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11C-039 (2) ` 7i FLORENCE ST BP-2011-0157 GIs #: COMMONWEALTH OF MASSACHUSETTS Man : B lock: l lc -039 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit # BP-2011-0157 Project # JS- 2011- 000164 Est. Cost: $6300.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 16552.80 Owner: DONALD P JUDGE Zoning URA(100)/ Applicant: DONALD P JUDGE AT: 73 FLORENCE ST Applicant Address: Phone: Insurance: 23 East Center St (413) 586 -2597 LEEDSMA01053 ISSUED ON. 8/27/2010 0:00:00 TO PERFORM THE FOLLOWING WORK.- RELOCATE BACK PORTION OF HOUSE FOR 16 X 22 GARAGE 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 8/27/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0157 APPLICANT /CONTACT PERSON DONALD P JUDGE ADDRESS/PHONE 23 East Center St LEEDS (413) 586 -2597 PROPERTY LOCATION 73 FLORENCE ST MAP 11C PARCEL 039 001 ZONE URA000)/ 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: RELOCATE BACK PORTION OF HOUSE FOR 16 X 22 GARAGE New Construction Non Structural interior renovations Addition to Existin 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 INFO MATION 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 Io ignature 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 s 4� Building Department e 212 Main Street Room 100 Northampton, MA 61060 phone 413- 587 -1240 Fax 413 - 54-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RE*VATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ' 1.1 Property Address This section to be completed by office `73 A fi G -5 l Map L'ot Unit t� --�G�� (� � 14�m� Zone 4vertayDistrict " 4 6's t. District ` " CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Q \ d Na e ( Print) Current MAi`r3Addr- lEqr Telephone Sig tune 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 com leted by ermit applicant 1. Building 060. ° I✓ (a) Building Permit Fee 2. Electrical C(j (b) Estimated Total Cost of d®- Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2+3+4+5) G ' % Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /inspector of Buildings Date tn► ok M C- 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: ° €,. ? R: i ` L: gi R ? ...` Rear- ,r Building Height I Bldg. Square Footage Open Space Footage %__ (Lot area minus bldg & paved p arkin g) # of Parking Spaces Fill: volume &Location i A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO � DONT KNOW 0 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 # , m _. B. Does the site contain a brook, body of water or wetlands? NO 0 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 0 NO IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO (a 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 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 F Addition F Replacement Windows Alteration(s) Q T Roofing �� Or Doors a Accessory BI g. ® Demolition New Signs [O] Decks [Q Siding[CJ] Other [p] Brief Description of Proposed l.�iSf:R: rJw� 'Q+CCl1 13 i tN11 AI Aw rho '4 Work: t i SIB A in bedroom Yes _ No Adding new bedroom Yes No O �A `f ttached Narrative £5 Renovating unfinished basement Yes %Z No Plans Attached Roll - Sheet a. Use of building : One Family Two Family Other N� b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. <constru e. Number of stories? f. Method of heating? es Number of each g. Energy Conservation Compliance. pliance form attached? h. Type of construction i. Is construction within 100 ft. of wetland/dgrade thin 100 yr. floodplain Yes No j. Depth of basement or cellar floor below k. Will building conform to th e Building an ? 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. as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by t ' wilding perms lication. 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 Signature of Owner /Agent Date f e SECTION 8 - CONSTRUCTION SERVICES 8.1 Licens . Construction Supervisor: Not Applicable ❑ Name of Llcense ldder : License Nu er Address expiration Date Signature Telephone Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. a 152, § 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 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 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 `�J T The Commonwealth of Massachusetts Department of Industrial Accidents . Office of Investigations 600 Washington Street Boston, MA 02111 ,• www.mass govA a -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Legib lv CX me ( Business /Organizatiow7ndividual): b� y /StateJZip: Phone. #: Are you an employer ?.Check the appropriate box: T project i .. m a g eneral contractor and I . � e of ect r P ) � � ur . �� 1. C❑ I am a employer with 4 � I a g 6. ❑ New construction employees (fill and/or part time).* have lured the sins- contractors 2. [l I ani a sole proprietor or partner- listed on the attached. sheet 7• ❑ Remodeling ship and have no epployees These sub - contractors have. .8. ❑ Deno;ition working for -me in any capacity- employees. anddhave workers' 9 `II gulling' ai� L�'flt9r1CeSS ' 1IIaL3Ce _. C,4mp. required ] 5. [� We are a corporation and its 10.0 Electrical repairs or additions 3 I am a homeowner doing all work officers have xercised their 11.Q Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12:1.Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. o workers' 13.0 Other [N comp. insurance requirrAl. *Any applicant Shat checks box #I: must.also fin out the section beloashowing ttuaworkers' compensation policy information t Homeowners who subnnt this affidavit.indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating suclL ZContracu rs that check this box must.attached an additional sheer showing the name of the sub- emuactors and state whether - not thoseentities have employees. if the sub- con=tors have employees, they must provide thew workers,' comp- ,policy number. f am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: Job Sit Address: City /Sta&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'ofMGL 152 can lead to $ie imposrtioti of'ciimin l penallies 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 and-a fie 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 16v tisations -of f the DIA, for insurance` covers a verifiddlion Ydo hereby certi enabies ofperjurp.that - the information rovidesl abovE_tsirur_artdcorrecL Si tore: �`ti art- Phone #: Official use only. To not write in this area, to be comp y city _1Z ' feted b or town o cc'raL City or Town: PernaitUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other F Contact Person: Phone #: s 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, - 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 backfill), sonotube holes (before your), 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 occupancv 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 /resi e ' gnature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to Date Address of work location t7 <sjua :�f to fj RQ \ h so NE.Q C006TP % n� yt { N d/'V1rdA1d i A X 5 � �� lot" fi 1 3 I f D cod F- !t T 4? - NEW arAc � comer �� t _d K 1 b � o ►, I r ! a r i (16' �� i ST1 tJ� Ov`t� k� � �� 1 � � �� V Tr qr T GN -0 File # MP- 2011 -0015 APPLICANT /CONTACT PERSON DONALD P JUDGE ADDRESS/PHONE 23 East Center St (413) 586 -2597 PROPERTY LOCATION 73 FLORENCE ST MAP 11 C PARCEL 039 001 ZONE URAU 00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE Z FO FILLED OUT eP rislov Bui Permit Filled out Fee Paid Typeof Construction: ZPA Move Garage 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 �� INFO TION PRESENTED: Nfi'� -- 6 ``J FA'(` pproved Additional permits required (see below) O J W—(;6 p rbTo PLANNING BOARD PERMIT REQUIRED UNDER: § FLA S4E1VWn 0 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 r�;� - /16 Signatur Building Offci 1 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 the Office of Planning & Development for more information. CITY OF NORTHAMPTON, MASSACHUSETTS DEPARTMENT OF PUBLIC WORKS 125 LOCUST STREET NORTHAMPTON, MA 01060 413 -587 -1570 FAX 413- 587 -1576 Edward S Huntley, P.E. Director August 5, 2010 Louis Hasbrook, Building Inspector Municipal Office Annex 212 Main Street Northampton, Ma 01060 Dear Mr. Hasbrook: I have spoken with Donald Judge homeowner of #73 Florence Street. He has informed me of his plan to relocate a portion of his house and rebuild. This will have no effect on the water service and therefore Mr. Judge is clear of any fees or permits associated with the City Water Department. Please contact me if you have any questions. mcerely, David Sparks Superintendent of Water Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer CITY OF NORTHAMPTON, MASSACHUSETTS DEPARTMENT OF PUBLIC WORKS 125 Locust Street i Northampton, MA 01060 �n n " 413 - 587 -1570 Fax 413 - 587 -1576 Edward S. Huntley, P.E. Director August 6, 2010 Mr. Louis Hasbrook, Building Commissioner 212 Main Street, Room 100 Northampton, MA 01060 Dear Mr. Hasbrook, Mr. Donald Judge was in my office yesterday on August 5, 2010, to show me his plans for rebuilding the property at 73 Florence Street in Leeds. I have no problem with the rebuilding he intends to do at the site and he does not need any sewer permits from the Department of Public Works. Si rely, A Jo Hall Sewer Department Foreman Cc: Donald & Karen Judge file