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17C-260 File No. 10080001 S KETCH ADDENDUM Borrower or Owner James & Carol Kelly Property Address 72 North Main Street cdy Florence County Hampshire State MA Zip Code 01 062 ` crent Northampton Cooperative Bank — Pay AN E��N� �'c� , �.�.��.� DECK ( Nt 6 �� Q ,�cs:`L OQENi� � twit. ��'� _r E Z—"--"-------- . • P B EDROOM < 6 " • C (9 : 5 r r,'' ,0-0 E H (1'44 " Pc FAMILY J BEDROOM ROOM 51c I WALK IN CLOSET CL WALK IN CLOSET BEDROOM ..-- CS) _ 2ND FRONT 1 Borawski Appraisal Associates., Inc. Page 16 o1'32 File No. 10080001 SKETCH ADDENDUM Borrower or Owner James & Carol Kelly Property Address 72 North Main Street cd Florence County Hampshire State MA Zip Code 01062 client Northampton Cooperative Bank iU CL 16 5" 5evanek BEDROOM b VC - r© -- � o c c9 0 0 I � G KITCHEN 12 7 S�cn DEN BATH 8 I 112 DINING BATH ROOM 1 L CL 15 BEDROOM 5 LIVING 28 ROOM 13 C9 1ST FRONT I OPEN PORCH 22 I • Borawski Appraisal Associates., Inc. Page 15 of 32 49_12919q g U 1 kOC vy■ r' ' 0') ( ,) 9'73OLQH *) zt 9..x.7 3-)o -vv15 S V taS .....1,-,,,,a,..).0,2 M (—.'\ sago { s I ("i, "-■ - \ • / „______ ,o, ' r I ----] I I J 0QP t , c oostriA04 0$ 6 , , ,A. n e RECEIVED • October 3, 2011 LA, I — I a To: City of Northampton J Building Department From: Christa Colly, 72 N. Main St., Florence, Ma. 01062 This letter is to confirm that Carol and James Kelly who own the home at 72 North Main St. in Florence, Ma. are my parents. The home was purchased as a family home and I live in it with my husband Christopher Colly and our two daughters. We have been slowly converting the home from a two family to a single family mainly doing the work ourselves. We are fully aware that my mother (Carol Kelly) has applied for a building permit in order to complete the electrical and gas line work necessary to continue with the conversion of the house to a single family dwelling. Sincerely, cf Christa Colly (H) 413 -584 -6676 (W) 413 -587 -1414 September 27, 2011 To: City of Northampton, Building Department This letter is concerning the matter of converting the residence at 72 N. Main St., Florence, Ma. from a two family to a single family dwelling. Please be advised that we propose the following work: 1. Removal of the upstairs kitchen. Cabinets, sink and appliances will be removed and the plumbing from the sink capped. This room will become a bedroom needing only repair to parts of the dry wall and painting. There will be no removing or adding of walls or any other construction. 2. Combining of the electrical to one household. 3. Combining the piping for gas to one household. 4. Adding a new water heater to replace two old ones and having it connected to gas. The current ones are connected to electricity. 5. Throughout the process it will not be necessary to remove or add any walls and there will be no additions of rooms inside or out other than converting the old kitchen to a bedroom. Carol A. Kelly (homeowner) 143 River Road, S. Deerfield , Ma. 01373 413 - 665 -4523 City of Northampton r c , s ue ` ` 3 c , ( ' M assachusetts 4 , , rte . -, ` � DEPARTMENT OF BUILDING INSPECTIONS e. 212 Main Street • Municipal Building )bA� ': Northampton, MA 01060 'sy «- - 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 /footinqs (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 I, CO A K. 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 9 /2.3/1, Address of work location 7 a N . Ma St. • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations =Sin= 600 Washington Street ` _ Boston, MA 02111 W. 0,, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): • 4 • Jame a It, Address: I 3 � 1 tr. City /State /Zip: ill-- 'z' _ Phone #: tti Are you an employer? Check the appropriat • 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 listed on the attached sheet. 7. akemodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub - contractors have 8. Prbemolition working for me in any capacity. employees and have workers' 9. ['Building addition [No workers' comp. insurance comp. insurance.$ ,required.] 5. n We are a corporation and its 10.L Electrical repairs or additions 3. L✓� 1 am a homeowner doing all work officers have exercised their 11.ErPlumbing repairs or additions 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Si. ature: ,� / . �.� � f -.� Date: Phone #: ( 3 - 5 2: 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder : License Number Address Expiration Date Signature Telephone b qis eyed:" iameafmproveme reCo tractor': < 4 N 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 ❑ 1.1 4Home caner Eemption 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 • A SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House In Addition ❑ Replacement Windows Alteration(s) jX1 Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition 1.4 New Signs [0] Decks [[] Siding [O] Other [p] Brief Description of Proposed . Work: Re_rl ue_ tip9tr6Irs corth ) Cprnh\ <%ief} -fu' B CD - nbin. . s An C©tliJex '10 S11151-€ Arn'hi Alt bedroom Yes No 7 Adding new bedroom X Yes No ttached Narrative Renovating unfinished basement Yes No Frans Attached Roll - Sheet f Ne sa4i wJiQUSesan or .addition.to::existing4housiti ornpletefthe foIJ`oW a. Use of building : One Family Two Family Other i b. Number of rooms inCCh family unit: Number of Bathrooms c. Is there a garage attached?'-, , d. Proposed Square footage of new co truction. Dimensions e. Number of stories? ‘'N \� f. Method of heating? .� t`ireplaces or Woodstoves Number of each ' g. Energy Conservation Compliance. ;�' ' -. Masscheck Energy Compliance form attached? h. Type of construction /-- J i. Is construction within 100 ft. of wetland? Yes No. IS within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building confornytcfthe 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 CONTRACTORAPPLIES 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 building per lication. Signature of Owner Date SDI A K i l , as Owner /Authorized Agent hereby declare that the statements a 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. Print Name I, i I't's' C1 z3 I Signature of Owner /Agent t Date it P //lA . . Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information b . Existing Proposed Required by' Zoning This column to be filled in by Building Department Lot -Size' " . �.." Frontage 1 ;E 1 ' ' Setbacks Front Side L:: L:' . I R:' I 77 Building Height i I i Bldg. Square Footage ( i j 00 l Open Space Footage % (Lot area minus bldg & paved 1 F f I i I I parking) I 1 # of Parking Spaces Fill: I --__. i (volume & .cation) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 21 YES 0 IF YES, date issued:F IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 1® YES 0 IF YES: enter Book Page E and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ED DONT 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 0 NO !® IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property ? YES l NO (4 IF YES, describe size, type and location: F 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. $ � 3 Q�. artn} R `(hfie Df� t� 7 ; r s x City of Nort hampton Statu l erma i Building Department G „,,''''R'-'''' tuu 212 Main Street Sew S i p tc � v.'al?it � • Room 100 a.,, a l a ® i$ , Northamp MA 01060 ''i r. tt P -* phone 413- 587 -1240 F ax 413- 587 -1272 Pla ans_ • APPLICATION TO CONSTRU ALTER, REPAIR, RENOVATE OR DEMO - H ONE O TW FAMIL D LLING $ EP 3 u 1wI SECTIO '1 - SITE INFORMAT =h Th se • '�+ o c e? 1.1 Property Address: �� m '` 3 ; a9 R e s �� } . k ' 'Ni ��V /�, � ` . ° , T h -. '' � LOS :-x � a ye` 5:.#fi` � n -- , - * - 1 t rli 1 , rz ` Zone x Ov D�stn z lm s t I �sfr�cf CB U�stnct SECTION 2. PROPERTY OWN /AUTHORI AGENT 2.1 O wner of Record: - �,� JCir\e K � -tt� t 4 3 � t�t+°r Zel . � . L� 'e r� 1 etC�� �c� Ot3'�3 Name (Print) Curre M A ddress: A _ 1� Telephone y ('3 — (0t” 5 _ �{ J Signature ') 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATE CONSTRUCTION COSTS Item Estimate Cost (Dollars) to be Officia Use Only °a' �c5 mplet ed by permi app licant 1. Building s o� (a) Building Permit Fee 2. Electrical Cy (b) Est Total Cost of X0 Construction fro (6) - :•-• : ' : • , ,,,, , 2 • : 3. Plumbing ©� Buil ding Permit Fee 4. Mechan (HVAC) 5. Fire Protection J ecum 45. Tota =(1 + + + 4 +5) 3J��TU c c7� This Section For Official Ch Us e N Only ate Building Perm Number: IssuDed: Signature. , Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0321 APPLICANT /CONTACT PERSON KELLY CAROL A & JAMES R ADDRESS /PHONE 72 NORTH MAIN ST FLORENCE PROPERTY LOCATION 72 NORTH MAIN ST MAP 17C PARCEL 260 001 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 deb $55^" Fee Paid Typeof Construction: REMOVE UPSTAIRS KITCHEN & CONVERT TO SINGLE FAMILY 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 INFOSMATION PRESENTED: fr4proved 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 O 0/ Signature of Building Official Date � g 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. 72 NORTH MAIN ST BP- 2012 -0321 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 260 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0321 Project # JS- 2012 - 000523 Est. Cost: $3500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 12066.12 Owner: KELLY CAROL A & JAMES R Zoning: URB(100)/ Applicant: KELLY CAROL A & JAMES R AT: 72 NORTH MAIN ST Applicant Address: Phone: Insurance: 72 NORTH MAIN ST FLORENCEMA01062 ISSUED ON:10/6/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REMOVE UPSTAIRS KITCHEN & CONVERT TO SINGLE FAMILY 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 10/6/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner