38B-210 (2) Page 1 of 1
Application Submitted
Your application has been submitted and all fees have been applied to your credit card. Please print this page as
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Annlication Information
Date Submitted:
Wednesday, July 29, 2015
Applicant Name:
RUSSELL P FARLEY
License Number:
CS-093211
Agency:
MADPS
Process:
Renew License process
Payment Information_
AuthorizationCode
Received Date:
Received Amount:
07787P
7/29/2015 8:24:32 AM
$100.00
https://elieense.chs.state.ma.us/eGov/WebIPaymentResult.aspx?answer=processed&payme... 7/29/2015
June 29,2015
For Fabrication
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TYPICAL WALL CORNER DETAIL TYPICAL CONTROL JOINTS TOP OF FOUNDATION WALL AT DOORS
7/7/2015
OF
JOHIV'R. '
TEYBAL
$TRUCYURAL Y„
MONTAGUE TIMBER FRAMES Hoff Garage Foundation Details 2 NTS. S-1.1
No.Stl
:y9
P
June 29 2015
For Fabrication
2)2x8 P.T.Sill Post
Fastened with 112'Anchor Bolts 48'O.C.
2)#4 Slab Dowels
18'Lap
#4 Centered in Slab
#4 Centered in Slab 16'O.C.Both Directions
16'O.C.Both Directions 8'Crushed Stone
0'-8'TO FND Wall OB Drainage Layer OR 8'Crushed Stone
_. a................._......,.,............._._....___.__._..... ___. 6x6WWF(8ga/W29-orgreater) Drainage Layer
6x6 WWF(8ga/W2.1 or greater) placed in center of slab
placed In center of slab
L, _,....._..
0'-0"TO Slab
-#4 Dowels @ 48"O.C.
Alternate Hook Direction ! -
_
10"Square
' ....... IIII
#4 Horizontal @ 24"O.C.
-3-0' TO FTR —
_ - - 7/7/2015
FEE1-11
-- —' SB OF
-1111 II—IIII IIII —1111 —IIII IIII II—I `
Jt}HN'R. a
a., TA5YBAL
2„ 10'Square Pier T 0"Square N0.5b 99 L rn
4)#4 Dowels P'
P4)#4 Each Way
MONTAGUE TIMBER FRAMES Hoff Garage 5-P,tt S, Foundation Details I N.T.S. S-1.0
June 29,2015
For Fabrication
� I I z3g• �
..D.. 2'101/16" m �
I I elydsmouth
.._....__..__...._.._..............>._......_.. _ .,
)n/M' B 3
__ m Em5e3_........._...
... ... ...._....I' _.�_. _......
B-4 Typical 6.Rafters
I !a E
Blydsmouth or Butt joint at lower girt
2)5/16"GRK
8 3 _...�._..._.__. _. ...._.__..... - e:io.. ._....._._....... ...._..._�_.. .. _...__....._.._ .__.._�, _ .._..m Emlaed........................
,..... - ._.._._..___ .... .....f.,. ,�r......_ ..... Typical 6x Rafters
's
Blydsmouth
2) GRK
exio Min n 3'3"Embed
Typical 6x Rafters
I
j I H-1"Vertical
j 2)5/16"GRK
6x10 Min 3"Embed
Typical 6x Rafters
= i j
I
d-- a
6.10
B-2
0
....___< v..._._. ...__... .........._..__..._ _._......_ _......__......._.......................................................__.. _......_..............._..............._.._.............._------._...
j i I
6.10
\ i i
j
6.10
6x10
7/7/2015
B-1
M OF
B-1 6x10 JdHIV R.
' a
a URAL
1 � Blydsmouth ° Np.5d59�
1 2)5/16 GRK ,
-- — Min 3 Embed
PTypical 6x Shed Rafters
MONTAGUE TIMBER FRAMES Hoff Garage 5-Fiit-t Roof Framing Plan 1/4" — I' T-3.1
�
June 29,2015
For Fabrication
Vi,3"Embod
Typos]6�Joists
Min 3'Ennin�d
Simpson MST136
overtop
6.9 19
6.9 Typi-I 6x Joists
64
I High Low Tenons
6.9 Notch 6x9 4"from top
Notch 6x7 3"from bottom
St,ir Design
OF
URAL
MONTAGUE TIMBER FRAMES Hoff :: Garage Loft Framing Plan 1/4" 1' T-3.0
June 29,2015
For Fabrication
� W �
N w
t
E
� I
EiE
E
E
1
1 I
t �
1
T-2,2x4" i T-2,2x4" T-2,2x4"3
f1 Peg i Peg
Haunch 3"from 2 Pegs H-75 Haunch 3"from
/ end of Plate I 21 5/16"GRK /— end of Plate
Min T.Em bad j
Typical 6x Posts
_ H-.5"
I a+rz 1)5/16"GRK
_E% Min 3"Embed
j _ I Typical 4x Nailers
F
T 3,2xt25°stub
4.4 5/8"All Thread Epoxy to
� N FND with Simpson Set
25"x25"x1/4"Washer m
iMortise Pocket 12"from
1 - m bottom of post,nut.
7 j typical.11 1.Posts to PT Sill
0'-8"TO FND Wall
E
_..._... ...._.__... ...................__...__
_........__._._......__.._.....__._..................._._..............__......._.._.. _.... .__......
0'-0"TO Slab A v A T2,2.1 5"stub
\ \\ 2)5/16"GRK
M n 3"Embed 7/7/2015
Typical 6x Posts
\ ._..___..._........ ........._...., Sy�OF qq
-3'-0"TO FTR E 4Tti
.lOHW R• a
T#lE76AL
V7 3/4" V 'STRUCTURAL m
11'8 1/4" z's^ a'z° No.50003
2a'o'•
�7 Foil
MONTAGUE TIMBER P E
FRAMES . .-
June 29,2015
For Fabrication
26'6"
W OJ W
r,> N
2'6"
T-2>2x4" T-2>2x4"
Peg 2 Pegs
Haunch 3"from end of Ridge T-2>2x4"
Peg
axlz {
1
1
T-2>2x3.5"
1 Peg
Typical Braces T 2>Zu4„
j T 3>2x2"Stub 1 Peg
DH-1.25" Haunch 3"from
Bolt Pocket and end of Plate
3/4"All Thread,Nuts,Washers f2x Fl Decking
_. ''. ___. ............... ..........
8x12 8x12
H-.75"
Wrench Pocket
3/4"All Thread,Nuts,Washers
T-2>2x4" T 3>2x2"Stub
H 5"
DH-1.25"
1 Peg 42"Top Spline j
Shed Tie to Post Beyond 2 Pegs Each Side
- - 2
t m m
0'-8"TO FIND Wall
0'-0"TO Slab Simpson CPS7
Epoxy 3/4"All-Thread
6'intn wit 7/7/2015
4"Into pier
tN of4��
-T-0"TO FTR ``evn
' JONNI R.
7'FIEYBAL
'STRUCTURAL G,
No.SM3
P 24'4^
i 3
MONTAGUE ■ ■ FRAMES
June 29,2015
For Fabrication
W N
I
Z
3
I
T 4„ T 4..
1.5>1.5 LS>1.5 1.5>1.5
1 Peg /end 1 Peg
from 121,9s t Haunch 3"from
end of Plate : £ of Plate
r _
ix Rough Sawn - H-75" -.5"
Diagonal Sheathing_ - �2)5/16"GRK 2)5/16"GRK
Below Finish Siding Min 3"Embed Min 3"Embed w T 3>2.1,25"Stub
Wall A Typical 6x Posts Typical 6x Posts 5/8"All Thread Epoxy to
{ T-2>2x1.5"Stub FND with Simpson Set
t.
r ao
2)5/16"GRK 2.5"x25"x1/4"Washer in
2 Min 3"Embed H.5 Mortise Pocket 12"from
1)5/16"GRK bottom of post,nut.
Typical 6x Posts Min 3"Embed < Typical.11 8.Posts to PT SIII
Typical 4x Nailers
0'-8"TO FIND Wall
I........_.._._.............._.._.._....._.__...__._.....................,.,....__._................ _.a _......,_.,.._.._...._....._.._..___....._._.._........ .. _.._....................._.._._.......__._._...__.
0'-0"TO Slab
7/7/2015
3'-0"TO FTR ' SKOFa
JOHN R.�"ksc
TAEYSAL
r e^ 9.0^ s'0• r e° STRM CUKAL w
No.saw
- o
11'8 114" 12'3 3/4"
24� �
TIMBER MONTAGUE FRAMES Hoff ..-
June 29 2015
For Fabrication
m m W
ro w
r
� t
i €
I
I
—2(!'2"
11'4 11.
T-2>2x4" T-2>2x4"
1 Pea ! T-2>2x4" 1 Peg
Haunch 2"from ? 1 Peg Haunch 2"from
end of Plate end of Plate
t
m r
FD x�T-22x3.5"
> Sim CPS6
H21 pson
a 1 ppg Epoxy 3/4"All Thread% Typical Braces d 6'I nto post
_.............._._..._................. ......_.........
0'-8"TO FIND D Wall Op1er
...
S
7/7/2015
_....._..._......... _._............... ._............ _. _..._......._ S OF
-T-0"TO FTR i
d4HW R. �
I I T�lEYBA
j STRUCTURAL H
No.5tY543
MONTAGUE i p�A
I i j
Pi
TIMBER • .• /Ncrth—pt— MA
June 29,2015
For Fabrication
n co D
9 2.RS Roof Decking
Off\
0
K1 64" 12 '
O6
9
1)5/16"GRK
H-5"
Min.3"Embed
1)5/16"GRK H-1
Min 3"Embed 2)5/16"GRK
Typical 4x I Angled from Each Side
0-.5, axn Simpson MSTCk10 on Face
Wall Framing
1)5/16";GRK ---_- '
Min 3'Embed -
H-.75" Typical 4x 2x Floor Decking
1)5/16"GRK- Wall Framing 4.4 axa '
Min 3'Embed
I
axa
r 6x6 6x6 _
._. axa Stub Posh � .----- -t� axa s-Pasc .........._..._._..�._._._., / '
6 9 ♦
H-.5"
1)5/16"GRK o i 1
..
Mln 3"Embed l - 1 H 1
Typical 4x L 2)5/16"GRK
Wall Framing 3"Embed
Simpson MST60
as Nud:onml axs r+o.ao,rcei Bend over plate to post.
_ s
3
0'-8"TO FND Wall
0'-0"TO Slab
ME 7/7/2015
-3'-0"TO FTR f_ .._...__._.�...___....___._._._.. ySNpF
I JOHN R. �a
T#�EYBAL
1'10 1/2" `gTRUC7URAL N
No.5ti959
P _ 28'°"
FRAMES MONTAGUE TIMBER . ..-
June 29,2015
For Fabrication
co
1.6"
w
1-4111 ........
B-4
Pad and 8 Pi-
2!33/4" 11'4 1/4" 11'41/4"
2tTV Bigfoot BF24
with 10"dis Pier
B-3
.1 --------------------------------- ---T-----------------------------
B-2
-—-------- .........
-----------------
TO FTR-3-0" 13'8"
See S-1.0 for
Typical FND Details
TO FTR-3'-0"
7/7/2015
SH OF
B-1
...... JOHN R
TOEYEAL
STRUCTURAL
MONTAGUE TIMBER FRAMES Hoff Garage Footer Plan 1/4" 1' T-0.4
N,rth--f-
June 29,2015
For Fabrication
D co l�
..... ,....._ TO Pier 0'8" ._...
B-4
$ � Pad and 8"Pier
i'7 3/4" 11'4 1/4" 11'41/4"
Bigfoot BF24
�'10,E
with 10"dia Pier
B-3
\ \
B-2 ` /
.............. ......-�...... ._._ v v \v A "�\� A \ s
See 5-1.0 for
Typical FIND Details
7/7/2015
m �ytN OF
B-1 l
3 1IM1GYBA`�. �i
O RUC'fUAAL -'
No.5tS5�3
MONTAGUE TIMBER FRAMES Hoff Garage th —pt—'r, 0')T�P
. . .
June 29,2015
For Fabrication
26'0"
of It
1'5" 11'4 1/4" 11'T ry
12'8 1/4" 13'3 3/4"
1'10 1/2"
Co
See 5-L01 \ \
Typical FND Details
\\q
7/712015
SN
low
EYSAL
5'3 7/8" 2'9" 4'7 3!8" V M9 CjgAL
NO.5ti599
13'3 314" 5'0"
26'01.
MONTAGUE TIMBER FRAMES Hoff :: Garage Post Plan 1/4" 1' T
June 29,2015
For Fabrication
y 6)
6
K
j �911
2.RS Roof Decking z
6�
p
2)CH 1
L)3/tl"GRK
TA" Rafterinto Tie s 9
Mln 3"Embed
i t5>LS � `-� s•� '
2 Pegs 9'•
_
DH 1"
bxio t 2)5/16"GRK
i - - j Angled from Each Side
Simpson MSTC 40 on Face
E - 2x Floor Decking
0::
a,a
- T-4" -
m �
H-1�� .- � x' 1 Peg
2)5/16"GRK
T 6.1
Min 3"Embed
Simpson MST60 `\
Bend over plate to post. \ T-2>2x3.5' -
111
1 Pe
1 Peg
n:n �r . Typical Braces
1)5/16"GRK
Min 3"Embed as lHo,,:1
Typical 4. _a`a _ H-.5"
Wall Framing l 1)5/16"GRK
m j m Min 3"Fmbed
Typical 4x Naiil-
0'-8"TO FND Wall
_.-—---------
0'-0"TO Slab ® H 1 s into Double PT Sou
1 GRK
Typical own l D Braces®Wall 7/7/2015
.............._._..._...,....,._._...._............___......._.___...__._ s .......,...._.....,.._.__.........._ _..... _ t�COF
-3'-0"TO FTR
5'3 7/8" 2'9" 4'7 3/8" bottom of post,nut.
Typical all 8x Posts to PT Sill TAEYBAL
o STRUC`IURAL v
NO.SM3
MONTAGUE P
TIMBER FRAMES Hoff :: ..-
June 29,2015
For Fabrication
Heavv Timber Framing
1 Framing Framing Fnlb,s Eastern h:t,?P:—;R..gh 3—r ,"-der state-size;Uns---ed-Grace:#2 and bx E. -1—rood.
2. Fact—erS
VV11,te approved ey,r--enf, i,ricted—rrnber d,—;r1q, dorreter-1ess noted
abn'ated f""Yl c eo 4'ght c-'1'defect fe'o'k..':it a:;I.;" i qr—not greater than 1.15.
L. Timber Sp!:—s: Match spec...,. fe--ted t::Ie,s(de-er —eptable). rie—, t-
q-,w �—k �,!.po�fgr,-,n.,gre.te,tiiio 1 15.
L-Ig Hlt Jlpp'd iASMC kl 821,,venerate inom —,ing —,be,8 d-,eters acted
-eel a,acted.
Et Faee--ter, r gene tT'V—:riic receiv.ng ti-ber.
HeadLok by aster rrasze,,3:' per.etr—,,nto re,e.,ng t:,,b,r.
RSI Ru-'Q,,d by GrK,3"rnz.--pe—tralo,rst�—e,—�q t—ber.
Seei d. 1 hre.aded and If,,F.10 goide A 3�,,5--55 st�1 p-de 3�� a,
for'redjon i wff:c:,?rc,terrfr-w, t) I,!,:,,,o k,,�d Jovr, ,d rl
a:.,;n,er,t—ti; -d fP--v-,t'...a.. a, he, -d&.phr au.
:-,
b. T�e—,,-i-I-r, ft- t,acre d,p—d,er, :i:r,ibers z ,-a—k-Wd.ted. I h deltgtl
nt ct—,
Wall Sheathing Attachment
Sheathing Dimensions Nailing at Shear Wall Edges Nailing at Intermediate Studs
1xt,a-d S—zier lS'....._-..,,man,� Na"s 2� 1 Con,rn.n Nark
A at d a IQ e r 4)V'd r—mmor,Na;ts co'n'nCri.lads
7/712015
OF
TA L
STRUCTURAL
No.SOW
MONTAGUE TIMBER FRAMES Hoff Garage N—th—,,p�F D o,t V t, 1 CY, Engineering Data NTS. T-0.3
June 29,2015
For Fabrication
Basis of Design
3, vtatc..a.,
1. -,.,ac,load a. C'n,mar f,r
Rxf dead load: "5 psf sieve,desiynatiun ,%'::y v,!gi,t.passing s,ev=s
b. F'roor dead lead: �1 osf .,rrich PO
2. LI.•e Icad r:o,1 45-?5
-. Roof hve load:snc,u load cover- ,-12
o. Floor 5ve load,mere than 3'-6"i'ezdroom: 40 psi c.,, C-6
_. Floor 1-�,.ad: 20 psf b. Cn.=-Led stones.
3. _nowbad +esig--.,.. byv < 'F- .,..,
a Ground snow lna<':
ae o: ,.
b. exposure fa<..... 1,'. 3 4 i,,,r. 90.100
,no,,_...final faror•..1.2 _. in.., ?0.55
d. nportance Factor: 1. no.n r-10
._ Iat roof snox•loan.: 34 Fsf .. ry;;
r � r
n. N',�d!^ad c. 3r,able cc s. ens ,.ra y:a <-�,cnahy free o{Ica-,s r.a.,e c�g,nic ratter.
B„is:....and speed:90 mph
a..c<Lrtor: 1.,: Cast in Place Concrete
*!ndexpo earegc P .. General
o n
d. real pre arc c_<�:a= ,' '.,..'3 a. C Imo.vitli p�,:.:c.-s tor. AC c. arr.sta^^ands.
:v...<....c.
fair r: 1.0 aticn ayy.air shin:, max.'•Ar.'C
slab
c. h. :pee.:.,.<<.ra� �spo,. ...��.e.a.:., ys: i.<::S oryade 4:vt:0 34' - 3"-5” 0,50
o. Mapped spectra;response accalert cn,51: 0,06?
Pa,e'o�vnc e, -e npv ar,re i,b<.o,,11'"'ecraa=ah e.vet or n'te tad Qo dap...
f. 5p na': aspon_._ceeffic ,..S..,: 40 d. C i,g:bey .:a r g a.....•as ree water ha pearec! cxpnsed.;..r:a..es. +.c e po_sl.1 seep
.. :_spouse wefft-.e.rt,Sa I O.1C? con f:..-usly :et e 72 hours .on..r ue cu cg by use of :t-e r„a,r'ny cover or :emorace form'ng curing cc mnoi rd.
Se's—design category_. B .:•.mete relnforinng
i. Ea_..s<!sm c f�cc �sl.,t:y y:iem: Sh a a Is�hea.n_c.'..t: +-a,7ona!:u.�cer sneatF ny rc.nfps!np s:ee:nha'be AS I V Act 5 i_xe:�e!d grade,deformed=_tee bars per ASTM 4305.
6. B�:Ikfinp code F, >e:..,,Mass shuse.t.,Re':��tial Ccde, b. 14'eldeo aie f.brc f. I be ASTM A'8t Lap a n. m pf t—rm-1
c. Con:_.eta cl.a ..c.e,fo el.ror c-me. ;, _.. ;ho' c,! -:ej:
Foundation Related Earthwork Scd+pm of fcpt4:s: 3”
Sides of.,otn 7"
1. .
F t'. n d y f .-: be-r rig na..y o:2000 p'f. grrra.to notify eng e—ar croon tc Yeas ct p s
Fro
led ryv��:.„ck ,,al,c c. rsd All ps,ra c,f.,..e so. lap,•...vss3_p: n "sp_<fcaly noted:o--he contrary.
b. coop,a doturpaid load demon n d rent contact-.wit+fou±a.rc .o c,stn „c,,a -:try.Place a n•',,.cure of
6 inche_of cru=_had stone bane,h spread footings if standing mater or clay soils are encountered in excaraticns-
c If eve•-eaca i n..c_u._, I name a v, ,,itab c� e.ra.r� ale ,in 6 non lifts,approved by th r9'neer
and compacted to 95%of mcdif:ed prcctcr.
d. Protect the site and all construcTior.,existing and proposed,from tf:e effects of freezing or frost action.
c. Footings arm to b,,placed n-,,rnan,4A"be!cw grade.
2. Bac-F.fill requirements
a. F!P.v,,h:,cullding envelope.
. Material: granular fill
Compaction: 95%modified proctor
b. Bac',<tfil along exterior of building at frost wa!Is:
.. Material:s .able nat.—sod
._.mpaa 9c:,rnedlfled p:odor 7/7/2015
JOHN R.
TAFYBAL �,
STRUMURAL N
No.5003
�o
i • • • • •
M
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31 ma
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MONTAGUE TIMBER FRAMES Hoff :: Garage "F' Overview 2:: N.T.S. T-0.1
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MONTAGUE TIMBER FRAMES Hoff :: Garage Northampton PAA QhO
Overview 1 :: N.T.S. T-0.0
Ul
DRIVEWAY
EASEMENTo
161 .28 ± ...
57
I
180.30*± A)RI VEIIVAY
= .EASEM EN t.
NA &
4NECTICUT ATTORNEYS TITLE INSURANCE COMPANY
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: �7
The debris will be transported by:
The debris will be received by: �'4r S/-A«c
Building permit number:
Name of Permit Applicant
Date Sign-ature of Permit Applicant
City of Northampton
Massachusetts
t DEPARTMENT OF BUILDING INSPECTIONS ax.
y , 212 Main Street • Municipal Building SJl•., bnr
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
1, 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
Department of Industrial Accidents
r 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
Name (Business/Organization/Individual):
(� vi ft Oext'V err
Address: Ora
City/State/Zip: t� r n trf lZ. �� � C�Phone #: ��1 `�7 �� ,
Are you an employer? Check the appropriate box: Type of project(required):
1.I�Rl am a �with employer 4. [] I am a general contractor and I
6. El 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
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 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' 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: ••1- " ` • ( `"��w I —
Policy#or Self-ins. Lic.#: d 0 - 66 � d r &3—— �O !st+ Expiration Date: �y
Job Site Address:3-7 N"o-4,+ J4 lle�eF 1 ��_kk City/State/Zip: / !/brf(;94A ^14 L9166
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 the pains and penalties of perjury that the information provided above is true and correct.
Sip-nature: +�•�/ 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 /£ J
Name of License Holder: 3k L�4e r'e Z ) y J 2 1/
/ L ci ense Number
, �/Io { 711 - c�1-• 0,-5 1114 01 3176, 17 2 ., /5--
Address Expiration Date
Signature Telephone
S.Registered Home Improvement"Contractor ', ,., „ _ Not Applicable £
Company Name fi Registra ion Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURAN E AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be comp) ed atTd 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; xemption
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.
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 [0] Decks [0 Siding [0] Other[0]
Brief Descriptii n of Proposed L n ,�C�
Work: C ttt c r Gl I C� r l e 7'` � �y Ge_ (`CL p e
Alteration of existing bedroom Yes_4 No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa,`If Newhouse'and or addfion to''existng 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 �d _ �p
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
1 � ff as Owner/Authorized
Agent hereby declare that the staterrIents 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 Name 3
Si atur 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 coliunn to be filled in by.,. <
Building Department
�
Lot Size
Setbacks Front
Rear
Building Height
Bldg.Square Footage 010 =r
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
x �
A. Has a Special Permit/Voriance/Rmding ever been issued for/on the site?
NO 0 DONTKNOY YES 0
P
IF YES, date issuedd,
IF YES: Was the permit recorded at the Registry ofDeeds?
�.� '
N0 uuN�| �nu� ,c�
IF YES: enter Book and/or Document#1
��
B. Does the site contain a brook, body uf water orwetlands? NO W�� DONT KNOW «�� YES
^
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 ' Date Issued:
��
C. Do any signs exist on the pnoper�? Y[5 �_/ NO
IF YES, describe size, type and location:
D. Are there any proposed changes tour additions of signs intended for the p,opert 0 y� YES NO
|F YES, describe size, type and location: L |
E. Will the construction activity disturb(clearing, gradin voUon.or filling)over 1 acre nrinit part ofa common plan
'
that will disturb over 1acre? YEG � l NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
t � -
r t w �pepartmeht,use onlX
- City of Northampton StatwsAai Petm►t,
�f� k i tti 'd��a, RII�
`^ j Budding Department Garb CUIt/DTIMceuva�rFermt#
LO'V : 1 F �
w.
jEle �L 3 1 _% ' 212 Main Street Sewer/sePticavalrabllrty i
Room 100 Water/ A:01l lhvatl�ab Ilty ' �
uOnNo rtham ton MA 01060 TWo c p SetsFaf Str�lrctutalRii
e 413-587-1240 Fax 413-587-1272 PloflSife Plan's
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 ,.
7 rf 7T Map Lot Urnt.
��d c Zone Overlay District
✓1
I
Elm St:Distract' c8 Distrct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: qje
Name(P n Current Mailing Address:
Telephone
Sig ature
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 ([d/ (a) Building Permit Feb
2. Electrical // 6 0 0 (b)Estimated Total Cost of
2� ` Construction from 6
3. Plumbing a Building Permit Fee
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-2016-0129
APPLICANT/CONTACT PERSON RUSSELL FARLEY
ADDRESS/PHONE 6 DEPOT ST TURNERS FALLS01376(413)775-3976 6K
PROPERTY LOCATION 57 FORT ST
MAP 38B PARCEL 210 001 ZONE URB(100)/ 1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
BuildinV Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 24 X 26 DET GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 093011
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFPRMATION PRESENTED:
proved 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
ZBuil tion D lay
Signature of di fficial 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.
57 FORT ST BP-2016-0129
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-210 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2016-0129
Project# JS-2016-000218
Est. Cost: $42500.00
Fee: $125.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RUSSELL FARLEY 093011
Lot Size(sq. ft.): 12980.88 Owner: HOFF R ALAN&JENNIFER ABLARD
Zoning: URB(100)/ Applicant: RUSSELL FARLEY
AT. 57 FORT ST
Applicant Address: Phone: Insurance:
6 DEPOT ST (413) 775-3976 WC
TURNERS FALLSMA01376 ISSUED ON:81612015 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 24 X 26 DET GARAGE
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 8/6/2015 0:00:00 $125.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner