851 3032 89% Total Load Max. Defl. (in) -0.16 U630 L 0.43 38% Live Load Max. Defl. (in) -0.13 L/788 L%360 0.28 46% Adjustment Factors �°° for id for V for E ' °°° Wet Service C = 1.00 1.00 1.00 0 Temperature C = 1.00 1.00 1.00 Beam Stability C = 1.00 N/A N/A 500 Size CF = 1.1 N/A N/A Shear Force, V (lb) Flat Use C 1.00 N/A N/A Incising C = 1.00 1.00 1.00 Repetitive Member C = 1.00 N/A N/A 3000 - 4 1"' , 11 1,4 1 , 0 1, ' , 11N4 ,,t ]lay 1411 t: 2000 d of �i I , { , l� e ll I(�ril i iI(< <i i��� a` Design Values i E i l I I l i I i( i ( 11i €1∎Il I'} i ll lidill li slg V IUe 1000 �,,�, ii;�f (�� � '' l i iii { l i i` €1Jlli i 'l l E lf ii I , il ' , �` � l ' � 1 Fh s' ,: i ''L' 0 ll ;[i , ' .. 1 1 , 1 ilf i1t 3 1nll i,, (P Fv(osi) E�RSij 0 i � ' �''' Tabulated 775 135 1100000 Adjusted 851 135 1100000 Bending Moment, M (lb-ft) Section Properties brea = 3 in d dth epth (d) (b) = 9.25 in .�_ __- ------ Area (A) = 27.8 in ^2 .,2„. x) 42.8 in ^3 Moment Section Modulus of Inertial (S (ix) = = 197.9 inA4 Total Load Deflection (in) ac (.\L. PLv., y clos.e., � 1 r \A t L �, 14 ck -_-_- 2 if < F ° (ION l I cr - Or • :,4) \c'''''' (. c-Clc;44 0,1° *k`ls- -2:71. 1° )'` I ,,, / / ? i maiii■ 1110111111110 MINIIPP 4011110PPP an Lan 0 \k.3 I ' OM ‘ ?'e 1, - - i I i <_______-------------° 5Qcon 1-.: / 2. , 1 c4.,0) ■ 0 I ?YQ S -- k . \ tom" 0 01/4n4_ .--;mina, $.`,on 1 i ■ r S b l t i fp u 7 11 frZ)* / O.0 . .4. 1 1 h 1 1 Fl F---- , ., , , , _ _ , __ l< ._ I ______-------- i)ro,\..,;,,. hol 40 sz JD._ 4" 5c) \ Qb friovs.R._ P 1 C ( , 0 , 9c.R4 / 7 v -r" r ,,,,,.> _ Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub - contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the - members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self - insured companies should enter their self - insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant • that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111. Tel. # 617 - 727 -4900 ext 406 or 1- 877 - MASSAFE Revised 4 -24 -07 Fax # 617- 727 -7749 www.mass.gov /dia The Commonwealth of Massachusetts --- Department of Industrial Accidents " xt _ Office of Investigations 4 4 600 Washington Street '� - 4 Boston, MA 02111 4....�° www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): (/ / e (V 0 Al 1'7 ___ Address: 5 r A ///90' S7 City /State /Zip: /A(014 IA ic- ,, Phone #: C( /./ () ^ / , � ? / r Are you an employer? Check the appropriate ox: Type of roect r ' 4. am a general contractor and I p 1 (required): ) 1. ❑ I am a employer with ❑ I g 6. ❑ New construction employees (full and/or part-time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. 7 , 4 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13:1 Other _ p _ ec 1 comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHo meowners 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: 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 fine of up to $250.00 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 coverage verification. I do hereby certify under e p • s and penal ' of p j ry that the information provided above is true and correct 57 Signature: Date: `� Phone #: e l () — 7 27 —(/ ? ( 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: City of Northampton • � v `' "re,!7,7444-kk Massachusetts k - .. 1 IL ... , ' , , { DEPARTMENT OF BUILDING INSPECTIONS - ' 212 Main Street • Municipal Building o f . " - -70 Northampton, MA 01060 jsE -s .)‘?, INSPECTOR Anthony Patillo Building Commissioner 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 any 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 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 ,7,2- l/ / "C d 'i-0 N P 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 , / 0 , Address of work local 7 ,1 7 Al / f o iV --IYr ArVk f 17 7 0219 0/4060 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 Improvement Contractor: 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 ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 ZoniLaws and Sta f M chus s General Laws Annotated. Homeowner Signature Gl SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) . Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other Brief Description of Proposed / X J � r / / `` Work: /t �� ,b €c �\ /ce#51A of 1/OUf Alteration of existing bedroom Yes r No Adding new bedroom Yes >< No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family �f. unnit t/ D : Number of Bathrooms c. Is there a garage attached ? / r /5 r CP 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 , 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 , 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 c)thc/ZI ( Section 4. ZONING All Inform on 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 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 •% DON'T KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 'f DONT KNOW Q YES 0 IF YES: e ter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 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 yg 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 1 211 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit !I 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: r This section to be completed by office fiii/ S Cor J Map Lot Unit `N 11 /Z Rif 0/1 / ' �1 / Zone Overlay District / Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ,, l QP / poi✓ e 3c� m/lsoiy J ' fi0, ,vy /6 Name (Print) Current Mailing Address: 0/060 Telephone 4//3-7-6P3/32 Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 1 cJ 3 00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) Check Number ?!T! 1s50 — This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date 1 File # BP- 2011 -0024 APPLICANT /CONTACT PERSON REDSTONE PAUL ADDRESS/PHONE 38 ALLISON ST NORTHAMPTON (413) 727 -8318 0 PROPERTY LOCATION 38 ALLISON ST MAP 18C PARCEL 117 001 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 - 9 j /� 52 Fee Paid Jo` 1 P Tvpeof Construction: CONSTRUCT 18 X 12 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 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 �x 7/19/10 Signa e 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. 38 ALLISON ST BP- 2011 -0024 GIS #: COMMONWEALTH OF MASSACHUSETTS I Map:Block: 18C .117 ' 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 -0024 Project # JS- 2011- 000046 Est. Cost: $2500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 9452.52 Owner: REDSTONE PAUL Zoning: URB(100)/ Applicant: REDSTONE PAUL AT: 38 ALLISON ST Applicant Address: Phone: Insurance: 38 ALLISON ST (413) 727 -8318 0 NORTHAM MAO 1060 ISSUED ON: 7/20/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 18 X 12 DECK 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 7/20/2010 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo