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BUILDING SECTION 1
ill■ , , ,, ,
General Building Information
a) Building Use : Residential
b) Square footage : Existing 1,950: + Addition 2,950 = 4,900 sf
c) Building height: below 36 ft
d) Number of floors above grade Two
e) Number of floors below grade : One
f) Type of construction: Type II
g) Hazardous material use and storage : Low hazard.
Project objective.
Applicable Laws, Regulations and Standards
a) 780 CMR, Seventh Edition,
b) NFPA Codes arid Standards
c) MGL., Chapter 148 .- Eire prevention,
d) 527 CMR. Fire prevention regulations,
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28
tos. R evisions
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11--75., �,� 100_0_ L
05/21 /2011
EARLE STREE1
1
General Notes
GC required to verify all existent denensions in site
SITE PLAN
0 NOT TO SCALE I
I I
project:
Home Addition
location:
188 Earle Street, Northampton MA 01060
owner: .
Polly Parker & Jonathan Yourya
contractor:
Richard Ruth Mass Lic. # l FOUNDATION
drafting:
Daniel G6loez, LEED AP. I Scale varies
/ fre - bued Q S q ,P „/ z <- z <-//
yee r , :r6,,,, r -
i
1 1
I I
Registry of Deeds Page 2 of 2
•
Bk: 10238 Pg: 294
Zoning Board o €Appeals - Decision City of Northampton
Hearing No.: ZBA- 2010.0032 Date: June 18, 2010 I I'
i i :in
APPLICATION TV SUBNA3316N LUTE: c
�t
•
•
RestdeiUf f Funding 540t2040 Bk: 1O298Pg; 294 Page: 1 of 2
J'ieoorded: G7/21/2910 12 :96 phi
Applicant's Name: Owner's Name:
NAME: , NAME:
YOURGA JONATHAN & PAIJUNE FAfiK R Yfy1RGA JONATHAN & PAULINE PARKER
AUDrC9S: A D L R E S: ...
ISSEARLE ST • f 8EARLt: ST
TOWN: SIAM tire:DOE.: -SOWN: �.... STATE ZIP CODE:
NORTHAMPTON MA 01060 NORTHAMPTON A4A 01060
N ONE NO,: FAX NO.: PRONE NO.: �y fax NO;
E MAIL ADDRE 0 1413) ADDRESS:
4, .... ..
Site information: _ Sur'veyor's Name:
STREY7NO: '
SITS ZOPANG; ... - COMPANY NAME;
1 MS EARL.E ST Sl(972/URC(. /
TOWlk AClIDN TAI? ALTDTESS: •
NORTHAMPTON MA 01080 Grant
AMP: NLOc ; LOt; MAP DATE SECTION OF BYLAW:
38.A1 0 95 . 00? J Chp.350- P.3: Pte- existingNoneOnfOmliflg TOWN: `STAFF.. IZIP�.O0E:
Souk: _ ' Paw .. Structures or Uses Maybe Changed,
1454 6T2 , Extended or Altered, :asome 1.10_: FAKA10.:
• ,-EMAIL ADDRE£.x
NATURE OF PROPOSED WORK•. - -
ZPA -Aor rrioN a ACCESSORY APT
OONOmO11 OF APPROVAL_
'INDINGS:
The dastgrtated Administrator granted the Hinting based on the materials and graphics submitted with the application,
The RnaWrngs of the Board Administrator under Section 9.3 for the addition of an accessory apartment as part of a sfngte family house
related to the pnl x3athig taco- confoutoing residential use to an Si d+strict
1_ The Administrator found that the orange would nor be substantially mars de54mearbal to the neighborhood than fie existing
nencanforming use The property abuts resident:at uses and Is the only kg in the Si district on that pavilion of Earle Street.
2, The Administrator found that the home waufti Oat extend any closer to any front side, or reerproperty boundary than the cunant
zoning allows and that the pre- exfstIng structure already extends.
1 The Administrator also determined Char the new construction would not create arty Pew violation of other zoning provisions; and does
not Involve a sign.
COULD NOT DEROGATE eEGA45E,:
FILING DEADLINE: MAIL AD DAM: ruARING CONTINUED DATE: DECISION DRAFTS?: APPEAL DATE
5M t/201 0 : /2010 G/z oit7
:m»PERRALs IN DAYS " NEARING DEADLINE DATE: REARING CLose DATE; FINAL SIGNING SY: APPEAL DFADLH+E;
519121710 7/14/2010 6111212010 6/24t2014 • 7/14
FIRST A,DVERTISJNO DATE; NENia14 DATE; varmO ELATE: DECISION DATE
. 5/2712010 0+1012010 6/141010 6/1G7310
SECOND ADVERTISING DATE: • ' HEARING TIME; -- VOTING UEAfXr NE: DECISION DEADLk1E:
6131zQ10 4 :00 PM , 9E/8/2040 91812010 I
MEMBERS ?RESENT: VbrE:
Malcolm B.E. Smith votes to Orant
ABOTIGT1MAtJE4Y: S9C,ONDFDBY: VIM 00r,m7: OECISIOH
Malcolm B.E. Smith . , 1 ...I Approved
•
MINUTES OF MEETING:
Available in the Office of Phoning & Devefopmerrt.
GeoTMSO2010 lies Lauriers MuuRioipal sambas, lne.
•
http: / /www.masslandrecords.com/malr/ controller? commandflag= searchByNamelD &optflag... 6/1/2011
File # MP- 2010 -0075 '
APPLICANT /CONTACT PERSON YOURGA JONATHAN & PAULINE PARKER t V I .
ADDRESS /PHONE 188 EARLE ST (413) 584 -3027 0
PROPERTY LOCATION 188 EARLE ST
MAP 38A PARCEL 065 001 ZONE SI(97)/URC(3)/
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: ZPA - ADDITION & ACCESSORY APT
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
IlIFWVIATION 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
Sig e 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
" , , . Office of Investigations
A k ...4.,..0.
t 600 Washington Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
ii4 Name ( Business /Organization/Individual): i L WM b eot-/_(
Address: 5 A ,a 1 _ f I f / f
City /State /Zip: t / / /, r, 7ihone #: 4 (3- U @ ) ) 34
Are you an employer? Check the approp ; to box: Type of project (required):
l. 0 1 employer with 4. 0 I am a general contractor and I
ployees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction
2. Di or
proprietor P a sole ro rietor partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub - contractors have 8. 0 D rtion
working for me in capacity. employees and have workers'
g any P t) 9. uildingaddition
[No workers' comp. insurance comp. insurance
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 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
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 DII • for insur,� „coverage verification.
I do hereby certify /r e p, f� /,penalties of perjury that the information provided abov is true ' nd correct
Sim a e: .A(,frtL/i _ Llr� Date: l r a/
Phone #: / 4/ * 65 - 95
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 ConstructiP Supervisor: Not Applicable ❑ 7
Name of License Holder : � 0
0, Z
/ License Num ' ` Z
r
EA .) CV, V -z-z5--Za7Z
Add / , Q�� �} Expiration Date
'n . �. 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. 162, § 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 buildin ermit.
Signed Affidavit Attached Yes No ❑
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. 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
,
. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0]
'- .. � _•� ... - � �. _ ` / r / �
1I►iliri � ��a/ /�i A / „_ ! , � l�✓
W Brief 5 ork: • .. �i�i� /��:��i _.,.r
Alteration of existing bedro +m Yes No Addin• new bedroom es No ��/
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa. If New house and or addition to existing housing, co mplete the following:
a. Use of building : One Family Two Family `� Other
b. Number of rooms in each family uni . 1 Number of Bathrooms 3
c. Is there a garage attached? � e2 - ( f7 /
d. Proposed Square footage of new construction. 2/' if (1 Dimensions 2(O 6 / 37
e. Number of stories? - T 3 e
f. Method of heating? C / Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compli nce form attached?
h. Type of construction G I'/ ff
I n ? Yes l 1s y r. construction within 100 flood lain Yes No
i. Is construction within 100 ft. o f wetlands? floodplain
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoni 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
1, .J/JN4 #h 6,9 y 0 c/ry- of , as Owner of the subject
property l �/ �� l� c pp /
hereby authorize R i G 1 ■G'' ✓C: 1 ft
to act on my behalf, in all matters relative to work authorized by this building pe on.
< / d0 //
Syrjl}! Owner � / Date
), .1'�/�
I, Lj as Owner /Authorized
Agent hereby d -, that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief. :::$2 d p Ierjury. �
—�� 2 7
Signature of Owner /Agent Date
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 G . 23 QC1)
Frontage too l
Setbacks Front 2 G
Side L: i ( IP R � L:44____ R: _
Rear t eo 9'C
Building Height l 3 �Y
Bldg. Square Footage t� ` % v �.,l
Open Space Footage %
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit/Variance/Finding ever been issued for/ the site?
Pe ';
NO 0 DONT KNOW 0 YES
IF YES, date issued: 3 .. e c4 4,9
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book 1 4 Page ( 7 2 and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO CDONT KNOW 0 YES
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 OV
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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excav ' n, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
S a-
f
t
^ x"14
f
.
i Department use only
R E, City of Northampton Status of Permit:
1 Building Department Curb Cut/Driveway Permit
44\4 — 1 0 1 1 212 Main Street Sewe aseptic Availability
Room 100 Water/Weli Availability
hampton, MA 01060 Two Sets of Structural Plans
= e 413- 587 -1240 Fax 413- 587 -1272 PIot/Sife 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 Pffice
1 V C�✓P'e�t(�'ll Map Lot Unit
\(2 jhmt/ fel IV\40/0&C) Zone Overlay District
EIm St, District CB District
SECTION 2 - PROP R TOW ERSHIP /AUTHORIZED AGENT
.1 Owner of Re • '
6 IIfi /� ad/de/ G �C �� ,,, .,
,„ �`� / x A i/
Name (Print) Current Mailing Address GZ
— 4(. 7 3
��' l�_r Telephone
•
� .gnature ���
2.2 Au v;.e razed • • ent:
Name Print) /// / Current Mailing ddress: /
Signatur; �� Telephone
SECT • N 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical t c (b) Estimated Total Co of
Construction from (6}
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection +' ()CI CI GC/
6. Total = (1 + 2 + 3 + 4 + 5) _ ; / OZ . Cc) Check Number dI�I� v v
This Section For Official Use Only
Permit Number:
Date
Building Issued:
Signature:
Building Commissioner /Inspector of Build Date
,
01
File # BP- 2011 -0989 ?1" -1V/
APPLICANT /CONTACT PERSON RICHARD R RUTH
ADDRESS/PHONE 15 MAPLE ST TURNERS FALLS (413) 863 -9334 P-wv
PROPERTY LOCATION 188 EARLE ST
MAP 38A PARCEL 065 001 ZONE SI(97)/URC(3)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid yD / 7 CS
Tvpeof Construction: CONSTRUCT 20 X 37 FOUNDATION ONLY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 07762
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9VIATION 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
di pprOW
. re of : uilding 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.
188 EARLE ST BP- 2011 -0989
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A - 065 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: FOUNDATION BUILDING PERMIT
Permit # BP- 2011 -0989
Project # JS- 2010- 001394
Est. Cost: $7000.00
Fee: $148.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD R RUTH 07762
Lot Size(sq. ft.): 10802.88 Owner: YOURGA JONATHAN & PAULINE PARKER
Zoning: SI(97)/URC(3)/ Applicant: RICHARD R RUTH
AT: 188 EARLE ST
Applicant Address: Phone: Insurance:
15 MAPLE ST (413) 863 -9334
TURNERS FALLSMA01376 ISSUED ON: 6/8/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 20 X 37 FOUNDATION ONLY
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 6/8/2011 0:00:00 $148.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
, o
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 ofNorthampton wants person(s) who seek to use
the home owirer exemption, 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 backlit!),
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 occuoancv
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
jermits 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, J wv 4 "k . y,‘, understand the above.
(Home owner /resident's-signature requesting exemption)
7
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date /7 0 2 Li 00 it
Address of work/ /
location g,1? ,' ✓I (4-
//o ✓ 4-�^�� o.- in-/3- c, /0 66
,
. The Commonwealth of Massachusetts
Department of Industria 1 ACcidents
Office of IniIestig,ationS
600 Wcishington Street
•i!.
4 y
44M---- g...... . -
• lam= Boston, MA 02111
=:...
, k,,,,--:-.- • . , , movanass.golVaria , ' 7,
1 .
-Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers - •
Applicant Information • Please Print Legibly
Name (Businesi/Organiiation/IndiviamD: c j00, 16 7,4.— ..
• • Address: A. v" 1 e (S F
• . "---"."-' .
CitylStatealp:/Ver • - 1 - 14.4n-ip - 4 - o ....,/ ,41/9- . o ia6a Phone.#: ___.c gl/-,0 7 1. -il 3- 577-25-/S
. • .
Are you an employer? Check the appropriatebox: - . •Type of project (required): i
• 1. 0 I am a employer with 4.. 0 I are a general Contractor and I
6. 0 New construCtion
have hired the sub-contractors
employees (fall and/or part-time).
listed on the:attached sheet: 7. 0 Remodeling .
2_0 I ant a sole proprietor or partner-
These sub-Contractors have.
ship and have no ••loyees -8. 0 Deitiolition - -
occoolov= andbave workers - - --
working forme in any capacitY. ----- ----- . ' g." Elltiiilili*aAclititiii -
[No wOrkqrs' comp insurance . - comP--io - - .. _______:._.__ :
10.0 Electrical repairs or additions
0 We are a corporation and its
, - 5.
• 3 )q I am a homeowner ding all work officers haVe4xeraise4 their . 11.0 Plumbing repairs or additiOns .
myself [No workers' comp. • right of exemption per MGL
12.0:Roof repairs . -
insurance r e q9 i re dj t • ' . : ,c. 152, §1(4); and we have no • . , .
eorkyees [No workers' 13.0 Other r :
. . . . comp insurance reqiiired.j. : . • .. .
*Any applicant that checks hem Ittmust also tilt out the section Mom/showing their compensation policy infolmatien;
\ I Homeownere who submit thii aflidaiit.inclidating they are doing ail vdotic and the hire outside contraCtora must submit a Dew ifEtdavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state-whether crrnotthoseentities have
employees If the sub-contraitorshaie employee& they must provide their weiTkeirs' comp policy number.
lam an employer that isproviding workers' compensation insurance fortify employees. Below is the policyandjoks'ite
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 reqiiifeA. iiiiilet SeCtroiit5A re: 152 can lea." dIO the imposition of of a
fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of g STOP W and a fine
of up to 5250.00 a day against the violator Be advised 'that a copy of this statement may be forwarded to ito.cit6celof
- Th.FesiiiiiiolissOfthEDIA. -- for insurance 6overaee verification _ — - _, .', . - .:.:'... - .. --.,...--:__.. . , .
_ .146:•her*_Ceiii un the pain sand penalties olyedury in:fOrauttionprovirierlibtimisLtnterrivj ' _
.., • z .
Si • tore: ■110:_:-,-_ _ ,....- 1P■IT -_ - ;_ - :- . _,... - ' • 9 ate- / t P
•
Phone il: , . .
. .1 & It fr . - . • . . - . - • .
. • .. . ,......_, - ..- ------- - '
. - Official use only. Do not write in thLY aria, to be comptited 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. ElectricalInspector 5. Plumbing Inspector
6. Other ,
•
Contact Person:
Phone #:. i .
• -
- •
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
!# R' egisteiixttcittfelmgroirmeri0onflran�r :a a°x «'Pr Not Applicable ❑
Companv Name Registra i ! er
Address Expiration Date
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, g 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" was extended to include Owner - occupied Dwellines 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 ip_ _�
•
SECTION 5- DESCRIPTION OF PROPOSED! WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing 0
Or Doors ❑
Accessory Bldg. ❑ Demolition Rt New Signs [0] Decks [I] Siding [0] Other [0]
Brief Description of Proposed � s
P P CRQM 'di ^.41 /� •r' BpC 'o.✓ CCv LKI/ ' )
Work: �J ./ I
Alteration of existing bedroom Yes t/No Adding new bedroom Yes i No
Attached Narrative Renovating unfinished basement Yes L,NS
Plans Attached Roll - Sheet
sa i M dtl:Wt `iifditi nkti it a MT np cts pf iktie fi t + :
a. Use of building : One Family Two Family Other
b. Number of rooms -ach family unit: Number of Bathrooms
c. Is there a garage attache.'
d. Proposed Square footage of ne onstruction. 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 w= .nds? Yes , 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, , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matte -- ative to work authorize. • , -' • ilding permit application.
Signature of Owner Date
7 ' 1 ( 7 - 07. - ...c.01. - '��t2e%� ( a ner uthorized
Agent hereby declare that the tatem and information on the foregoing application are true and accurate, to the s of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
/SPY ay �vjl
Sign- 1 er /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplet nforpation
Existing Proposed Required by ning
This column to filled in b��j, „ A
Building Depa ent i i F# ii
Lot Size r i
Frontage i ` ,.
Setbacks Front r i
Side L.. R:L 1 L:1 R :i
Rear i I „ j i i
Building Height i i 1
Bldg. Square Footage ( 1 1 ' I I i l
Open Space Footage %
(Lot area minus bldg &paved , ; t, 1 n . -„m. —,
parking)
# of Parking Spaces — i V _,
Fill: _- .�...., . �.._
A
(volume & Location) 1` €
A. Has a Special Permit /Variance /Finding ever be •n issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:s
IF YES: Was the permit recorded at the Re.• try of Deeds?
NO 0 DONT KNOW 1110 YES 0
IF YES: enter Book 1 Page and /or I •current #'
B. Does the site contain a brook, body , water or wetlands? NO Q DONT KNOW S YES 0
IF YES, has a permit been or n- -d to be obtained from the Conservation Commission?
Needs to be obtained �� Obtained , Date Issued
C. Do any signs exist on the pr perty? YES 0 NO 0
IF YES, describe size, ty &e and location:
D. Are there any proposed hanges to or additions of signs intended for the property ? YES Q NO Q
IF YES, describe siz=, type and location: i
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 O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton �' ,
ENV � �
RE B ui lding Department ' i ' t iti � , - } t `;
1 212 Main Street m �`� E
WI 2 Room 100 E�' ��
.rthampton, MA 01060 - g $ = �r " - 7� . ,
41 - 587 -1240 Fax 413 - 587 -1272 '' 0,-',,,,,,
i • • ,- "mAlio Svc» . Ss
B � r z s . .
AP PLICATION 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
'f�? e -i" /� ‘S-4--- Map Lot Unit
��� ha 4171-0.-,/ �j e7/e%'69 Zone Overlay District
Etm St District CB District
SECTION 2 -PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
<J ./4f✓� I tei"i kc cif A Pi f : - / e- p./lee s le ✓/e Si 0% t1 ---- 7:--•/ mil-
Name (Print) , Current Mail Address:
c'-Z7/ .3D a 7 Re S S7/y /gf ex s 5.29
-.1� �� Telephone ] ?_ 3e7 73 /s
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
2. Electrical
Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
(a) Building Permit Fee
(b) Estimated Total Cost of
OV�/ Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
A7/4" t‘ ) 3 g (i0 5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Offic Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2011 -0976 '
APPLICANT /CONTACT PERSON YOURGA JONATHAN & PAULINE PARKER
ADDRESS/PHONE 188 EARLE ST NORTHAMPTON (413) 584 -3027 0
PROPERTY LOCATION 188 EARLE ST
MAP 38A PARCEL 065 001 ZONE SI(97)/URC(3)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out rt. 56-
Fee Paid
Tvpeof Construction: REMOVE SIDING FOR PREP OF ADDITION
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:
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
24tH
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.
188 EARLE ST BP- 2011 -0976
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A - 065 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: vinyl siding BUILDING PERMIT
Permit # BP- 2011 -0976
Project # JS-2011-001599
Est. Cost: $800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10802.88 Owner: YOURGA JONATHAN & PAULINE PARKER
Zoning: SI(97)/URC(3)/ Applicant: YOURGA JONATHAN & PAULINE PARKER
AT: 188 EARLE ST
Applicant Address: Phone: Insurance:
188 EARLE ST (413) 584 -3027 0
NORTHAMPTONMA01060 ISSUED ON: 5/27/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE SIDING FOR PREP OF ADDITION
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 5/27/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner