23A-026 02/11/2014 12:13 1-413-534-2290 MCMAHON SCHOOL PAGE 02/02
45 'ark St, 01062. Bedroom to Bathroom conversion
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Bathroom at 45 Park st,the room is located on the second floor. It is about 8 by 10.
The window and the door are staying the same.
The walls were opened on the sink side,the window side,and the door side.
Thank yogi, Q
c)72�iC,/J
Alexia Ma Zin
(413)218-6079
City of Northampton
� Massachusetts fie;
'Y 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 statf 'fines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends to be two family dwelling, attached or detached structures
accessory to such use and/or :ks. A person who constructs more than one home in a two-
year period shall not be cor -ner."
The building departmer ants any person(s)who seek to use the home
owner exemption, to isor, to be aware that by doing so you
become responsi' -odes and regulations. The inspection
process requires ,-.t work at various stages, which include
foundation/fo amour), a rough building inspection
(before wor' .d a final building inspection.
The buildir o�3N e is concealed, failure to secure
these it 4 - if occupancy until the work can be
inspects ���
If the home( al, plumbing & gas) the homeowner will be
responsible to i, �" proper permits In conjunction to the building
permit issued, ano .ions. Failure of the individual trades to secure
the permits and inspe� .e project until such time as the proper permits
and inspections are made
J understand the above.
( e owner Ire ent sign esting exemption)
I will call totschedule all required builai, ipections necessary for the building permit issued to me.
Date J, \V AA
Address of work location (��° �
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
x www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
t
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #: ��
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 I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. E] Building addition
[No workers' comp. insurance comp. insurance.1
required.] 5. ❑ We area corporation and its 10.E] Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.E] 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.
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 hereb certify der the pains and penalties of perjury that the information provided above is true and correct.
Y
ature: Date: V '
Phone#: 10
Of 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 Reaisfered Home Ima"rovement 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...... £
Home Owner`'E" emption
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 Ordinance State and Jo-,al Zoning Laws and State of Massachusetts General Laws Annotated.
omeowner Signature,
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 [O] Decks Siding[O] Other[O]
rief Description of Proposed
Work:
Alteration of existing bedroom_ Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
t3a. If New house and oi''additi'on towexistinq.h'ouslnq, 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
1 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
I PAk PI I as Owner/Authorized
Agen reby declare that the stateme s and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Si ed and the pain' nd pen s of perj ry.
P me
Sig t f wner/Agent /Date U
~ ~
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
I'his column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front =7j
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has a Special Permit/Yariance/Rnchng ever been issued for/on the site?
x~~�
NO �� DON7 KNOW «�^r�/ YES ��
IF YES, date issuedd �
IF YES: Was the permit recorded at the Registry of Deeds?
NO ~_.K � D
IF YES: enter Book Page and/or Document#
�� ��
B. Does the site contain a brook, body uf water nrvvet\undsJ NO �~��� DON7KNO\0 �~� YES �_�
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tnbeobtained ~��~\ Obtained �-�~�� Date� ' .
C. Do any signs exist on the property? YES 0 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 0 NO 0
IF YES, describe size' type and location: ' !
E Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre nrioit part ofo common plan
, that will disturb over 1acre? YEG ���l NO ����
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
"ifiP FY.4;,,{
City of Northampton S„tatus of Permet
--- ding Department Curb}' Cttt/Drf�euvay Perrrtit r �F' ( r i kx }r s a
� h,d JF
'4 a i iF.'� s tlx p J s
2 Main Street Seyvim/SepticAvaJta6�li�y r � :
�}} h �
Room 100 W" .9 ertVitel[A�atlab�il�ty
(� i R,Ff ,ix, Lr m kJ
20f4 N�' t hampton, MA 01060 Two,S is of S r�ctural Plank r l ea a r�l '� `r{`
! '
phone 41�-587-1240 Fax 413-587-1272
�_. I ��j -r J,G-•.y,.r�i ? r �i T F��, �- �, h h{ to- L x _ 1
APPLICATION TO_CONSTRU�T,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
(,�51 ,
F)v enu, '
�
' r
'Elm St District :'! ! Ce.Distnct ; r r
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2 Owner of Rec rd:
I ,n �n_ (�C �errLA Lr
Z( rint Current Mailing dd ess: Q f S�p- q�p�
__N JVA Telephone
ure
2.2 Authorized Agent—/
gen .
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
completed b permit applicant
1. Building D/y1 (a)Building Permit Feb
W
2. Electrical /j� (b)Estimated Total Cost of
(J Construction from 6
3. Plumbing Building Permit Fee
lD�(JIIJJV
4. Mechanical(HVAC)
5. Fire Protection _
6. Total=0 +2+3+4+5) Check Number �!
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector`of Buildings Date
File#BP-2014-0866
APPLICANT/CONTACT PERSON GAUTIERI GABRIELLE
ADDRESS/PHONE 45 PARK ST NORTHAMPTON (413)218-6079 Q
PROPERTY LOCATION 45 PARK ST
MAP 23A PARCEL 026 001 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
Fee Paid
T1eof Construction• CONVERT BEDROOM TO BATHROOM/LAUNDRY ROOM
New Construction v� W
Non Structural interior renovations a Cls'�
Addition to Existing
Accesso1y Structure H'I
2 Geb
Al Building Plans Included: ° e
Owner/Statement or License
3 sets of Plans/Plot Plan E
THE FOLL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 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
Signatre ofici 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.
45 PARK ST BP-2014-0866
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-026 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Plumbing BUILDING PERMIT
Permit# BP-2014-0866
Project# JS-2014-001275
Est. Cost: $8000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 17772.48 Owner: GAUTIERI GABRIELLE
Zoning: URB(100)/ Applicant: GAUTIERI GABRIELLE
AT. 45 PARK ST
Applicant Address: Phone: Insurance:
45 PARK ST (413) 218-6079 0
NORTHAMPTON MAO 1060 ISSUED ON:211112014 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT BEDROOM TO
BATHROOM/LAUNDRY ROOM - AIR BARRIER IS REQUIRED BETWEEN TUB/SHOWER & EXT
WALLS FLOOR TO CEILING END TO END
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 2/11/2014 0:00:00 $55.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner