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16A-020-414 (2)
City of Northampton • S�5 ;: SSC • ' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ws rD. Northampton, MA 01060 Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall act as supervisor. 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. _ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ssbwa`�4 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 /c 1, Eric Boudreau understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 28 November 2018 Address of work location 414 Fairway Village, Leeds, MA 01053 City of Northampton Massachusetts ��. L DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building yJti cD� r Northampton, MA 01060 Debris 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. The debris from construction work being performed at: 414 Fairway Village, Leeds, MA (Please print house number and street name) Is to be disposed of at: Glendale Transfer Station, Northampton, MA (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 28 November 2018 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton Massachusetts # 1 DEPARTAMNT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.—or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Bedroom Renovation Est. Cost: $4400 Address of work: 414 Fairway Village, Leeds, MA 01053 Date of Permit Application: 28 November 2018 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 X Owner obtaining own permit(explain): I will be doing all work myself except drywall Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building pegwjt as the owner of the above property: 28 November 2018 Eric Boudreau ^ Date Owner Name and Signature SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Imorovement Contractor: 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....... EX No...... SECTION 5-DESCRIPTION OF PROPOSED WORK(check all apalicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ID Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[dj Brief Description of Proposed Update Master Bedroom, replace insulation, air-seal, drywall, bamboo floor, paint Work: Alteration of existing bedroom X Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housina, complete the followinsa: 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. 1. 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 I, Eric Boudreau as Owner of the subject property hereby authorize Eric Boudreau to act on my be hal ,i all ma rs relative to work authorized by this building permit application. 28 November 2018 Signature of Owner Date Eric Boudreau 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. Eric Boudreau Print Name � ////� 4 28 November 2018 Signature of Owner/Agent Date Section 4. ZONING All 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 minus bldg&paved parking) #of Parking Spaces Fill: volume&Location 7 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © 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 © 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 O 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 O 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 © NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit L 212 Main Street Sewer/Septic Availability ( Room 100 Water/Well Availability ` Northampton, MA 01060 Two Sets of Structural Plans n* phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans r Specify APPLICATION TO CONSTRUCT, LTE }►!E DEM LISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATIONQ�$ 6 n, I -Ij his section to be completed by office 1.1 Property Address: O-o 414 Fairway VillageLot Unit DEPT OF riUILDIN( IN Leeds, MA 01053 NOne RTHAMPTON.M DA01Q060 Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Johanna Kasidi and Eric Boudreau 414 Fairway Village, Leeds, MA 01053 Name(Print) Current Mailing Address: 978-815-0887 Telephone gnature' 2.2 Authorized Agent: Eric Boudreau 414 Fairway Village, Leeds, MA 01053 Name(Pri -,( Current Mailing Address: 978-815-0887 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $4400 (a)Building Permit Fee 2. Electrical $0 (b)Estimated Total Cost of Construction from 6 3. Plumbing $0 Building Permit Fee 4. Mechanical(HVAC) $0 5. Fire Protection 6. Total=0 +2+3+4+5) $4400 Check Number This Section For Official Use Only Building Permit Number: DateIssued: Signature: Building Commissioner/Inspector of Buildings Date Cf-(C (� �0y 466 L/ °@ /K EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) File#BP-2019-0639 APPLICANT/CONTACT PERSON BOUDREAU ERIC ADDRESS/PHONE 414 FAIRWAY VILLAGE LEEDS (978)815-0887 Q PROPERTY LOCATION 414 FAIRWAY VLG MAP 16A PARCEL 020 000 ZONE URA(102)/WP(17)/WSP(15)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: UPDATE MASTER BEDROOM REP INSULATION,AIR SEAL,DRYWALL New Construction Non Structural interior renovations Addition to Existini 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 INF 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 D.emQi1don el 7—leT Sign uil ' ffic 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. 414 FAIRWAY VLG BP-2019-0639 Is#: COMMONWEALTH OF MASSACHUSETTS MV31Q& 16A-020 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permi # BP-2019-0639 Project# &2019-001041 Eat.Cost; $4490.oq S65.Q0 PERMISSION IS HEREBY GRANTED TO: Cot.Class_; Contractor: ,License: Y. Vic rG Dura,' Homeowner as Contractor Lqt Sjze(sg.ft): Owner: 13OUDRLAIJ ERIC Zoning:URA(102)/WP(17)/WSP(13)/ Applicant: BOQQRE.AU ERIC AT: 414 FAIRWAY VLG Applicant Address: hone: Insurance: 414 FAIRWAY VILLAGE (978) 815-0887 Q LEEDSMA01053 ISSUED ON:12/10/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-UPDATE MASTER BEDROOM, REPLACE INSULATION, AIR SEAL, DRYWALL 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 Finals 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 sienature: FeeTyue: Date Paid: Amount Building 12/10/2018 0:00:00 $65,00 212 Main Street,Phone(413)587.1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner