49-023 (2) 664 PARK HILL RD BP- 2011 -0995
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 023 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit # BP- 2011 -0995
Project # JS- 2011- 001621
Est. Cost: $8000.00
Fee: $192.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 85334.04 Owner: EMERSON THOMAS A
Zoning: SR(100) / /WSP II Applicant: EMERSON THOMAS A
AT: 664 PARK HILL RD
Applicant Address: Phone: Insurance:
664 PARK HILL RD O 584 - 7551 O
FLORENCEMA01062 ISSUED ON: 7/13/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 24 DET GARAGE W /STUDIO
SPACE ABOVE
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 7/13/2011 0:00:00 $192.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
#'
File # BP- 2011 -0995
APPLICANT /CONTACT PERSON EMERSON THOMAS A
ADDRESS /PHONE 664 PARK HILL RD FLORENCE l 584 -7551 0
PROPERTY LOCATION 664 PARK HILL RD
MAP 49 PARCEL 023 001 ZONE SR(100) / /WSP II
THIS SECTION FOR OFFICIAL USE ONLY
PERMIT APPLICATION CHECKLIST�s- ¢ �_
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin_ Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 16 X 24 DET GARAGE W /STUDIO SPACE ABOVE
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
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
{ 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.
June 8, 2011
Tom Emerson
664 Park Hill Road
Florence, MA 01062
Subject Property:
664 Park Hill Road
Florence, MA 0I062
Mr. Emerson,
The plans for the garage/s udin dated 4-26-11 require additional information as noted;
1. Due to none prescriptive framing methods the plans require a registered design
professional's signature.
2. Itairsvvithvvindersmusthaveaminimum3^treadatthenar/nvvend.K311I4.2
L " Charles Miller
Assistant Commissioner of Buildings
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Building 212 Department '
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Room Main 100 Street e a of (e' ` r� hty�' , � � 7,-,A.
S m orthampton MA 01060 fAva e . r,' - r lu e � � t' � `
phone 413- 587 -1240 Fax 413 -587 -1272 P1atI i 2 e 'tarts A� o
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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
(e)( P1 k 1+% l'1 (a t'ki Map Lot Unit
Zone._ " . = Overlay District" " '
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
`� ����A S-8(1-7.53-1
' - Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Offic Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) ; Estimated Total Cost of
,ii da --- Construction from (6)
3. Plumbing Building Permit Fee
N®
4. Mechanical (HVAC) Are
5. Fire Protection X8(1
( --- 6. Total = (1 +2+3+4+5) gfov6 C Number '`
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
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
La T' Building Department
Lot Size I . acres I i 541vv.e .®, 1
Frontage --
Setbacks Front 1 ce $
r w -
Side L ? -a R:€ ? L: �' i R:` � . i
ilia I.I
Rear .. `
Building Height !
osp
Bldg. Square Footage I itoe j " %
Open Space Footage % _. — " b /
(Lot area minus bldg &paved l ! ' / r + i''' C 191/'x1 SG1- -R)4 S
parking) aaa ►1)
# of Parking Spaces ` 1;3_ i ; I � i
Fill: ` : tt 1 f i
(volume & Location) ,i F, ® -- —.
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Ri DONT KNOW 0 YES 0 S )S
IF YES, date issued: ti OS 0 4
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book I Pages ry and /or Document #1
gg 1 j
4 y r � -Only Mivvi
B. Does the site contain a brook, body of water or wetlands? NO..;'.ie DONT KNOW 0 YES S , e 2.00
IF YES, has a permit been or need to be obtained from the Conservation Commission ? A1
Needs to be obtained Obtained , Date Issued: t See_ Di 1 d
uiei1 ,� malt ke s
C. Do any signs exist on the property? YES 0 NO lam' s ill ir. V!A�2a
IF YES, describe size, type and location: ..._ J �
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 131 3
that will disturb over 1 acre? YES 0 NO 0 0 S
IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t 44-4,
3Ot P.&
14(7-., `135GO s . -. x 1.851 �- 'Rs, 33q.
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, 1 ii St.e d
m ' 61 A- /3VH 9 P - , £4
VS -, ,
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1 O,1 '31sv s5. q R,1 6e
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors 0
Accessory Bldg., Demolition ❑ New Signs [D] Decks [Q Siding [D] Other [il]
Brief Description of Proposed
Work: b 1a I emit 5 44 , 4 6 42_ LA) Y LAI01 -° ■?±L4 b d p"rt Witt_
Alteration of existing bedroom Yes new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes I.o
Plans Attached Roll - Sheet
�
s:. tf:New house and ar.a d t>IOti to.exl "tlnq housrnit .com61ete:tl e,'fallc wl u a S lieek •
kis
a. - of building : One Family Two Family Other
G1oSe
b. Numbe •f rooms in each family unit: Number of Bathrooms
c. Is there a ga -•e attached?
d. Proposed Square •otage 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 • -de
k. Will building conform to the Building and Zoning regal. 'ons? 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, �0 (Jy _..L4t zlw_ , as Owner of the subject
property
hereby authorize 6'4"'J4
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Own r uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to th •es my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner /Agent Date
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Regi redHonielrripioverimeiitCo ZE N . ._,qFE. _:... b T..,. .._ Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- WORKERS' 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 ❑ No ❑
1 < +a rcO wner em tioi
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 .i� ,a 5° Zj
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
iaermits 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, d� 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 tome.
Date $ 'fit(-
Address of work
location °° P,44(
D v a O l o o '� .
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The Commonwealth of Massachusetts
• Department of Industrial Accidents -
��= • i .
5 ;� O ffice of Investigations -
of =° -_mil;* ~ 600 Washin , ton Street
1-= �'
Boston, MA 02111
- : f wwwmassgov /din
°Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information - (------- Please Print LegibIy
Name (Busines/ Organization /Individual): / �yh. i K' 0 4 +' ')}
• Address: ( ( k F k 11;4/ ill Lk-r'
City /State/Zip: /o' e.,'i- e...,. ii a4.. Old 6 i Phone. #: 64N 4-S c,i2A. `f 2,36- -8(ez:
Are you an employer? Check the appropriate box: • . .Type of project (required): 7
1. ❑ I am a employer with - 4. ❑ I am a general contractor and I
6. grNew consfzuction e
employees (full and/or part- time). * have hired the sub- contractors
2 [� I am a sole proprietor or partner-
Ted on the attached sheet 7. ❑ Remodeling
ship and have no e loyees These sub - contractors have. .8. ❑ Demolition
working for me in any eiggo_yecs and have workers' -
g y capacity 9 0 Hutlding adifion
[No workers comp. insurance -comp- „ nc #: •
erg 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. I am a homeowner doing all work officers have frXercised their • 1 L0 Plumbing repairs or additions
myself [No workers' co right of exemption per MGL
Y Tap- 12.0 .Knofrepairs
insurance required.) t • c: 152, §1(4), and we have no .
employees: [No workers' ' 13. Other
- comp. rance requu-ed_ . -
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insu
*Any applicant that checks box #1 must also fill out the section below showing theuvvorl a s' compensation policy information. .
t Homeowners who submit this aidavit:indicatmg they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the nano of the sub = contractors and state whetherornotibose entities have
employees. If the sub - contractors have employees, they must provide their workers' comp.poficy number.
I 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 Site Address: City/State/Zip: - .
Attach a copy of the workers'' compensation policy. declaration page (showing the policy number and.expiration date).
Failure to secure covera e:as r • i n der.Sechon'25A of1�IGL c 152 can lead the
g equtre8 . mnposmon of crmm;al penalties of a
fine up to $ I, 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 5250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the O.ffi'ce of
Hvestiga. ions of the n s ranee' covexa a Verification _ _ _ .....;.. _,_:_.,
Ida hereby certify under t pains and penalties ofperjury that the tnformatinnprovided_abov rs tru and Corm& ' _
Signature: D ate. • .
• Phone #: • .
- Official use only. Do not write in this area, to be completed by city or towta"offrial
City or Town: PermitlLlcense #
Issuing Authority (circle one)
.'1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector
6.Other
Contact Person: Phone #:
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