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44-058/44-118 (2) 1196 FLORENCE RD BP-2006-0957 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-"058 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0957 Project# JS-2006-1429 Est.Cost:$25700.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT CARRIER JR 059154 Lot Size(sq. ft.): 104064.84 Owner: DAVIS CRAIG R&DUANGCHEUN Zoning: SR Applicant: ROBERT CARRIER JR AT: 1196 FLORENCE RENCE RD Applicant Address: Phone: Insurance: 16 David St (413) 527-0333 SOUTHAMPTONMA01073 ISSUED ON:3/21/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN& INSTALL CABINETS 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 3/21/2006 0:00:00 $50.002166 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-0957 APPLICANT/CONTACT PERSON ROBERT CARRIER JR ADDRESS/PHONE 16 David St SOUTHAMPTON (413)527-0333 PROPERTY LOCATION 1196 FLORENCE RD MAP 44 PARCEL 058 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �/�� ��� Fee Paid Typeof Construction: REMODEL KITCHEN&INSTALL CABINETS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 059154 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 Commi n /4L6 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: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 I19cp Flo'1r•• Le. lam- • Map Lot Unit F e- - M Pc o I a ro i Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: If 99(o f I o r e.v Lk 20,3„ 1144L.,fic Name(Print) Current Mailing Address: C � ,s Telephone _ �..ff ► � zt Signature (..•c�i � • � �.,,/..,A T 3 � — � 0 2.2 Authorize nt: 04.t ; 51• sauuL0 Nam nt Current Mailing Address: - — d 7 • 0 33,3 Signs re 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. Mechanicai(i-WAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 4.B.,S']00• o-t✓ Check Number 44v This Section For Official Use Only I Building Permit Number sssuu ed: Signature: - Building Commissioner/Inspector of Buildings 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 1 Frontage I 1 I Setbacks Front 1 i i Side L:�-' R:� L: � R:I �I 1 Rear • Building Height ^^-^ r-- • Bldg.Square Footage i i (�1 % �� I Open Space Footage % (Lot area minus bldg&paved i i I I 1 I I parking) #of Parking Spaces —7 r Fill: u (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: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES O 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 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 © NO O IF YES, describe size, type and location: i D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: I I 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 O , 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 El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [OJ Other[D] Brief De ription of ProP�ose II 11 nn II jj Work: c. • , �5 +w S 1« 1 • CStDi.uc� 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 house and or addition to existinq-houstnq, 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, Cir , as Owner of the subject property hereby authorize r�+ Cis r v�► �e Y to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owne Date I, e , 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 3 r -7— (c, Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES .f • 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: t�t`?20y-\ a ,-r-t. Q S /.' i License Number betVt 14 . sex,- -L 7L 06 Expiration Date S nature Telephone a Not Applicable 0 sReti�ste 1 'rk"io ne`"'mp>+ weme/titontrac£o. s `t / l—Cr•�IYI�/� � L4✓`�wr� 1. �ryw�t� � / l/ 33 Company Name J J Registration Number DaL.; A 5 - Sc,141s-Lc/4s t, xs"---0 Address Expiration Date Telephone 5`3'7-o33- 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 0 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-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 amoral Laws.Annotated,von may he liable for persons) 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 r • (y±02 a parfliampfott I g ,; a rl.satcrattcrt,s t- _ ; • _ .: DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street ' Municipal Budding Northarnpton, Mass. 01060 r' • WO.RCEIZ'S COKPENSATIO.N CNISURANCE AFFIDAVIT • (licenscx/perlittcc) with a principal place of business/residence at: - -- (phone=) (s0-=,/city/said ip) do hereby certify, under the pains and penalties of perjury. hit ( ) I am an employer providing the following;worker's compensation coverage for my employees working on this job: • • • (iasurnc Company) (Policy Number) (a-airation Dam) • ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the coon-actors listed below wwrbo have the following worker's compersadon policies: . (Name of Con:r ctor) (In t ranc t CoitrnanyiPoiici N'u n cr) Date) • (Name of Coon cior) (Ins-wance Company/Policy Nunncfs) (L?Wirtion Daft) • (Name of Conn-actor) (Insurance Company/Policy Nusb_.r) (Expirtioo Date) • (Name of Contractor) (In urance Comcauy/Policy Numb:r) . (ac.aLt sdroaJ tSaC iracectry to atdud_iaforata.6'oo p ioias to all oo=r-t-o:a) (� I am a sole proprietor and have no one wot-I3n for me. 1 P 8 ( ) I am:a home owner performing all the work myself. NOTE:plcx be ctv-Arc the Mtri)c bocxowam tabu cxaloy pcoai to o^," tmau s rocx ao a d••e1Li;of sat snort:thus ttS'ee trots is tabida the boctoou ac maids or oo the croustade mpartra_t tbr_o s t oat Cr—.!!y oµ.:d-d to be ctpioycs uad=the Lai; a tom--.tics Ac(GL!152=1(5)).e-ppticaLtioo by a bomeoQaa fc a Gam.a pcmit cs_y a ideaoc the 1ep.1 menu of ea stay«wader do Wortol.eocopeon.lioa Ao_ I uadc-s a o4&a a Dopy of Luis mtecum may b.fo ..J to the Dcp.rtmot of 1oasrial Acodat-s'Off+oe of lraur•ocr roc II. oovec veirelioo icd t .z Ci)tae to ooc,r bovert•,o^e tads sx L tioo 25A of MO 152 can Iced to the is .oa of ciminsl per`shies i �+^iao-^c of a rise of up to Si}00.00 armor izzp:iso®en of up to Doe yens cad c.i1 pcsatoo io Se form or.Stop Wort Ord=sad a fim o(S 100.00 a day aping ton. For d.mana-,..--4at v.c only • 1 . Permit Ntim Sig ntur of Lic ..sccfPctmiucc Lace -. . O¢5 M PTO ` •( � etsce w ,..LxT1 D �11Y�JLTIt Z �,1 $ �'� � �+ilassacitusrtts r \-": =ts"l y �U` �, rza.-r"$ DEPARTMENT OF BUILDING INSPECTIONS - a /_i INSPECTOR 212 Main Street • Municipal Building ' Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:•.:sor. The stare 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 bui1 ing 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 bacldill). 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 F. , 1 , ! ! 1 a i 1C-.. f ; _lin-%) ii.v trs,1 4 e iv , IT )\.€,(1,5 1 1 Ve_ci u v.s, --,- ept ki 1 ) o'l-kti side rd Lr I . Serirk., (..... 1,14_6( p4t6e.,41.4 i . . . I • 1 ,., . , . I • 1 . • / 7 k;); I * , 1 *t f•4 I r I , I • / . st i I . P . . . • I i• 1 . • • f I a ' ,•• . ., . 1 ' • . I 1 . . 1 I'' i .."— ,, • 4 C4 900 1.3. ' 1 .yft•41C.• I -,- I,)r,ike*4" • , 44--<'.>..... ' 1 4 '. 6 " • -- i q'- 6'' —kt- e•I ' r •l' HZ tst ICI F.. E ,, . 1 ri; . ,. . • 4 * , E. k.i • •. • , '1 1 0 ••I .'. 1 I I 1 i.• *-k, -......„ * -----'7--- I 1 ' • ' 't ' : I ' , 1 12) , . 51, toiMe. ve)oe. -----..,,.' l 1,aliNfampoliiiiiii . ;f9 1:- .• '9.. "'• f 1 !••• t. 1 . 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I .... -... • I 9 . .___,, !,..) ._ -=.-._=-7-- -. .77 1 • ) tti\ All dimensions_size designations given are 744 ID 20 i I, This is an original design and must not be 1 Designed: 2/17/2006 subject to verification on job site and fralKolucits/M released or copied unless applicable fee has Printed: 2/18/2006 -- - adjustment to fit job conditions. been paid or job order placed. i {---. 1L_ !JDavis -17Fp-i-------Fria-w-ing#: 1 ... ... .... . .. • - _ . .. .._ .. .. ......