35-076 (5) 848 RYAN RD BP-2016-1525
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -076 CITY OF NORTHAMPTON
Lot:-001
Permit: Building BUILDING p
Category: window replaced BUI LDI \ G 1 ERMIT
Permit# BP-2016-1525
Project# JS-2016-002597
Est.Cost: $300.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
u:e Group: Homeowner as Contractor
Lot Size(sq. ft.): 17554.68 Owner: YOUNGER-FLYNN JOY& PETER D FLYNN
zo, nln2-:- Applicant: YOUNGER-FLYNN JOY & PETER D FLYNN
AT: 848 RYAN RD
Applicant Address: Phone: Insurance:
848 RYAN RD
F LORENC EMA01062 ISSUED ON:6/24/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: New window framed into garage door opening.
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: OI: 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: FeeTvpe:
Date Paid: Amount:
Buildine 6/24/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
'(3
Th/an IPJ �r / 7 Map Lot - Unit
FT0 rent(C (' l Qi OD \ Zone Overlay District
Elm St.District CB.District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: Pd
R TC 0;7 yt✓rd `3"``t - RYAAl
Name(Print) Current Mailing Addres
yf 3-J)o 7U o
✓%tea Telephone
Signature - -
2.2 Authorized Agent:
Nil
Name(Print) Curren(Mailing Address'.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ,t3 UU Q-1 (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6) _
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5 Fire Protection ¢‘s. OU
6. Total=(1 +2+3+4+5) Check Number �v l
This Section For Official Use Only
Building Permit Number: Issu
,/ yn atetl:
Signature: � ../��` e/'2-q/ic
Building Commissioner/Inspector of Buildings Date
I.
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'his column to be filled in by
Building Department
Lot Size --_. . . .
Frontage __. -. --. -
Setbacks Front
Side L ...- R L R: .
Rear
Building Height (((
Bldg Square Footage / ,
Open Space Footage
(Lot area minus bldg&paved r � '
parking) / -
#of Parking Spaces -- / - -
Fill- -. -- OIL—
(v I &Location) _ gi
A. Has a Special Permit/Nana nc /Finding ever been issued for/on the site? / t� 1 1
NO O DONT KN W Q YES Q / 1\VI
IF YES, date issued
IF YES: Was the permit rec rded at the Registry of Deeds? I
NO Q //pNT KNOW 0 YES Q
IF YES: enter BoLk Page; and/or Document#
B. Does the site contai a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a p@imit been or need to be obtained from the Conservation Commission?
•
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q 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 Q NO 0
IF YES, describe size, type and location:
E. Will theconstructionnruacre?
a tivtdisturbYEb(clearing, grading,ng excavation,cor filling)over' acre or is it part of a common plan
that l
IF YES,then a Northampton Storm Water Management Permit frcm the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
ADDINC WwV
New House 1Z Addition ❑ Replacement Windows Alteration(s) Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition /❑/ /,/New Oyil iSiigns [O7 Decks ID Siding[CI Other[DI
Brief Description of Proposed s�G[ k/A101cie
Work I4 SIC ReQjei h� atoy"'
Alteration of existing bedroom Yes No Adding new bedroom Yes �f No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga. 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
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 y / Date
I, / cg IAVN , 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 pain. .- altos of perjur . fia1c7.n
Print Name _
Signature of Owner/Ag to/ Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder
ffVD\1-2 O�I` License Number
II � )o
Address v Expiration Date
Signature Telephone
9.Registered Home Improvement Contactor 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 resat
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 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 Lo al Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature fr1
The Commonwealth of Massachusetts
(Department ofTnchtstrial Accidents
i_ ra
F Office of Investigations
� y -J �. 600 Washington Street
Boston,MA 02111
-_� rvrvw.mass.gov/rises
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
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. ❑ I am a general contractor and I 6. New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
2.CI I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.; 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.El I am a homeowner doing all work officers have exercised their 1L 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 dirt cheeks box 01 must also fill out the section below showing their workers'compensation policy information.
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.
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 the pains and penalties of perjury that the information provided al✓ove 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#:
City of Northampton
'SyLIMassachusetts ry
& DEPIETPaNT OF BUILDING INSPECTIONS
�> N, 212 Main Street o Municipal Building �r
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 ad 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 .-
flit/Ai / 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 RYAN R0
ldrF C/
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: ky,a w J
The debris will be transported by: yf,/r-) (—ow N F(p
The debris will be received by: 1;ietJsic Pr) 1a✓i5fer
Building permit number: J'
Name of Permit Applicant ,f6:7-(2.
Date Signature of Permit Applicant
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