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38B-129 { k,; Ia AL vAA feAm .1...d A. ' ' - 1 :, 4 4‘ _ ...\• '''''. Z-- i 7".7(l'iL-1 , r, il' .. ', > i t , ‘,, f__. Ge.. -1- h 1-a- ,r TK k u . ` a_ lam. f �, Figure B Foundation P � D it i lam- �`� s . 2x4 2' x 18" x 18" Se TREATED CONCRETE l /g (71 / , !� / GR AVEL 5j % t priro i r 2x10 A i TYPICAL illalW SECTION ��1 / / /,���'� A , ,f— 5' 10 "-- 7v �'w K /o ,49 / X /2 i .2 . GRAVEL 8' /2/)4467 BASE /°-/Pe 16' 4" �"-- TREATED B'4 ' / RY A / �j�f / 2x10s - --' I Y `� // Q / (/ //,' /„ e ' .- / l, „G .b-- 9 ' 10 ” -4 0 14/ to-- 5'6' — � Vim`/ J I � ,, r / F „.., Ro� .. 1 .rfo bA_ , o`-L4 Ail,vt A 1 6 ” or( -y- //ut[/ \ TREATED � ( x) ( v \ O , 6x65 v-71-/ �� Ink 1 / a / /644-41--- 1 � A l ` � -,�- Pu4- i I llo 0 0 of —NOTE — THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED k 58.45' VO \°\ 1,t9A to t0 BOOK 8454, PAGE 99 LAN BOOK 167, PAGE 72 (LOT A) 1 0 d .d10 1 40446A ; r 1 — #46 co 20 I I - • i 670 5#1 ',, + side 1 I • • � • 73.36' 0 l '/6 COLUMBUS AVENUE TO: APPLIED MORTGAGE SERVICES AND FIRST AMERICAN TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION; KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIRI F FACFMAFNTC FN( RnAta- IAAFNTC /thin 81111 niNnq ARP 1 nreTrn nN lntormation and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuat to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub- contractor(s) name(s), address(es) and phone number(s) aloes with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) th not m e zher r ran the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Shoriid you-have- any questions regarding-the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self - insured companies should enter their self - insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed Iegibiy. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that roust submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information - necessary) and.under "Job Site Address°' the applicant should write "all locations in (city or town)." A copy ofthe .affidavit that has been officially stamped or marked by the city or town may be provided to the appiicantas-pl oofthat . :vaird affielavit_is -on file- for future permits or licenses: A new affidavit must be filled out each year Where` a home owner or citizen is obtaining a license or permit not related to any business or commercial venture. (i.e. a dog license or permit to buin.leaves etc:) said person is NOT required to complete this affidavit. The Office of Investigations would hketo thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.: The Department's address, telephone and fax number The Commonwealth of Massachusetts > epaitalent of Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617 - 727 -4900 ext 406 or I- 877- MASSA.FE _. .__AF.azc.�_�. -?�7 7744 _ -Revised- 4} -24 -G7 - - -- - ww w.mn.ass.gov /dza y-- The Commonwealth of Massachusetts 7 ,_ r--- Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /EIectricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization /Individual): I R4W g f (JCb Address: 41, (1 , 0-A--- City /State /Zip: (� % , , c /o. ' - / a_ Phone #: l 7 < 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 1 6. SNew construction employees (full and/or part-time).* have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any ca employees and have workers' Y P ' aci.Y . t S. ❑ Buildi -tg addition. [No workers' comp. insurance comp. insurance. 10. Electrical rep airs or additions y required.] 5. ❑ We are a corporation and its 3. I am a homeowner doing all work officers have exercised their Y 11: ❑ Plumbing repairs or addit ons myself. [No workers' comp. right of exemption per MGT- T2. ❑Roof repairs insurance required.] f c. 152, § 1(4), and we have no employees. [No workers' l3. ❑ Other . l j 1( L comp: insurance required.] "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Ho meowners who submit his affidavit indicating are doing ail workand- 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 Naive: 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 ofMGL c. 152 -can lead to the inipos tiara 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 ofper�ury that the information provided above is true and correct. Simature: 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 #: ' City of Northampton • HAM /'A 0ti \5 • ' , Massachusetts � ? s c % ,, .A . ! DEPARTMENT OF BUILDING INSPECTIONS 1.. 212 Main Street • Municipal Building Northampton, MA 01060 ss � W 3 n ��`�\ INSPECTOR Anthony Patillo Building 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 olook (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 ma • e I, 5/ understand the above. (Horhe owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Ard Address of work location 'y co /to m b' 3 ,4� 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 Improvement Contractor: 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 ❑ OW 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. CM( 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 Loc: i t Zon g Laws and State of Massachusetts General Laws Annotated. Homeowner Signature / Z ,--- - • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) 00 i New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ' /iit Demolition ❑ New Signs [0] Decks [IJ Siding [0] Other [0] Brief Description of Proposed v1_' i; t r (t /� t ', ' i f b j, y � M , Work: l e Hc� "� 87� r 1.� fi!" It C.� t" r Alteration of existing bedroom Yes A No Adding new bedroom Yes X No ` Attached Narrative Renovating unfinished basement Yes ,7-- No - Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other '�lGQ S L ` ya.t1.e -tt 5119A b. Number of rooms in each family unit: Number of Bathrooms 0 c. Is there a garage attached? ci5 d. Proposed Square footage of new construction. / 7 ( Geirt Dimensions 1 � 6 9 e. Number of stories? 1 f. Method of heating? Fireplaces or ov s A( Number of each I g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction j) 0 0 cl yy ,. Is construction within 100 ft. of wetlands? Yes f' No. Is construction within 100 yr. floodplain Yes ( No j. Depth of basement or cellar floor below finished grade 10" k. Will building � ' conform to the Building and Zoning regulations? Yes k No . I. Septic Tank / _! nf City Sewer / 14 Private well "A City water Supply A0c SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES 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 permit application. Signature of Owner Date I, , 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. Signed under the pains and penalties of perjury. + 'print Name /° . Y S i g nat o + er /Agent a te N a= Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning O This column to be filled in by � f 14 � D Building Department Lot Size 10 d .211 / f Frontage 7 3 /F'" Setbacks Front J & l � ; U 2� .o r 42 Side L: � R: 35 3 L: Pi R: 1� l,s-- c( Rear D 1/ 2Q Building Height ,3o / 3 J,1� % 3. / Bldg. Square Footage ©C0?/) -/ % iv/ �f Open Space Footage % pq //�� (Lot area minus bldg & paved 7/5 t/ Ti 1310 73'2 30z parking) # of Parking Spaces 2- Fill: (volume & Location) _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? asp"" NO I/ DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES o NO fill 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 Ate'• IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 4, Department use only r ,�;: 1. fit of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability v ^ 1 0 2 °u' Room 100 Water/Well Availability At Northapipto , 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 i-_ t? CO( v0 ,,, b j Av, ,vim Map Lot Unit \ & i -f k1 +-er , " ` �t o I D 6D Zone Overlay District y Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: bf)3DRAti E (a c &/c u c. 2 YL. c ai5s I— , (a i ' b o.5 , Name (Print Current Mailing Address: a Telephone Sign ure 2.2 Authorized Agent: ) oM.2Em.; Pet- k A+1 Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building rec(� m-i r CEO (a) Budding Permit Fee F.PAI■1 WW1) 2. Electrical (b) Estimated Total Cost of N/A t' Construction from (6) 3. Plumbing / — _ Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection /O D v _ 6. Total = (1 + 2 + 3 + 4 + 5) 5-0. d0 Check Number ) 7 , This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date _. k File # BP- 2009 -0831 APPLICANT /CONTACT PERSON CROSS CHERYL J & DEBORAH J BRUCE ADDRESS/PHONE 46 COLUMBUS AVE NORTHAMPTON (413) 727 -8134 O PROPERTY LOCATION 46 COLUMBUS AVE MAP 38B PARCEL 129 001 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 Tvpeof Construction: CONSTRUCT 144 SQ FT SHED & INSTALL WOODSTOVE 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 INFQRMATION PRESENTED: lt- '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. September 30, 2009 On April 16, 2009, I requested and received a building permit to construct a 144 sq ft shed in my backyard at 46 Columbus Avenue. [permit number BP- 2009 -0831 and project number JS- 2009 - 001229]. After starting the project, I realized how small the room would be and I am wanting to modify that permit, or receive a new one. Please advice. The building footprint would extend 4 feet longer (total 10 ft x 16 ft) for a total of area of 184 sq ft. And there will be an overhanging loft area that will extend another 4 feet (its area will be 4 x 10 feet.) The location of the building is still 4 feet from my sideyard neighbor and about 20 feet from my backyard neighbor. The total building coverage on the lot is 2274 sq ft (house 2090 + shed 184). The lot size is 10,024 sq ft. This equates to 23 % coverage. Deborah Bruce 46 Columbus. 413 727 8134 , f/A-nt 9' a l A ., 51Z- re, X 4_ 1.4-6754-4 545-172.-- 46 COLUMBUS AVE BP- 2009 -0831 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 129 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 -2009 -0831 Project # JS- 2009 - 001229 Est. Cost: $2850.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 10018.80 Owner: CROSS CHERYL J & DEBORAH J BRUCE Zoning: URB(100)/ Applicant: CROSS CHERYL J & DEBORAH J BRUCE O,',7: UM VE Applicant Address: Phone: Insurance: 46 COLUMBUS AVE (413) 727 -8134 () NORTHAMPTONMA01060 ISSUED ON:4/16/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT4 SQ FT SHED & INSTALL 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: Final: Smoke: Final: O - - D K ID .5 q _.fro-✓ 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 4/16/2009 0:00:00 $50.00317 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo