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23D-037 Lic. #060247 Reg. #114593 AGING IN PLACE BUILDERS INC. 37 PINE ST NORTHFIELD, MA. 01360 PHONE 413 - 225 -3047 FAX # 413- 225 -3047 Aug 19,2009 Ruth Yeh 11 Ormand dr Florence Ma 01062 MUD ROOM ADDITION 1. Build an approximately 6'x12' Mudroom / Entryway off the existing breezeway door 2. Elevate existing breezeway roof to give more slope and build a shed roof over the new mudroom. Blend into the existing house and garage roof 3. Provide and install 2 vinyl windows and a new fiberglass 9 Lite door and a storm / screen door 4. Siding and trim will match existing house trim 5. Provide and install a vinyl floor ( pattern and color to be owners coice) Armstrong Solarian or equivalent 6. New interior walls and ceiling to be finished and painted sheetrock. (white) 7. Include all electric work as necessary for new interior and exterior lights and switches 8. Interior vinyl siding and existing doors to remain 9. Include all necessary permits and disposal of demo materials ESTIMATE $8500.00 k,425i# V;VA79 • . ( ..' . ! L , -.... -:::- ------ ti . _.-- 6:11, 01 o I , f Aers v g fti L. 4' 4 1 Art6 ■ 1 1, „,, -- ------- .-- .._ - , ' 11 rot I.. i------Ei __ e 7 _ 6 I, i i r.------------ ---..„ ----- --_,, ,I , • , .,__________________ 5 ---------->- •. , , , -----:'-- - , - „. 7r 7- - c -:• - ,- r - r _. r ,?„,,,,,,,,,,;,,_ - ----- 1 , ;it 1 ( / '; t i e Aue. di, 1 \ ,_ I/ € ( • [-, t ip r i' , , . , . - , „ , , ,, , •,-) cts or 1 _ vo\tber v • )‘, ti ill " i ' 1 • / ,, ,, 1 1 _ _. _1 _. I .,. .‘,..; 1-7> f ' 1 ',. :,,, i ■ Ii ' ' i, ' , , : , _ . L I 1 ! ii 1 - - - _ _- ,:„._ - - _:_ _=:-: -_ : • ' 1 , --- 0 _ - • .?x-g 1 tt---- --- ....-- 41 ) ., ____, ...1 --r- I/ L. • - --,,,%--_-_ - ..-. 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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 own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulation it - • t • - .. - -. - .t the buildin. de.artment 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 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 me. Witte Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents E. Office of Investig ations =: ; 600 Washing on Street _ Boston, MA 02111 �� www.massgov /dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A • nlicant Information / / Please Print LeaibIv Name ( Business /Organization/Individuai) : ' /, �� �( r _ a( c /4 L i t i C' Address: 3 7 Prte cl A /r. . C(k ,4 Q36 City /State /Zip: Phone. #: Are you an employer? Check the appropriate box: Type of project (required): l'' 1. ❑ I am a employer with 4 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub- contractors 2- ❑ I atn a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have. no employees These sub - contractors have. 8. ❑ Demolition an working for me in capacity. employees and have workers' Y 9.Butlding arl�iiti wor on [No workers' comp. insurance cornP. insurance required.] 5. ' We are a corporation and its 10.9 Electrical repairs or additions _ ors ve' ,�icis s their —I- -. Plumber a 3. ❑ I am- a�ieraeowner- daia�ai} homeowner-doing-all-work- _ -- - — ,• -- . ❑ g 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. :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 decclaration 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 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fire of up to $250.00 a day against the violator: De advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. by p ofp • ' ry that the information provided :abov -e is_true and correct I do hereby certi u % er the � ' � a � en � _ • � o -. II S i • .. tare: / F / � ' 1 ���� D . / .. iy (s Cl Phone #: i l l /3 0 30.4 7 Official use only. Do not sin& in this area, to be- completied by city or town official City or Town: Permit/License # Issuing Authority (circle one): " I; Board of Health 2. Building. Department 3. City/Town CIerk 4: Electrical Inspector 5. Plumbing Inspector 6.Other r - Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �j ( Not A ❑ V Name of License Holder : v ; 11! G* G ✓ l od / 7 31 / f[ b`e ` " ` CJ License Number 16 0)6 /V Addr ss Expiration Dafe /(10,44( Y/3 - Signature Telephone 9 Registered Home Im troveine tontraetorx:: K ... �, '� = Not Applicable ❑ /19513 Company Name Registration Number Addre � /yJ /K v ) J 3e Expiration Date 37 1 Jt rf; N `�� P24 Telephone l� / � 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 buildin permit. Signed Affidavit Attached Yes No ❑ 115 Ltje k trt _The_current_exemption for "homeowners" was wended 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 sort ampton •rima'c' , " at — � `o 0- - . s- GeneralLaws_Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition 0 Replacement Windows Alteration(s) El Roofing El Or Doors 0 Accessory Bldg. El Demolition El New Signs [❑] Decks [[=I Siding [❑] Other [❑] Brief Description of Proposed Ake / Work : NkirihW / J eidr 1A3; LI P 4✓ / 1 eL ehiel O / lle1 y Alteration of existing bedroom Yes I No Adding new bedroom Yes y No Attached Narrative . Renovating unfinished basement Yes Y No Plans Attached Roll - Sheet sa, ieNeiktiaiiitid= ar ectdi#ion'i i existi i ` ouiiiiii &iii lete iie iitt`i%Miiti: a. Use of building : One Family 1r Two Family Other . b. Number of rooms in each family unit: 'jam Number of Bathrooms r. c. Is there a garage attached? 1f eJ' � I / d. Proposed Square footage of new construction. ) Y ' Dimensions 6 c 1) e. Number of stories? f. Method of heating? j,( it ivecti‹0 ektby Fireplaces or Woodstoves 4 Number of each g. Energy Conservation Compl iianc . ( Masscheck Energy Compliance form attached? h. Type of construction be l`��� i. Is construction within 100 ft. of wetlands? Yes `No. Is construction within 100 yr. floodplain Yes t j. Depth of basement or cellar floor below finished grade f trs - l 1e id 0 ' E k. Will building conform to the Building and Zoning regulations? Y 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, iet-%� // L• t��J� , as Owner of the subject property hereby authorize & Li to act on my behalf, in al matters rela ive o work by this building permit application. Signature of Owner Date /+ . z I, Vit O f Ja Qy1•( LF ^,0 , 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 u / n /) der theerains and pe alties f perjury //b44-1 14,_60")1/ .1i Print i/t 4\ ;r 4 '___iic_____62 Signature of Owner /Agen Date i , 4 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 i Lot Size . Frontage l4 __ _ Setbacks Front � � __ -_ �_ �� _•...__ ' / . Side L )d R:.. Q-. L:_ R .__ Rear, __. Building Height ` _" Bldg. Square Footage 710 6 % I Open Space Footage % 0 (Lot area minus bldg & Pit parking) # of Parking Spaces Fill: 54 i (volume & Location) _ __„ _ .. _.. A. Has a Spe • l Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ^ O YES IF YES: enter Book Pages and /or Document #, B. Does the site contain a brook, body of water or wetlands? NO 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 e r IF YES, describe -size, type and location: D. phere any proposed�cfianges to or a loons o signs intended o th property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca tion, 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 WaterManagement Permit from the DPW is required. . , pE City of Northampton S ta gy � ofr e� Building Department Cu 0. lD el t ` . i - , i 212 Main Street Se . °veitability wa o i et e , . - Room 100 a 6ii k y 09 Northampton, MA 01060 tr1 o *- is , '�� ~ phone 413- 587 -1240 Fax 413- 587 -1272 P.1 ` ns � _ :l r��„ x �� -' �s-- iii ' '4 . 1 ,, ` , x "te ,, p.,. r „ 4,. t 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: I / 1 �6 Map Lot Unit u rmc j V r, dVr�r � LLL ' Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of ecor : j.. -4e11-.. il A ji dr-A144 ii_A U`, Name (Print) iz . Current Mailing Address: j Telephone L / /3_ ' - - _ Y 8 Signature / ! Q (1 Q 2.2 Authorized Agent: /� �� �� 1 i u (G ^ 37 ifse J, /�� � € Name Current /4 /4 2 Current Mailing Address: 7 1/43 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only c ompleted by permit applicant 1. Building 00 (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 ` 3 6. Total (1 + 2 + 3 + 4 + 5) ® ©(,� r D® Check Number / _ lCJ This. Section Forbfficial Use - dray' Building Permit Number. Issued: Signature: Building-Commissioner/Inspector of - Buildings- Date , File # BP- 2010 -0314 APPLICANT /CONTACT PERSON WILLIAM LABOMBARD ADDRESS /PHONE 37 PINE ST NORTHFIELD (413) 498 -5856 PROPERTY LOCATION 11 ORMOND DR MAP 23D PARCEL 037 001 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 /(L6 f , Fee Paid (P Tvpeof Construction: CONSTRUCT 6 X 12 MUDROOM /ENTRYWAYOFF EXISTING BREEZEWAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 060247 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION 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 2e zeo9 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. ] l .I .' " BP- 2010 -0314 GIS #: COMMONWEALTH OF MASSACHUSETTS 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 -0314 Project # JS- 2010- 000417 Est. Cost: $8000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: - WILLIAM LABOMBARD 060247 Lot Size(sq. ft.): 7535.88 Owner: YEH RUTH Zoning: URB(l00)/ Applicant: WILLIAM LABOMBARD AT: 11 ORMOND DR Applicant Address: Phone: Insurance: 37 PINE ST (413) 498 -5856 NORTHFI ELDMA01360 ISSUED ON:9/28/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 6 X 12 MUDROOM /ENTRYWAYOFF EXISTING BREEZEWAY 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 9/28/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo