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24C-121 (12) File ft BP-2008-0845 APPLICANT/CONTACT PERSON TYLER BERGERON ADDRESS/PHONE 7 SCHOOL,ST GRANBY (413)427-8034 0 PROPERTY LOCATION 132 FRANKLIN ST MAP 24C PARCEL 121 001 ZONE URB THIS SECTIONFOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � e� Fee Paid JRW(( r+/f 41 Tvpeof Construction: DEMO DET GARAGE&CONSTRUCT 20 X 24 STUDIO New Construction Non Structural interior renovations Addition to Existing Accegsory Structure Buildine Plans Included: Or+nr/Statement or License 080274 3 sets of Plans/Plot Plan THETHE FO LOWING ACTION HAS BEEN TAKEN ON'THIS APPLICATION BASED ON INF 4ATION PRESENTED: , Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: ,,,,,- Site Plan AND/OR Special Permit With Stle 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 Cutfrom 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 f /Ale Signature of Building Of cial 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 Flaming& Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water ell Availability Northampton, MA 01060 _L Sets'of Structural Plans. phone 413-587-1240 Fax 413-587-1272 Prot/Sae Plans ciy Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOV/4tEctR MOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address' of III `.r'a This section to be completed by office J j3.). FFAgk�>m 5Ataf IVSTIONS Lot Unit 11 OEr Of . t 01060 /VOA �♦'`u A M14- l Zoltle` Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:\ � r- T¢.11 yl1TCr 1 awb / 3). lraYKhA sJ c«t /tfod µ IA PonMA Name( t) Current Mailing Address: a 1 J�41^-+-Y l — Telephone gnature C] -)`-� 2.2 Authorized Agent: 7 [ [J ( B y Name(P t 1 c irca & LOO( ✓11[Ct U(c,A, M(1 oio ' 7 Current Marling Address: /•.,I 9i3-9)-7-8o3y Signal re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building -.r0 DOD '(a)Building Permit Fee 2. Electrical / (b)Estimated Total Cost of 11 000 Construction from(6) 3 PlumbingrOOO Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 7Np00 Check Number 3965 P6--- This Section For Official Use.Only Building Permit Number -Date Issued Signature: IBuilding Commissione7/Inspectorof buildings - Date Section 4. ZONING AU information Must Be Completed.Fermis Can Be Denied Due To Incomplete Vehemence Existing Proposed I Required by Zoning This column to be fled Inby > r Haddam Depar:mevt Lot Size _.,. L4.00_.-.- _. �___ latc.QQ Frontage — _kr9__.._._ .... _��r.. a`_4v .__. Setbacks Front11� Side t 3F? Rlit ii..,r13- R.-3%-. -idf- ly Reay Building Heialtt - r "/ Flldg. Square Footage jinp. Y80_ Open Space Footage _y"} )'t' (frit area minus bldg paved wit -421 y}.S gktne) P of Parkins Spaces -�--- ---- Fill: tmolume S.Location} A. Has a Sp i Permit/Variance/Finding ever been issued forton the site? NO ' DONT KNOW O YES Q IF YES, date issued:: IF YES; Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW p YES Q IF YES: enter Book Page andior Document if B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW © YES 0 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 ahy signs exist on the property? YES O NO Er 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 IF YES, describe size, type and location: E. Will the construction activity disturb(rbering,grading,ex on,or filling)over I acre or is it part ota common plan that will disturb over I acre', YES 0 NO IF YES,thea Northampton Storm Wafer liabliffent Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) i New House El Addition Replacement Windows Alteration(s) U Roofing U Or Doors 0 Accessory Bldg. Demolition New Signs IC] Decks [C] Siding[CD] Other[p] Brief er cn "on of A I 0' • L=m L} Wont; ? ,P , . .�1��..t .. . r CCSS�rr 6ira it ,04, INA of pAJcx+n+f. Alteration of existing bedroom Yes if"- No Adding new bedroom Yes /INo Attached Narrative Renovating unfinished basement Yes -Pell-4o - Plans Attached Roll -Sheet Ca. If New house end oradditicin 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 0. Is there a garage attached? /� l�7�- d. Proposed Square footage of new construction, 7 , 7e) Dimensions r20 0}71 e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number f each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? _ h. Type ofconstruction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr, floodplain Yes_No ). 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETE) WHEN OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT Jentl ter '1—Ae4,6 , as Owner of the subject pri perry hereby authorize , V (( r C ' rofl to act on my behalf, in all matters relati a to work authorized by this building permit application. Slgna�r of wrw4 Date 8fitfiere9ffi as Owner/Authorized Agent he declare thaft the statements 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. ktV Print Na •- L u /% // Siy,aur- :Ytmer/Agent Date SECTION 8-CONSTRUCTION SERVICES B.t Licensed Construction Supervisor: Not Applicable ❑ \ {� Name of License Holder: I ICC Ze't 1P tnlj „ „� (51 P d-7% jj {{ / G� License Num -r Sck1kcl SAtrekG l'c,nLy NIA 0103 3 f Adtlres - Expiration .ate ' /0 Sign Telephone 9 RegisteredHorne ImproyementiContractor' ” ; Not Applicable ❑ T �l lr s TA( . /1i767b1 CampanyN Registration Number 7 5cLLrnl (7c ,s MA 0/033 74101 �- Address I j� Expire on D e Telephone J/3'9)7-803f( SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GI.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 ... I I'.=Iiome`O*nerExempiion The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or rwo(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner arts as supervisor.CMR 780. Sixth Edition Section 11183.5.1. Definition of Homeowner: Person(s)who own a parcel ofland 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 suck 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 penult 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,von may be liable for persons) 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 Office of Investigations _ 600 IJashin�an Street Boston, 314 02111 wniw.mass.;of/dia Workers' Compensation Insurance Affidavit: Builders/Contractors'Electricians/Plumbers _Acolicant Information Please Print Legibly Name (Sus nes.Orzac:zaticn:Individuail: Beegp(nr\ EL.: aMS Thr , _ Address: 7 5rio0J 5-1(1rr f V City/State/Zip: w _ L j 0 0 Phone=: / - 'ib 1 Are you an employer? Chec the appropriate box: Type of project(required): I 1,Li 1 am.a est:toyer`with 3 4. Q I am a general contractor and I 6. New construction (fit and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on de attached sheet. l i. ❑ Remodeling 11 . ship and have no employees These sub-contractors have I S. 5 Denotation I working for me in any capacity. employees and have workers' 9. ❑ Building addition. [10 workers' comp. insurance comp. insurance.- _ I tee a1 5. _I We are a cm-parna and is 10.0 'ec nosy repairsor additions .,^ I amomeown.er doing all work officers have exercised their 11.7 Plumbing repairs or additions myself [No workers comp. right of exemption per MMGL 12.5 Rod repel s I insurance required.] ` c 13, §I(4), and we have no 13.�Od: employees. [No workers' 13.Q/other rI LG t34•��.5 comp. insurance required.] 'Any applicant that checks box 61 must also fill out the section below showing their workers'compensation policy information. Ho meowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. {c:nnc ors Mat cheek this box must attached an additional sheet showing the name of the sub-connaeors and state whether or not those endues have employees. If the sub-cone cors have employees,they must provide their workers'comp policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information p �//�� Insurance Company Name: tl0.rltorcJ 11(141. CD . Policy=or Seif-ins. Lic. #: (Q S o 16 5) CC I ttio7 .Expintion Dare: 7 YS-OB Job Site Address: ID. FRxl�lh S4rrct ,Freerr--, Ciry/State/Zip:A/crth„fion MA caw 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 MOL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,50J 00 andior 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 azinat the violator. Be advised that a copy of this statement may be forwarded to the Office of invest:gators of the DLA for insurance coverage verification. I da hereby coy yfi�/r srderthep r-tueti-fie alties_efpe turtlaarthe information provided above is true and correct •Signature: " " 7 Date- k/_OS - Phone=: q/3. 9.)_7- gray — 1 te5e-anlr_Da rot writednlhis areal be completed by city or town official - it City or Town: Permtt'Lrcense# i11 Issuing Authortry(circle one): 11 Board of c _ltb - Bnfdina Department 3 C -' Town Clerk Electrical Inspector 5. nUrn5 _1ns_e tOr I . it 6. Other I (Icntacr Perron: Phone g: ' - � _j .,, . -_ ' s -1 , tarxscrazew " _ HOME OWNER EXEMPTION ArIC OW-r EDGEINLENT The S e of M each se.s allows the homeowner the.-.z::rnaer 7EOCfli_a 103.3 4 to act a_ .-.:sfite:construction sod-) _. The rake defines `ro„eowner'as "Person(s) who ow- ar rcei on whichh she resides or intends to be, a ore or tuofm-.uy oven'. �.::..caed cru c_ed••_c..r -n^ats,rr o suchfirm use atdform stud ares. A person w_o cors-ars mire than one hone in a two-year pe od sal not be censide;ed a I` home c..,.er." The ba mde ea for the City oxNorEa,oton watts.ny pc—,cc(s)woo seek to use mehome over wpt'.c; t;cm as their own coristromicas superrisch to be aw'_e that by der-s so you become responsible for comp,'iance with state buildiug codes 1fl2a bad re ons The inspection prods-rhes that the building.der..-lime=be called to inspect work at ,cu steam, -which include foundationifootia25/before baddill). soaotabe holm(before pour). a roti b bin ildmsiiusaect:os(before work is ceuxeale:, i isrithaaa lashection-(if reaaire)nada fi elhni3din.iur*rc a.The -ottilefero cess pea reqthres these isae ors before the work is concealed, failure to secure bare b i e_tions aux result in failure to obtain a certificate of occnnancv amen thewrk caabears ectel-- - I due hnrmerner hires otter trades to perform work(de„^t:ci, ptambing&as) the ho neo _er will be res ensble tc make sire that the atm hired se...ne their proper 1.-.c-ts in 0a-4m-ham to the boil-_pest issued, and that they get then-required b:spections.Fa!tre oft_e iadi iez!wades to sr--e the permits and ha rectios as require~ can DELAY the prcjer _.=i such time as the proper Pers is and ospealora are made • rutder..and to above. ( oke ownerl7 esideat's sionatur a requesting exemption) I e call to schedule all require`' building inspe:ices ne^_essa y for the bciids._permit iss ec to me. Dale ndr�sp wnrc . _ _ S 'i7 C o,,,,aO,,,,r,dtlr , . %f,v+„1L,uaW Board of Building Regulations and Standards Construction Supervisor License License: CS 80274 2 Birthdate: 7/2811911 4.00;‘, Expiration: 7/28/2009 Tr* 1225 Restriction: 00 TYLER R BERGERON �; . 7 SCHOOL STREET GRANBY,MA 01033 Commissioner .iii, a//4,tt Board of Building Regulations sad Standards r# 5? HOME IMPROVEMENT CONTRACTOR }../II Registration: 147679 Expiration: 721/2009 Tr# 1'%2936 Type: Private Corporation BERGERON BUILDERS INC. TYLER BERGERON 7 SCHOOL STREET GRANBY,MA 01033 Admiuismtor Apr-01-2008 01 :26 PM Remillard Insurance 14135386010 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE8y DATEOaWDW BERGS-2 04/01/08 PRIMMER THIS CERTIRCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND NO FUGHTS UPON THE CERTIFICATE Remillard insurance Agcy, Inc HOLDER.THISNFERS CERTIFICATE DOES NOT AMEND EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley m1 01075 Phone:413-538-7862 Max:413-538-7179 INSURERS AFFORDING COVERAGE NAM ft INSURED Be11REI& Safety Insurance Company 39454 Bergeron Builders Inc SOURER O: Western World ITLe.A Co. Bergeron INSURER C: Hartford Ins., Co 7 SSchoo la01033 .gmmt B: INSURER E COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEE HBI RED TO THE INSURED WACO.VOVE FOR THE PONI.Y PERDU INDICATED.NOTWMISTAMW3 ANY REQUIREMENT.IERM OR COMMON OF MN CONTRACT OR OWER MOMENT WITH RESPECT TO WHICH THIS CERTIRCATE MAY BE/SUED OR MAY PERTAIN,THE INbIWMJCEAFFORDED BY TIE PdICIEB DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,OCCLUSIONS NO CONDMONS OLSUCH POLICIES.AGGREGATE UNITS SHOWN JAY HAVE SERI REDUCED BY PAID CLAW, Worm.* POLICY LTR NSW TYPE OF INSURANCE POLICY NUMBER AOI I DATE( UMTS GENERAL UA LRY EACH OCCURRENCE 3500000 e X Wwm rnrGENEALLDesOY HPP1063865-1 09/12/07 09/12/08 PREM°�'°`isEs(Esmamml $50000 CURS MADE n OCCUR MED EXPORT one BALs) $5000 PERSONAL SAW INJURY $500000 GENERAL AGGREGATE $1000000 GEHL AGGREGATELIMOAPPLIES PER: PRODUCTS-COMP/OP AGG $500000 n MGT nm 7 LOC AUTOMOBILE LIABILITY SINGLE LMT $ A ANY AUTO 2433163 07/14/07 07/14/08 _ Aft OWNED ALMS BODILY INJURY $100000 X SCHEDULED sums Pm Plow/ X HIRED AUTOS X NONOWNWAUTOS BODILY LosuWRNPIIrm s 300000 PROPERTY DAMAGE s 100000 GARAGE Wain* AUTO ONLY-EA ACCIDENT R AIN AUTO EA AW MISER THAN AUTO ONLY: A66 E%CESINMBREIA COMITY EACH OCCURRENCE OCCUR OAN4 MADE AGGREGATE DEDUCTIBLE trans $ WORIERS°°YPENSATIONNO XI TORYlasTs ER c EMPLOYERS LIABILITY 6560035136036407 07/23/07 07/23/08 ELEACHACOCBIT 100000 AIN PROPRETORNMTNEMECEO.IINE OFFICEWUaAffROB111[IPOT EL DISEASE.EA EMPLOYER 100000 MAI P $PAWS PRIelO xseMW. EL DREA.Re-POLICY UMW 500000 OWER DESCIVITION OFOPERATIONS:LOCATIONS/VeitLT=I EACLUROM AWED BY ENDORSEMENT I SPECIAL PROVISIONS carpentry CERTIFICATE HOLDER CANCELLATION CITYNOa SHOULD WO,THE MINE DESCRIBED POLICIES BE CANCELLED BEFORE THE EAPB M K DATE TIEJEOF.TIE ISSUING INSURER WtL EMEAVOR To MAIL 10 DAYS METTER Northampton NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIM LEFT.BUT FAILURE TO DO S°MMU City Of Northampton IMPOSE NO O8LIGANLNI OR LIABILITY OF ANY IAO UPON TUE*ISOMER.ITS AGENTS OR 212 Main Street Northampton MA 01060 REPRESENT/CORES. ADTXOR® ATME ACORD 35(1001108 Ram te.. ( ./4RBKCORD CORPORATION 1988 APR 2008 April 7,2008 City of Northampton Office of the Building Commissioner Puchalski Municipal Building 212 Main Street Northampton, MA 01060 Re: 132 Franklin Street Dear Office of the Building Commissioner: We write in connection with a building permit filed on our behalf by Tyler Bergeron of Bergeron Builders. We have hired Bergeron Builders to construct a post-and-beam out-building at 132 Franklin Street. The building will be used as an artist's studio and workshop. It will not be used as an apartment or any other purpose not permitted under the Northampton zoning ordinances or other applicable regulations. Thank you. Jen fJ. .'. Mic .- . .ch Notary Name: / " ✓C r it/ L. Cj-scc ` l c c 7 i1 I `\owlIlia gi% Notary Signature _J .47. •\:4 . GFG• ,o tat 71.3 Til fob o.� %/419y X •• •••0 4 II•••04`\\` Seal: