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30A-046 (4) / / / / y t/ /". / rr SKETCH /AREA TABLE ADDENDUM Casa Nu 010301 -5.052 File No 010301 -6.052 pi:,puy Addles 37 Lexington Avenue idly Ni,,., nanIpI.�n „iii lly 11.0 ui., l,, MA Lrl' 81062 u „ Suwllerland a uertl L u Florence Savings Bank L/C Address 85 Main Street, Florence, MA 01062 ■ Appr:usor Name Karl Robert Heston Appr Address 44 Conz Street, Northampton, MA 01060 3 I S k _ ..._._ -�- - i /5 n .11, _ Bedroom Kitchen b N co 21.0' 21.0' CV kiJ 1 /2 Family Dining o Bath Room Room Bedroom Den W ' O 5.0 1 5.0' 140 0 14.0' o liqt Living o Room . Bed • 18.0 18 0 1st Floor 211(1 Floor Conllllellls Scale. 1 0 12 • AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code Description Size Totals • Breakdown Subtotals (11.1.1 Flr Floor 944.00 )44.00 k'irst, Floor 671,2 second Floor 1008.00 1008.00 10.0 x 24.0 432.00 14.0 x 14.0 196.00 5.0 x 12.0 60.00 ' 16.0 x 16.0 256.00 Second k'l oor 16.0 x 32.0 512.00 CO z 12.0 x 21.0 252.00! O 12.0 x 18.0 216.00 ft • 2.0 x 14.0 08.00 • • • 4 • • TOTAL LIVABLE (rounded) 1952 8 Areas Total (rounded) 1952 • "�`� 10 5.72'± _.........., S 1•■•••••1 1•••• 9 . . • ..., i .c \x c izi • DECK i i GAR. . i i • o_) CO i i k 4, 'rzt / _ '1" > HOSE co 1 0 7 , 0 ' ...., __.__ ■, . . . . . City of Northampton Massachusetts ' ' Kf� r ' DEPARTMENT OF BUILDING INSPECTIONS w /4 212 Main Street • Municipal Building Northampton, MA 01060 '5'1Zy 1t INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 any 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 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 1, 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 ,"a Department of Industrial Accidents 411111,11EM 15 Office of Investigations 600 Washington Street "f" :1 4 Boston, MA 02111 www mass gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): _ , _ �„A • Address: /) 2 1 'Ili i e L 1 -11 O City /State /Zip: — • ra , 41 , „ d Phone #: / , 6 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 6. ❑New construction ployees (full and/or part- time).* have hired the sub - contractors 2. I am a sole proprietor or partner- ors listed on the attached sheet. . 7. ❑ Remodeling These sub-contractors h ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' 9. [7�Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. n We are a corporation and its 10. ❑ Electrical repairs or additions officers have exercised their 11.❑ Plumbing repairs or additions 3. ❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12. ❑ 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. 1 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 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 certi under th ) ains and penalties of perjug that the information provided above is true and correct Si ature: — Date: / Phone #: 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 Contact Person: Phone #: y ti SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : n L rz'vr Pr • / r L ' /Ale. 0 6 t� License Number .Z ie _ p .: , . ;- — 71/9/7O/ Address ` Expirati Date Signature Telephone ., , eaiste edd -Inns mprovemen. = ontracto � ; `„ ,' ' Not Applicable ❑ �b l-- Yr% 03, i f? rck, eV JO/ `7 0 y Company Name r� Registration Number Z L e 4-1 1 2 p C t )Arry i 1O.■.) 42/. Address Expiration Dat .) L�r►,�i � !� Telephone i/? 2i - / 9 SECTION 40- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG L c52, § 25C(6)) :r ; 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 buildin permit. Signed Affidavit Attached Yes 2 No ❑ ta q erl •f e 1p' 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 SECTION 5- DESCRIPTIQN OF•PROPOSED WORK ICheCkall applicable) „ . r New House ❑ Addition Replacement Windows Alteration(s) n Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks [p Siding [0] Other [0] Brief Description of Proposed Work: 47, I r . /�NL /O$IIY� � ! x 16 �4yP.L /4 )1A".. xiNLA 1� DlJi 1.3.... ar J� 7 FNi2+� 4r Io�J Alteration of existing bedroom Yes f No tt, Adding new bedroom Yes � '// No / Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6 .' eiteS6iis nd.or ad dit i6 eztitkit! trains • i " * tlrnii14444461 11 w i " q: a. Use of building : One Family V Two Family Other b. Number of rooms in each family unit: 3 Number of Bathrooms 2 c. Is there a garage attached? N' 3 r • • i d. Proposed Square footage of new construction. C1 5 Dimensions ( X 9 .4.- S X'- e. Number of stories? 1 f. Method of heating? Ste 4 1" - Fireplaces or Woodstoves N,■.\ Number of each . ' r . g. Energy Conservation Compliance. N `'i Masscheck Energy Compliance form attached? h. Type of construction \) t. , 1(to_ i. Is construction within 100 ft. of wetlands? Yes X_ No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade II r+ k. Will building conform to the Building and Zoning regulations? x/ Yes No . me I. Septic Tank City Sewer Y Zo Private well City water Supply V SECTION 7a y OW N ERAUTHORIZATION TO B COMPLETED WH , , ', ]OW - NE - RS A OR:CONTRAGTOR FOR:BUILDING PERMIT . I, L iter_ � �' GJ"\ P JQ 3 rl -r�.. , as Owner of the subject property hereby authorize d r A_ 0._ m fL e t e` n e- toac on my behalf, in all matters X' o , • Y a tl • ' ed by this building permit application. 4 /1)22-11t Signature of Owner Date I, /C_j 1 yc►ry►ia,�G/r, /e/A,c, , as Owner /Authorized Agent hereby declare t 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. ' �t+ k) 1_ w m FA 2 to i ni Print Name ' 04.1.44..044,,--: / , '7 z- // Signature of OwnEr Agent Date • e J Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inco tete triformation Existing Proposed Require y' e T onin ., l .. This col to be fille. . ' Building epartiuent A . Lot Size Frontage 1 V i- - t i 1 I 1 .. -ck- 1? , Setbacks Front s 1 Z 1 I I Side L:i - `' R:i L:i 3 I R:FCTI I 1 I j Rear Building Height 1 2 ,p I 1 I 1 Bldg. Square Footage • , , i I % r = I Open Space Footage % (Lot area minus bldg & paved 1 S1 = 1 "7 r _ parking) # of Parking Spaces l t Fill: i _ - _ _ __ _., —._._. __ t I _. (volume & Location) A. Has a Spe ' ermit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:! , IF YES: Was the rmit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book i Page! 1 and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ODONT KNOW 0 YES 0 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 property? YES i NO ( - ;: c 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 e: 5 ' IF YES, describe size, type and location: I i E. Will the construction activity disturb (clearing, grading, ex ation, 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. f , (� Cit' of Northampton Sty us o i t � � iikeC V � Building Department a ,p � 212 Main Street , Se ea. , t a » tk. � y � 1°N1 2 � � Room 100 LISH A as [ R T � : �� �,z,.-7,5;t•,,,,41,,,,,:,;;; � No ha MA 01060 + ",•� - 87 -1 Fax 413- 587 - 1272 o S t �� ` - ` r �� ', `� ` 4 p a pe_c1 ..�.�,. DE ..u�� . APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR M O NE OWO FAMILY DWE SECTION 1= SIT.E w r �Th is= se ct i on to be complete by office s ' < i 1.1 Property Address:* >< ✓l i' Ut a /)C -� . a Lo i4V n� pr , U ' it �J I r ; Asa � � R 4. e,11 a '?z ,A;VIt ' U l: 2° `� - :�s'is� 2��," �s�c�an x �YB 18 �I' D lStrlC.t: � x, -v�r • �_ c x i;•'% ; . '. � "fi � `"'""h , "�' , s y �, s `� ^ t i t ' ' `' � yam `! '4 x EImS Di trict '' a� �-` :- -CB District SECTION 2 PROPERTY OWNERSHIP / AGENT 2.1 Owner of Record: f _ -, r.1-, 4 I S0 . ' � i �� ��� b ► E �. t z. 3'7 e ,ei k, +tx_ — -Flee HA o �o 6 ?- Name (Pnt) Current Mailing Addre : r 7 //-I ILL, >.�,I� ' Telephone Signatur 2.2 Authorized Agent: Current Mailing Address: C1i�T Na e (Print) '� r� Y/3 5 7 d /67 Signature Telephone SECTION 3 "ESTIMATED CON COSTS Item Est Cost (Doll to b e O fficial Use 0- completed by permit applicant '‘", ,,,,,, .._ , - „,,,-..., : , 2 ' ; - - 1. Building (a) Building Permit Fee 2. Electrical (b)Estlmated Total Cost of Construction from (6) 3. Plumbing B Permit Fee - �. s - ' ' ' -' -' 1 - 2 . ' : ' - : ''''' : - : : ' - . , c. - " :1 ' ' ' ' ' 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) / 9 61'61() -1-' Check Number T This Section For Official Use Only Date Building ;Permit Number Signature Building Commissioner /Inspector of Buildings bate • File # BP- 2012 -0509 ( „�ti APPLICANT /CONTACT PERSON RONALD LAMAGDELEINE )(J ADDRESS/PHONE 112 LAUREL HILL RD WESTHAMPTON (413) 527 -8169 PROPERTY LOCATION 37 LEXINGTON AVE MAP 30A PARCEL 046 001 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 Typeof Construction: ENCLOSE 4 X 15 OVERHANG & ADD 5 X 7 ENTRYWAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 8067 3 sets of Plans / Plot Plan THLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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.