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NOTES:
L 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS.
j 2. HEAVY DOUBLE LEAF STEEL DOORS.
3. OPTIONAL DOOR LOCK AVAILABLE.
M
V t
I HC
HA
HB
8 1"
f W i 1 i. L r -
END VIEW SECTION VIEW
BASEMENT FLOOR
HEIGHT
W L HA HB HC WEIGHT ITEM
TYPE (WIDTH) (LENGTH) (TOTAL) (PRECAST) (DOOR) (LBS) NO.
S 51 45" 95" 43" 52" 2,400 BH —S
A 51 60" 90" 60" 30" 3,600 BH —A
B 55 66" 90" 68" 22" 4,800 BH —B
C 55 74" 95 76" 1934" 5,500 BH —C
D 553x" 86" 106" 84" 22" 6,200 BH —D
E 58" 9534" 115" 93" 22" 7,800 BH —E
F 58" 104" 123" 101" 22" 9,000 BH —F
F.
1
SHEA New /o' Pre
s mier re cos /er
800 - 69 nd 6 -7432 (sHEPA) BULKHEAD
CONCRETE PRODUCTS www.sheaconcrete.com
773 Salem Street 87 Haverhill Road 160 Old Turnpike Road Page: A4.1 ,,
P.O. Box 520 P.O. Box 807 Nottingham, NH 03290
Wilmington, MA 01867 Amesbury, MA 01913 bulkhead.dwg 12/07/2006 iIPCR
Specifications subject to change without notice
g
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
iermits 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
!" understand the above.
(acme owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date f ' 'L
Address of work
LL
location 7 3 �- 2 %� 1. r 7 j A;
The Commonwealth of Massachusetts
• Department of Industrial Accidents • ,
OA
= t Office of InvestigafionS
_ ° ie l .=
_ 600 Washington Street
t e Boston MA 02111 -
k.. www.mass gov /dia
• •Workers' Compensation Insurance Affidavit :.Builders/ Contractors /Electricians/Plumbers
Applicant Information - Please Print Legibly '
/ Name ( Business /Organization /Individual): V o,d A ,••n v'"' ` I7 4/ . ..,,;,
� 3 t ,A /1 c r. G'
\ • Addre -
City /State/Zip: r elj R Pi C 11 2-Phone. #: /(i _5 -1 /4 _7
Are you an employer? Check the appropriatebox: • . -Type of project (required): /
1.0 I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction
employees (fall and/or part-time). # have hired the soli- contractors
2_0 I ani a sole proprietor or partner- listed on -the attar -hed sheet 7. 0. Remodeling .
ship and have no employees .. These sub - contractors have .8. ❑ Demolition •
working for -me m any capacity. easiloyees-and have workers' - •
[No insurance 9--- lliul ' a..dtoon
Lam"' workers''comp- insurance -
required 5- 0 We are a corporation and its 10.0 Electrical repairs or additions
— 3. ® I am a homeowner doing all work officers have xerc their • 11.o PImbmg repairs or additions .
myself [No workers' comp. right of exemption per MGL 12: Roof repairs
insurance re ed t c: 152, § 1(4), and we have no • �'
13.❑ Other �
.. employees: [No workers' �
• comp. insurance requii ed.j. •
'Any applicant t checks box #1- must also fiil out the section below theirivodo;rs'-compensation policy mformptian: .
t Homeowner§ who submit this affrdavit:indicanng they are doingali work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box mustatiached as additional sheet showing the name of the sub = contractors and state whether•ornotthose- cooties have
employees. If the sub- contractors have employees, they must provide their workers' camp. policy number.
I am an employer that isprovid.ing workers' compensation insurance for My employees Below is the policy and job - site
information.
Insurance Company Name: . -
Policy # or elf 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 ex date).
Failure to secure coverag as required under Section 25A L ofMG c 152 can lead the imposition o f nominal penalties of a
fine up to 51,500.00 and/or one - year imprisonment; as well as civil penalties in, the form of a STOP WORK-ORDER and a fin
of up to 5250.00 a day against the violator Be advised 'that a copy of this statement may be forwarded to the Office of :
Investisations ofthe )IA for` in coverage vermcatron: _ - - .. . , ,: . .,..: _ ::..
I da. hereb - certt nder u the
y .fj' y� p / af a xd penaltiesofPeriurYt ltafthe ucformationprovuledibuvE�st zur a_adrarr ' �d . - - Signature: Ul u.a� It bi.!> /~z _ I?ate � L' d ✓ -. 1 ZV , I Phone # : & 3 5 �' - p ` 2 7 . • .
_ Official use only. Do not write in this trier:, to be cinimpleted by city o r town off c %a1
City or Town: Permit/License. #
Issuing Authority (circle one):
:1. Board of Health 2. Building Department 3. City/Town Clerk . 4. Electrical 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 -- CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
LAOCIiitiredliatiefiitidiaiititiiiiiittiatiatitaign%AaVVARteMba2gEtil 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 ❑
11.4 aml:60w> a .em 311 on
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 ��_.�
SECTION 5- DESCRIPTION OF PROPOSED! WORK (check all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) JRI Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0]
Brief Description of Proposed � K Mf A D
Work: An. u
Alteration of existing bedroom Yes '- No Adding new bedroom Yes K. No
Attached Narrative Renovating unfinished basement Yes Y No
Plans Attached Roll - Sheet /
a. Use of build • : One Family Two Family Other
b. Number of rooms in - : h family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new con ction. Di • nsions
e. Number of stories?
f. Method of heating? Fir= *laces or Woodstoves Number of each
g. Energy Conservation Compliance. sscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? es No. Is constructi • ithin 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finis. -d grade
k. Will building conform to the Building and oning 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
I, , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this bui g permit applica
Signature of Owner Date
I, Ag 4 Le 4/ P-6 F- , as wner uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to theQmy knowledge
and belief.
Signed under the pains and penalties of perjury.
� 7 zJ, A t,o/ /~�< r: G
Print Name
Fne0111,-eriAgent l�.l,,z 7t `y 1 / 1 '
Signature of Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning tg
This column to be filled in by
Building Department
{
Lot Size .-.°' ?
Frontage -.- --- 1 l ---
Setbacks Front E
Side L: R: L: i R �!
Rear I1L ! f too!
Building Height i i r ! F s
Bldg. Square Footage % 1 g = L a
Open Space Footage % r� a
(Lot area minus bldg & paved x ,__~ ,_,.,„,j ( 1 ? - --
k
parking)
# of Parking Spaces r- ,-- _w
Fill: I ,�.....w�.� 4
(volume & Location) 1 i - -- -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES Q
IF YES: enter Book Page: and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW R YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued: _
C. Do any signs exist on the property? YES 0 NO Co
e . _...,._.,.�___.„ .___._._,,,.___,.._.__.. ..._..,,_
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, 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.
a
• 1
�" � (City of Northam ton . ° ' _, a ,
IF
RECEIV `
RECEIVED tv p
Building Department t V� �:
212 Main Street -. - a - ``
.mil 4 `Z )
v' I ` Room 100 r „ :, '
rthampton, MA 01060
.OF BUILDING INSP Re 41 - 587 -1240 Fax 413- 587 -1272 s
NORTHAMPTON MA 1060
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
3'3 1. ) e ,� AM L Unit
�"� e")../ � ,) / U� j, done Ov rlay District
r.
� Eirn' St District C District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
w,vA ._ f �! ll 6� .33 ii-Awp?j P. c.-0 e 0iP
i Name (Print) Current Mailing Address:
0 Telephone
Signature Tele $� /(G 1 2.2 Authorized Agent: CJ (J
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /-2-100 (a) Building Permit Fee
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
(b) Estimated Total Cost of
_ Construction from (6)
Building Permit Fee
CA v
5. Fire Protection
6. Total = (1+2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Build Date
• A
File # BP- 2011 -1047 .
APPLICANT /CONTACT PERSON ABEL DONALD W /
ADDRESS/PHONE 53 FOX FARMS RD FLORENCE �) _ gt — 477
PROPERTY LOCATION 53 FOX FARMS RD
MAP 17A PARCEL 158 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid �� y!
Building Permit Filled out _'
�_,JV�� r
Fee Paid �v `J
Typeof Construction: ADD BULKHEAD Jvt aTT IN S r rX F Iue r To 6AC'I'C FILL-
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
INF(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
d/i (//1
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.
•
•
53 FOX FARMS RD • BP- 2011 -1047
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A - 158 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit# BP- 2011 -1047
Project # JS- 2011- 001691
Est. Cost: $2700.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 28793.16 Owner: ABEL DONALD W
Zoning: URA(100)/ Applicant: ABEL DONALD W
AT: 53 FOX FARMS RD
Applicant Address: Phone: Insurance:
53 FOX FARMS RD (413) 586 -1877 0
FLORENCEMA01062 ISSUED ON: 6/17/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD BULKHEAD - MUST INSPECT PRIOR TO
BACKFILL
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 6/17/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner