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17A-069 16 MOUNTAIN ST BP- 2011 -0420 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: BUILDING PERMIT Permit# BP- 2011 -0420 Project # JS- 2011- 000689 Est. Cost: $15000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT NICKERSON 053156 Lot Size(sq. ft.): 10018.80 Owner: LABOUNTY KERRY Zoniniz:URA(100) //RI/WSP Applicant: SCOTT NICKERSON AT. 16 MOUNTAIN ST Applicant Address: Phone: Insurance: 197 NORTH LEVERETT RD (413) 896 -3347 O Workers Compensation LEVERETTMA01054 ISSUED ON. 111412010 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE WALL, NEW CABINETS & SHEETROCK BEDROOM 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 Sisnature: FeeType: Date Paid: Amount: Building 11/4/2010 0:00:00 $90.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0420 APPLICANT /CONTACT PERSON SCOTT NICKERSON ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413) 896 -3347 Q PROPERTY LOCATION 16 MOUNTAIN ST MAP 17A PARCEL 069 001 ZONE URA(100)//RI/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: REMOVE WALL, NEW CABINETS & SHEETROCK BEDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 053156 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 gnature of Building bfficial 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. r Depaitmeint:use only City of Northampton Status of Perr►t�t S i Building Department Curb Cut/Dtxyeway Permit phc 4va, a ib 212 Main Street SewerlSe Room 100 Waer/ifVIi Avaiiab,i,t Northampton, MA 01060 Two etsstrrtra1 phone 413- 587 -1240 Fax 413- 587 -1272 PIot/Sr #e Plans ' Other' ... APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FA LY ELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be.�dpapleted by office - Map Lot = .. Unit / /1n 0 Zone Overlay District U � w� -Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: a U14 S wc.��t At Name( ri Cu ent Mailing Address: .yam 1�S -Y6�a C�e..l f Telephone ' Signat 2.2 Authorized Agent: / _CQ f e- .0 �'r'� cam., % ! /�/ Ge ire.y 7y JG c�1 Name (Print) Current Mailing Address: era yj3- 9 96 - .73r� Sig re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building / (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 - 3. Plumbing Building Permit Fee Q n 4. Mechanical (HVAC) l oo 5. Fire Piulecliun 6. Total = 0 +2+3+4+5) LPL' G/ Check Number 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 Setbacks Front Side L. ._...,_ RV__ L: ............ R _.. Rear Building Height Bldg. Square Footage % Open Space Footage _- (Lot area minus bldg & paved --- - ----- # of Parking Spaces Fill: (volume & Location) A. Has a Spec' ermit/ Variance/ Finding ever been issued for /'on the site? NO DONT KNOW 0 YES 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 Page and /or ocument # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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: / D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca i TT, 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 applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [O] Other [O] Brief D cription of Proposed / Work: Z n - / / (� �� AC v1 i4 �• . c :) GC�T r ®� /� G� e ��d �•,� -� Alteration of existing bedroom Yes -- Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. If New house; and or addition to ezistir 'housin coin fete the followin a. Use of building : One Family Two Family Other b. Number of rooms in each. family unit: Number of Bathrooms c. Is there a garage attached? 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 as Owner of the subject property hereby authorize to a o my behalf, 'n all m;; ers relative to thorized by this building permit application. Sign. re of Owner D to as Ow <r/Auth:orized Agent hereby declare t he statements and information on the foregoing application are true and accurate, to the bes and belief. Signed under pains and penalties of perjury. Print me Signature of /Agent e SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder: `� C �� ✓ C"� License Number c Address Expiration Date Si e Telephone 9 Registered lmproyerrieiifdbfitrai:far Not Applicable ❑ Company Name Registration Number Address fx 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 emit. Signed Affidavit Attached Yes....... No...... ❑ I1 ..Home ©�n�'er E�empltlan 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 1083.5.1. 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 p ermit. 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 "" Department of Industrial Accidents Office of Investigations 600 T1 -ton Street zv Boston, MA 02111 -_ www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/EIectricians /Plumbers Applicant Information �/ �( ,(/ Please Print Legibly Name ( Business /Organization/Individual): -5 lT !� Ale L r- '- e c., Address: y } � t� C C �e 'e — Q/ 6 City /S tate /Zip: Zr_ e 4 Phone #: 1/ Y Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I a employer with 4. � I am a general contractor and I ployees (full and/or part- time). have hired the sub - contractors 6. El New nstruction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. emodelino ship and have no employees These sub - contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. Building addition required.] 5. F� We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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 employees. 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 up to $1,500.00 and/or one-year i imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day again,, olator. Be adv' that a copy of this statement maybe forwarded to the Office of Investigations of the D - nsuranc erage verification. I do hereby certi er th ains and penalties ofperjury that the information provided above is true and correct. Sienature: Date: !l 1 l4 Phone #: �/ - i 7 3 Y Of use only. Do not write In this area, to be completed by city or town official City or Town: Yermit/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 backfilb, 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 l Zip �J� usti " L> �l �; le 1- -t o 4, �a r k l c t � r ` 7 � r 13- Aomk ' r f � ti LABOUNTY GIRDER :,. 3/4" x 9 1/2" 1.9E Microllam® LVL TJ -Beam® 6.36 Serial Number: User:' 10 ' 22 ' 20 'THMPRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE Page 1 Engine Version. APPLICATION AND LOADS LISTED F_ F 13' i Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 10' Primary Load Group - Residential - Living Areas (psf): 30.0 Live at 100 % duration, 12.0 Dead SUPPORTS: Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Live /Dead /Uplift/Total 1 Stud wall 3.50" 1.88" 1950 / 840 / 0 / 2790 L1: Blocking 1 Ply 13/4" x 9 1/2" 1.9E Microllam® LVL 2 Stud wall 3.50" 1.88" 1950 / 840 / 0 / 2790 L1: Blocking 1 Ply 13/4" x 9 1/2" 1.9E Microllam® LVL -See iLevel@ Specifier's /Builder's Guide fordetail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Location Shear(lbs) 2718 -2325 6318 Passed (37 %) Rt. end Span 1 under Floor loading Moment(Ft -Lbs) 8608 8608 11775 Passed (73 %) MID Span 1 under Floor loading Live Load Defl (in) 0.388 0.422 Passed (U392) MID Span 1 under Floor loading Total Load Defl (in) 0.555 0.633 Passed (U274) MID Span 1 under Floor loading - Deflection Criteria: STANDARD(LL:U360,TL:U240). - Bracing(Lu): All compression edges (top and bottom) must be braced at 13' o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: - IMPORTANT! The analysis presented is output from software developed by iLevel@. iLevel@ warrants the sizing of its products by this software will be accomplished in accordance with iLevel@ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel@ Associate. -Not all products are readily available. Check with your supplier or iLevel@ technical representative for product availability. -THIS ANALYSIS FOR iLevel@ PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. - Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevel@ Distribution product listed above. -Note: See iLevel@Specifier's /Builder's Guide for multiple ply connection. Operator Notes: 30/12 LOADING @ 10' TRIB PROJECT INFORMATION: OPERATOR INFORMATION: SCOTT NICKERSEN JoeBaillargeon LABOUNTY JOB Cowls Building Supply MOUNTAIN ROAD, FLORENCE, MA 125 Sunderland Rd. North Amherst, MA 01059 Phone: 413 549 0001 Fax : 413 549 4686 joe @cowls.com o-:ci 1 gr ' _ Fear : . W- wv.. ■ LABOUNTY GIRDER 3/4" x 9 1/2" 1.9E Microllam@ LVL TJ -Beam® 6.36 serial Number: User:' 1 0/22/20' TH PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE Page 2 Engine Version. APPLICATION AND LOADS LISTED Load Group: Primary Load Group 12' 8.00" ^ Max. Vertical Reaction Total (lbs) 2790 2790 Max. Vertical Reaction Live (lbs) 1950 1950 Required Bearing. Length in 1.88(W) 1.88(W) Max. Unbraced Length (in) 156 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 700 -700 Max Shear at Support (lbs) 818 -818 Member Reaction (lbs) 818 818 Support Reaction (lbs) 840 840 Moment (Ft -Lbs) 2591 Loading on all spans, LDF = 1.00 1.0 Dead + 1.0 Floor Shear at Support (lbs) 2325 -2325 Max Shear at Support (lbs) 2718 -2718 Member Reaction (lbs) 2718 2718 Support Reaction (lbs) 2790 2790 Moment (Ft -Lbs) 8608 Live Deflection (in) 0.388 Total Deflection (in) 0.555 PROJECT INFORMATION: OPERATOR INFORMATION: SCOTT NICKERSEN JoeBaillargeon LABOUNTY JOB Cowls Building Supply MOUNTAIN ROAD, FLORENCE, MA 125 Sunderland Rd. North Amherst, MA 01059 Phone: 413 549 0001 Fax : 413 549 4686 joe @cowls.com r.,__ m is_er �deaa�i of L . *�1