Loading...
16A-017 h ' . BP-2010-0600 GIs #: COMMONWEALTH OF MASSACHUSETTS 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- 2010 -0600 Project # JS- 2010- 000856 Est. Cost: $5816.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT A OSGOOD 74278 Lot Size(sq. ft.): 17859.60 Owner: MCDONALD JEAN D TRUSTEE Zoning: URA(100) / /WSP Applicant: ROBERT A OSGOOD AT. 437 SPRING ST Applicant Address: Phone: Insurance: 297 BRIDGE RD (413) 626 -3280 FLORENCEMA01062 ISSUED ON. 1211412009 0:00:00 TO PERFORM THE FOLLOWING WORK.- REMODEL BATHROOM 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 12/14/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0600 APPLICANT /CONTACT PERSON ROBERT A OSGOOD ADDRESS /PHONE 297 BRIDGE RD FLORENCE (413) 626 -3280 PROPERTY LOCATION 437 SPRING ST MAP 16A PARCEL 017 001 ZONE URA(100 )/ /WSP 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: REMODEL BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 74278 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 1) 9ATION 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 z / JL11 69 Signa re 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. w City of Northampton Building Department � , 212 Main Street S,eer Room 100 - Northampton MA 01060 phone 413 - 587 -1240 Fax 413 - 587 -1272 v x APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address Map Lot Unit A se zone Overlay District Elrn St" District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2_1 Owner of Record, (Print) Current Mailiffig Addre l �c elephone ignature 2.2 Authorized Agent: OIQG Name (PriV Currentilinng Add ress: `- ),Ma 1 d- 6 Pc)-G - - 3,-,2 ,� Q Sign! re Telephone SECTION ,3 - ESTIMATED CONSTRUCTIDN COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building I 00 O 0 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost.o€ © Construction from 6 3. Plumbing Building Permit Fcc X00 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number " This:Section ForOffciai Use Onl Date Building Permit Number: Issued: Signature Building Commissioner /Inspector of Buildings Date + r 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 _.__ L _...__. R Rear _ _. ...._ Building Height ..... ... Bldg. Square Footage _ % ._. Open Space Footage (Lot area minus bldg & paved ' p arking) # of Parking Spaces Fill: (volume & Location) -- - -,• . -•.— A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DO KNOW 0 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? Needs to be obtained Obtained , Date Issued: C. Du ally signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location:; - - 'v ' ` - >7Y�� ny ern nsar� r_ tinges to nr a: _ltinnt n igns infari Qr3 r - tliP prnporty 7 YFS 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 that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION b- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [0] Other [0] Brief Descri ti Toim d Work: FATti PEMQ D 6 L^ Alteration of existing b4room Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. ifNeW.,f>IO�se::a "nci o ':ac�rl�t�orito "ex>ISfiitY #lete "`'t�e:fio>�ouiri�i " ": a. Use of building : One Family Two Family b. Number of rooms in each family unit: Nuooms c. Is there a garage attached? d. Proposed Square footage of new construction. Di sions e. Number of stories ? f. Method of heating? f G���PiZ or Woodstoves Number of each g. Energy Conservation Compliance. Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction thin 100 yr. floodplain Yes No �, L/ j. Depth of basement or cellar floor below fished grade T k. Will building conform to the Buil ' and Zoning regulations? _ Yes No . I. Septic Tank City wer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO"SE COMPLETED WHfN! OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER MIT /J l >� yi y 1� „ o , r � _ Q� as Owner of the subject property hereby authorize G>�C� L n to act my behalf, in all matters relative to work aut d by this building rmit application ignature of Owner Date as Owner /Authorized Agenf hereby declare that the statemerffs 6d information on the foregoing application are true and accurate, to the best of my knowledge and belief. S' ned under the pains and penalties of perjury . Pri nt N Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construct' n Supervisor: Not Applicable ❑ Name of License Holder 1 -2 J , Z 7 JQ � License Number I -A r re"Vc g q. o/C� //- A Adds Expira tion Date �1� "� e Telephone 9 easteretl Elolrie .,liirareiyetnentGontractor.' g : �: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone S ECTION 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...... ❑ Jfj }? as T� III Z _ The_ current _exemption for `lomeowners" was ext ended t o include _Owner-occupied Dwellin s 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 108.3.51 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 Supervisur yuw presence on the job site will be required from time to time, during and „rnn 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 o amp on r finances, s- General L- aws Annotated. Homeowner Signature 1 r The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investig, ations 600 Washington Street Boston, MA 02111 www.mass gov1i a -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers Applicant Information Please Print Ledbly Name ( Business /Organization/Individual): Address: City /State /Zip: Phone.: Are you an employer? Check the appropriate box: Type of pro ):. 1. Q 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 5. E3 New 2_ % I am a sole proprietor or partner- listed on the attached sheet. 7. T Remo ship and have. no employees ave. 8_ Q Demolition These sub . h ave working for me in any capacity. employees and have workers' 9. Q Building � required:) 5. Q We are a corporation and its 10. [No workers' comp. in ce comp. insurance_ Electridditions 3. Q I am -a- homeowner -doing Work -- - - - Die z bwmlxcmisad - . lurnb ing -repairs or additions myself. [No workers' comp_ right of exemption per MGL 12. Q Roof repairs insuran required_] t C: 152, §1(4), and we have no employees. [No workers' 13. Q Other comp. insurance requited} *Any applicant that checks box #1 mist also fin out the section below showing thew workers' compensation policy information_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ;Contractors that chock this box must.attached an additional sheet showing the name of the sub = contractors and state whether or not those e have employees. If the sub-contiactors have employees, they must .provide their workers' comp.,policy number. ram an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: CityiState/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 MCTL c. 152 can lead to the imposition of crimmal penalties 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 ORDER and a fire of up to $250.00 a day against the violator. to advised that a copy of this statement may be forwarded to the Office of Investisations of the DIA for insuran coverage verification I do hereby: _ce . under the pains and penalties of perjury that t1 :e infonnation -proviuded above Larueffnd_correet _— St tur . ate Phone #: L/ 13- b,-26 en - Offuial use only. Do not write Li th area, to be comp ed by city or town ork&L City or Town: Permit/License # Issuing Authority (circle one): Board of Health Z. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspect _ 6. Other Contact Person: Phone #: r V y J 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 regulation The insrnecti_on nr requires that the buildm' g department be calle to inspect work at various stages, which include foundation /footings (before backfdl), 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 — – - -- its- in-- conjunction.to the - -buik ing permitissued,_.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. Address of work location � e , �� 3 � �c 7 �, �9 �' __—�— CS` `� ., — �� 1 � � 1 � � � ���,' E \ i n J u: