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11A-072 (4) 17 LEONARD ST BP-2017-0401 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 1 IA-072 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-0401 Project JS-2017-000662 Est.Cost: $2875.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: NEWMAN'S CONSTRUCTION 64690 Lot Size(sq. ft.): 13242.24 Owner: RYAN SUZANNE E&TIMOTHY G Zoning: URA(1001/ Applicant NEWMAN'S CONSTRUCTION AT: 17 LEONARD ST Applicant Address: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 N O R T H A M P T O N M A01060 ISSUED ON:9/23/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP ONE LAYER OF ASPHALT & INSTALL NEW ASPHALT SHINGLES 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 9/23/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0401 APPLICANT/CONTACT PERSON NEWMAN'S CONSTRUCTION ADDRESS/PHONE 697 BRIDGE ROAD NORTHAMPTON (413)586-0273 PROPERTY LOCATION 17 LEONARD ST MAP IIA PARCEL 072 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid `i6) Building Permit Filled out Fee Paid Typeof Construction: STRIP ONE LAYER OF ASPHALT&INSTALL NEW ASPHALT SHINGLES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 64690 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 o "•, s-lay y„/7 Sign: re of Bui dingfficial 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. INC l ;y� Deuartmes ra ani/ G City 401 rrthampton styivaof Peimn Eli: awn, ( epartment curb ccvDnvewaytP rm{it = r _ g 21 M in Street Serve lS p(m Araliaotllt/, x �� }� Roc WaterIWell?,vailabthy_ _ p $` i 100 Q�/1 o = ampr n, FIA 01060 Twtl sets of Linrc uraFPiaps phone 413-587-1240 Fax 4'13-587- acet1272 Pld{Sltelans - - IOthct Spe ry vu^1` . . '__ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEdlIOLISH A ONE OP,TWO FAMILY DWELLING SECTION 9-SITE INFORMATION 7.1 Property Atldress: This, eruon to be completer!by office /7 N�'/y�4o s� Map of �^"" xZone - rneday:G s net aLt% ds A (3/653 TbIFItTFSPUPIstrIO'' G80istr(cf SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _rim u v J7 Alai 5 i-4 . .r 10_ . Name(Print) C�unen/l�alling Address _ Tetepnane Signature ) A �r 4" — . c✓, 1-uL ., 6Y .e r a ... ! - 2.2 Authorized Aaent: Na,- (Print) Cui out Haling;Dur ,. h°F-��S&'6'l aj Signalize Telephro-�n�e �' __ SECTIO - -ESTIMATED CONSTRUCTION COffB I e i ("2• dL� Item Estimated Cost(Oollers)to be Official Use Only completed by permit eonlicnnt . (a)Budding Permit Fee 1Budding 2 Etear�t � Building structiono from ste, —.... / +mated Cn nn Imm(B) 3, Plum ' Permit Fee 4. Mechanical(HVAC) 5. Fire Protection rn 01 6. Total=(1 +2+3+41-5) ,ChsckNumber J 5 This Section Enr Cfficiai Use Only ., _. Date Building Permit Number: — Issued:,— Signature: Sul(drn i g Gosstonertinsyector of Suddings Gate o alltlElaallie mal 0 . a, ,_ Section 4 ZONING AB Infornanon Must as Completed Perm it Can Be Pentad Due To incomplete trtorrnatlun Existing Fronosed r Required by Zoning This column to be filled in by _ .. Building Depatment rbir Etc Frontage Setbacks Front Side L. R ,_w Lff Rear Building Height ).. — Bldg. Square Footage cm'" °o - Open Space Footage (nt ,naiuusbtdg&payed #-of Parking Spaces _ __...._. t.otkme&Location) A. Has a Special Permit/Vdriance/Fin.d�i^n�pg ever been issued for/on the site? NO O _ . .PON?KNOW "�4– 'YES 0 _ IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO ,,,ppp DONT KNOW YES 0 _.._ rr YES: enter Book '- Page and/or document ft B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained E J , Date Issued C. Do any signs exist on the property/ YES 0 NO 00 IF YES, describe size, type and location: D. Arc there any proposed changes to or additions of signs intended for the property ? YES 0 NO V IF YES, describe size, type and location E. Will the construction activity disturb(clearino,grading excavation or filling)overt acre oris it part of a common plan that will disturb over 1 acre? YES NO 0 iF YES,then a Northampton Storm Water Management Permit from the DPW is required. a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aololicable) `,— New House L✓I Addition H Replacement Windows Alferaticn(a) f Roofing ,r� Or Doors D C , Accessory Bids. E Domoli:ion ❑ New Signs (o] Decks (0 Siding WI Other(Dl Brief Description of Proposed / Work 51,1`{1 on 1-‘47,it- 4 a— ♦.'LT" cn A,2._ ds4..) 6-spleU 9),'.itt% Alteration of existingbedroom //Yes No Ad.rig new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll ..Sheet 6a'If New houseand or add'stion to existing housing,complete the following a- Use of budding: One Family Two Fatuity 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? I. Method of heating? Fireplaces or Woodstoves; Number of each g. Energy Conservation Compliance. Masscheck Energy Cornp7iance form attached, h. Type of construction i. Is construction within 100 I, 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 AUTHORIIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT !I 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 Date YH n / £.W' � nde �/�a, ,he Owner/Authortzed wle Agent declare that the state en s and information •n the foregoing aRPlica ion are true and accurate, to the best of my knowledge and belief Signed under the pains and penalties of perjury. (7r /f,-r.r4/1AA.) _. Print Name ha v Signature of n Seen Date ' _ SECTION 8-CONSTRUCTION SERVICES q.1 Licrnsad Construction/S�unervison .r � Not AppplQica�blee/E / Nome of Licrnse Holder: ( 1( l�/ C..aG1' 4'bV License Number 7. AddRS' ( Explrp a to seri telephone 9, Reolsternd Home Improveme f Contractor:[ /y - - • Not Appficable £ _J'u1Yilit 'f 3./S/atLCLl e.� — tip., 7 Company Name ',( ` Registration Number Address ExpositnO e Telephone, ', f6 c 1.3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this;appllcafon. Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached Yes £ No. £ I 1. -S3ome wuer xemp2ioll Tire current exemption for"homeowners"was extended to include Owner-occupied Dweltfnes of one(1) or two(2)families and to allow such homeowner to engage an individual for Imre who does not possess a license,provided that the owner acts as supervisor cMB 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 faum structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Saab"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be responsible for all such workperformed under the building permit As acting Construction Supervisor your presence on the oh site will be required from time to tune.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 ofEmployers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von 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,0tate and Local Zoning Caws and State of Massachusetts General Laws Annotated. Homeowner Signature ' �?'- T e Cr um°mte�ad h tfBfasstseluatsetis � v p Depaacimn t zrj'Jiaad ss'o•dcrl Accidents Office of Investigations Waasdeaoegdon Sired. rtX7✓C� p'tostona, MA 92111 www.mass.gov/dw Workers' Compere sadiunm them-mace ce AffZt!avft: thailclers/Contractarel n Pectristensf?hsmbers Applk ntJnffo nahtn PCUS..11, PrnmtLemdbpy Name (Business/Organization/Individual): A c Na'/YS0sfez.21 :_�Addressq t ' AG * 1� p -"r 1 hl d VA)C....... City/State/Zip: Phone#: 1773— 5T. -Tar, Are you an employer? Check the appropriate box: Type of project(required): I. I am a employer with 4. ❑ I am a general contractor and 2mployees (full and/or pan-tine).' I have hired the sub-contractors 6. ED New construction 2, am a sole proprietor or partner- listed on the attached sheet, 7. 0 Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. employees and have workers' r comp. insurance.t 9, n Building addition [No workers' comp. insurance Electrical repairs or additions 5. 0 We ere a corporation and its10.0 P 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MOL c. 152, 72.g Roof'opens t insurance required.] §1(4), and we have no employees. [Na workers' 131— Other comp, insurance required.] "Any applicant that checks box#1 must also.`,-11 out the section below showing their workers'compensation policy infbrrnation. filo=owners who submit this affidavit indicating they are doing all work and rlten 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 mast provide their workers'comp.policy cumber. 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 DLA for insurance coverage verification. I do hereby certify under the pains and ena ties ofperjury that the information provided above is true and correct. Signature: ....Date: Phone#: A{43 -6f -JOTS .. Official use only. Do not write in this area, to be nompleted by city or town official City or Town: Permit/License# - issuing Authority(circle one): 1. Board of Health 2.Building Department 3. C'ity/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone(t.: City of Northampton si Ir Massachusetts XIT- OFt©LL U 'CTZONS tcc ` .7 212 Main Street a Municipal Building ' No Champ t on 1a 01060 INSPEECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HONE,OWNER E.x"FMPTION ACKNOWIEDGE.NENT 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 andior 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 a 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 understand the above. (Home owner/resident's signature requesting exemption) 1 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 tie building permit all cebris resuiting from the construction activity governed by his Building Permit shall be disposes of in a properly licensed solid waste disposal facility, as defined by MOL c 111, S 150A. Address of the work: /7 , ;;, The debris will be transported by: A E s s _ Tie debris will be received by: V//7 rSc_ ikt kt. Building permit number: — Name of Permit Applicant 1' art/ Date Signature of Permit Applicant — meme - PagB No. of Pages 9ropo9FIl NEWMAN'S CONSTRUCTION 697 NorthamptoB n MA 01060 1213 413.586-1043 li PROPOSAL SU5MTWD TO �7 PHONE BATE i SWEET JOBNANE / (7 )--L, .)2t. ," J 1r CITY,STATE Finagle CODE JOBLOCATION I ' ,-W ;�5 ✓1 rt APCHNECT DATE OF PLANS JOB PHONE — We hereby submit Specifications and estimates for: • • • • le propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars(S ' ,c." ) Paynrentto be made as follows: AP material is guaranteed ro be as spedlied. All work to be completed in a workmanlike Authonzad manner according to standaNpact Any alteration or deviation from abovespecdalum sed. nvolweg extra costs will bBrrwe executed only upon written ordersand will become extra Signature dmover and above the eotm oate.At agreements dons geupon tnkee xtlents or delays beyond our control.Ownerto carry fire,tornado and othernecessary- rallce. Note This proposal may be - \Our workers are fully covered by Workman's Compensation Insuranar withdrawn by uswithin da s, Acceptance of Proposal __Theabove prices,soecdicatons \ and conditions are satisfactory and are hereby accepted. You are authorized Si.fat AAl y.an to do the work as specified, Payment will be made as outlined above. Piff Date of Acceptance:.. ...._ Signature ' - / i