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23A-210 (7) 74 BEACON ST BP-2017-1447 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-210 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2017-1447 Project# JS-2017-002410 Est. Cost: $5500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sq. ft.): 18513.00 Owner: HENSLEY MARK T&KAREN THOMAS Zoning: URB(100)/ Applicant: HENSLEY MARK T & KAREN THOMAS AT: 74 BEACON ST Applicant Address: Phone: Insurance: (413) 587-2265 I) FLORENCEMA01062 ISSUED ON::6/27/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE BASEMENT WALLS, REPLACE BASEMENT WINDOWS, INSTALL OUTLETS**per 9th edition*** 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: FeeTvoe: Date Paid: Amount: Building 6/27/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Hoa= File#BP-2017-1447 w \'- t ADDRE APPLICANT/CONTACT (43)587 2265W1N�O NCE 1 T&KAREN THOMAS M� w;c: .s USE PROPERTY LOCATION 74 BEACON ST •P 6- Mti MAP 23A PARCEL 210 001 ZONE URB(100)/ 7 Cdbtt., X1 S 5a6(THIS SECTION FOR OFFICIAL USE ONLY: G • pyd tag PERMIT APPLICATION CHECKLIST V1tU so, ENCLOSED REQUIRED DATE ' 1.6 ZONING FORM FILLED OUT ,f st tff` Fee Paid -ry / ,t 6 f'� Building Permit Filled out W �j Fee Paid Typeof Construction: INSULATE BASEMENT WALLS,REPLACE BASEMENT WINDOWS. INSTALL OUTLETS t4EED M-OFF£ DOM IL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: CAT)proved 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 DPWStorm Water Management Signa'Prof Building O 1-.al 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. • City of Northampton " - Building Department - >2. 212 Main Street ?x s, Room 100 A e •11 j=r ., s:t r4 N Northampton, MA 01060 a` .a n^ phone 413-587-1240 Fax 413-587-1272 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 7 (,t I1. EALON S., Map ,RM Lot t9/O Unit FL02ElacE NA o/062 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: MAH ek FNS/ cy 114Aa.6N THo44*c AS AROVE Name( lint) • Current Mailing Address' Telephone� Eke-404 ignature 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 S ono (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of .TOO Construction from(6) 3 Plumbing Building Permit Fee 4. Mechanical(HVAC) 5 Fire Protection �/�� 6. Total=(1 +2+3+4+5) Check Number gq7 y This Section For Official Use Only Date n Building Permit Number: Issued: n 7,e_ 7 - 1 Signature: JAI 12 211111 Building Commissioner/Inspector of Buildings ate ll:',ol DEPT OF WU0!N5PFCMNe W NOPAMFIOF.MACICS: R Section 4. ZONING Atl Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This ethane to be filled Im by Building Depamnea Lot Size .. _,... .,. ...._ _._. . _. ... ... Frontage _. Setbacks Front Side L. R:1 L:_ . /1." Rear Building Height Bldg. Square Footage Open Space Footage �.,. % ,_..._.. (Lie area minus blds&paved parking} #of Parking Spaces Fill: (totem&Location) A. Has a Special.Permit/Variance/Finding ever been issued forton the site? NO er DONT KNOW 0 YES O IF YES, date :issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES CJ IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO e 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 V IF YES, describe size, type and location: E. Will.the constrjdion activity disturb(cteanng,grading,excavation,or filling)over I acre or Is it part of a common plan that will disturb over 19ge?cYES O NO IF YES,then a Northampton3Storm Water Management Permit from the OPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors Er Accessory Bldg. ❑ Demolition ❑ New Signs [Cl Decks [q Siding[Cj Other[CI Brief Description of Proposed Work: IN5u.LATF FRSFL4EtJr WALLS REPLACE (3RSO-IFAIf Gv/NAVA, /N$TALLoccTLE7S Alteration of existing bedroom Yes )( No Adding new bedroom Yes )( No Attached Narrative Renovating unfinished basement ✓ Yes No Plans Attached Roll -Sheet 6a If New nodalandroa addition to existing"houslnnfaincil te2Kefollowino: KA 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 Date 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable E Name of License Holder: License Number Address Expiration Date Signature Telephone 9:Registered:iome.ImprovementContractor: Not Applicable £ 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 result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes E No E 11. -Hume Owner Fslempti©n 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 109.3.5.1. 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 Local Zoning Laws ss-randd�State�taof Massachusetts General Laws Annotated. Homeowner Signature /�/7�y,?L��� C/ • The Commonwealth of Massachusetts Department of Industrial Accidents _Wit `t Office of Investigations ;h!_ « 600 Washington Street =i6= Boston, MA 02111 '-'_•�1 . www.mass.gov/dia 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.= re ed.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. tion. tHo 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 subcontractors and state whether or not those entities 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: City of Northampton • rd'' Massachusetts 45 �d< d$ ; na. F° t. DEPARTMENT OF BUILDING INSPECTIONS ' q+ 212 Main Street a Municipal Building `) . O� Northaroton, MA 01060 s1;;ar 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 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 �/ / MAP IC �EWSLF y gfr understand the above. (Home owner/resident's signature requesting ption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date & . 6_ Z0f7 Address of work location 7/ a4rorJ c'T oeFAIt' F AIA /7/D<7 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: ilt IGoe5nUCE /OA or662 The debris will be transported by: ,I.JA , /IsystEz The debris will be received by: C ,r7 oG Aloe;,/RMPronl £ Lg j enE 4 Lanflt/LL Building permit number: / ' Name of Permit Applicant /{/�At HkNSc,_Gy &I4120 7 /1 6 Date Signature of Permit Applicant 11111111111111111112017 11 ii1111 111 9 RESTRICTIVE COVENANT: Bk: 12647ag.zos Page: 1 of 1 Heco,tlece 06/12/2017 11:58 AM KNOW ALL MEN BY THESE PRESENTS That Mark Hensley and Karen Thomas, owners of the real estate at 74 Beacon Street, Florence MA 01062, hereby Covenant and Agree that the basement space at 74 Beacon Street, Florence MA 01062 will be used for storage, office, studio or recreation. It will not be used as a sleeping space without first obtaining a building permit and meeting all the requirements of the Massachusetts State Building and Health Code for a newly created bedroom. 74 Beacon Street Florence MA 01062 is the property more particularly described as that certain tract and parcel of land with the buildings thereon situate on the Southerly side of Beacon Street, being lot, number ten (10) on plan of lots of the Landy estate. Commencing on said Street at the Northeasterly comer of the described premises, the same being the Northwest comer of premises now or formerly of one Elliott; thence running Southwesterly about one hundred thirty-nine and one-tenth, (139.1) feet along land of said Elliott to a stake; thence running Southwesterly along land of said Elliott about two hundred and one and two-tenths (201.2)feet to a stake and land supposed to be of one Higgins; thence Northwesterly along land supposed to be of said Higgins about fifty-three (53) feet to a stake; thence Northeasterly along lot numbered nine on said plan about three hundred forty-six and four-tenths (346.4) feet to said Beacon Street; thence Southeasterly about fifty-four feet along said Beacon Street to the place of beginning, being the same premises as described in the deed dated May 27, 2003 and recorded in Hampshire County Registry of Deeds in Book 633937 Page 436. 7219 l31 The basement space at 74 Beacon Street, Florence MA 01062 will be used for storage, office, studio or recreation. It will not be used as a sleeping space without first obtaining a building permit and meeting all the requirements of the Massachusetts State Building and Health Code for a newly created bedroom. Executed as a sealed instrument this - 6 - ) Z - ( 7 . Mark Hensley ren Thomas ••'yP s?RF" F,` qp . a, o I ) u -3 • cg ��y. l l.0 0.•••-ss`:cr_:.•�U T4 RV PV�r' • AMLST: HALLPSEC E, 6'ZW1 ! D1 REGISTER MARY 1LBER 1