25-020 (2) '7
{ .0.
I
! 2014
JACOB SMITH ENGINEERING & DESIGN
January 14th, 2014
To: Louis Hasbrouck
Building Commissioner
Town of Northampton
210 Main Street
Northampton, MA
01062
Re: The Historic College Inn
74 Bridge Street
Northampton, MA
01060
Louis:
On January 14th, 2014, I visited the address indicated above with Mr. David Claxton a general contractor
to observe the progress of construction of this project. Construction is underway to alter this existing structure as
on indicated on the architectural drawings dated 5/17/13 produced by Tom Douglas Architects. This existing
structure is an R-1 occupancy classification and a type 5-B construction type. At the time of my site observation
the work indicated on sheet S 1 of the structural drawings that I have previously produced and dated 5/22/13 had
been completed. An existing LVL beam supporting second floor framing has been reinforced with a '/z" thick x 9"
high steel plate installed in lieu of the specified 1 3/4" x 11 7/8" LVL ply. This was due to existing conditions
constraints regarding installation. This is an acceptable modification.
The structural work indicated on sheet S2 will be commencing this week. I will be revisiting this site for
further observations as warranted by the progress of construction.
It is my impression that the general intent of the contract documents has been followed during the
installation of the new structural elements as indicated on sheet S 1 of my 5/22/13 structural contract documents.
Please do not hesitate to contact me with any questions.
Jacob S iith Enoneer ing and
By a
acob F. Smith, P.E. c��_ 't►
51,AtTM
CAVIL
U Np.47AX
S COATEs AVENUE; SOUTH DEERFIELD, MA 01373
jacob@)jacobsmithengineering.com
VOICE 413-397-3441 FAX 413-665-1142
v _It
&Gas f{,spections
Nort ham
p�tric,Piumbi ton, MA 01060
City of Northampton
Massachusetts �ti.:•
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 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, 4J�c_a (Ack.vt L-C � 0C1Y-e__ understand the above.
(Homeowner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date `/ `1
I zz Address of work location �5 Cr' - ,�5 p `� ' �Z
ell
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
4 Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leffily
Name(Business/OrganizatiorAndividual):
Address:
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F� I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
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. F� Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp.insurance comp. insurance.
$
required.] 5. E] We area corporation and its 10.❑ Electrical repairs or additions
I I am a homeowner doing all work officers have exercised their 11.❑ 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' 132rOther..C s7,Gu-
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 Dat 4
i J
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy nu 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 cerdfYender thepains and penalties ofperjury that the information provided abo a is true and correct.
Signature: % --.� .._ Date: / /G� r
Phone#:
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:
License Number
Address Expiration Date
Signature Telephone
9:Registered Home lmprovemenfCont"ractor _ µ_,_ 4,.. ;,_ w 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._Egemptio
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 Laves z Staff of Massachusetts General Laws Annotated.
[/.
Homeowner Signature.
' L.
Y
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House E] Addition Replacement Windows Alteration(s) Roofing
Or Doors ]1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[O] Other
Brief Descriptiqqn of pproposed
Work: 1� skr(/rr—� y (G�(t �;� ;' (nor►-• � ,,, ��^iYl��YV, ` i Iu Sd �'
Alteration of existing bedroom Yes _No Adding new bedroom Yes No r
Attached Narrative Renovating unfinished basement Yes P<— No
Plans Attached Roll -Sheet
sa.lf:New;houseand:-oraddition.to'exisfing:h iu ii::completethefol(owln :
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 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
kjX H 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.
eD
Print Name
Signature of Owner/Agent Date
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 --— -• '— --- L_ _ _
Setbacks Front
Side L:= R:= R:=
Rear I ±
Building Height(
Bldg.Square Footage l� % I
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces �---
Fill: ,_..u..__..�,_....._�•_.__._....�_...._. _�.____....__._..__��,...._... �___... �_..�... ...._...y,.....__
(volume&Location)
A. Has a Special Permit/Vari ance/Finding ever been issued for/on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:! ^�
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book ' — � Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued: 3
C. Do any signs exist on the property? YES Q NO 0
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 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 O NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
`` ....� M' EM II a, ,e�a-tmeft',��ise�.only
5, le n!t h11 �Y
City of Northampton SiatuS�tTRernttt •�A�" zlallr}l; �� M r4xq^!
dnR !"r '+ 4� �d
!t r Building Department cilrb` utlfettrra 3 errti#sx
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,u'3
212 Main Street SewerfSe>?ticAa�ra $(I�y
i t ..� 5 "' r uax '�I•a, ,;,'�'�v�'''�-� 1 i�,1r u.�
Room 100 Waterlfel A�ralabtlit AE r 4 �L n ylt u f
. Northampton, MA 01060 TWO,S�rye.#s.�tya>Str,tctr,ral Pfatts5 � ���� 4'
tkOtlb
tOLne 13-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Protaertv Address:
y�
�-°- �� Thus secfrorr fa be completed by t�ffice
rMap 2"� ! �, _� � . .tLot .}���l �..! ! ii 2U��t•::
((1/ v 4-ti et mt 1, � ZOne � F` ! OverlayD�sYrict y�
Elm St Distryct
SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1
14,,Gt r cI s S Y-c' I t Ct 1 h
Name(Print) Current Mailing Adores :
1 QC-/ x6?1z
Telephone
igna re
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 ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
C'nstruction`from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Onl
Building Permit Numbee Date
Issued:
Signature:
Building Ccmmissionedlnspector`of Buildings , Date
56 CROSS PATH RD BP-2014-0806
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25 -020 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2014-0806
Project# JS-2014-001188
Est. Cost: $500.00
Fee:$55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 348480.00 Owner: MOORE HOWARD T&STEPHANIE BURNS MOORE
Zoning: Applicant: MOORE HOWARD T & STEPHANIE BURNS MOORE
AT. 56 CROSS PATH RD
Applicant Address: Phone: Insurance:
56 CROSS PATH RD (413) 586-8612 O
NORTHAMPTONMA01060 ISSUED ON:112112014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL INSULATED METAL CHIMNEY&JOTUL
502 WOODSTOVE
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:Oifj^/5 I�Cvle-I
Rough: Oil: Insulation:: -
Final: Smoke: Final:Ok'1-15— l 0AIAt--
THIS PERMIT MAY BE REVD D Y E ITY F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND G
Certificate of Occu a Si nature: 7"
FeeType• Date Paid: Amount:
Building 1/21/2014 0:00:00 $55.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner