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24C-120 (3) 134 FRANKLIN ST BP- 2012 -0040 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 24C - 120 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 -0040 Project # JS- 2012 - 000064 Est. Cost: $62157.00 Fee: $373.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group_ SERENA TORRY Lot Size(sq. ft.): 6011.28 Owner: Chiavetta, Carol and LaMee, Maggie Zoning: (100) Applicant: SERENA TORRY AT: 134 FRANKLIN ST Applicant Address: Phone: Insurance: 158 PLEASANT ST (413) 634 -8088 PLAINFIELDMA01070 ISSUED ON. 7/15/2011 0:00:00 TO PERFORM THE FOLLOWING WORK.- Finish Attic Add bedroom 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 $373.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2012- 0040 01 APPLICANT /CONTACT PERSON SERENA TORRY ADDRESS/PHONE 158 PLEASANT ST PLAINFIELD (413) 634 -8088 � Lsc � 0� PROPERTY LOCATION 134 FRANKLIN ST f i t-1 , 1 MAP 24C PARCEL 120 001 ZONE URB(l00)/ F LO Ofi' J C THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT e Paid 1 l0 Iv Buifding Permit Filled out ee Paid Tweof Construction: Finish Attic Add bedroom New Construction Non Structural interior renovations Addition to Existing Accesso1y 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 INFORMATION 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. r `n Northampton `J g Department t Main Street :I JUL ! 3 2011 oom 100 Nort pton, MA 01060 -- "phone 413587 1240 Fax 413 -587 -1272 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 1 y F( ^ k I� � ,hfot Umt 0 1 / / QYerlablstrlct INa r r'N G1 v�, ri ' �/ D ! O D aS h r sEthir,5tl7i3triot � :GB DiStiYct SECTION 2 -.PROPERT OWNERSHIP /AUTHORIZED AGENT 2.1 Ow ner of Record C�u �� I i iE�� ,r'I� c t,-4 'e �, s�j c�SZs eA �Mo &Q & rr rint) � ,:, u aili ress:� lephone Signatu 2.2 Authorized Aoent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed b permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estlrr ated Totsl Costa Construction -from 6 3. Plumbing Building PermitFee 4. Mechanical (HVAC) 3 too � c 5. Fire Protection 6. Total= 0 + 2+3+4+5) / S �. c7�' Check Number _-_-- Thls Section For Official Ilse Onl Date Buildin Number. Issued: Signature: Building CommissionetArtspecto.rof I3uildings Date' I `� I A/, C Gl 4 n y , tv .-e X * yr, v r Section 4 . ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning f This column to be filled in by `Q k � � � CA 4 H Building Department Lot Size I � r Frontage Setbacks Front Side L: R: L: R: Rear --- — Building Height Bldg. Square Footage ° /U Lo ta r Space_Footage_ _ -_% (I.ot area minus bldg 8c paved arkin # of Parking Spaces Fill: volume &Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW 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 Pag and /or Document # I B. Does the site contain a brook, body of water or wetlands? NO 14�) DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: 4 � ^ C. Do any signs exist on the property? YES ® 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 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 ja IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF'PROP.OSED WORK (check all aaalicabtel New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition New Signs [o] Decks [Q Siding [p] Other [p] Brief Description of Proposed Work: fev,owcexiStil� Il�1% "G /lt fY-�V iVi "� /J -0 S�fiock - 0 add - thK - -- r- ,lki'n i a 5e 7 '(b r Alteration of existing bedroom Yes X 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. Will.: building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a.- OWNER A.IJTHQRIZA7IQN TC1 BE CQMPI.ETED 11. OWNERS AGENT OR: CONTRACTOR aPPLtES FQR B JIF flIN ' PERM17` 4 ✓ ' e as Owner of the subject ' Cii property hereby authoni �� C' ✓' °` 7 ©: r e is a, my f, in all aft relative to wo aut rized by this building permit application. } Sighatujf blowner Date -1 S� re ✓io. ' d r _ _ _ as Owner /Authorized Agen hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and Signed under the pains and penalties of perjury. V- C, j f _0- Print Nam 30 Signature of Own Agent Date SECTION 8 -PONS TRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicabl2 ❑ r Name of license Holder : -O C� f e n c ! of re �/ 7? q 0 1 License Number pfo 3- �C7i3 Address ! -- ! 3 L I 309 J Expiration Date Signature D Telephone ✓J Not Applicable ❑ S�' Y f ✓�a 1� �rt�r'� S� �o w a � �u stn. C sIY14 '{"7 '3 ri Companv Name Registration Number I.S. �J e s 4 '� S� ,Flu, - i (�! /'1A p v 7 L) 3 - v Address Expiration Date Telephone 6 j L / - YOYY SECTI0N:11I G WORKERS'COMPNSATION INSURANCE AFF1fJAYIT.(M, L. c 15,§ 25G(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...... ❑ 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 lanc)ron which he/she resides or intends to reside, on which there is, or is intended to be, a ne or two family dwelling, attache4 detached structures accessory to such use and/ or farm structures. A erson who c structs more than one homirin a two-year period shall not be considered a homeowner. Such "homeowner" shall subn)q sub ' to the Building Official /on a form acceptable to the Building Official that he /she shall be responsible for all such work Am formed under th l;uildi permit. As acting Construction Superviso our presenc n the job site will be required from time to time, during and upon completion of the work for which this unit is ' ued. Also be advised that with reference to C t I52 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in De Nasssres ponsibili assachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you unde tl` The undersigned "homeowner" ce ' es ty for compliance with the State Building Code, City of Northampton Ordinances, Stata�nd Locas and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth ofAfassachusetts Department oflndustrial Accidents. , Office oflnvestigations t , 600 Washington Street Boston, MA 02111 wwx,.massgov /din -Workers' Compensation.Insurance Affidavit: Builders/ Contractors /Electricians/Plumb.ers Applicant Informafion Please Print LegibIy Name ( Business /organizationdndividuat): se f e n 'TO r r P jL Address: 1 S 8 J e c, 3 u J .; City /State/np: RQ i� 04 Phone. #: 2K 3� `1 8 0`39 .Are you.an employer?. Check the appropriate'box:... -Type of project (required)•. L ❑ I am a employer with 4.. ❑ I am a general contractor and I - - - = - -- -= « -- - - - - -- -have hired -the- sub - contractors -- = -- 6. El N c onst_ruchon - - - _ _- __ -- -_- -- , -- - - employees (fiiIl and/or part time. 2.. I am a sole proprietor or partner- listed on the attached sheet 7 ,Remodeling - - These -sub- contractors - have.- - - . ship;�nd bane. no e�Ioyees - .8. ❑Demolition working for me in any capacity. employees and have workers' $ . 9: [3 Building addition [No workers '. con p. insurance comp. insurance required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have' their 11. Plumb' r 3. El I am a homeowner doing all work ffiex,f • ❑ � repairs or additions myself [No workers' comp. right of exemption per MGL 12. ❑.Roof repairs insuran required] t P. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance req iire&] *Any applicant that checks box #I must also fill out the section below showing then work=' 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. TContractars that check this box must.aitached an additional sheet showing the name of the subcontractors and state whetheror not those entities have employees. If the sub - contractors h employees, they must.prowde their worl=' comp. p olicy number. lam an employer that isproviding workers' compensation insurance for my employees: Below is the polity and job site information. . Insurance Company Name: . Policy # or Self -ins. Lic. #: 1. pirationDate: Job Site Address: City /Stafe/Zip: Attach a copy of the Workers" compensation policy declaration page the policy number and expiration date). Failure to- secure coverage. as required under Section 25A of MGL c. 152 cau 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 is 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification Idoo hereby certify under the ainsa ndpenafties of perjury that the information provided above is true and correct Date: 6 3 l Phone #: e✓f / 6 3 `/ Y J {3 Official use only. Do not write in this area, to be completed by city or town offu:iaL ' 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 r Contact Person: Phone #: w f r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 7 OCMR 108.3.4 to act as his/her construction supervisor. The state defines "Romeo er" as, " Person(s) who owns a parcel bn which he/she resides or intends to be, a o e or two family dwelling, attached °oi . detached structures accessory to such and/or farm structures. A person who constructs more than one home in a two -year pp iod shall not be considered a home owner.'' The builduig department or the City .of.Nortliampt0 wants persons) who. seek to use the home owner exemptm to act as their owsco I.0 rxron supervisor;' to be Aware that by doing so you become r 'ponsible for compli e with state building codes. and regulations.'The inspection rocess requires' the.building department be called to _ inspect work at various stages, which_ include �undation /footin (before backfill sonotube holes (before- our rou h bul in ins ection (before work is concealed` insulation ins ectio if ed) and a final building inspection. The building departm re quires these,' V b efore the work ss concealed, failure. to secure these in actions can sul n ure to obtain a certificate of occupan until the work can be inspected. If the homeowner hires other trades rform work (electrical, plumbing & gas)-the homeowner will. be. re 'onA) to_ e e. that the trades hired secure their proper . sP ermits in conjunction to the buil g p 't issued, and that they get their required inspections. Failure of the indiv'dual trades secure the permits and inspections as required can DELAY the proj until such ' e as the proper permits and inspections are made I, understand the above. .(Home owner /resi nt's signature requesting emption) I will call to schedule 1 required building inspections ecessary for the building permit issued to me: - Date Address of work location C v de ' I b A k I f, V , ---- - - - - -- ---- - - -�, 1 Ccflufost %) awlspace wo g / I � 1 closet I I� desk / LIV qsq A piaster bedroo / 824 sq ft - 1 24 - 0 ml both \ I / / 1 1 / UP landing 1 and stairs / I I re -built UP for head crawlspace room I — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — y LIVING AREA 864 sq ft REC EIV'' - 15 2011 DEPt OF BUILD IN � C , SP[:C71p f O M MA Ot Og0 4 1 r [ y {� i i A � a 4 �TY�f l,+ `� 9. t 2 4 REC IVE ED 4 t' - -� 2011 w pEpT. OF BUILDING INSPECTIONS NORTHAMPTON, MA O1060 d .I 1) 0 :at 1 l h: 6, 1 A , h ` _I x �� ���`� �,