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17A-184 • Project Description 179 -181 North Maple Street Florence Mass Richard and Ann Roughton Contractor: Benjamin Greene 47 Chapin Street 01027 413 -374 -9826 Existing side porch (7' x 11'9 ") on driveway side of house shows sagging from inadequate (rotten metal tube) footing on rear corner. Upper porch to be supported and lower porch removed. Three 10" Sonotube footings to be dug and lower porch ref ramed with pressure treated 2x8 lumber. Ledger bolted to house with Ledger Lock screws and joists hangared to ledger and double 2x rim joist. Porch deck to be supported by 4x4 pressure treated posts bolted to footings with post hangers. Three 4x4 posts from lower porch deck to upper porch beam will provide continuous point loading for upper porch. Floor to be fir decking board installed over preasure treated 1/2" plywood. Porch to be trimmed to match existing with painted pine and 6" exposure clapboard siding. Assessors Off [city of. rpton M A. Residential Property ecord and k c'a Pf`}�tn e Rferrc Ca =f 1Nrcel - Location - Zoning - Assessment M ap- l3l k - tart: 1 7A -t 84.001 zoning: Assessment: Luca on T8:1 NORTH MAPLE ST t�eigl c n �iuin Units: Deed Book; 675 Building: 2 - 04. Deed 203 To L 3 IDwe l . lirginforYtion , uildlng Sketch sty" Conventional Year Built: 1928 Story Height Attic: fin 1 B asement: F 14 E 14 Tel Rooms 12 12 27 Bedrooms: 5 14 2Fr/B , 14 Full Baths: 2 ti , 378 Half Bettis, © t o ZsOFP Exterior walls: Frame r 1 Od Unfinished Area: 0 UA /2Fr /B 44 Ground Floor Area: 1276 44 ; ' 1276 ) Total Living g ;Area: 3308 Finished Basement Living 0 X o Area: 29 Basement Recreation O X 0 3 B 3 Area: Wo dhurning Fireplace 1 Staci(si M tat Fir, niAre The Commonwealth of Massachusetts Department of Industrial Accidents 1< { °�t Office of Investigations I e , r 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information / Please Print Legibly Name ( Business /Organization/Individual): �Yl a ''1"' ,� l'71 --e— Address: 1-fl -- C in '''' , --, S t (ns' f f City /State /Zip: � & O I I3- O I y Phone #: �{ 13 1. ` `? if 2 L Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. 0 I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2. [4 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance required] 5. 0 We are a corporation and its 10. ❑ 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' 13.0 Other ?or c k Diet i f S 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 foe 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 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 certify u der the pains and penalties of perjury that the information provided above is true and correct. Signature: 7 '1S? _ Date: 1 1 2 2c re, Phone #: 1 113 3 ' 4 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 !'.... +..n+ D......,.... DI.....n 0. SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ t Z Name of License Holder : t , t " 1 " M r 6N, (.) I ` License Number L (- �. k r �, , k ' h5jti -' j) ( 11`1I- coo 21-- 2 ( re Address Expiratio ` 413 3'f Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Tiev, te, : .� 6, is - 58 33 Company Name / Registration Number G i (ice .t f ; [I loa o i/ Address Ex pi tion ate t let eA _ (1 r"•• •A 1 1 7 1:1P1 Telephone 1113 J 7 f 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 Owner Exemption 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 be/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 ❑ Replacement Windows Alteration(s) IN Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [D Siding ED] Other [I:3 Brief Description of Proposed Ref.( lte �: c. w► z I o"- l' T eor H --. t; 4.) ; . r c v, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes i k No Plans Attached Roll - Sheef) 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family X 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 stones? 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 'till 1, RlG-vas) e-oU - ecJ as Owner of the subject property �, hereby authorize 2 Je 4/1 (� vv1 :e\ I " to act on my beha , in all a is relative to *o rk authorized by this building pe it application. > -- 4 — i OS / 0 Signature of Owner Date 1, 1)Q fl i CArA i eN V C. e-RANL. , as Owner /Authorized Agent hereby declare Viet the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. ilkvc((AW t� V1Q rQ Print Name l,- � f ; , / c;,;u� 1 v 2 ao Its Signature of (Agent 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 Rear Building Height Bldg. Square Footage °Io Open Space Footage °b (Lot area minus bldg & paved Ping) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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 O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit tit ; _ L �D'! 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify 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 11 Gi N. 1vA4k. Map Lot Unit o (� fl Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ■ Clack,/ G' R0,11/11-0'--"N k SC N$I J&TbN kV Pt's Ntrika- fAn�ac4MA 6(C�'oo Name (Pr . / � Current Bing dress: �13 ' Ad S�6 -217Z /y13-38? - SZILi- Telephone Signature 2.2 Authorized Ascent: ° )ev*I i w.Q- LIT Ctiwpo., s ; G f- Name (Print) 3 Current Mailing Address: n /Ca a Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building IT' �r1 ©o (a) Building Permit Fee 2. Electrical f (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) i? 0 Check Number ‘7 �5�` This Section For Official Use Only Date Building Permit Number:, Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -0009 APPLICANT /CONTACT PERSON BENJAMIN GREENE ADDRESS/PHONE 47 Chapin Street EASTHAMPTON (413) 324 -9826 0 PROPERTY LOCATION 181 NORTH MAPLE ST MAP 17A PARCEL 184 001 ZONE URB(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 I 7 Tvpeof Construction: REPAIR LOWER PORTION SIDE PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 96066 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQ 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 / 4/4-"'" - 0 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. • • Vlai 4 0'14M 1 00 BP- 2011 -0009 GIS #: COMMONWEALTH OF MASSACHUSETTS k:17A -184. 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 -0009 Project # JS- 2011- 000010 Est. Cost: $4720.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BENJAMIN GREENE 96066 Lot Size(sq. ft.): 7187.40 Owner: ROUGHTON RICHARD Zoning: URB(100)/ Applicant: BENJAMIN GREENE AT: 181 NORTH MAPLE ST Applicant Address: Phone: Insurance: 47 Chapin Street (413) 324 -9826 0 EASTHAMPTONMAO1027 ISSUED ON:7/7/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR LOWER PORTION SIDE PORCH 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 7/7/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo NO 5Nr?