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44-052 (11) 1140 FLORENCE RD BP-2017-0048 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-052 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Inground Pool BUILDING PERMIT Permit# BP-2017-0048 Project# JS-2017-000089 Est. Cost: $54000.00 Fee: $7 .00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa. ft.): 165963.60 Owner: POWERS DEAN Zoning: Applicant: POWERS DEAN AT: 1140 FLORENCE RD Applicant Address: Phone: Insurance: 1140 FLORENCE RD (413) 923-2455 0 FLORENC EMA01062 ISSUED ON:7/22/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 36 X 21 INGROUND POOL 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 7/22/2016 0:00:00 $75.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File BP-2017-0048 SON(11 CIL- APPLICANT/CONTACT PERSON POWERS DEAN f'-"" ADDRESS/PHONE 1140 FLORENCE RD FLORENCE01062(413)923-2455 Q �" PROPERTY LOCATION 1140 FLORENCE RD MAP 44 PARCEL 052 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 418o 47S Fee Paid Typeof Construction: INSTALL 36 X 21 INGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan TH F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 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 e wlition Delay 7 a// S re o t ding 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. REUEIVED Depa menruseonly I CIhJ of Northampton Status of Pero 2016 Suilding Department caro Gat/Dri eway Permit" • 212 Man Street Sewer/Septic Availability Room 100 WaterNVell Arallablllty- p®roreuIniNoespecnoNB hl)rthar'tpton, MA 01060 Two Sets of Structural Plans NOFFeugmNN,MA mccc Rllone4-1,1_587-1240 Fax 413-587-1272 Plot/Siie Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Properhr Address Thi_ secnon to be completed by officeI�qo FJVe1tt 1Z7 Map Lat - Unit FLU yP4CL nta. oya‘ }-' Zone Overlay Dstnct _ Elm St.District CSG strict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owthl of Record: / C .srroad Name ` ini) ✓. /, // 4a f4Uvcn. e-0- (2- (ddmB(P Int) d Brit Ma ng ap4255 r . 4/3- 7z3-a-v 5S eetn 9 o.�G "O Telephone Signs .re 2.2 Authorized Actent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Hem Estimated Cost(Collars)to be Oficial Use Only completed by permit applicant 1. BuildingS3o0 C (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of 1/4"0?.../ Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection < <' i 6. Total=(1 +2+3+4+5) 5- 4/G61 0 ,Check Number Q A75 This Section For Official Use Only Building Permit Number: Issu a0ed: Signature: Building Commissioner/Inspector of Buildings Date E/II • � ho, r� � z oo—n ark , co C Section 4. ZONING AU information Must Be Completed. Parrott Can Be Denied Due To Incomplete Information Existing Proposed Recuired by Zoning This column to be filled':n by Building Department Lot Size .. _.. __.__.._. Frontage - -- Thi -- Setbacks Front - ( — Side RL - RI -i� / Rear ( Building Height - - Bldg_Square Footage - -i % --- Open Space Footage o _ (Lotareaminusbldg&paled _. -- park:ng) #of Parking Spaces T'— ' Fill: i - _ (volume&1_ocation) - m - A. Has a�Sp(ecial Permit/Variance/Finding ever been issued for/on the site? YL�2 NO DONT KNOW 0 YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 L w IF YES: enter Book Page, '. and/or Document# �r-� B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES ty/ IF YES, has a permit been or need to be obtained from the Conservation Commission? /� Needs to be obtained Obtained 0 , Date Issued: __ 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 far the property? YES 0 NO cgr IF YES, describe size, type and Location: E. WIII the construction activity disturb(clearing,grading excavation,or filling)over t 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. , r a • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition f I Replacement Windows Alteratio(1(s) n Roofing n Or Doors C Accessory Bidg. n Demolition ❑ New Signs CO) Decks ](] Siding lDl Other[] Brief Description of Proposed , n Work'. h Y ( 0 6. /,ALL—d -, • ••-• Alteration of existing bedroom Yes / No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba, If New house and or addition to existing 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 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, , 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 a Date --i &( * 44.441 as Owner/Authorized Agent -reby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. un the pains and gegalties of perjury r 9h ] �G/ A � d. PU � Print Na Signature of6wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name Licensa Holder'. License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor Not Applicable E 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 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 lure 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 Ire/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 m Deal, •" h- : sachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work . .. -•I er s permit The undersigned' • eowner"certifi: and assumes res.onsibility for compliance with the State Building Code,City of Northampton Or' nances,State and L•. al Zoning L. and State of Massachusetts General Laws Annotated. Homeowner Signa re 24, Art The E'©rtuaeanweaith of'Iblassachasegs -* In Department ofI(fdststrial Accidents 4Office ofInveslzgations ' "+�� 600 Washington Street �*ia—aagg ¢ —.a— Boston, MA 02111 .L`: i/;'—0 www.ntoss.gav/ilia Workers' Compensation I nsnrence Affae2avf. EwuMers/Cmuatrack®o•s/e lleo¢risuams/1P➢uuoDn2a'trs A pifeant Information Please IPrhmk 1LegiWy Name (Business/Organization/individual): Address: City/State/Zip: Phone ft: Are you an employer? Check the appropriate box: Type of project(required): 1.[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.❑ I am a sale proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shi and have no employees These sub-contractors have pS. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.t 9. ❑ Building addition [No workers' comp. insurance P rrrhhh required] 5. El We are a corporation and its 10.0 Electrical repairs or additions 31p 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.n 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 41 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 entitles have employees- If the sub-contractors have employees,they must provide their workers'comp.policy number. /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 cover.• as require der Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to SI,500.01 nd/or one-year lin') sonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up t "t.it . say against the violate . Be advised that a copy of this statement may be forwarded to the Office of I stigations of• SLA for insurance overage verification. I do hereby cerfffy der the ' s and penalties ofperjury that the information provided above is true and correct. \; attire\ -ea1N \ 0-444/1/1 Date: 7-/F-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#: City of a3ortharroton Maeeaehusa0 is r< / d t Ik9 � TTART NT OF BUILDING .,No ACTIONS erF k ' 212 Marr Street a Municipal Building Northampton, MA 01060 � �)-r • INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER Ek`CMPTTON 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 rouch 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 ins ns are made understand the above. (Home owner/resident's signature requesting exemption) will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location • 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: ii ((a F/ovcif cc (C3 The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicar A\ /_& vr;-,-€17 S Date Signature of Permit Applicant