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22D-060 i F t M0'P' t� 0 4'-4" Both 7-10 x 7-8 Bedroom ❑ 13-8 x 15-3 Bedroom 12-8 x 10-6 EXISTING SECOND FLOOR i 0 e°e 0 28" Li New door ho 32 Check depth door requirement of Laundry - stackable laundry . unit _ 40" w. x 36 deep 32 Clos door C'C 2® 2s" doors n n �' >,� `'v/l- FIRST FLOOR - 05D i New narrower window 30" w, window � O New wall >, narrower Hall 5, N ' x5' —0" tub �' s ower 3' gl s ncl J C16s. � i 0 b 32" New 36" w. hall I 32" Bedroom Move all 24" I 10-9 x 15-3 new C bor 3' W. I closet 30" pocket door added to inside of existing wall to retain continuity Bedroom of wind shear wal 3 w 12-8 x 8-6 closet 30" PLAN 05D i 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: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant °� � Date Signature of Permit Applicant City ' of Northampton Massachusetts DEPARTMENT OF BUZZD114G INSPECTIONS �+ xi 212 Main Street • Municipal Building Northampton, MAI 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner i l 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" als, " 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 i 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 ihspect work at various stages, which include foundation/footings (before backfill), sonotube holes (Mefore pour), a rough building inspection before work is concealed insulation inspection if re uired 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 certifi'ate 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 I$roper permits in conjunction to the building ' permit issued, and that they get their required inspectionis. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemp ion) I will call to schedule all required building inspections necesspry for the building permit issued to me. Date Address of work location I j The Commonwealth of Massachusetts Department of Industrial Accidents 1. Y11- Office of Investigations 600 Washington Street F Boston,MM 02111 4 y4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ??� , Please Print Legibly Name (Business/Organization/Individual): l-�/� 51n` /7�/� Address: �� /� �� P-12 City/State/Zip: /5 Phone#: X13 5 75-- ,T 7 0 3 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction loyees (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for in any capacity. employees and have workers' 9 E]Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ 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.❑ 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: Policy#or Self-ins.Lie. #: 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 the pains and penalties of perjury that the information provided above is true and correct. Signature t� ! � Date• 1/�/i6 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 87 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: 06Z-17-Z- License Number Address Expiration Date Sigrfature' Telephone Company Name Registration Number '21 P-109 Address zb Expirition Date Telephone SECTION 10-WORKERS!COMPENSATION INSURANCE AFFIDAVIT G.L.c..152,§2 1 5C(6)) Workers Compensation Insurance affidavit must be completed and submift:bd with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. The current exemption for"homeowners"was extended to inclu4e Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire+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 ion 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�ff o-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a fbitn acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building�-e�rt- As acting Construction Supervisor your presence on the job sit4 will be required from time to time,during and upon completion of the work for which this permit is issued. Also ooadvised that with reference no (Workers'Coppensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetits 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 responsibili�y 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. | ! � . / | ' ' | � | F CTION 5--E ESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) [v Roofing Or Doors F Accessory Bldg. ❑ Demolitio ' ❑ NeUpSign in Other[,? Brief De s ,i o Propos d /� Work:- /"� '� �lr12--1N� ��— "5en, /0 �' �/�✓ /j� 2-1 C_ Alteration of existing bedroom ✓Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet _ ,• K sa:If. New hawse and t.addI: ioii fo exjsfing housltlq"compCete fFie followlnr 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. flocdplain 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 u� �v 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'. 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 un r the pains and penalties of perjury. 1140116 Print Name Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. PE rmit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size #-- Frontage i --- -----? — —� Setbacks Front Side L:' - y R: L: R�— Rear Building Height Bldg.Square Footage Open Space Footage {-- —'�� % ; (Lot area minus bldg&paved parking) #of Parking Spaces ��--� - Fill: tt= (volume&Location) i A. Has a Special Permit/Variance/Finding ever beer]issued for/on the site? NO DONT KNOW Q YES Q IF YES, date issued: --� IF YES: Was the permit recorded at the Registry of[feeds? NO Q DONT KNOW Q YES Q IF YES: enter Book L �i PIge,; and/or Document# i B. Does the site contain a brook, body of water or wetlonds? NO _ DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained firom the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: , D. Are there any proposed changes to or additions of sighs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, exca)ztion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Per it from the DPW is required. artment use onlyy < °I -- -' T, rI P. s }s r ity of Northampton Status ofPermtt, � T i r y �;Ser'i f B ilding Department 17. 12 3 12 Main Street S4ewer/Sep(icArzailallrty r�Y "' �3'' kI NU Room 100 UVaterlU�fe7A4ai1a6111t r "' „1+Jr'i{iJp :;Ti� ort ampton, MA 01060 !Twail.Set` a5#r''�ctral of ,, �0 - 7-1240 Fax 413-587-1272 PIo/Site Plans`°f ",t, j Mi gq -:5!iG_ ;�—.,!J;r•, }i�.:!.+ tr,- -,_:;,c,:: ,� N_'-':�"•?_.`.c`�'-=''�.'i;G''� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This,sectiorrto be completed by office , 1.1 Property Address: _ ❑4 _, I F nit U4, ,_ L ry r CBEMS& SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT'.;. 2.1 Owner of Record: �(/ ( � Q J /� h To c� �� 1 f I�� `�i � � '�rC'tif 1��✓ L ��erce {''�/ Name(Print) Current i sailing Addrres `may `' o l Telephone Signature 2.2 Authorized Agent; &/Ll�y Name(Pri 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 /0` (a) Building Permit Fee 2. Electrical U (b)'Estimated Total Cost of Construction`from(8):' 3. Plumbing rl Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection -0 6. Total=(1 +2+3+4+5) j G' 21 Check Number This-Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector.of Buildings: 2 Date | i i | | / ' / | ' ! | | | | i ! . | | | � ! | / ' | . File#BP-2016-0870 APPLICANT/CONTACT PERSON ROBERT SPELMAN ADDRESS/PHONE 71 NASH HILL RD WILLIAMSBURGO1096(413)575-5703 Q PROPERTY LOCATION 41 FLORENCE RD MAP 22D PARCEL 060 001 ZONE URA(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid will Building Permit Filled out Fee Paid Typeof Construction: REMODEL 2ND FLR BATHROOM&CONVERT 1/2 BATH TO FULL BATH/LAUNDRY ROOM New Construction Non Structural interior renovations Addition to Existinge Accessory Structure Building Plans Included: Owner/Statement or License 082172 3 sets of Plans/Plot Plan THE FOLLOWING 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 oli i Delay Signature of Building Of icial 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. i __ 41 FLORENCE RD BP-2016-0870 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-060 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0870 Project# JS-2016-001470 Est. Cost: $18000.00 Fee: $117.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT SPELMAN 082172 Lot Size(sq.ft.): 16727.04 Owner: MATRONE TIFFANY E&DOUGLAS M KIMBALL Zoning. URA(100)/WSP(100) Applicant: ROBERT SPELMAN AT. 41 FLORENCE RD Applicant Address: Phone: Insurance: 71 NASH HILL RD (413) 575-5703 (� WILLIAMSBURGMA01096 ISSUED ON.-11712016 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL 2ND FLR BATHROOM & CONVERT 1/2 BATH TO FULL BATH/LAUNDRY ROOM 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 1/7/20160:00:00 $117.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner