38B-151 65 COLUMBUS AVE BP- 2012 -0037
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map-Bloc 38B - 151 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2012 -0037
Project # JS- 2012- 000061
Est. Cost: $1100.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 12240.36 Owner: FIELDS ROBERT G & TAMAR TAITZ FIELDS
Zoning: URB(100)/ Applicant. FIELDS ROBERT G & TAMAR TAITZ FIELDS
AT. 65 COLUMBUS AVE
Applicant Address: Phone: Insurance:
65 COLUMBUS AVE
NORTHAMPTON MAO 1060 ISSUED ON :711512011 0:00:00
TO PERFORM THE FOLLOWING WORK.- Renovate Kitchen
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 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 -0037 �(Gp
N
APPLICANT /CONTACT PERSON FIELDS ROBERT G & TAMAR TAITZ FIELDS '
ADDRESS/PHONE 65 COLUMBUS AVE NORTHAMPTON
PROPERTY LOCATION 65 COLUMBUS AVE N g
MAP 38B PARCEL 151 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE ✓ C ,
ZONING FORM FILLED OUT Cp
Fee Paid O
Building Permit Filled out
Fee Paid
Typeof Construction: Renovate Kitchen _ ,' ,SID
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included• -
Owner/ Statement or License
3 sets of Plans / Plot Plan OK
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 Delay
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.
t e '
of Northampton
REC EIVES 3 ulli ling Department
2'2 Main Street
JUL I 1 N rth Room 100
pton, MA 01060
58 1240 Fax 413 - 587 -1272
=. of etro ur+a pdBPbGT10N�
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 byv vice
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Cu f E s 1 V�h
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SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
L Z fr
Name (Print) Current Mailing Address: I /
- L� Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION: 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building + G o (a) Buiid ng Perm it.Fee
2. Electrical
(b) Fstirriated Total Cost of
onstruction: from 6
3. Plumbing
8uiidingPermit Fee
imp MOW
J
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1+ 2+3+4+5) Cheok Number
-- -
This; For Official Use .Qnl
Building Permit Number: - Date
slued:
Eignatur
Building Commissioner/InspeCtor of Buildings Date
a
t
Section 4 . ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colt rin to be filled in by
Building eparttnen"K
Lot Size
- Frontage
Setbacks Front
Side L: ._- R: L: _.__I R:
Rear
Building Height �� I
Bldg. Square Footage % C� �
_ 01IMSpace Footage _ _. %. _
(Lot area minus bldg & paved
arkin
I
# of Parking Spaces - —
Fill:
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNO 0 YES 0
IF YES: enter Book � � Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q 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
Date Issued:
C. Do any signs exist on the property? YES 0 NO
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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all aoolicable)
New House [- Addition ❑ Replacement Windows Alteration(s) 0 Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [D) Other [c7j
Brief Description of ProposedU t��.
Work: C
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll - Sheet
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. Will3building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION ya 4 OVVNERAI L IT H ORIZATIONA.1.1 TO BE GQlII1LLETED; WHEN;
OWNERS AGENT OR CONTRACTOR APPLIES QR B) 31E DING: PERMIT
1 - as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I : , 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
ii
Signature of Ow ent Date
r �1
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicably ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
e Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 11Ift7R10ERS.'; gMPMSAnON wSCJIZANCI A 1°FllalkillT.(Nf G.L. c.1;?2, § 25C(
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 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 uerson 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 buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of 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 permit.
The undersigned "homeowner" certifi an assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Vocal ning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
r y . The Commonwealth of Massachusetts
Department oflndustrial Accidents ,
Office of Investigations
600 Washington Street w r
Boston, MA 02111
ww».massgov. za
- Workers' Compensation. Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organizarion/Individualy. .
Address:
City /State/Zip: Phone. #:
.Are you an employer?. Check the appropriate'boa:. Type of protect (required):.
1.0 I am a employer with 4.. r I am a general contractor and I
—_ -- - -_ - - -- 6 _0 Ne on
w_co nstrttcfi_
employees (frill and/or part=tiue* - -- have hired the - subcontractors— - - - - - --
listed on the attached sheet. 7.
2_ I am a sole proprietor or partner- • . � .
These - sub- contractors - have -- ---- - .
and have - na c�ployees -: - __ .8. Demolition
working for me in any capacity. employees and have workers' 9: ❑ Building addition
[No workers' comp. insurance comp $-
required] 5. El We are a corporation and its IO.Q Electrical repairs or additions
--
3. ❑ I am a homeowner doing all work officers havezxercised their 11 .11 Plumbing repairs or additions
myself [No workers' comp, right of exemption per MGL 12.Q.Roof repairs
insurance required.] T c. 152, §1(4),'and we have no .
employees. [No workers Other
- - comp. insurance_regtrued }:
*Any applicant that checlo; box #I must also fill out the section betowshowing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must.attached an additional street 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.
ram an employer that is providing workers' compensation insurance for my employees Below is the polity and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. # Expiration Date:
Job Site Address: , City /StafelZip:
Attach a copy of the workers'7 compensation policy declaration page (showing the policy number and expiration date).
Failure. to- secure coverage. as required under Section 25A of MGL c. 152 can lead to the imposition of crimin4I 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
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
mvestieations of the r insurance coverage verification
I do hereby certify nder epains.andpenalties ofperjury that the information provided above is true and correct
i tore:
__ Date: j
Phone#
OffxW 7Dte write in this area, to be completed by city or town official
City or Permit/License # Issuing one): Boar ilding Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
ti. Oth Contact er Phone #:
' 1
f
HOME OWNER EXENTTION 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 persons) who seek, to use
the lio &e owner a mptibi to act as ttreir owff coustructrga - supervisor, - to`be aware that
by doing so you become responsible for compliance with state budding codes and
regulations. The inspecdon.process requires that the.building department be called to
inspect work at various stages, which include foundation /footings (before backrdl),
sonotube holes (before•your), a rough buildinginspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building depart re quires thes inspections before the work is concealed, failure. to
secure these inspections can result_ in faflure 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. responAi'_ 'to make sure that the trades hired secure their proper
ermits 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
Kitchen Renovation at 65 Columbus Avenue Northampton
This project does not involve any expansion of the home in any way. It is simply an upgrading of
the kitchen appliances and the accompanying electric and plumbing work which will performed
by an licensed electrician and plumber and add a couple of windows and a sliding door.
As you can see from the diagram below there is a back room off the kitchen and an adjacent
enclosed porch that make up the back corner of the home. No work will be done in the porch.
The following work is anticipated in the kitchen and "back room ".
1. Replace old appliances.
2. Sand kitchen floor.
3. Lay new layer of flooring, either wood or vinyl, in back room.
4. Add one window in back room.
5. Replace one window in back room.
6. Install sliding door in back room.
7. Remove suspended ceiling in back room and add insulation to ceiling /roof.
8. Add an island in kitchen with plumbing for sink and dish washer.
9. Replace window in kitchen with smaller one.
10. Remove door to bathroom from kitchen and wall over doorway.
11. Add sheet rock to walls in kitchen.
12. Add lighting to kitchen and back room.
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