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18C-070 (2) / k / &7 • 1, .s Board of� �' _ 'A(' su we etio �6 s ` czc4uee i 6 Q � nd Standards e NOME IY IMPROVEMENT CSC tOR tf� ' 146292 2/201 Try 28136$ a uai WAYNE BO 7 "w ' '' . [, d1SyE 'wtR eAsito L. a --__ »__ �71 tt i Massachusetts - Department of Public Safety Board of Building Regulations and Standard s Construction Supervisor License License: CS 87453 Restricted to: 00 • WAYNE M BOISVERT 48 CARILLON CIR EASTHAMPTON, MA 01027 II IP �'e.-- --- — Expiration: 11/29/2011 ( orunissioner Tr#: 9371 1 n 5 ..1 ( '" ' ,./ - / - 1Yc ) ./ / t: / i ----..--,; 2/)7 ; --,.; 7-; (2',6-/e-•2-d ,--,,F /),, / l I . , NN n : X ' . — I I ' l '... - k _ 1 --.‹ , „ \ -- 1 , \ 1‘, I ri ,... 1..... \ I d 1 .,■• It i f f'l i - -- -- --- -- ;Y.•-.761, ' 1 1 - i 41% Or --,, / . I , , I I ./ -.......A1 AO 4 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 owzrconstmction 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 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 Date Address of work location The Commonwealth of Alassachusetts Department of Industrial Aacidents Office of Investigations 600 Washington Street =51= a Boston, MA 02111 , www.mass Grov/dia - Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinesS/Organization/IndivirinnO: '- eno . velzr Address: 45 q ,aiI/o, 64, City/State/Zip: gridApyli.d M. 010? 7 Phonel#: (4/0 ..539 i003 Are you an employer? Check the appropriate box: Type of project (required): / 1. 0 I am a employer with • 0 I am a general contractor and I 6. 04 New co - have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet 7• 0 Remodelir!, 2..IX I era a sole proprietor or partner- These sub t-contracors have ship and ha.ve no .1loyees 8. 0 Demolition employees and have wOrkers' working for me m any capacity. 9. 0Building A [Ne workers' comp. insurance requirecL] 5. 0 We are a corporation and its 10. Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have4xercised their 11.n Ph:tithing repairs or additions myself [No workers' comp. right of exemption per MGL r—/ 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. No workers' 13.1:1 other comp. insurance required]. *Any applicant that cheeks box #1 naist also fill out the section below showing their workers' compensatice policy infonnation. t Hoow who subrnit this affidaVit inclicating 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 itities have cnployets. If the sub-contactors have employeea, they must prcrvide their workers comp. policy number. lam an employer that is providing workers' compensation insurance for my einployees. Below is the policy and job information. • Insurance Company Name: - • Policy # or Self-ins. Lic # Expiration Date: Job Site Address: City/Stafe/Zip:' - Attach a copy of the workers' compensation policy declaration page (showing the policy number and eapiration date). Failure to secure coverage as required Under Seetibil'25A C. 152' can lead to the IMPOSitieri of Crimine,1Penalties of a fine Up to 81,500.00 and/or one-year imprisonment, as well as civil penalties in the form of; STOP WORK ORDER. and a &_e of up to $250 00 a day against the violator. Be advised that a copy of this statement may be forwarded iotlie Office of �f theDLk for msurance _ - - - I do Jebj cerlz u der the pains t d penalties ofp that the infonnationprovidedabove_isinte:tinaioriPc1 - -- Si. • tire 4 / AS" ' , . D Phone #: (4/ 1) 1.5 - • • use only. Do not write in this tura, to be completed by city Or town official City or Tovvii: Permit/License # Issuing Authority (circle one): :I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical,Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: mom SECTION 8 -- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable / ❑ 3 Name of License Holder : 10/4, ) Q- eBO (,4j v 314 / 4 .6 3 . l / License Number /a/40 , :d11 Ain 6/02 lik 11it Addr ss / o Expiration Date (4/3) S:39 -koo 3 Si gnatu r Telephone $. RrtistrtfiiiniprK�veme�frihestrf� 7 Not Applicable ❑ 'Bo t5 v' ' elzr l4fe a9? Company Nanle Registration Number 1 Ne- 4)/af Address Expiration Date/ - TD Ci'/u! /aN at 6 0 / i 7 V Y A ? � G 4 t % 4 4 . t /0 J1elephone(/3, S39 4 33 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 X" No ❑ 114* 014161 tit tefil 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 4. f SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition El New Signs [O] Decks [,[ Siding [0] Other [0] Brief Des pti9q f Proposed / /' Work: firy l A /7 P,(.// 610 X /7.5 ) l a' /411 OP ilauS Alteration of existing bedroom Yes x No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes 04 No Plans Attached Roll (heat) eat t `kiv 6ti tfiairaiiiit 'o `m aimfig i bite t ` 11+ ° u ia: 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 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 V I /5-4 c / s X • �Q A'.JDi/ 11 E' , as Owner of the subject property hereby authorize t) ©I,SV e- —' to act on my behalf, in all mattejs relative to work authorized by this building permit application. %4 '.ti•r- X / t7 4.w— ''// //2 J CD Signature of Owner Date I, ZCI T13 013 /e 1 , as Owner /Authorized Agent hereby declate that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed Pain unddr the pains and p- alties of perjury. t N t- F©14v Print 1(i 4 i: 1 alit- • . 1 / Signature of Owne;'gent Date OMM ' 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 1 -I .. . _. I € _._ �.._..� _.�.�.. 1 Frontage E Setbacks Front ( ,i i i , ( i Side L:1 ' i R:i /' L: /O`' R :=�t e Rear o `. I Ac ` Building Height E.-1 Bldg. Square Footage % I Open Space Footage % € 7 (Lot area minus bldg & paved L.. .. I i L-1. -• parking) # of Parking Spaces _ °-- Fill: t ? (volume & Location) i l A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW !,'. YES 0 t IF YES, date issued:; j 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 Document #; NW__.. B. Does the site contain a brook, body of water or wetlands? NO ,110 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 0 , Date Issued C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: L D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO t _, 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. i set I I cDity of Northampton rfri 4 -- _ :-- B uilding Department g � "r. � 212 Main Street - � L JUN 1 4 2010 100 E phone-41-3-5671131P2°41110 a on, MA 01060 ' � -� .1 ;.,: - L , Fax 413 - 587 -1272 , Y i - _ , .. ., rv.... ^ a� .� * : ` S" ,,, irk 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: 165 8/2/D6 eRon-1 Map L ot Unit 1101 i- p� Al ) 0114. 61 4 bane OverlayDistnct aim St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: V ! 1 i2 /iw C / S X , De n1 UM v e 74 r 5/e /a f e f1c'! •tJa.er�.�- ,' ' Name (Print) Current Mailing Address: X Telephone ( / j) ._� ,7i, — Z c' 7 A" Signature 2.2 Authorized Agent: A e (11.6 Ve.42,1 — 4 A ( ('1ra 6 tifir)p ,J, m4 Name (Pri ) d Current Mailing Address: efta�,ri (Cl/3)3 - 23003 Signa ure Telephone SECTION 3 STIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building S . 2 ®d t Crel (a) Building Permit Fee 2. Electrical (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) Check Number 0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -1139 APPLICANT /CONTACT PERSON WAYNE BOISVERT ADDRESS/PHONE 48 CARILLON CIR EASTHAMPTON (413) 539 -8003 PROPERTY LOCATION 765 BRIDGE RD MAP 18C PARCEL 070 001 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 /3% Tvpeof Construction: CONSTRUCT 10 X 17'5" DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 087453 3 sets of Plans / Plot Plan S ' O ► . ) ( 1 ; (4. r E ! J 1 5 F00711 — 4 1-064W-34,5051 14X b e r 22,a P IA Merak THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFONVIATION 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 6117110 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. ,, ,. 765 BRIDGE RD BP- 2010 -1139 GIS #: COMMONWEALTH OF MASSACHUSETTS Map :Block: 18C- 070 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- 2010 -1139 Project # JS- 2010 - 001672 Est. Cost: $5200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WAYNE BOISVERT 087453 Lot Size(sq. ft.): 11499.84 Owner: DONAHUE FRANCIS X Zoning: URB(100)/ Applicant: WAYNE BOISVERT AT: 765 BRIDGE RD Applicant Address: Phone: Insurance: 48 CARILLON CIR (413) 539 -8003 EASTHAMPTONMAO1027 ISSUED ON :6/17/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK :CONSTRUCT 10 X 17'5" DECK 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 6/17/2010 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # MP- 2012 -0003 APPLICANT /CONTACT PERSON DONAHUE FRANCIS X ADDRESS/PHONE 765 BRIDGE RD (413) 584 -8207 0 PROPERTY LOCATION 765 BRIDGE RD MAP 18C PARCEL 070 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid /( e4Q `.J Building Permit Filled out Fee Paid Tvpeof Construction: ERECT 8 X 8 SHED 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 INiFO PRESENTED: j 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 Yak) k) 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 the Office of Planning & Development for more information. 765 BRIDGE RD BP- 2010 -1139 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 070 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- 2010 -1139 Project # JS- 2010- 001672 Est. Cost: $5200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WAYNE BOISVERT 087453 Lot Size(sq. ft): 11499.84 Owner: DONAHUE FRANCIS X Zoning:URB(100) /' Applicant: WAYNE BOISVEaRT AT: 765 BRIDGE RD Applicant Address: Phone: Insurance: 48 CARILLON CIR (413) 539 -8003 EASTHAMPTONMA01027 ISSUED ON:6/17/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 10 X 17'5" DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Meter: Footings: Rough: Rough: House # Foundation: 0 1 6 _ I —(® ti+ Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Insulation: Final: Smoke: Final: ois (o 12_, ( L ott ( 5 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 07:40,4 gfrokopii&cip Certificate of Occupancy 612 1- rvl "&Signature: FeeType: Date Paid: Amount: Building 6/17/2010 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo