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23A-059 55 Maple Permit App 2017-04-20
Ho(...t) - File# BP-2017-1176 CAU,S) if rr· N\ESSl\~u - J APPLICANT/CONTACT PERSON BRANDON J BOUCIAS ADDRESS/PHONE PO BOX 1001 BUCKLAND (413) 625-2467 PROPERTY LOCATION 55 MAPLE ST MAP 23A PARCEL 059 001 ZONE URB(lOO)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid T eofConstruction: NEW SINGLE FA" New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 80979 3 sets of Plans/ Plot Plan ENCLOSED REQUIRED DATE THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PJlESENTED: _·_. _Approved .JL Additional permits required (see below) 3cc ~ TJ\8(£ 0 f Us~ 2),1~ St(V.ALTL\,~ PLANNING BOARD PERMIT REQUIRED UNDER:§_., ________ _ Intermediate Project: t/ 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: rvolf ~ ;pR.\ v( uJ At:\ tL Curb Cut from DPW 1 /Water Availability ~ c' ~ ___ Sewer Availability CUR f, CV.,\ 7 \-:1 - ___ Septic Approval Board of Health ,n ••t-ii,-Ju: e.o t-'!'-~ ____ Well Water Potability Board of Health rL.P."" .. 1 A<'PflJ)'Jt'(i Permit from Conservation Commission Permit from CB Architecture Committee ------ ___ Permit from Elm Street Commission ___ Demolition Delay Signature of Building Official _____ Permit DPW Storm Water Management Date A~b l)fv,, 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. City of Northampton Building Department 2.12 Main Street Room 100 Northampton, MA 01060 ~:~~ttif l;ii~,;_::_':_/ _______ ....... __ Sewer/Septi6 AVa.ifability ; . ) < :/ ' ... . . > ·<; .:--------~-......, \JIJater/WellAv9ili;ibility __ •.··-' --------..,.. Tli'J() s'ets·•6fStruttui~LRi'ans ... :··-···,,..·O:··------ phone 413-587-1240 Fax 413-587-1272 •e1oySit~P[~n~-·-·-···----- OJhe'r'~~e9ify __ >·-· ____ _,....,_.,... APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: !i.'i'" /YI ,JPu sr. This section to be completed by. office Map._ -<*-=13_/4_---,--.... Lot ·-, /Jif ·.: --Unit_.,.... __ _ Alo v·l-l,, a~ fz,-tt J m'f. Zone __________ ......,..Ovej-l~y District ...... -~------- Elm St. District~-----'--· ""-. -CB.District:...;...;...a_-""--"'--1---------------------------, SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT Telephone 2.2 Authorized Agent: {$:JmfA1 Fttu,s &IJus lll 1 !30X /{1)/ . Buck.Jard. /114, Ots3'S _ :/Current Mailing Addres~ 1 &r;;, vi drm Bo u«°a5 Name Print) fl/:) 6:i. s; ol Lf h '7 Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Official Use Only 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 + 2 + 3 + 4 + 5) L/00 ., OD 000 · (JV_ ;;L 000 /3 00(). Cf[) (a) Building Permit Fee (b) Estimated Total Cost of Construction from 6 Building Permit Fee Check Number /I This Section For Official Use Onl Date Building Permit Number: ___________ _ Issued: _________________ _ Signature: ------------------ Building Commissioner/Inspector of Buildings • Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To lnCOJllplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ' ',, ' .... ' .. ' ,,, ,. ,., ,, ,, Ii·· ... Frontage ' Setbacks Front Side L: R: L: _._._.R: --------- Rear Building Height Bldg. Square Footage % .<i/J.2 Open Space Footage % (Lot area minus bldg & paved ' oarkirni:) # of Parking Soaces ' '' Fill: .. (volume & Location) ' ' .' ' " ' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES 0 IF YES, date issued: , IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES 0 IF YES: enter Book Page and/ or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 ·, Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF ¥ES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q IF YES, describe size, type and location: NO 0 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 Q NO Q . IF YES, then a Northampton Storm Water Management Permit from the DPW is required. D D Accessory Bldg. D Demolition New Signs [D] Decks [0 Siding [DJ Other [D] Brief Description of Props~ " St?; .Work: /tW ·~ k'& . . ~ Alteration of existing bedroom __ Yes __ No Attached Narrative Plans Attached Roll -Sheet Adding new bedroom Yes ___ No Renovating unfinished basement ___ Yes ___ .No a. Use of building : One Family )( Two Family ____ Other ___ _ b. Number of rooms in each family unit: , '-/ Number of Bathrooms._;L=----- c. Is there a garage attached? tP-tr JtJllY' I-I d: Proposed Square footage of new construction .. ___ '/....._'2 .... 2.=· _______ Dimensions e. Number of stories? __ 1 __________ _ f. Method of heati.ng? A1c ·wra,, .. "-84 !'VT Fireplaces or Woodstoves --'--'M=.o"--_ .. Number of each_. _ g. Energy Conservation Compliance. -------.---Masscheck Energy Compliance form attached?------ h. Type of construction Sf,c}t. ~ti~ ( i~ t/' } i. Is construction within 100 ft. of wetlands? __ Yes -4-No. Is construction within 100 yr. floodplain __ Yes __ No j. Depth of basement or cellar floor below finished grade _S='-"/i..:::a .... h .... e _ _,.p __ n _____ if'""9. ·_r....;;.~ ..... -· -.- k. Will building conform to the Building and Zoning regulations? >< Yes ___ No. I. Septicy~nk_. __ . Gity 8~1Ner. · K Private well _____ City water Supply._,){;.___ I, __ )(_ ... __ ·· _:.S_.~ __ J'-'_l_,T_· ___ ~ __ lz4_N_· __ ·----( A_____.l( __ f_R__..._ __________ , as Owner of the subject property · Swl1m(!vi F, · /iv; /Jers 1, JtA-41 "t'ol\J I. l3NUkS Agent hereby declare that the statements and informati and belief. Signed under the pains and penalties of perjury. fipwdtYL ,T ffiuc/{;J Prinf .>.,;ft.#ICW;:; l.$" IISV/ ~ lA-C. , as Owner/Authorized on the foregoing application are true and accu ate, to the best of my knowledge /" Jot Applicable D /]uv l1td /S'a.lmun bttt.. /Jv,/J,,,~~--·'---· . ..:......· . __ _..;_ __ l icense Number 8. 1 Licensed Construction Supervisor: Name of License Holder : . (1a. h dovi SI 0,;«cSf. lJtJX IO.tj/ . ÷,~ AAtf, 0812,/79 Address 7 / ;; ;;, Expiration Date __fl/A~ L/J? (;;Jj g;} '/6 7 /0' iu .. -1,/1n ~ Taiephone / Ul. , Not Applicable 0 /31:?0t/ Company Name /3aw~laa ,Y: &ovy4J ~~ OOH Jtv,/k,r-s LLC) Registration Number Address 71117/ I? ExpiratiM Date . {bQ!X /IJ'O I !Jtl"Jc./uu/J tf1A:. Telephone Ylf ,z.[,;2.Y[J 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 ....... lli!' No...... D 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 license, 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 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 :13uilding Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature-----------~------------ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, .MA 02114-2017 www.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization~ndividual): 5'4,/rf!drJ /}+us d.11 ldvs. L.l-C Address: /JJX !OIJI,, s7 Vf!fo/= • SI-. . . r . &r.;clav~ /f11. . ..... . ,· ·''' . c: ', City/State/Zip: Phone#: f/? 6:;iS-;). '({; "7 Are you an employer? Check the appropriate box: 1.1&] I am a employer with :J 4. D I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 2. D I am a sole proprietor or partner-listed on the attached sheet. ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* required.] 5. D We are a corporation and its 3. 0 I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. J2Sl New construction 7. D Remodeling 8. D Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 1 LO Plumbing repairs1or additions 12. D Roofrepairs 13.0 Other --------- * Any applicant that checks box# 1 must also fill 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. +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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ _,.l ...... at~(..._L.,..i!rc..c./-'ty___,-==:5"-'-...,)'--'N~S"-,--------------------- Policy# or Self-ins. Lie. #: ·7 p J Ui8 -99 q O rn 3] ·~ 9 ·-/ h Expiration Date: /o/a:; / cJ:2& /1 r I Job Site Address: S5 ~ £+,. City/State/Zip: AJ~h/J~, flflc, · 0 I Ob 0 Attach a copy of the work:.;;.;:i;ensation policy declaration page (showing the policy number anexi:iration date). Failure to secure coverage as required under Section 25A ofMGL 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 ofup 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. ify under the pains and penalties of perjury that the information provided above is true and correct. Date: lfi //If. 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ___________ _ Contact Person: __________________ Phone#=-------------,,..- City of Northampton 212 Main Street, Northampton, MA O 1060 Solid Waste Disposal Affidavit In accordance of the provisions ofMGL 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 1 SOA. ? Address of the work: ,i,2._ ~le Sf. J · The debris will be transported by: AfknJ lfel/ tJlf {'tJYl/a1/1tU/'j The debris will be received by: ------------- Building permit number: ------------- Name of Permit Applicant --------------- Date Signature of Permit Applicant '' VDAC ~ TRAVELERSJ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CHANGE DOCUMENT WC 99 99 98 ( A) POLICY NUMBER: (7PJUB-9990M33-9-16) CHANGE EFFECTIVE DATE: 10-22-16 NCCI CO CODE: 1 3579 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED'S NAME: SALMON FALLS BUILDERS LLC This change is issued by the Company or Companies that issued the policy and forms a part of the policy. It is agreed that the policy is amended as follows: An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at time of audit. ADDITIONAL PREMIUM $ 8467 ADDITIONAL NON-PREMIUM $ 472 RETURN PREMIUM $ NIL RETURN NON-PREMIUM $ NIL THE CURRENT POLICY EXPOSURES AND/OR CLASSIFICATIONS HAVE BEEN UPDATED TO REFLECT THE LATEST AVAILABLE AUDIT INFORMATION. THE FOLLOWING ENDORSEMENTS ARE ADDED: WC89041500 POLICY INFO PAGE ENDT WC89061400 POLICY INFORMATION PAGE ENDORSEMENT WC999998 A CHANGE DOCUMENT THE FOLLOWING CLASS CODE IS ADDED TO THIS POLICY: STATE: MASSACHUSETTS RATING GROUP: 0001-01 CLASS CODE: 5479 (INSULATION WORK NOC & DRIVERS) ANNUAL PREMIUM BASIS: $10,606.00 PRO RATA FACTOR: 1 .00 RATE: 8.9 ANNUAL CLASSIFICATION PREMIUM: $944.00 THE FOLLOWING CLASS CODE HAS CHANGED FROM: STATE: MASSACHUSETTS RATING GROUP: 0001-01 CLASS CODE: 5645 (CARPENTRY -DETACHED ONE OR TWO FAMILY DWELLINGS) ANNUAL PREMIUM BASIS: $117,823.00 PRO RATA FACTOR: 1 .00 RATE: 8.11 ANNUAL CLASSIFICATION PREMIUM: $9,555.00 TO: STATE: MASSACHUSETTS RATING GROUP: 0001-01 CLASS CODE: 5645 (CARPENTRY -DETACHED ONE OR TWO FAMILY DWELLINGS) ANNUAL PREMIUM BASIS: $214,512.00 PRO RATA FACTOR: 1 .00 RATE: 8.11 ANNUAL CLASSIFICATION PREMIUM: $17,397.00 DATE OF ISSUE: 03-31-17 TL CHANGE N0:003 PAGE 001 OF LAST POL. EFF. DATE: 10-22-16 POL. EXP. DATE: 10-22-17 OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: 28WML COUNTERSIGNED AGENT City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street• Municipal Building Northampton, MA 01060 Fee Calculator for Residential Properties Location : __ S)_Yv\_C.{"""4--~--k_S\:........._ _______ _ Basement @ .20 18T Floor@ .50 2nd Floor@ .50 % Floors, Finish Attic, Garage @ .20 Deck/ Porches@ .20 Square Footage Amount --- Total: (-; ================================================= TAUER RESIDENCE ACCESSORY APARTMENT OWNERS Jonathan Tauer 55 Maple Street Northampton, MA NORTHAMPTON, MA 6 OCTOBER 2016 SCHEMATIC DESIGN UST OF DRAWINGS LI SITEPlAN Al.I ARST A.OCR PLAN Al.3 ROOF PLAN A3.I ELEVATIONS A4.I BUILDING SECTIONS & WALL SECTlON A7.I INTERIORELEVATIONS&SCHEDULES :'--! !, =============================================================== ~ fl,(?,:,,PLAN Tauer Accessory Apartment New Construction 55 Maple Street Northampton, MA [. . . . -------------f "'"""' '""""' smccru<E I ----------------------/ . ·y. c=" La__. . . . CD ~!;.~~N = ENGAGE SURVEYORTO LOCATE FOUNDATlON IN REIATIONTO SETBACKS PRIOR10 CONSTRUCTION. AS-BU!LTSWILL LIKELY BE REQUIRED BY THE OTY. 60ctober2016 SITE PLAN Schema.It Design L1 Tauer Accessory Apartment New Construction 55 Maple Street Northampton, MA -r $ 4 ..... 11" J.., ,e. E$) = B '~ ~ <2> . ................... 4 iL~ MECHANICAL SYSTEMS NARAA]YE HOTWATER; ON DEMAND HOT WATER HEATER ONE SMALt UNIT FOR.BATHROOM AND ONE SMAlL UNrT FOR KITCHEN MOUNTED IN EAa-t OFTHOSE ROOMS VENTILATION: ERV INSTALLED IN MECHANICAL Q.OSEf SUPPLY BEDROOMS. EXHAUST BAiHROOM & ITTCHEN HEAT &AIR CONDmONING: ,dJR SOURCE HEAT PuMPS (I) ourDOORUNITlO SUPPLY (3)WALL MOUNTIDCASSETTES N m#,,HJ4"'MJi"1*:f (A'\ 1/4'=1'-0"' ~ 6 October 2016 FIRST FLOOR PLAN 8chemallc Oeslgn A1.1 7 ~ -------------------------------\_------------------; --PWMBINGVENrSTAQ( 1-----~~ , _, l'--~~=EAT ~ }12 0 H--;;;======-i=====.=a=ar-t-}12 ! @ .... : .. ····iJ····""'"'~ ~ ~ N o@ Tauer Accessory Apartment 6 October 2016 ROOF PLAN A1.2 Schematic Design New Construction 55 Maple Street -· Northampton, MA E!W!NTAKE&EXHl'.I.ST 0 .!!~'~~ ~ ~FLOORPtAN ~·" .... G) ~g1: ~;EVATION 0 ~~J _E,~EVATION ~ ~~>ViN © ~';f.n·IJLEVATION CD ~W .. HJLEVATION Tauer Accessory Apartment 6 October 2016 ELEVATIONS A3.1 New Construction Schematic tJe!jgn 55 Maple Street Northampton, MA OJTR!GGERR.OOF~ @ ~tr:~ST SECTION ==c:...--------------~ CONT1NJOt6 BEAD OF CON5TRUCT10N ADHESIVE G) ~~T~;_!,OUTH SECTION G) Y)!_ALL SECTION Tauer Accessory Apartment New Construction 55 Maple Street Northampton, MA !XSTAA?PNG ~ I Llll'Gm. -clfrZIPSHEATHtNGAIA8AARIER, e October 2016 Schema1iclleslgn TAPEAU.SEA1"'5 SURFACE MOIJNTID UGHlSANO DEVICES WITH GASICETI:0 AIRTIGHT SOXES VA«>\-4'XPSRlGIOFOAM '""""'"""' BUILDING SECTIONS & WALL SECTION A4.1 'B ,D \ ; \ l ·~~~1tl\~;, t \iii66669~b 1,.,.,.,. .. nnit ~ i;;.t?!?~';,~~~~~i i ~ ;,, h <'I ; / ~ ~ oil(/) a:~~ 90::, 0:.F.,@ i~~ UJ d it .,),i /