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31A-088 17 Vernon St Application 2015-04-24OK FoP-PLAtJ ~t\f {£bJ : File # BP-2015-0997 NO fttl~L Lt tJ l' {l,., APPLICANT/CONTACT PERSON HANS DALHANS ADDRESS/PHONE 11 CHERRY ST EASTHAMPTONOI027 (413) 977-6094 1l1'"e ILl\ti fcfppJNlfl.r PROPERTY LOCATION 17 VERNON ST MAP 31A PARCEL 088 001 ZONE URB(100)1 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out zt,'r rlq6(j Fee Paid TypeofConstruction: CONSTRUCT 2 STORY (BEDRMlBATH) 22 X 24 ATT GARAGE,REPLACE PORCH WI 13 X 14 BEDROQM & ADD 7 X 12 DECK New Construction Non Structural interior renovations Addition to Existing AccessOJ,y Structure Building Plans Included: Ownerl Statement or License 101628 3 sets ofPlans I Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION ~SENTED: __Approved _V_ AArldditional permits required (see below) 350 -2-.L TA6L~ OF use 3SO A1\ ,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 WNING BOARD PERMIT REQUIRED UNDER: §_________ Finding=_____ Special Permit'--______ Variance*____ ___Received & Recorded at Registry ofDeeds ProofEnclosed'---____ __Other Permits Required: Vcurb Cut from DPW ___Water Availability ___Sewer Availability ___Septic Approval Board ofHealth ____Well Water Potability Board ofHealth Permit from Conservation Commission Permit from CB Architecture Committee --~ --~ __-,Permit from Elm Street Commission ___Permit DPW Storm Water Management __-'Demolition Delay S· ~.~~ Date I 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 ofMGL 40A. Contact Office of Planning & Development for more information. L~~~-,;:=;-~\fJ'ef.:'\ City of Northampton ding Department tth<,rnr't"n, MA 01060 Fax 413-587-1272 CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLIS':' A ONE OR TWO FAMILY DWELLING SECTION 1 ~ 1.1 PropertvAddress: (1 \J$(fl\()r' ?f-. Nos~J/l1t 0/1)60 SECTION 2~ PROPERT'iO'llfNERSHIP'IALITHORIZED :", :" .. :' 2.1 Owner of Record: ~ ~17Ver~~<;>1:.. Current Mailing Addres~2~}3 3 =;r)7/ 7Name (Print) Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: 212 Main Street Room 100 -1240 , Official Use Only" .,'. 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) Building Permit Number.,_________' '-,-_",,;,­Date I~s,ued:,__-:--____'___________ Signature: _--'-______:--_..,..-'-:<----'''--~-..;.__:_ SUildin'g Commiss(oner/lns~~~or'of'B'uildingS ,: , ,.. " Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tliis coltmm to be filled in by Building Department . .i Lot Size I: I ! J .Frontage I !Il III Setbacks Front CJ CJ CJ Side d !R:CJ L:[ :J Rf 1 [J I ] Rear '-_I CJ CJ Building Height i c:J ! I Bldg. Square Footage CJ c::::::J % CJ I I c:1 Open Space Footage r--j % L_,_J I_J I I(Lot area minus bldg & paved L................s parking) " r---l r~lCJ \i # ofParking Spaces i....--.l ~ Fill: "'''''I (volume & Location) A. Has ~;e.eJal PermitlVariance/Findi~g ever been issued forlon the site? NO \a' DON'T KNOW 0 YES 0 ,..---------, IF YES, date issuedt . r IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES 0 0 0 -~'----+-1 r-~~ IF YES: enter Book l I Pagel I andlor Document #"-"__,__~-'--' B. Does the site contain a brook, body of water or wetlands? NO ~DONT KNOW 0 YES. 0 IF YES, has a permit been or need to be obtained from the ConserVation Commission? Needs to be obtained Obtained 0 o C. Do any signs exist on the property? YES NOo 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 0 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 0 NO ~ IF YES, then a Northampton Storm Water Management Permit from the DPW is required. b. Number of rooms in each family unit: c. Is ther~ a garage attached? ~ d. Proposed Square footage of new con~uction._.... e. Number of stories? ___ f. Method of,heating? ___ g. h. Type of construction --5t..~ i. Is construction within 100 ft. of wetlands? ___ j. k I. Septic Tank __ City Sewer SECTION 5-DESCRIPTION OFPROPOSEDWORK(check aUappHcabre) New House D Accessory Bldg. D Addition Replacement Windows Or Doors D Alteration of existing bedroom ---'~_ Attached Narrative No Adding new bedroom Yes _.."..,-_ Renovating unfinished k~-;;~~:-____ Plans Attached Roll -Sheet a. Use of building: One Family --t'--Two Family Other ____1 Number of Bathrooms"--Ai3 ......____ /-"1-::.-...;O;;......,.,D=--___Dimensions ________--------­ ---:,...--:(A=---=--...--_____ ......:.h..:..-o.::..l--......:w:::...!!J(;;loa...-=-­____ Fireplaces or Woodstoves _____ Number of each Energy Conservation Compliance. _-.-_______Masscheck Energy Compliance form attached? ______ ~ Yes -2S.-No. Is construction within 100 yr. floodplain ___Yes XNO Depth of basement or cellar floor below finished grade Y , Wlil b"'dlng conionn to the 8""'i<'" Zan 'ngceg"atlon,? X Ve, ___ No . Private well City water Supply ___ BE COMPt.ETEDWHEN f"\D".r-r\l\,'"T~D~~T1i'R.tl..PF'LlE;s'FO~,BUILciiNGPERMIT ---:------t.~:......~-~=.......~:!!!!!!~=-------------------'as Owner of the subject ~;TE=E~~~~~~~~~~~~~;;;;;~~~"fh;~=~;;:;_;;_;::;;:;r;;::;;t;;:;;:;_;;~t;:;";;;;_;;;;:r;;:;::;_;;:;;t;;;'Tn' as Owner/Authorized ;;-; application are true and accurate, to the best of my knowledge SECTION 8 -CONSTRUCllONSERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ CS-\{)\b<26Name of License Holder :---T----------------------­-t\-U\1\~ bc.j\/\~~ . License Number ~))/~Dl (7 Signature . \ Telephone I 71 SECTION 10-WORKERS' COMPENSATION INSUR,O,NCEAFFUJA\fIT(M,G:L. c;.;152, § 25C(6)) ! L 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 ofthe building permit. Signed Affidavit Attached yes....... £ No...... £ The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a lic.ense, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel ofland 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 ofthe 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) ofthe Massachusetts GeneralLaws 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 ofMassachusetts General Laws Annotated. Homeowner Signature. _____~___________________ ~ 1. ne L-ummunweatrn OJ iVLassacnusellS Department ofIndustrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractor.sfElectricianslPlumbers Applicant Information Please Print Legibly Name (Bmrin",,,o,g..iz.tionlindividual): D"" ~w-O ~~ *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. '. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. Ifthe sub-contractors have employees, they must provide their workers' compo policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a fme 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 fme ofup to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the .office of Investigations of the DIA for insurance coverage verification. aJUl-Bt.~llties ofperjury that the information provided a ove is Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlLicense # ___________--:-.".-__ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.0ther~~~__~~____~____ Contact Person: Phone #: Address: t \ L~_S} City/State/ZiP:[~ M~al D2 Are you an employer? Check the appropriate box: 1.0 I am a employer with ____ 4. 0 I am a general contractor and I have hired the sub-contractors. employees (full and/or part-time).* listed on the attached sheet.2.0 I am a sole proprietor or partner­ These sub-contractors have ship and have no employees employees and have workers' working for me in any capacity. compo insurance.+: [No workers' compo insurance required.] 5. I)lWe are.a corporation and its 3. OJ am a homeowner doing all work officers have exercised their right of exemption per MGLmyself. [No workers' compo c. 152, §1(4), and we have no insurance required.] t employees. [No workers' compo insurance required.] Type of project (required): 6. !61 New construction 7. fKJ Remodeling' 8. !ilDemolition 9. ~Building addition 10.~Electrical repairs or additions 11.l:2"U>lumbing repairs or additions 12.~ Roofrepairs 13.0 Other_______ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNEREXEMPTION 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 I, 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_____________ Address of work location________________________ City ofNorthampton 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 J \.2'CJYh)Y'-'St ­. The debris will be transported by: l:jQ.I:d.kj2,~,j J1-')\1\, ? The dE?bris will be received by: _____________ Building permit number: _____________ Name of permitAPPlicant~tii,1'\ S, h.\bev-6 Cf/dJ;Jr:~~ Date Signature of Permit Applicant , , 130.51' fD . - Green: Addition Footprint ...... Grey: New Driveway o ~ Red: Section to be Removed ,q ! '\ ,! ,I I ! ;, I I *.~ !