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23A-057 4 \ 'IA r - ,ei „ 7 - ir \ i M I( b° K \ t .4j ■ o j --- 0Z - v3 _c °i t ` Ce p -,-aeG j 0 k h(,) / /7 li No i 10 i 0/ c s ' rI Z L.16. ' s l CiLp" ?Ilit fa ://// 111 1.\ __- ,, 0) i , / - . . , sirs )„,..... 0 .3 !!!....1- 71 , c ) 1 )0(.s1---ryt\ oo_i C‘IC / - e 9 'IV —°°-' C n14 \ 1,. ) r / cl ic)5) — ....0 1(29 c)181()1 . " • I NEW WATER i I GAS SERVICE EXISTING GARAGE NEW ADDITION i ) t-- , bb > r O STUDIO /RECREAT1ON o EXISTING 1 ROOM IN GARAGE HOUSE l NEW ROOF * 4 WINDOWS; REPLACE y j GARAGE DOOR WITH DOOR AND WINDOW; FRAMED FLOOR W/ PLYWOOD SUBFLOOR; VINYL FLOORING j _s Ae_arzt I j APPROXIMATE 14\ PROPERTY LINE t N S -S8' STREET SITE PLAN 62 M 1 D D LE STREET CONTRACTOR: STEPHEN YOSHEN FLORENCE, MA 0 1 062 LICENSE #: CS 88490 OWNER: DANIEL TRENNER tut 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 pieessmoires 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 ---- - - - - - pennits - conjunction_.to_theh ' 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 The Commonwealth of Massachusetts Department of Industrial Accidents _7 = Office of Investigations _° r�Y®I= 600 Washington Street [.f Boston, MA 02111 ....... _ www.maz ovv/dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): - Address: - City /State /Zip: Phone. #: 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 employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction 2. 0 I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have. no P' 10 gees These sub - contractors have. 8. ❑ Demolition working for me in any capacity. employees and have workers' Y P t3' $ 9. 0 Building addition [No workers' comp. insurance comp.- ;nsurance. required:] 5. [-_-_] We are a corporation and its 10.0 Electrical repairs or additions 3. Q I am a-homeowner -doin -allwork — offer ,s_have xtzcise_d weir —14 [I 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 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 _Lt ft ormation 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 imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a of up to $250.00 a day against the violator. 13e 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 under the pains andpena/tios of petjury that the infornmation provided abov_e_is_true and_correct._.__ Signature: Date: . Phone #: t - Official use only: Do not write in this area, tto - be completed by city or lown officiaL City or Town: Perrmt(License # Issuing Authority (circle one): I. Board of Health 2. Buiidi -ng. Department 3. City/Town Clerk 4. Electrical Inspector 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 9':::Registered>Home Im proverrient:Confiactor „ ,.. ,. = . -n,,, z .,F .« 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 ❑ The_current_exemption for "homeowners" wasextended 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 l:iable 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 1 611 ampton • r e mane- , a e an' :- . . ° . • • i +: - . • - -its-General-Laws-Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House 0 Addition Replacement Windows Alteration(s) ❑ Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I:2] Siding [0] Other [0] Brief Description of Proposed Work: t T PI v.) AcLi Td C xACif" . Alteration of existing bedroom Yes ✓No Adding new bedroom Yes N o✓ Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a_ If New` house snd:6r..addi#lon'to existing hooustnq - complete the following: 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? i 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 ( I, /`.-- \ ` 1 ' ' ..* , as Owner of the subject property f ,, r� hereby authorize aXte 1 \ ^. L -\ to act • - y be - f ' • • rs relative to work authorized by this building permit appli -tion. Si atureofO, -r � �ufm, Date 1, , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. i Signed under the pains and penalties of perjury. I Print Name Signature of Owner /Agent Date 5£E a 246I0v R-t,, Pet/0 R' J 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 i ,; '" S" Side L:1 . Fa R. .„ L:.�? Q._ R: 1. ?.; _._ Rear 2Z � ._ Building Height Bldg. Square Footage r - Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces -•• - Fi11: I (volume & Location) --• ,.._ ---• __ ._ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 40 YES IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW i,�� YES 0 IF YES: enter Book Page= and /or Document #' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the preperty? YES 0 NO 9) IF YES, describe size, type and location: D. Are there any proposed Changes to or additions oTsiins intended for he 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 p IF YES, then a Northampton Storm Water Management Permit from the DPW is required. . A r A- Bp---0-$(),1 City of Northampton S of Pertlt 4 M Building Department �C s�yPerttt 212 Main Street e tiS e c�a rlabrt Room 100 a 4 y et 4 Or� � ' At� �I �_ — — —No thampt�AVIA111_060 , " y '1 4� t i s, - ' �i. :is ,,,A phone 413 - 587 -1240 Fax 413 - 587 -1272 Pl ,_ � 1 -( a n s � t. r �t�k a APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE ORDEM.QUSI-[A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office a 6" t k)C J 1 "Map " Lo d Unit Zone Overlay District FrN t M Elrn St District CB District SECTION 2;- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: )ty � I c Name (- C Mailing A�Idr s:_ _ D- 0 S #. /y / Ilia Telephone ir r - - thoriz- • • gent: 5 66� , Name (Print) Current Mailing Address: of Signature Telephone SECTION 3 - ESTIMATED .CONSTRUCTIO COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant - _,_3, 1. Building ACM oDco 4 ! 00 (a) Building Permit Fee 2. Electrical (b).Estirnated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) A t�+nl�NR €0 1.0 Q 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Only Date Building Permit Number: .Issued: Signature: 1 Building Commissioner/Inspector of Buildings::' Date . • • • File # BP- 2008 -0901 APPLICANT /CONTACT PERSON STEPHEN YOSHEN ADDRESS /PHONE P O BOX 41 CUMMINGTON (413) 634 -5431 PROPERTY LOCATION 62 MIDDLE ST MAP 23A PARCEL 057 001 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 O Typeof Construction: CONSTRUCT 6 X 9 MUDROOM ADDITION, RENO KITCH /LAUNDRY, FINISH ATTIC W /BATH, ENCLOSE & INSULATE GARAGE ' ig1) pom, : YwAY, New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 88490 3 sets of Plans / Plot Plan THE Fe LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF '.' 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 /t 2A. J 0 Signature of Building fficial Date * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. . • 6 152 MIDDLE ST 11 BP- 2008 -0901 GIS #: COMMONWEALTH OF MASSACHUSETTS ap:Biock: -057 gi CITY OF NORTHAMPTON Lot; - 001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2008 -0901 Project # JS- 2008 - 001360 Est. Cost: $67000.00 Fee: $336.00 PERMISSION IS HEREBY GRANTED TO: Coast. Class: Contractor: License: Use Group: STEPHEN YOSHEN 88490 Lot Size(sq. ft.): 6795.36 Owner: TRENNER DANIEL & NOREEN Zoning. URB(100)/ Applicant: STEPHEN YOSHEN AT: 62 MIDDLE ST Applicant Address: Phone: Insurance: P O BOX 41 (413) 634 - 5431 CUMMINGTONMAO1026 ISSUED ON:4/22/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 6 X 9 MUDROOM ADDITION, RENO KITCH /LAUNDRY, FINISH ATTIC W /BATH,ENCLOSE & INSULATE GARAGE,AMENDED - ADD ENTRYWAY TO GARAGE 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 4/22/2008 0:00:00 $336.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo