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32-045 9 CHERRY ST BP-2017-0927 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A-045 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit it BP-2017-0927 Project# JS-2017-001578 Est. Cost: $100000.00 Fee: $650.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot size(sq. ft.): 5009.40 Owner: POE MARSHALL Zoning: URC(100)/ Applicant: POE MARSHALL AT: 9 CHERRY ST Applicant Address: Phone: Insurance: 9 CHERRY ST (734) 255-6677 0 NORTHAMPTONMA01060 ISSUED ON:2/6/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:PHASE 1 INTERIOR DEMOLITION, DISCONNECT UTILITIES, REFRAMING, DRYWALL, PLUMBING, ELECTRIC 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 q 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 2/6/2017 0:00:00 $650.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner m v u mr r �p City of Northampton "b.Y. C;725 14L i Building Department t°..;Ca*°!ujn:l-AY, YP,elu - 5 212 Main Streetf , et-Y4)t u, !'yrlliF - ` "�� �` Room 100 Ys +.'-lC-.l'tiit+i ,--� Northampton, MA 01060 .7 i �s3. {_,r phone 413-587-1240 Fax 413-587-1272iii ' HrIS ` , . r iVi 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 9 C .2 zsz_y -Se Map Lot Unit W.)DkE ea o Y` ) i\J Zone Overlay District Elm St DIstrict CB District SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record; )1n- glnatf oc '7Z 1 .tZLt Name(Print) Current Y 2 Mailing Address — e6677 'I elephane Signature Jry7Rilt WarriWiQ.' ttvse6imet wa,I CO 2.2 Authorized Anent: �"'' L Name(Print) Current Making Address. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only ' completed by permit applicant 1. Building 4'S, pea. uc (a) Building Permit Fee 2. Electrical i D; " ` " (b)Estimated Total Cost of I Construction from(6) 3. Plumbing /Pr " " v<'' Building Permit Fee q Oen) 15a 4, Mechanical(HVAC) % ; o0 5. Fire Protection 6. Total =0 +2+3+4+5) /Dd/ c'cc - UJ Check Number This Section For Official Use Only Date Building Permit ..Number fillier Signatur /-+ .in er r of Buildings —4{ W — 71 Isyuad: Date Section 4. ZONING All Information Mug Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by � qq Building Department Lot Size -7 ,Z75f � ,Z2y X �/-I- � [ .... _ I L _ 1 Frontage - Lit - Setbacks Front I Ii L 1 L_ 1 Side LLI�11 R:L7 1.:..„.___i RUC L__ II Rear 7D 7r o.:S8 1___J L___ 3 6wcv....ge _ Building Height at] Z.7 L._-.I Bldg. Square Footage l7 r— 1----1 % C._ 1 F 1 '_ Open Space Footage — % _ (Lot arca minus bldg&roved Vibe) parking) N of Parking Spaces [- I L II i- — I Fill: J ___II_ _. _ __ (volume&Location) — - -- -- • A. Has a Sp tial Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW © YES IF YES, date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 YES 0 IF YES: enter Book 1 Pagel and/or Document kl_ B. Does the site contain a brook, body of water or wetlands? NOecl DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: 1 C. Do any signs exist on the property? YES © NO V IF YES, describe size, type and location: / D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. , SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) Roofing 0 r7 / Or Doors � ec Accessory Bldg. Ell Demolition I' I( New Signs [DI Decks [C] Siding iIZI/Other[l7)4 Brief Des dpton of Proposed Work/WWC / /nDemo ,Di. COilak*d ,'Ltat251 pt-41 Am-, -Dpb, WA-nt. tpti nia.i— y`� Alteration of existing bedroom Yes �No Adding new bedroom Yes No cQ.Lhxr4�- Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet ea:If New house and or addition ty existinsl hotfsinO, complete the following: a. Use of building : One Family Two Family Other /b. Number of roams in each family unit: 9 Number of Bathrooms c. Is there a garage attached? A la d. Proposed Square footage of new construction. AT 3 lb-0--' Dimensions e. Number of stories? "2— f. Method of heating? G rive, f H. VI/ Fireplaces or Woodstoves ?Va.) Number of each a g. Energy Conservation Compliance. ., Masscheck Energy Compliance form attached? h. Type of construction W60 D ED-A-Asp i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain YesNo j. Depth of basement or cellar floor below finished grade f -CE- k. Will building conform to the Building and Zoning regulations? ✓ Yes No . I. Septic Tank NO City Sewer yG5 Private well CO 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 ehaan all m tters relative to work authorized by this building-permit/application. Ye6. b / 2017 Signatur of wner/ Date IIIIIIII I, ,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 pains and penalties of perjury. Mokraittl Il (Pt Print Name Signature et "04 wner/A fent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Heider: License Number Address Expiration Date Signature Telephpne Emar /: 9.Replstered HontelOprobement Contractor , " Not Applicable 0 .. .._— ' Compapv 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....... 0 No...._ ❑ 11'. =Homtoewner=Exemption The current exemption for"hometnvners"was extended to include Owner-occupied Dwellings of one(0 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.CMIt 780, Sixth Edition Section 108.3.51. 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,duringand 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 vork for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with de State Building Code,City of Northampton Ordinances, State andanLee ing Laws and State of Massachusetts General Laws Annotated. Homeowner Signature /fft,lll/ _— t 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: q CIiQz zrzy 9 /tbEE-&min p6a (J t)2? S,. The debris will be transported by: 7) yC Ao `TP— k_,t&q The debris will be received by: r7cJSc,9-(J Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts --w.=.--:= t Department of Industrial Accidents , w7s5 Office of Investigations .I�.` 1 Congress Street, Suite 100 • ='•p,= Boston,MA 0211 4-2 01 7 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M et:zsha,t t Po e _ Address: 17 Iz. t=1-1.-e 7'Py . -�. . City/State/Zip:NbaMmf J 1'iWeto6DPhone#: 721/- zSc 6d77 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 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.LI I am a sole proprietor or partner- listed on the attached sheet. 7. 2-Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp.insurance comp. insurance.t cuquiredd 5. ❑ We are a corporation and its 10.pi-Metrical repairs or additions 3. I ran a homeowner doing all work officers have exercised their 11E1-Plumbing repairs or additions myselfworkers' right of exemption per MGL Y [No comp. 12.alboof repairs insurance required.]t c. 152,§1(4),and we have no ,, '` employees. [No workers' 13.❑OtheryvxL9-'�}.a Ni comp.insurance required.] *Any applicant that checks box MI must also fill out the section below showing their workers'compensation policy information. r-' t Homeowners 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 entities 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sigpature: 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct huildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary) and under"lob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 7-2013 www.mass.gov/dia City of Northampton A. s,� , Massachusetts Ec/ a"- 'cr' DEPARTMENT OF BUILDING INSPECTIONS o dd 's. 1` �� 212 Main Street • Municipal Building'Iptee u.,. Northampton, MA 01060 j'Ya;'' 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 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 foundationlfootings (before backfill). sonotube holesjbefore pour), a rou hg 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 inspeccan tions 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 •• understand the above. Home o ner/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