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16A-009 498 SPRING ST BP -2010 -0248 GIS # : COMMONWEALTH OF MASSACHUSETTS Map-Bloc 16A - 009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: BUILDING PERMIT Pernut +'# BP -2010 -0248 Proiect # i`' JS- 2010- 000312 Est. Co st: $25000.00 Fe $150.00 PERMISSION IS HEREBY GRANTED TO: Con Class: Contractor: License: Use Grog p: EDWIN OLANDER 049348 Lot Si ze(sq. ft.): 56192.40 Owner GRIFFIN SHELLEY ROCHELLE & PAUL L GRIFFIN Zo ning: URA(100)/ Applicant: EDWIN OLANDER AT. 498 SPRING ST Applicant Address: Phone: Insurun e : 97 CHESTNUT ST (413) 695 -5580 O FLORENCEMA01062 ISSUED ON. 91912009 0 :00 :00 TO PERFORM THE FOLLOWING WORK .- RENOVATE BASEMENT 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: , J'Fk M `L"? 4� Rough: Rough: j/ House # Foundation: ��� Driveway Final: Final:) ° �"1��p FinaL• r' '���✓���� Rough Frame: Gas: Fire D epartment Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Fi..al: 'OK It r t r l THIS PERMIT MAY BE REVOKED BY T E CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATION Certifi of Occu anc S rl 0 co" 6 signature: FeeType: Date Paid: Amount: Building 9/9/2009 0:00:00 $50.00 212 Maui Street, Pholie (413) 587 -1240, Fax: (413) 587 -1272 F . Building Cottunissioner - Anthony Patillo � s BP- 2010 -0248 GIs #: COMMONWEALTH OF MASSACHUSETTS i - = CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category_ BUILDING PERMIT Permit # BP- 2010 -0248 Project # JS- 2010- 000312 Est. Cost: $25000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: EDWIN OLANDER 049348 Lot Size(sq. ft.): 56192.40 Owner: GRIFFIN SHELLEY ROCHELLE & PAUL L GRIFFIN Zoning: URA(100)/ Applicant: EDWIN O LAN D E R AT. 498 SPRING ST Applicant Address: Phone: Insurance: 97 CHESTNUT ST (413) 695 -5580 O FLORENCEMA01062 ISSUED ON :91912009 0:00:00 TO PERFORM THE FOLLOWING WORK .- RENOVATE BASEMENT 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 9/9/2009 0:00:00 $150.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0248 APPLICANT /CONTACT PERSON EDWIN OLANDER ADDRESS /PHONE 97 CHESTNUT ST FLORENCE (413) 695 -5580 Q PROPERTY LOCATION 498 SPRING ST MAP 16A PARCEL 009 001 ZONE URA(100)/ 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: RENOVATE BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 049348 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 Demolition Delay Signature of Building Offi ' 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 Office of Planning & Development for more information. )epartme *use Dnl of Northamptontu ofrrrtt s Building Department T a aw s� � a xa 212 Main Street SeuuertSeptc jArailabtltty E Room 100 W teit>ktetl A�iarlabllr �lorthampton, MA 01060 6:1 Ski ctta a? laps `? ph�ne 413 -587 -1240 Fax 413- 587 -1272 PiotfStt Pros y v� Other S�e�fiy � _.� 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 `T' Zone Overlay District Elm St. District C6- District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record l 1 L -* Sf4UJL 6Mf F-I N 40 W ood IaviA A 1-i6APaee- Name (Print) \ Current Mailing Address: r e, 6E Telephone Sighature 2.2 Authorized Agent: Q� g ? �N s� r� rz►r Name (Pri nt Current Mailing Address: Signs ure Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building 24( (a) Building Permit Fee 2. Electrical V (b) Estimated Total Cost of Construction from 6, 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Totai = (1 + 2 + 3 + 4 + 5) Check Number 31(04 1 w/50 This Section For Official Use Onl Building Permit Number: Date 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 Building Department Lot Size Frontage Z1r"..... . Setbacks Front Dp' Side L 1.dA R. _. �CZ,.Q L MM..._ .,.. R: L— Rear. Building Height -" - Bldg. Square Footage Sa _. % Open Space Footage % (Lot area minus bldg & paved q i parking) # of Parking Spaces -- -- Fill: (volume & Location) - • _ " , A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued , IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page' and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? / 40 Needs to be obtained Q 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 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 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 ❑ Addition ❑ Replacement Windows Alterations) Roofing Or Doors I Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [CJ Siding [❑] Other [ ❑] Brief Description of Proposed �,, ` �— 1 C h a,� O� I� �,� / Work: RfWoVA / /0 � d r 1- lU eNN�% 64T1!!-yk �7 y - T Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to eAstinq housing; complete -the follow na: a. Use of build : One Family ✓ Two Family Other b. Number of rooms in ea family unit: (� Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new constru Dimensions e. Number of stories? f. Method of heating? i laces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck ergy Compliance form attached? h. Type of cons<the i. Is constructiof wetlands? Yes No. Is construction within 10 floodplain Yes No j. Depth of bas on oor below finished grade k. Will buil i g uilding and Zoning regulations? es No . I. Se c Tanker Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR 'BUILDING PERMIT I,C 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, ��(J c �� , as Owner /Authorized Agent hereby declare that the statements formation on the foregoing application are true and accurate, to the best of my knowledge and belief. Sign un er the pains and penalties of p 6 Print Na Signature of Owner/Agen 4C Date r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applic ❑ Name of License Holder y�l �� U �— ��IC `7 72 T4 License Number 17 cc ?eyui Sr, Ro -iD Address ` Expiration Date Sign ure Telephone 9. Reaistered''Nome�Irii verien#'Contric z ,,, Not Applicable ❑ _ 60 w0`J lad Company Name Registration Number IZ -16 _Q Address Expiration Date 97 �< Telephone y/ 3 Shy Z10 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...... ❑ 11 Home Ownerempion 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 h omeowner. 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 ° -; The Commonwealth of Massachusetts a_ Department of Industrial Accidents -� "- °' Office bf fizvestigations , 600 Washing on Street n = Boston, MA 02111 � T www.mass., Idia Workers' Compensation Insurance Affidavit: Builders /Contractors/EIectricians /Plumbers Applicant Information �j Please Print Legibly Name ( Business /Organization/Individual): oe Address: City /State /Zip: A_Y�e 6L_J 64!�_ Phone #: 2(c) (] Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part- time).* have hired the sub - contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have g. Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its 10. El Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' 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. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employee`s. If the sub - contractors have employees, they must provide their workers' comp. policy 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 coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine np to $1,500 00 anti /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 Investigations of the DIA for insurance coverage verification. I do hereby cert' a pa is d penalties of perjury that the information provided above is true and correct. Signature: / Date: Phone #: [�(� Official use only. Do not write in this area, to be completed by city or town officiaL 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 Contact Person: Phone #: 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 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 permits 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 Office of the Building Inspector Puchalski Municipal Building 212 Main Street Northampton, MA 01060 August 19, 2009 To whom it may concern, I hereby authorize Edward Olander of Edo Construction of Florence MA and Architect Mark Gellotte of Hatfield MA to act on my behalf with respect to the application for the appropriate permit for the purpose of renovation a portion of the basement at my house at 498 Spring Street in Leeds. Paul Grifh 498 Sprin tr t Leeds, MA 01053