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t Scope of work for Friedman project located at 9 Sylvan Lane Northampton MA. The purpose of the project is to provide clean, dry, unheated (except for residual heat) storage space in the basement area of the home. The existing basement project area currently has bare concrete walls and floor. %" soft foam foil laminated roll insulation is to be applied to the existing walls providing an R 16 equivalent insulation and moisture barrier. %" 1x3 to be installed 16" o.c. over the insulation with %" drywall installed as a finish wall surface. The current 1 floor framing has fiberglass insulation between the joists which will remain in place. 1/2" drywall will be installed directly to the bottom of the existing floor joists creating a finished ceiling in the new storage area. A floating laminate finish floor installed over a moisture barrier foam pad will provide a clean dust free finish floor. A wall will be constructed using 2x4 16" o.c. with %" drywall on both sides to separate the furnace area from the new storage area. The wall will have two 3 -0 x 6 -8 doors between the new storage area and the furnace room. The existing stairs to the basement will have new treads and risers and a handrail to code. The intention of the owner is to have wire storage racks and storage cabinets installed after the space is complete. The Commonwealth of Massachusetts rc-,, Department ent of Industrial Accidents "`" Office of Investigations • !. — G G �` 600 Washin Street � ,7 Boston, MA 0 111 '� " www.mass.gov /dia - Workers' Compensation insurance affidavit: Builders / Contractors /Electricians/PIumb.ers Applicant Information J Please Print Legibly Name ( Business /Or�ani7tion/Individual): ,'.vE 2vcc_E1 1 N n- ddress: '3a 6iftiys, 064.4 1 ti A Oi o Phone o% .;==: -I /) 5 5 :),)-5? City /State /Zip: �,/�rE ih� , Are you an employer? Check the appropriate box: Type of project (required): 1. El am a employer with 4. El I am a general contractor and I employees (full and/or part time).* have hired the sub - contractors 6. El New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodelinff ship - ?x+� P.T.,.1 a These sub - contractors h E D i u have no employ eeS $. (� LemOuuOIl working for me in any capacity. employees and have workers' insurance comp. insurance.: [No workers' comp. ins 9. ❑Buildin addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 PIumbing 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' 13.21 Other (re .: (6 dig. W comp. insurance required.] t < < .n< z. * Any applicant that checks box 7 must also ell out the section below showing their waiters' compensation policy inf.' - ;on. t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contactors 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 most provide their 'workers' c:,uip. 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. Lie. #: 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 secare coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 31,500.00 and/or one-y as well as civil penalties in the fora of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance. coverage verification. I do hereby ce under the pains and penalties of perjury that the information provided above is true and correct 4. / Sio�ntsre: ;WI ' ' M + . .r.frr' "t Date: / al 5 .7.a, Phone #: / i ii )- 5'3S ay i 6 Offwial use only. Do not write in this area, to be completed by thy 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 0 Name of License Holder : St v -e^'"1 2 v CC_tt 1 3 5 ki License Number - 7o 61 k yA P, /3i/ 2.0j Address Expiration Date ?A oiot A) Signat Telephone 9. Registered H Improvement Contractor: Not Applicable ❑ �f ar�ti, 2u cc. h hQ /00/ 9 ` l Company Name Registration Number jct -t (� it ,20ry Address Expi►`atioDate Telephone )c i 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 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 -vear 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, von 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 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 f in by Building Dep ent Lot Size \ �, /' Ord Frontage Setbacks Front ,,. „.• • Side L: R:" .. �� R: Rear 'r f l /,1 Building Height Bldg. Square Footage 7 Open Space Foota d (Lot area minus bld paved parking) •,, # of ing Spaces Fill: � N.,„,_ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: �-- IF YES: Was the permit recorded at the Registry of Deeds? ..-'' NO © DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O gbtained Q , Date Issued: C. Do any signs exist on the property / YES O NO © ,k/ A ..„ ...., IF YES, describe size,,type and location: ," D. Are there any posed changes to or additions of signs intended for the property ? YES © NO O IF YES, scribe size, type and location: E. Will a construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or,is it part of a common plan at will disturb over 1 acre? YES © NO O N. IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors CI Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding ID] Other Ni Brief Description of Proposed + c ? Work: F, ; 5], ��.i -t,T Ave,. G_Ye,..ic ry (f i 1')v G rtc.. 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 addition to existing housing, 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? 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 ( 7 \ -Q-4V ‘ 1 I Air ) I' I'ft)0 , as Owner of the subject property hereby authorize J +Uevl Ii 20(r. 11 1110 t• , act on my behalf, in all matters relative to work authorized by this building permit application. Signature of • tri Date r' I, 5}x'1, +ei 7 =✓cL_ t ► , 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. jt'tp,Je 7,/(J1 hit? Print N. e I/ 44 1141. L as ,.Z0j Sign -tune of Owner /Age D: e City of Northampton Status of Permit: Department use only Building Department Curb Cut/Driveway Permit L. JAN 2 5 2V13 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT OF s Northampton, MA 01060 Two Sets of Structural Plans N ORTHAMPTON, MA - 010 L S � t1ppC � 13- 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: This section to be completed by office Q Map Lot Unit ��c. h L. A 14 V-. Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I 'viil11 //- r Fr ie,,41e, h 7, iY;., I"r,' /? stir 9 s /ihh La hr Name (Print) 6 ,-- Current Mailing Address: 1 ), -1, ,! Telephone /� Signature 4 // 3 3 74 1 019 2.2 Authorized Anent: 5KtIelr► 21cc- t i10 7 0 6 co -, 0,) k /rfal471 - e,. ti Name (P,ii, 1 Current Mailing Address: IF .:,.Z.L 1 s) 5 O.)-; Signa ure 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 ,� t e �^ _ (b) Estimated Total Cost of tl Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) '' ‘ i rj b : ,7p Check Number P 0)6 / This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date Tile File # BP- 2013 -0723 . � U'- 1/ APPLICANT /CONTACT PERSON STEVEN ZUCCHINO �e (141 S r;F: y an ADDRESS/PHONE 70 Gleason Road NORTHAMPTON (413) 584 -3878 No, ( if l ye t/ PROPERTY LOCATION 9 SYLVAN LN cw Lr / MAP 35 PARCEL 289 001 ZONE L THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /0/3 0/0/ Fee Paid Typeof Construction:_FINISH BASEMENT (STORAGE AREA) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 021356 3 sets of Plans / Plot Plan T FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: A 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 iii tion Delay / Signature of Building 0 ficial 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. 9 SYLVAN LN BP- 2013 -0723 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 289 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 -0723 Project # JS- 2013- 001225 Est. Cost: $16900.00 Fee: $101.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEVEN ZUCCHINO 021356 Lot Size(sq. ft.): 32713.56 Owner: FRIEDMAN PERRY Zoning: Applicant: STEVEN ZUCCHINO AT: 9 SYLVAN LN Applicant Address: Phone: Insurance: 70 Gleason Road (413) 584 -3878 NORTHAMPTONMA01060 ISSUED ON:1/28/2013 0:00:00 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT (STORAGE AREA) - LETTER NOT SLEEPING AREA 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 1/28/2013 0:00:00 $101.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner