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23A-182 (8) 1 -Ij I �t a _LH o 11 J i 4 1 ' Nn O - i .r,,�j� I°(j ! i 1 7 . 3 Vi 1io 1 Z eSS Lw6MT AN, N' ". /-\LL MO&H W n'w j A TT 04 P-X hT t DIVNI 1",q THE 050,' In z7j J�)E P'c 0 CIO S ET 'T ,N Lu [CCR T-_ vo I iF N W 17H AU AND W&Fir AND ON G MC C>EN GY I \. \ UNIT �c; rim wool F-K Vy 0 T" TS iT N T NIX 1-1 L blWN61j:.'AIAIL'" LAvW1Y<y CTo C,hirnneY) z � Z Q Q — r 4rWah \ Ley ti N '2 -4 Y K �_ Q� Oi Q v n"P rz r plr(IN6 oK FAMILY ROOM z . STACKEfl I tpi X u I w IJv fi � '1i5,.x5'IYyr back - -aF Vani�y� �3r3rix �r3�. 0 \ CLOSET � �r6 rr (wt Centtr� 6 oR x 4,4,1,. h,gn =AN11LY BEER 00� 9'3" l►' t -- KITCHEN - � (�EDKO0M -- (fo end Of Cusiorn ca in el x CVSTONM CUSTOM CABONETS CLUSL-I POQ� CLOsET {i uj \ (D 13 Sp,c6 FS oe ST LL uj 0 z i o ��J u) w•Z 00 L��iINC� r5rr z I a i ' poK 7/7//SX Z/0" �3 CJ: FRONT STAI tzCASF— I / (ExiSTiNG) f r F2ON'T Gtasf'f j�ll�(!N 4V " tt , WAL-L MA I Coldham&Hartman Architects 49 South Pleasant St., Suite 301 Amherst, MA 01002 Ito prig r YA -- UO -N o o � i .. Z#1 Coldham&Hartman Architect. E / ( 49 South Pleasant St., Suite 301 Amherst, MA 01002 K 4�1 J2 I 1 � -------------------------- E' it II A-- 0i �I C) WEST ELEVATION NORTH ELEVATION SOU ELEVATION u J TH aeM O/a MPS' pdeaaWial is WM1Vc _ - Revisions �a I I a v II I EAST ELEVATION — s V Q LL i DSECTION B SEC a. ELEVATIONS& e SECTIONS D.-by; iF i \�. ------- ---- -- ----------------------- --- y acnn°�,sca�wears a­asc—n�.,,° � �.. I � j . NEV a� r�c.._9 Ornr P III I � a0�.'uJ .•e.,�.. g� �� � r- r =� i x;i sting E �s causei I 8'3" U i I I -- - - ----------------- I • I n . � I L_�+�1FRAN„D 1.r_,�T Revisions By v� ROOF PLAN FunIDAar_, �o I i i I q,A CMi BUII,DIN6 WIT I i T un�feuc�ERED ON / I®I '� 1 P" KTING 4A7'.f5. ��\ AND GATE r E xI+ND LOORWINDOV '� I —By V/ �q� A �✓ I 9 rc ?GJN(ETE STRIP O'fGGOEUB TrSAICM E ((C�J , V1l iN/O il4 BARS .. . 1 AIL —__ __uL. WALL FACE WRH R V✓iNDOW�ND - '� 3 KRETE -----------------------. ___ LL .......... I+,§ONLO OO RN LTS '+ ' it CL I _" I FLOOR&ROOF —��r m --------- - -- -- PLANS F FOUNDATION PLAN STUDIO FIRST FLOOR�— � °�° N z°I A— 4 a , BcaLE.,,a ,o F— aem,or. ec 1 CWnars'sGmw.hrtnu i RS, co';; j E';. U i i 1 Nen w.tirre �� -' i Revisions �\o� sting j o � -louse J S ist�ng Existing �" / ou e I Ij House � r , _ NEW (I EwmrGEr+T �_: $TYDl ' l , GATETC I IJ LFronc Serh¢Gk—LS-teet_,a= s _ _' � m i rvEV+P HNG 2T � sse sort t' 41 41 LL �,EHUV£wnr Sidewalk CL PINE STREET �I SITE FLAN 1✓ SCME:1' =10' _� tr fie: 9eB aea.n T �� 3 / Drawn DY: BC j Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership., association, corporation or other legal entity,or any two or more of the,foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax# 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts it`s ' Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 + Boston, MA 02114-2017 wwwanass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L,eaihly 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. r_1 I am a general contractor and I employees (full and/or part-time).* have hued the sub-contractors 6. ❑New construction 2.N I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. EJ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. ❑Building addition required.] 5. r-1 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 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. 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.#: 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 hereby certify under th" f ains an :aloe of erjury that the information provided above is true and correct. Signature. Date:' 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: UeA)�` 5 t/l` (i�J`� CS r � y � 6:�, 6 License Numbe 3 Addre s Expiration Date Signature Telephone 9.Registered Home Improvement Cordractor: Not Applicable ❑ V ag Company Name Registration Number Address `,� Expir tion ate C.4 f- Y- 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 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-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 buildine 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 lure 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 5-DESCRIPTION OF PROPOSED WORK(check all ag)plicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg.,M Demolition ❑ New Signs [p] Decks [Q Siding La Other[Q Brief De�sscription of Proposed Work:'K,iI 6NA R !46' � V.— Alteration of existing bedroom Yes )< No Adding new bedroom Yes _No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If Ww house and or addition to existing housing. complete the followinsa: 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, cS :0 as Owner of the subject property hereby authorize to act on y behalf, in all matters relative o work authonzed by this building permit application. GT � Signatu of Owner Date t, Acm Is, 1 ('VS 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. Si71e'�under the pains and penalties of perjury. c`� V Print Nam aA, ignature of 6wner1A 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 Q Building Department Lot Size Frontage Setbacks Front Side L: R: t L:.–(�—R: Rear 1 � Building Height Bldg.Square Footage Open Space Footage % f (Lot area minus bldg&paved 44+ parking) #of Parking Spaces Fill: . (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW O YES O IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW O YES O IF YES: enter Book Page, and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO jo DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO...--�' IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO a 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�&- IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only Lesetric, �Vi y of Northampt on status of Permit ilding Department CurbCuttDrN4"'' 'yf?ermit- 7 2��4 12 Main Street Room 100 ing&Gas ins ampton, MA 01060 SAO of Structural Plal" orPhIMMA -1240 Fax 413-587-1272 Plot vd Plans Other ..o 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 Map Lot Unit � a Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: K ra� S M tj I z u E STKG&T, F L.o E c k Name(Print) Current Mailing Address: • `f I - SRZ--o3 0 Telephone SigrIature 2.2 Authorized Agent: 1 ll Ul Name(.rnr Current Mailing Address: ` � y I3 C,�� 60��1 e Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �1SU (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of V Construction from 6 3. Plumbing / - Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) coo Check Number , This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date a Iji 1� 0 i - File#BP-2015-0397 731J- P APPLICANT/CONTACT PERSON HANS DALHANS VLc PI ADDRESS/PHONE 11 CHERRY ST EASTHAMPTON (413)977-6094 �V.(" PROPERTY LOCATION 12 PINE ST MAP 23A PARCEL 182 001 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 Typeof Construction: CONSTRUCT 364 SO FT DET STUDIO/GARAGE New Construction Non Structural interior renovations Addition to Existin Accessory Structure Buildine Plans Included: Owner/Statement or License 101628 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INWkMATION 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 Signature of Building Official 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.