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22B-008 (10) 130 SPRING ST BP-2009-0753 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B-008 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2009-0753 Proiect# JS-2009-001121 Est.Cost: $5200.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: THOMAS DOLAN 039281 Lot Size(sq.1): 65775.60 Owner. PEASE THOMAS R&PEGGY-ELLEN Zoning:GI(100)//WSP Applicant: THOMAS DOLAN AT. 130 SPRING ST Applicant Address: Phone: Insurance. P O BOX 297 (413) 585-0612 Workers Compensation CHESTERFIELDMA01012 ISSUED ON.4/2/2009 0:00.00 TO PERFORM THE FOLLOWING WORK.-REPAIR 12 X 14 WATER DAMAGED ROOM (WINDOWS,DRYWALL,INSULATION) 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: FeeType: Date Paid: Amount: Building 4/2/2009 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo t � File#BP-2009-0753 APPLICANT/CONTACT PERSON THOMAS DOLAN ADDRESS/PHONE P O BOX 297 CHESTERFIELD (413)585-0612() PROPERTY LOCATION 130 SPRING ST MAP 22B PARCEL 008 001 ZONE GI(100)//WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: REPAIR 12 X 14 WATER DAMAGED ROOM(WINDOWS.DRYWALL.INSULATION) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039281 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFqF&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 Demolition Del Signature of Building Official 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. Department use only City of Northampton Status of Permit: h� It Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability MAR 8 2009 Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRU6T,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 1.347 5?rt/rtc; .s� Map Lot Unit f Zone Overlay District d/o6z Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 7.1 r)wner of Record: Name(Print) Current Mailing A dress: f Telephone gev- ignature oz�� 2.2 Authorized Agent: M :?1p a0A 297 Cl/1^le4 f-ie/c/ 06, 0/0/-Z-- Name /0/2Name(Print) Current Mailing Address: o�Gh/-//3-5'96--061 197-52/61! Signa ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) zDO, w Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Buiiding Commissioner/Inspector-ofBuildings - 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 M....._.. 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) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 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 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors C] Accessory Bldg. ❑ Demolition ❑ New Signs [t]] Decks [Q Siding[O] Other[O] Brief Description of Proposed .11�,fv�aNaa mob �o ,�•n „� JVIYis(- Work: I w A! iai i.✓ 0412 U COrJ.Lil fwll a f v+ti Alteration of existing bed com Yes�_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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 I, as Owner of the subject property hereby author e to act on my half, in a afters relative to work authorized by this building permit application. n.. Signature of O Date — fg. I, / Qsv- J�o� 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 Signatur f Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /�) ) NotApplicable ❑ Q Name of License Holder: �/Lt ,C/��y�/V _�.SS .2 2 C/ License Number Ch /a?- Address Expiration Date 76" o Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ //a�A") l�� - Gorlf�eacyo�c- zz?ySyo Company Name o Registration Number o r s GhPsrPk`.��.i /1l�.Dior �- 2y- �oio Address Expiration Date Telephone QK_06/z- 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....... ❑ No...... ❑ 11. - Home Owner Exemption 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 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-vear 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 and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth ofAlassachusetts Department of industrial Accidents Office ofinlestzgazions ' 600 Washington Street Bostoj4 MM 01111 J www.mass.Qov/dia Workers"Compensation Insurance Af_nda-v-it: Builders/Contractors/EIectricians/Plumbers ADalica.nt Information Please Print Lembly Name(Business/oraanizadon/Individual): o �a�1is!tJ Geh uJll��c Address: City/State/Mp �S�eG f�%/h(�� D/a/Z- Phone= �//3 - S8S=d� L2 F22. re you an employer?Check the appropriate box. �I am a employer with / 4. I am a bene-al coactor and I Type of project(required): employees(fall and/or part time).* have hired the sub-contractors 6. 0 New construction 0 I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship a=d have n7 .Io;Tees These sub-contractors have g. Demolition working for the is any capacity. employees and have work.Azs' [No workers'comp;t zu--anca camp.insurance.+' 9. Buildingaddition required-] S. 0 tii%e are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12 0 Roof repairs ftw=nce required.]t c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required_] - —��7TP rcrn caerr¢ooz anut also=out the secaon oeraav snowing w cornpeasaaaa.po ey otmation T Homeown=who submit thrs affidavit mdirrung they are doing all work and then hue outside contcacfots auLst subunit a aesv affidavit mdicatag such *Contractors that 1-hl-s this box must-attached fie additional sheet showing the name of the sub-contractors and state whether or not those eatides have employees. If the sub-conamators.have cmpioyes,they rrnrst provide their workers'rn rip.policy numbs I am an employer that is providing workers'cam in pensation insurance for my employees Below is the policy and job site formadom Insurance Company Name:- X/`JpIli�►/ U�i� Policy#or Self-las.Lis. :p/G 2 •. 3/sem 36 Z/51- 0/7 Expiration Date:- 5-- 2 6O fi Job Site Address: C' /Staid m' zip=. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required Tinder 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 ofa STOP WORK ORDER and a rye Of up to 3250.00 a day aoa=the violator. Be advised that a copy of this statement may be forwarded to the Office of Iavestioations of the DIA for insurance coverage verification. I do hereby certify under the pains and pWLIes of perfury that the information provided above is nue and correct - Dare: —Iv v971c=use only. VO not write vt this area,to be eomp[ered by Cz7Y or town_ o,!2:ciaL f� _ ._City or Town: _ ------__.___ --p-ermiVUcense R Issuing Authoritv(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other mnspecI Contact Person: Phone T- 3 ,� ,� d �riaseacbuscE'a �� DEP??ZTbf=NT OF BUILDENG L SPECTIONS a= r= 2121V1.un Strut • Munidpal Buildin- INSPECTCP 4a F Nord=npuin, MA 01060 HOME OWNER EXEMPTION AC'ICgOW7 EDGEMENT The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to act as his /her construction sup :or. 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 I home owner." The bi-rildin&,tiepa=ent for the City of Northampton wants any person(s)who seek to use the h6iiie 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 bac1i11). sanotube holes (before uour) a rough building insaection(before work is corneal. . insulation insaection (if reuuired)and_aT al-buildina.insnecti.on. 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 umtil-t#e-wark_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 ca-11 to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location