25A-159 245 NORTH ST BP- 2012 -0034
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map. 25A - 159 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Repair BUILDING PERMIT
Permit # BP- 2012 -0034
Project # JS- 2011- 001689
Est. Cost:
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13982.76 Owner: TAYLOR SHERRY L
Zoning: URB(100) Ap TAYLOR SHERRY L
AT. 245 NORTH ST
Applicant Address: Phone: Insurance:
25 EDWARDS SQ (413) 341 -3409 (�
NORTHAMPTON MA01 060 ISSUED ON. 7115120110:00:00
TO PERFORM THE FOLLOWING WORK.- Replace Porch; Same footprint and height
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 Siinature•
FeeType: Date Paid: Amount:
Building 7/15/20110:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2012 -0034
APPLICANT /CONTACT PERSON TAYLOR SHERRY L j.
ADDRESS/PHONE 25 EDWARDS SQ NORTHAMPTON (413) 341 -3409 Q It
PROPERTY LOCATION 245 NORTH ST S `
MAP 25A PARCEL 159 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY: p t
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Ld uildiniz Permit Filled out
1 Fg:(Paid
Typeof Construction: Zftt - 2 FAMILYReplace Porch; Same footprint and height
New Construction
Non Structural interior renovations
Addition to Existing
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 464ATION 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 Delay
7h
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 CuNDriveway Permit
212 Main Street SewwrAVtic Availability
Room 100 WaterlWeM Availability
Northampton, MA 01060 Two Sets of Stnxtwvj 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 .Prooerty Address This section to be complebd by office
Map Lot Unit
V"- i vvt t1k v t (s G v Zone
Ouierirry District
Ekn tip. Datrlet CS DNbk:t
SECTION 2 - PROPERTY OWNERSHP /AUT"ORIZED AGENT
2.1 Owner of Record
• �� Viol �
Nsme (Prkt) -- Current Ltd" Address: Y7
:312 -=1�v
Telaphore
2.2 Authorized Aaetrt»
Now (Print) Current Me" Address:
signal re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Ofrrcial Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 8
3. Plumbing Building Pem k Fee
4. Mechanical (HVAC)
5. Fine Protection
8. Total = 0 +2+3+4+5) ) Check Ntxrrber
This Section For OMNchd Use On
Building Permit Number Date
Issued
Signature:
BuMdkg Commkssiorrer/kuspedor of Bta kW Date
City of Northampton
Massachusetts
212 Hain Straat • Municipal Building`'
Nk 01060
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 hone 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 twin construction supervisor, to be aware that by doing so you
become responsible for compliance with state buNding codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundationlfootinas Mellon becldNlL sonotube holes (before Dour), a rouah buNdina inspection
/before work is conceaWk insulation inspection (if reauired) and a final building irapsction.
The building department requires these inspections before the work is concealed, faNure to secure
time 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 c or jurxtion to the building
permit issued, and that they got their required inspections. Faikme 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 m
I understand the above.
(Home s s ir xem
I will call to 71
all required 1de inspections necessary for the building permit issued to me.
Date ��
Address of work location oZ'`�� /UG►'Z.� ��
4n. , t A- D/ D G o
)&r Ex f�h F° 9 o4
P
Section 4. ZONING All hnforntatlon Must Be completed. Permit Can Be Denied Due To kxwvtete infWmation
Existing Proposed Required by Zoning
This c ulumn to be filled in by
Bing Dapwtwd
Lot Sine
From e
Setbacks Front
side L: R• L• R•
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
# of Parking S paces
Fill: ---_..
volume dt I.ocadon
A. Has a al Permit /Variance /Finding ever been issued for /on the site?
I r DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT 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 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO i/
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
IF YES, describe size, type and location:
E. Will the construction ach* disturb (dead% grading, a anon, 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 Perrrtitt from the DPW is required.
SECTION &, DESCRIPTION OF PROPQ= WORK (ebeck all applicable)
New Hour• ❑ Addition ❑ Replecarnerrt Windows Alteration(s) Rooikrg
Or Doors
Accessory Bldg. ❑ Demolition New Signs [tom Decks [ Siding P:3) O#w [tom
Brief Deser"n 9f
Alteration of existing bedroom Yea ✓No Adding new bedroom Yes _ J N o
Attached Narrative Renovating unfinished basement Yes
Plans Attached Roll - Sheet
Oa. If New house and or addition to existing housing. compieft 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. Masecheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 R of wetlands? Yes No. Is lion within 100 yr. floodptain Yes No
j. Depth of basement or oellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
t. Septic Tank City Sewer Private wall City water Supply
SECTION Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMT
t, as Owner of the subject
ply
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1, wr
as Ow/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and aocurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury
Print Name
Soature of OwnedAgent Date
SECTION 8 - CONSTRUCTION SERVICES
81 t.icsth VA Construction Supervisor. Not Applicable D
Name of LIGiinnt Holdw: l foerase Number
Address Expiration Dale
Sipnabne Telephone
Not Apps D
Company Name Registratlon Number
Address Expiration Date
Telephone
SECTION 10- woRKERS' COMPENSATION It68uRANCE AFFDAVIT (M.G.L c. 152.1 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....... 0 No......
11. - Home Owner Exemption
The current exemption for " homeowners" was extended to include of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not poetess a license, orewtded that the owner acts
as sunen*visor. CMR 780. Sixth F.dkios .Section 108.3.5.1.
Definklim 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 structim accessory to such use and/ or farm
strUCtures. A person who coastracfs amore tiaa one home is a two-year period shag sot be considered a boneowaer
Such " homeowner" shall submit to the Building Official, on a form acceptable to the Building Offi that MW shag be
responsible for aN meb work oer!orned w■der the begun per=il.
As acting Coastrrretion Swperviaor 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, row am be gable 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 Zoning Laws State of Massac Laws
Hoomwaer Sillsatwre
[ 7VE EIVE �� The Conunonahk of Massachusetts
DepanWsent of Industrial Accidents
1 201 I Twe of Investigations
600 Washington Street
tvU irsFr Bo ston,lKA 02111
ON, F,1A Ot ES
www ma=gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Leeibly
Name ( Busitess /Organizatiomindividunly u [ r2i
Address:
City /S Phone #: 3 f 3 — 2-0
Are you as empbyer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part- time)." have hired the sub- contractors 6. F] New construction
2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
(No workers' comp. insurance comp. insurance.t
aired.] 5. E] We are a corporation and its 10.[:] Electrical repairs or additions
officers have exercised their
3. 1 am a homeowner doing all work 11.❑ Plumbing repairs or additions
yself. [No workers' comp. right of exemption per MGL l2. ❑ Roof repairs
insurance iequired-] t c. 152, § 1(4� and we have no
employees. [No workers' 13 :g p
comp. insurance required.]
opay applicant that ebecks box /1 must also fill out the section below showing their workers' compensation policy isformeioa
t Homeowners who suI - Win affidavit indicating they are doing all work and then bin: outside eoadacton mast submit a new affidavit indicating such.
=Contractors that c beck this boot mast anac ad an additional abet sbowiug We acme of the sub- combact s and state wfiAw or not tbow entitiff have
anploya a. if the sub- conbaclors have employees, Wey mast provide dk* workers' comp. policy number.
l mn an mgdoyer that is provi&g wodrers' compmsaaon bmwawe for my empkyem Below is ike porky and job site
infonnadom
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration hate:
Job Site Address: Cityaawzip:
Attach a copy of the workers' compensation policy declaration page (shower the policy number and expiration date).
Failure to secure coverage as required wider Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip to S 1, 500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of tip 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.
I do ber+eby tern nder the paL perft" AN fire provided above Ir bwe and correct
Date-
Offkla/ use oohs Do not wrke In airs ar w, to be wnrple rd by city or town ojfidef
City or Town: PermitllAcesse #
lasing Authority (drde one):
1. Board of Health I Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plembisg Inspector
6. Other
Contact Person: Phone#:
_ E E
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