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11A-021 58 UPLAND RD BP-2011-0131 GIS #: COMMONWEALTH OF MASSACHUSETTS M W .Block: I IA - 021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -0131 Project # JS- 2011- 000222 Est. Cost: $14000.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEVEN OLIHAN 045567 Lot Size(sq. ft.): 16596.36 Owner: SKANTZ LESLIE & MARILYN J Zoning: URA(lOO)/ Applicant: STEVEN OLIHAN AT. 58 UPLAND RD Applicant Address: Phone: Insurance: P O BOX 86 (413) 250-2293 GOSHENMA01032 ISSUED ON. 8/20/2010 0:00:00 TO PERFORM THE FOLLOWING WORK. RENOVATE 2 BEDROOMS TO ONE 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 Siiinature: FeeType: Date Paid: Amount: Building 8/20/2010 0:00:00 $84.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0131 ,, , e APPLICANT /CONTACT PERSON STEVEN OLIHAN .� 0 193 Kw be a5b a ADDRESS/PHONE P O BOX 86 GOSHEN (413) 268 -0005 PROPERTY LOCATION 58 UPLAND RD MAP 1 I PARCEL 021 001 ZONE URA(100) 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: RENOVATE 2 BEDROOMS TO ONE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 045567 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN� 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 De olit' r 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. City of Northampton Building Department, 212 Main Street Room 100 44orthampton, MA 01060 ` phone 413 - 587 -1240 Fax 413 - 587 -1272 r 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 Map Lot Unit J C C Zone` Overlay jstrict s i EIm St Dlatrlct CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record l � s i Name (Print Current Maili g Address: Telephone Sjgfatufe 2.2 Authorized Agent: J o+ 0 3 2 Name (Pri Current Mailing Address: X1 - 1 _3 -- 2S Signature Telephone SECTION 3:- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building o (a) Building Permit Fee 2. Electrical .��9 r 1 (b) Estimated Total Cost of Construction from 6 3. Plum Building Permit Fee 4. Mecha 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) ( o 00 Check Number This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date s JI 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 Setbacks Front Side L: I R: 1 L: ' R: ' i Rear �— I '- ---- -� Building Height Bldg. Square Footage % ---- Open Space Footage % (Lot area minus bldg & paved _.a park # of Parking S paces - - Fill: volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: o , IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q 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 Q NO a IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: 1 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 a wlicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [C] Siding [[:]] Other Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa [f Neill otlis a c nit °ai c _ i f to a 11AW0 s � +e, a. Use of building: One Family Two Family Other b. Number of rooms in each family unit:_ J Number of Bathrooms ��— c. Is there a garage attached? & 5 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' Z -0 / 1, � l I _ � ��- ?.,�`� . as Owner of the subject property ) hereby authorize – P--�/ to act on m behalf, in all ma relativ, to wo authorized by this building permit application. 0 S' atur6 of Owner Date 1, ) r J as Awner /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. � f 0. IN Print Name Signature of gent Date SECTIONS -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor / Not Applicable ❑ Name of License Holder : _�� �L ��� ✓ I/ 6 VXI-A License Number �Q AddrW,p Expiration qa Signature Telephone / 3 lstti ~H+drnemnrodile�Cot�t ,� Not Applicable ❑ Company Name Registration Number Address c Expiration Date Telephone -:ZS O — ZZ SECTION 10 1NORKERS' 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....... CK 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 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 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 r The Commonwealth of Massachusetts Department of Industrial Accidents . Office of Investigations _ 600 Washington Street Boston, MA 02111 v www mass gov /dia -Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumb.ers Applicant Information p� Pleas P Lein Name ( Business/OrgmizatiowIn (iividual): Address: City /StateMp: S L_2, t r01 1�, ,°) o 3 Z Phone. #: Are you an employer?. Check the appropriate - box: -Type of project (required):. 1. ❑ I am a employer with 4.. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑New construction 2.Q I am a sole proprietor or partner- listed °II the ��' 7. Remodeling ship ;nd have no emp loyees These sub-contractors have .8. Q Demolition working' forme in an em Izape workers' y tY me nt— # ._ _ - 3 Q Buuldmg addition [No workms comp: insurance - . required:] oration and its 10 Q Electrical repairs or additions 5. 0. We are a corp 3. Q I am a homeowner doing aII work officers havehercised their 11.Q Phunbing repairs or additions myself o workers' co right of exemption per MGL 12. .Roof airs i nsurance 3 required) t c. 152, § 1(4), and we have no 13.Q Other employees. [No workm' comp. insurance required-]. *Any applicant Shat checks box #1 must.also fill out the section belowshowing d1Cir vV0d err'. compensation policy information: t Homeowners who submit this afdavit.indicating they ae doing all work and then hire outside ooatractois must submit anew affidavit u davit indicating ch. IContsactois that check this box must.attaehed an additional sheet showing the name of the sub-conttactozs and state whether or notthose-emities have employees If the sub- contiacto s have employces, they must.prmde them workers' comp. policy number. Jam an employer that isproviding workers' compensation insurance for my employees. Below is the policy gnd job site information. Insurance Company Name: Policy # or Self - i ns. Lic. #: Expiration Date: Job Site Address: CrtyiSt#e/Zip. Attach a copy of the workers' compensation policy declaration page (showing the pplicy number and ezpirafion date). Failure. to secure coverage. as requited bnder Section 25A 'of1VIGL c 152 can lead to the imposition of crimmI penalties of a fine up to $1, 500.00 and/or one.- year as well as civil penalties is the form of a STOP WORK - ORDER. and fine of up to $250,00 a day against the violator. Be advised fliat a copy of this statement maybe forwarded to the Office of Tnveshsahoiis of the D for insurance covers ee vcrs�ciition I do hereby certify e d ties ofpe*y that the inforinatron rovidedsibov assrtie_andcarred Si tore: ate- Phone 4 Official use only. Do not write in this area, to be comp y city '-- fj ' feted b or to o u:gaL City or Town: Nrmlt/Llcense # Issuing Authority (circle one): J. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • i i } 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, 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 backfill), 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 �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 Date Address of work location , k 58 UPLAND RD BP- 2009 -0990 GIs #: COMMONWEALTH OF MASSACHUSETTS Map l 1A - 021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2009 -0990 Project # JS -2009- 001397 Est. Cost: $72000.00 Fee: $306.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: Licenser Use Group: STEVEN OLIHAN 045567 L ot Size(sq. ft.): 16596.36 Owner SKANTZ LESLIE & MARILYN J Zoning: URA(100)/ A pp licant: STEVEN OLIHAN A?': 53 UPLAND R� AppIicantAddress: Phone - ins urance: P O BOX 86 (413) 250 -2293 0 GOSHENMA01032 ISSUED ON. 61212009 0:00:00 TO PERFORM THE FOLLOWING WORK .- CONSTRUCT ATT GARAGE (25 X 24) & 3 BEDROOM ADDITION 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: 9lS /�� House # Foundation: IZ Driveway Final: Final: Final:/.z - /(L-0 1 Rough Frame: ©k o �(S Gas: Fire Department /�' ---- Fireplace /Chimney: R eyh. Oil' Insulation:0 0 Final: Smoke: & Final: d Ax"' 4�9, 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 6/2/2009 0:00:00 $306.00 212 Main Sheet, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo