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23A-272 (5) 32 Middy 1st Floor I�� lL _ 1_ _- , Jeffrey B 32 Pine c I 1 Florence I _ 413 584 New Bathroom 0 J Study r SI Sit E New Stair location Kitchen Living Room St I TV Room 1 1 32 Middlf 1st Floor L - _ Jeffrey B 32 Pine ,S I Florence — 413 584 New Bathroom Ti Study 01 ___ _ N replacement t windows , , -------1- 7 1 Sit New Stair location Kitchen Living Room Si 7 TV Room 1 32 Middl 1st Floor 1, , L t4 __ -_-, 1 1 ( - , Jeffrey F 32 Pine Florence 413 584 -- -' New Bathroom .I o _ Study replacement windows L_____,, , ai , -� - __H 1 11 , , , ,, 1 _,„ ,_ , S i ,, d 1 New Stair location .tiOsO E1.S tt VEIZSO\ - i (PL1 Kitchen Living Room Sr j TV Room -- _- - 32 Middy ii-- — 11 L.,__', 1 _,,. 1 st Floor Jeffrey 32 Pine Florence - 413 584 New Bathroom o Study replacement windows Oil r F ---- - 1 „__ _ __ , , _ , Si , ____ __ New Stair location 7/ VEttA LAS 1 P L Kitchen — 1 Living Room S I TV Room i 6 _/ 1 /2 .. L H ■o 2x10 floor joist 16" on center Main beam 2x10 -3 ply 3/4" Avantech subfloor glued and nailed 1 A i 1 1 M 16 "x16" pier ' N r-+ 1 j 7' -2 3/4" 11' -10 1/4" 4' -71/2" 23'-8 1/2" 32 Middle Street Apartment Additional Work. 1- Reframe fitst floor under kitchen and living room 2- Replace 4 windows with new Anderson 400 3- Remodel bathroom, since floor needed to be replaced 4- Relocate stairs for better access to second floor Thanks, Jeffrey Bott Jeffery Bott Contracting jeftbott@aol.com. 4 H- r-, L I i ( 32 Midd] 1 I Jeffrey I I 32 Pine �, Florence New Bathroom 413584 Study I replacement windows _ .__:- - _ 01 .____ ...__. S F' New Stair location Kitchen Living Room c TV Room r. 6'-7 1/2" ■o 2x10 floor joist 16" on center Main beam 2x10 -3 ply _ - 3/4" Avantech subfloor glued and nailed V 16 "x16" pier I r I 7' -2 3/4" 11' -10 1/4" I I 4' -7 1/2" 23' -8 1/2" ► 1 rat 32 Middle Street Apartment Additional Work. 1- Reframe fitst floor under kitchen and living room 2- Replace 4 windows with new Anderson 400 3- Remodel bathroom, since floor needed to be replaced 4- Relocate stairs for better access to second floor Thanks, Jeffrey Bott Jeffery Bott Contracting jeffbott Z))aol.com. City of Northampton _ • • (' #• Massachusetts 73f f� :; i fit` DEPARTMENT OF BUILDING INSPECTIONS . ' 1 g 212 Main Street •Municipal Building t, ) , As, "', Northampton, MA 01060 s ti INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3 % act as his /her constru tion supervisor. The state defines "Homeowner" as, " Person(s) who ow s parcel on which he/she'resides or intends to be, a one or two family dwelling, attached or det. c' ed structures accessory to such use and /or farm structures. A person who constructs more n one home in a two- year period shall not be considered a home owner." The building depatnent for the City of Northampton wants any person ) ho seek to use the home owner exemption, to *t as their own construction supervisor, to be a,- that by doing so you become responsible r compliance with state building codes = n. regulations. The inspection process requires that the ilding department be called to inspe wo at various stages, which include foundation /footings (befo backfill), sonotube holes (bef. e p. ur), a rough building inspection (before work is concealed),`insulation inspection (if req red) : nd a final building inspection. The building department requires, these inspections before e wo k is concealed, failure to secure these inspections can result in failure to obtain a ce ficate •f occupancy until the work can be inspected. If the homeowner hires other trades to perform work -lectrical,/olumbing & gas) the homeowner will be responsible to make sure that the trades hired sec e their prolber permits in conjunction to the building permit issued, and that they get their required i , spections. Failure of the individual trades to secure the permits and inspections as required can DE ' Y the project until such time as the proper permits and inspections are made I, \, understand the above. (Home owner /resident's signature equesting ex- ption) I will call to schedule all required buildi • inspections nece• ary for the building permit issued to me. Date Address of work location / • The Commonwealth of Massachusetts Department of Industrial Accidents g Office of Investigations 600 Washington Street Boston, MA 02111 #t: www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business / Organization /Individual): '- S C ,k .-1 Cam\ tv\ -, vAA F I Address: � �- �� REET" City /State /Zip: V (-0 x. VPA Phone #: 44( 3 tc ? f 2S� L Are you an employer? Check the appropriate box: Type of project (required): 10 I am a employer with 'i/ 4. n I am a general contractor and I 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. "g Remodeling ship and have no employees These sub - contractors have 8. n Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. n We are a corporation and its DID Electrical repairs or additions q ] officers have exercised their 11. Plumbing repairs . El I am a homeowner doing all work h id g or additions p • myself. [No workers' comp. right of exemption per MGL 12.1 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13. ❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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: f ��t _ .I C Policy # or Self -ins. Lic. #: S d 000 4 (9 P { Z d t•- Expiration Date: b = ZO f 3 Job Site Address: 3( Vvi I DD L 7 - t:fe(\ C-e, to City /State /Zip: 0 d C) Z 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: 04-- Date: (V � l f Phone #: Is9 4) ` 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 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : � c_ r� y �r� Off C. S 5 l License Number 2- Pww -e.. SS c`wv- evtc.a_ a t b 2,013 Address Expiration Date f _— N (3 5 r 625 Signature( Telephone 9. =Regist re ed Ho me. Improvement,Coritractor, „_ ,y e „ E css _,,, ,.,, Not Applicable ❑ , A C-2s t'1" H r t lo /2_2:4 Company Name ( Registration Number 6 25 2c J f Address Expiration Date sM.A 0 (0 ' Telephone 413 6 6251 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:¢ # . HomeOwner Egeri ptio 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 • W SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House F Addition ❑ Replacement Windows Alteration(s) 0 Roofing I I Or Doors D t-1 Accessory Bldg. I i Demolition ❑ New Signs [0] . Decks [[l Siding [El] Other [O] Brief Description of Proposed -. ` Work: ' fie �l�ct t `�� f �o[>� I v.�tnr�owa 1��-►'hod e.� � Alteration of existing bedroom '$ Yes No Adding new bedroom Yes 7. No 54r IV4i'S Attached Narrative Renovating unfinished basement Yes -- No Plans Attached Roll - Sheet 6a. If =N house,.and orsaddition to,exist ii hous nq,compiete the :following: a. Us- _ suilding : One Family Two Family Other b. Number of room each family unit: Number of Bathrooms c. Is there a garage attached . d. Proposed Square footage of new con ction. •imensions e. Number of stories? f. Method of heating? ireplaces or Woodstoves Number of each ' g. Energy Conservation Compliance. Masse- Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of w ands? Yes No. Is construction withi 00 yr. floodplain Yes No j. Depth of basement or c r floor below finished grade k. Will building co rm to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION la OWNER: AUTHORIZATION- TO BE COMPLETED WHEN OWNERS AGENT`OR CONTRACTORAPPLIES -FOR BUILDING PERMIT Z ,- v—..q, ∎- ED \ as Owner of the subject property 1 _{.�.. 1 1 t Ir' hereby authorize '�'�`''�- u'" v1. "� cA(vk to act on my behalf, in all matters relati 4o work au orized by this building permit application t Doe S t. \ Cp. Si. atu er I e... ∎.- -+2- Z .n 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. T � -Y- (--tiii 6 Print Name • Or ` �� 0 vi_ Sign . 4 0. r /Agent I - te . . . Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information \ Existing Proposed Required 6y oning This col •.. to be filled in by Building Department , It Lot Size J ! / Frontage _ -- Setbacks Front , / Side L:, R:---- L. __ R:.. , r Building Height , l Bldg. Square Footage ' % Open Space Footage , ■ - (Lot area minus bldg & paved \ _ parking) \ i # of Parking Spaces i , 1.) \ „ _ 3...,.) Fill: .- \ ■ (volume & Location) , . A. Has a Special Permit/Variance/Find g ever been issued for/on the site? ,V. NO 0 DON'T KNOW 110 \ YES 0 U IF YES, date issued: IF YES: Was the permit recorde• at the Registry of, Deeds? 0 NO DON , KNOW 0 , \ YES 0 , IF YES: enter Book Page\ 1 and/or Document # B. Does the site contain a bra ok, body of water or wetlands? 0 0 DON'T KNOW 0 YES 0 IF YES, has a permit • een or need to be obtained from the nservation Commission? Needs to be obtain d 0 Obtained \ Date Issued: C. Do any signs exist • the property? YES 0 NO 0 , IF YES, describ& size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q 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. . De p artme>�t:use on4 0, s� �-�s 9@ ; ity of Northampton Stat of P , v 0 �` - � � ' � - . , PErE 7 uilding Department Curb Cu t/D n Weway Permlt ;� _ n 212 Main Street �'e iNer / A�181��ibElltj� � 9 �� ��"'� r'�"+ry '�� « � �` Room 100 Water/VilellA�tal( a'r n � No hampton, MA 01060 T rr,Yo Sets of StructurahF'a���� � � ��: ' : .i:!:4 i ti „1 : ' -' : :;;f :: ;:. 13 87 1240 Fax 413 587 -1272 PIot15ite Pla PP OP RAMP TON, M 01060 Other. Specify p fiY .� 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 comp le t ed by office P '( p' ( 1 - 5--(` Map Lot 31 ' Unit r zone Overl District F LT — >✓V\ �� V4he ©i c z EIm St. ,District ' CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: , ......4-17',,--4.. 1 ft` -3", 1 h - ,.S--I— �,vec��Z. tic Name (Print) Current Mailing Address: ..11 L Telephone s 4 ( Sign0e1 ` 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be O fficial Use Only,. completed by permit applicant 1. Building �� (a) Build Permit Fee 2. Electrical (b) Estimated of Construction fro Total rr Cost r (6) 3. Plumbing - c.,'Z=r-t� Building Permit Fee' 4. Mechanical (HVAC) 5. Fire Protection ., 6. Total = (1+2+3+4+ Building P r. Gam' Check Number This Section For O fficial tIss Use Only Number. " : Signature: Building Commissioner /Inspector of Bu Date File # BP- 2013 -0218 APPLICANT /CONTACT PERSON JEFFREY BOTT ADDRESS/PHONE 32 Pine Street FLORENCE (413) 584 -6251 PROPERTY LOCATION 31 MIDDLE ST MAP 23A PARCEL 272 001 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 597 3 Fee Paid T peof Construction: REPLACE PLASTER W /SHEETROCK & UPGRADE INSULATION & WIRING, • PLACE 1ST FLR 4 WINDOWS, REMODEL BATH, RELOCATE INT STAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 053157 3 sets of Plans / Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 De I lition Delay Signature of Building Official ate 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. 31 MIDDLE ST BP- 2013 -0218 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A - 272 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- 2013 -0218 Project # JS- 2013- 000359 Est. Cost: $6000.00 Fee: $110.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JEFFREY BOTT 053157 Lot Size(sq. ft.): 20778.12 Owner: BOTT JEFFREY & VIRGINIA L MILLER Zoning: URB(100)/ Applicant: JEFFREY BOTT AT: 31 MIDDLE ST Applicant Address: Phone: Insurance: 32 Pine Street (413) 584 -6251 Workers Compensation FLORENCEMA01062 ISSUED ON:8/28/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE PLASTER W /SHEETROCK & UPGRADE INSULATION & WIRING, AMENDED 11/2/12 - REPLACE 1ST FLR 4 WINDOWS,REMODEL BATH, RELOCATE INT STAIRS 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 8/28/2012 0:00:00 $110.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner