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38b-002 (32) 21 PAQUETTE AVE BP-2017-0585 GIS II: COMMONWEALTH OF MASSACHUSETTS Man:Block:38B-002 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv:INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2017-0585 Project JS-2017-000948 Est.Cost:$42000.00 Fee: $273.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DAVID JAGODZINSKI 106068 Lot Size(sq.ft.): 95962.68 Owner: DEAN MARK S&ELLEN CADY Zoning:URc(100)/WP(14)/ Applicant: DAVID JAGODZINSKI AT: 21 PAQUETTE AVE Applicant Address: Phone: Insurance: P O BOX 204 (413) 230-9160 WC NORTH HATFIELDMA01066 ISSUED ON:11/1/2076 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE ALL EXISTING INTERIOR WALLS, RECONFIGURE & NEW FINISHES 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 11/1/20160:00:00 5273.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0585 APPLICANT/CONTACT PERSON DAVID JAGODZINSKI ADDRESS/PHONE P O BOX 204 NORTH HATFIELD (413)230-9160 PROPERTY LOCATION 21 PAQUETTE AVE MAP 38B PARCEL 002 001 ZONE URC(100)/WP(14)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 6,1 Building Permit Filled out Fee Paid � yyTvpeofConstruction: REMOVE ALL EXT—d:IOR WALLS.RECONFIGURE&NEW FINISHES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106068 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 die / Y Signa ure o Building Official 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. ' e . cr.02. Department use only - " .� City of Northampton Status of Remit Building Department Curb Cut/Driveway iveway Permit L 6 UGI 212 Main Street Sewer/Septic Availability Room 100 Water/Wel Availability DEPT Cr- ,orthampton, MA 01060 Two Sets of Structural Plans oHiE 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 DWEWNG SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office aI �I1P4ldetiC Ave, � Map Lot Unit IVprt&&nl( 'avll ',(" W.SS Zone Overlay District l7 Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: &k Jr,° tS LLC Rid cl.7nnd r Name(Print Current Mailing Atltlre�s 5!a in D 53 Telephone lure 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Mtl�0l OCC Co (a)Building Permit Fee 2. Electrical T s7�C (b)Estimated Total Cost of dIi Construction from(6) 3. Plumbing lI [/ (cc, cc Building Permit Fee 4. Mechanical (HVAC) �qp S 5. Fire Protection 'I cl/J f ) /J / h 6. Total=(1 +2+3+4+5) - 2�d/ 0C(�� Check Number /3(; 7. c1 73 This Section For Official Use Only Building Permit Number: Isste Issued: Signature: Building Commissionerllnspector of Buildings Date Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This 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 minx bldg&paved parking) I of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition 0 Replacement Windows Alteration(s) If i Roofing Or Doors 0 Accessory Bldg. 0 Demolition ❑ New Signs (D] Decks [D Siding[D] Other[CS Brief Description of Proposed 1 /j�� 7) (� Work: R0,1E ce 0.1f Efi:�ho, i litercc ' a S( ILCC ri Cy Pee Nine/ ,ir&.) Alteration of existing bedroom A Yes No Adding new bedroom Yes /` No Attached Negative Renovating unfinished basement _ Yes No Plans Attached ROH -Sheet ha.If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Family X Other b. Number of rooms in each family unit: .1 Number of Bathrooms f c. Is there a garage attached? Aa!J d. Proposed Square footage of new mosbuction. _Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves „Number of each g. Energy Conservation Compliance. Masscheck Energy Comptiance 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 Boor 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 COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ft r C4+" .as Owner of the subject pr1opel ... hereby authorize . ' ♦ `-'Gt OGh I Nfr�"i to y behalf. , .7 i • age relative to vrk authorized by this building permit application. oat ` "3/f{� Si,. :.Me or Owner .as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my koowtedge and belief. Signed' � under the pains and penalties of perjury. `} 1 jAeiga 15CC 7ifr1.5L( Print Nam?) Sigmte of Y er/;gent SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable 0 p Name of License Holder: fly Nil CD Zln5Lt CS " 161,010S License um A4GF eU 14,630,S 01.0(0(0 l ld aL`l7 p� ' l Fri to �/n//a/u � - pho3��.�c - �i6,U S Nm Telephone 9.Registered Home Improvement Contractor. Not Applicable ❑ At alA„ et -j 2ekoAc e(,l cv 7 /lu Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL.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 pi No ❑ 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 1083.5.1. 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 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 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: I },Guc L The debris will be transported by: Av.-kr: s\ ir,,,L,,. The debris will be received by: I(ey C e \/c( v . Building permit number: Name of Permit Applicant \,�, �cx ICY utAk< /1$Date Signature of Permit Applicant The Commonwealth of Massachusetts P=_c= Department oflndustrialAccidents kfl 'el Bt 'l=a® Office of Investigations s AA= 4 I Congress Street, Suite 100 \ME' ='�a- Boston,MA 02114-2017 �� www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly p Name (Business/Organiza[ioMndividual): /ht 3 Ld",IcP'� o;•(lVPe` 1,/`` —Lk=- A �t Address: I r -,-I- Y N, t4gVI{ r4c. Jvcs / (), SGf 9C9 Ni City/State/Zip: t, NaklAdI_krkss c(ëti Phone#: _ Are you an employer? Check the appropriate box: Type of project(required): 1.rp I am a employer with 4. 9 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 9 Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance a required.] 5. 9 Wee are a corporation and its 109 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.9 Roof repairs insurance required.] t c. 152, §I(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t(ontractors that check this Fox must anached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors 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. ,, �T Insurance Company Name: 13PI I,Ai t(Cl', (5 t)ur(k N A(A ,)a_1 T++SJ cr,StCQ Policy It or Self-ins. Lic. #: T).c wC,�j(„C:1 rj ] Expiration Date: 141/16 Job Site Address: .;I Ycclk'{(-e- Atjc City/State/Zip: 1-.1e; - ottte[cia 1''4L% CEIX Attach a copy of the workers4 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 carrier ,pains and penalties of perjury that the information provided/abo is a and correct. Signature: , Date: /(� �� i6p Phone#: VS- , 36-7/66 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#: Coity of Noel/ampi n r S S/ b t'•}1/ , A, BRassarfjusr#s DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building .;y .,q�. Northampton, MA 01060 INSPI(Cru IZ A&S Building and Remodeling, Inc. October 28, 2016 P.O. Box 204 North Hatfield, MA 01066 Subject Location: 21 Paquette Avenue Map Block: 385-002 Mr.Jagodzinski, Your building permit application with plans dated 10-23-2016 has been approved as drawn, per this memo and as noted on the plans.All work must meet applicable codes whether or not included within this memo. Please follow upon the following items: These items will need to be accomplished as the project moves forward and before rough inspections; 1. All work must meet the 2009 IECC. 2. Smoke, Heat and CO detectors throughout the structure to current building codes. 3. An emergency escape window is required within every bedroom and basement if modified. 4. An air barrier is required between the tub and the wall cavity. 5. If permeable insulation is used air sealing and an air sealing inspection is required at the exterior and interior skins.Typically the sheathing and drywall. 6. Fire stopping must be completed per R302.11 7. The structure must have two entrances doors per MA amendments R311.1 8. Stairs, landings and doors must be built per R311 with MA amendments 9. Windows in hazardous areas per R308.4 must be tempered. 10. Any modification to the design as shown on the plans provided must be documented. As of August 4th 2011 the 8ih Edition MA code is the 2009 IRC with MA amendments. In the following are some generic requirements which seem to be problematic. This is not intended to be comprehensive, nor is it a substitute for purchasing and reading the MA codes. Read only international codes are available on line at http://publicecodes.cyberregs.com/icod/one must also consider the MA amendments to these codes which can be found at www.mass.gov/dps/bbrs . The current relevant building codes are: 2009 IBC, 2009 IEBC, 2009 IMC, 2009 IRC, 2009 or 2012 IECC,AA115, MA amendments. Relevant items must be submitted to the building department for approvals before inspections and or Certificates of Occupancy can be issued. Feel free to call if you have any questions. My telephone number is 587-1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, except we close for walk-ins at 12:00 noon on Wednesdays. My email address is: cmiller northamptonma.gov Thank you for our cooperation on these matters. Chuck�� City of Northampton Assistant Commissioner and Zoning Enforcement Poi J / a. „nen. 04i��l i i 1 or /0_f/d /e - f 0 i,-i- ow iofo /fii\ d I 1� -d kyd -� F-- i *6 K; • City of Northampton /d-,2 3 /( • J,..Loke_/Co, Building Department � / ot� 3 Wan Review 212 Mam Street ly vnpten.MA 01000 , arc �Boc 1D, 1„ \a' 1 /0 -43-A' ( c omit g 04'g E d „1e „vs- 7trAi41 .f' -JV11'04)1:;<5 O4»1:;<5o rA dna.r'�, /� `_ale op( cr . . tole -..r --- (4424 tlAninnterD l gp Z l //�S�t Urotort .nnvroivv 5 ant y DSII/ E salio r oy �a� Nr V/-\” ' SMrijr1 20470s8 �4� hi? bshy+/ dr gana _LP awCILs � _ - "we