Loading...
32A-187 (3) BOB THIBODO ROOFING & SIDING Shingles, Rubber Roof Systems, Vinyl Siding, Replacement Windows, Slate Removals, Slate Repairs, Chimney Pointing, Chimney Capping, Aluminum Trim Work, Over Hang Enclosures, Gutters FULL INSURANCE COVERAGE Mass HIC # 152172 MASS CS # 065699 Chuck Miller Assistant Building Commissioner City of Northampton Town of Williamsburg September 15, 2014 1 request that you grant a modification to waive the requirement for control construction for the project at 23 Pomeroy Terrace in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety,or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work Thank you for your consideration. Respectfully, Bob Thibo Bob Thibodo Roofing &Siding PO Box 201 Northampton, MA 01061 City of Northampton Massachusetts � M 'p sin¢ STS DEPARTMENT OF BUXLDING INSPECTIONS r 212 Main Street • Municipal Building xQgsL,` 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 detacherl structures accessory to such use and/or farm structures. A person who constructs more than ne 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, 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 Address of work location The Commonwealth of Massachusetts k9i` Department of f Industrial Accidents Office of Investigations ` 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i r Name(Business/Organization/Individual):_ � 1 T P Address: City/State/Zip: Phone #: 4 S AYI u an employer?Check the appropriate box: Type of project(required): 1. am a employer with 1�1 _ 4. ❑ I am a general contractor and 1 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 - - have sub-contractors ship and have no employees These 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.$ 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.❑ P Bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[9Roof 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. 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.#L� Q� O �Q�\ d Expiration Date: Job Site Address: n( Y`G CQ City/State/Zip: ()yIAAA Attach a copy of the workers'compensation po y declaration page(showing the policy number and expiration ate). 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. 146 hereby certify under the pains and penalties of perjury that the information provided bove is true and correct. Si afore: C ` Date: Phone#: � l - -- --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#• SECTIONS w CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:" Not Applicable ❑ Name of License Holder ey d 5-c7 —1 Li nse Number r. Aid Expirati Date Sig ature Telephone %we:, R ' 'o m .rove ntn or Not Applicable ❑ Com n Na a Registration N mber 1 AdcTress Expo do Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G., 25G(6)J 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 buildin permit. Signed Affidavit Attached Yes....... No...... ❑ OTIi ,,�WIl� :: J.tlOII 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 J SECTION 5 DESCRIPTION OF PROPOSED WORK`d'heck all apalicablel 1 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[I3] Brief D iption of Pro sed �� R1 �d��^' �1` s� ,V��1 S Work: ' V K �►'� u<I.) � 1 A_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet V MW a ou ud,bKafdd ill i i exi ffn ausi Ot e# ]ie�o owrncl 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 Coriservation 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 OWNERAUtH13R1ZA710W_,TO BE,COMPLETED WHENY OWNERS AGENT OR CONTRACTORAPPLIES FORBUILDING PERMaT Ylp ,� as Owner of the subject property hereby authorize to act on my behalf, in all matters relative o ized by t s building permit appiicatio Sign re of bwner 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 ame Signature of O er/Agent Date J 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 3 iI I Frontage Setbacks Front �1 Side L:= R:-j L:° Rear Building Height 0 j Bldg.Square Footage _ . -Open Space Footage - (Lot area minus bldg&paved parking) #of Parking Spaces I--- Fill: (volume&Location) l 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:` r IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 -� IF YES: enter Book ! € Page' and/or Document#� I B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO Q 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 IF YES, describe size, type and location: i 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton s x e F Lr I '} Building Departmenttil 212 Main Street r" a SEP 5 2014 Room 100 a t orthampton, MA 01060 ip 13-587-1240 Fax 413-587-1272 lectric, Pw i,nc;tti r a I, ), att- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION �. This sectrort to be completed by`pffacer 1.1 Property Address: 7 � r W\ry-K , isb ct � - e .. � tSCSvsfrcct�^.v � _ .a �GP1 District ,'SECTION- PROPERTY 6wNERSHI ./AUTHORIZED AGENT 2.1 Owner of Record: �% -z Y1 o c z5 yv\Z/ LD u f\r Y`c C-Q Name(Print Current Mailing Address: �>< - jj '7A—A A,#—,A Telephone Signature 2.2 Authorized Agent: Q 1- Name(Print) Current Mailing Address: 0�—\�&V----v 4 r> � k4 0 -1 Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost(Dollars)to be OfficIaF Use pnly l' completed by ermit applicant 1. Building (a)Building Permit Fee . a 2. Electrical fib)Esttmatei#Totat Cost ofi �° .ws`.C©nstruction from 6 - 13­1 3. Plumbing uilding Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ' 6. Total=(1 +2+3+4+5) Check Number - This'Section For Official Use On l'' Building Permit;Number Dsued. k Signature.- Building Commissioner/Inspector of Butldings'.; Date XM rR'o C>'�\Nf,c—, Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Commercial Property Record Card New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block-Lot: 32A-187-001 Zoning: Assessment: Location: 23 POMEROY TERR Neigborhood: 8 Land: 131. #Living Units: 4 Deed Book: 10738 Building: 258, Class: A-111 Deed Page: 307 Total: 389, Building Information Building Sketch Bldg #: 1 20 Year Built: 1900 # of Units: 4 Quality Grade: C 16 35 2sFR/B # Efficiencies: 0 6 Qoo Up 21 21 # 1-Bedroom: 4 go # 2-Bedroom: 0 6 11 # 3-Bedroom: 0 A 12sFR/B Covered Parking: 0 5sa 25 Uncovered Parking: 0 36 Total Unadj RCN: 228,220 Total Unadj RCNLD: 287,390 6 11 Grade Factor: 1 39 # Ident Units: 1 �c s � s Func/Econ Factor: 1 RNCLD: 287,390 Detail Information: [Attached Improvements 1 Levels Use Ext Walls Heat ©% Good Una Type Meas-1 Meas-2 Fm -3 # Units _B1 86 00❑0C P7 ®0 29 1 0IT] � � O1 11 Frame HW/Steam 0 FR-P-7] 8 0 15 1 1- 02 11 Frame HW/Steam E0I- RPS ®� 15 0 _Al 11 Frame HW/Steam�0� Land Data 110utbuilding Info S uare Foot Type t;;ties Length Yr Phys Fur q Yp Descr Width or Size Qua Built Cond Uti SQ Feet Value n no 7 12,960 r 1,040 information 1 Other Improvements: F http://www.northamptonassessor.us/noho/commdetail.php?map_no=32A-187-001&pagecar... 9/5/2014 File# BP-2015-0258 APPLICANT/CONTACT PERSON BOB THIBODO ROOFING&SIDING ADDRESS/PHONE P O BOX 201 NORTHAMPTON (413)527-7663 Q PROPERTY LOCATION 23 POMEROY TER MAP 32A PARCEL 187 001 ZONE URC(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 Typeof Construction: STRIP PLY& SHINGLE ROOF&NEW FLAT ROOF New Construction Non Structural interior renovations Addition to Existing- Accessory Structure Building Plans Included: Owner/Statement or License 065699 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 lition Delay Signa re o Bu mg 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. 23 POMEROY TER BP-2015-0258 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 187 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2015-0258 Project# JS-2015-000493 Est. Cost: $6485.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BOB THIBODO ROOFING & SIDING 065699 Lot Size(sq. ft.): 12980.88 Owner: ZIMNOCK ANTONIA A Zoning: URC(100)/ Applicant: BOB THIBODO ROOFING & SIDING AT: 23 POMEROY TER Applicant Address: Phone: Insurance: P O BOX 201 (413) 527-7663 () WC NORTHAMPTONMA01061 ISSUED ON.912912014 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP, PLY & SHINGLE ROOF & NEW FLAT ROOF 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 SiSnature: FeeType: Date Paid: Amount: Building 9/29/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner