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24A-187 4/12/2010 Steven Zucchino 70 Gleason Road Northampton, MA 01060 Work to be done for- William Adams 45 Jackson Street Northampton, MA 01060 Project specifications - Build wall in master bedroom to create a walk in closet /dressing area. Wall to have a 4 -8x6 -8 full lite primed, fir, center hinged door unit. Wall to be framed with 2x4 KD studs, 16" o.c., %" drywall, taped and sanded. Base board to match existing, door trim to be flat poplar same width as existing trim. All materials and labor needed to complete the project will be provided by the contractor. All project related debris will be removed by the contractor. Any painting, staining and clear coating is not included and will be provided by the homeowner. No electrical is included or needed. Permit 50.00 Debris removal 35.00 Materials cost 1176.00 Labor 2100.00 Total cost 3361.00 Terms - In advance $1000.00 Upon completion 2361.00 Total $3161.00 /4 ci/ / z } W illiam Adams Stev Zucchino Dil .171 Grit? .I lr ± c .r. _°PF TMENT OF BLPLDOG INS?ECTiONS "14 R 212 M g Main Strtct • Municipal Building. Northampton, MA 01060 1" HOME OWNS D L yE7�FTinNr A CKNOWT.PDGFMFNT 11 V.�12� �! 7r15 u s�i J - . 0 - ...- The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 to act as his "ner construction sup -. , sot. 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 bacldilI). sonotube holes (before pour), a roush building inspection (before work is concealed). insulation inspection (if required) and afnal builddin2 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 -w-ark can- .be,insp.ected.- If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above_ (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location c The Commonwealth of lkrassachaserrs e., ar:meni of fjzdzisrrrial _ cc dents _, ,. Office ., -- G of In vesiig a ions t.,— 600Washin� on Street Ki Boston, M4 02111 ��=- �. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busines/Organinon� dt� divii): 54 vex-, Zvc -c-Pi j ' Pk) Address: iv (' 71e 4 1Sr -, far-,c_P A6i4l' , NA oi'- - City /State/Zip: Phone. -: /3 575- Sr I Are you an employer? Cheek the appropriate box: Type of project ( required): 1. ❑ I am a employer with 4. El am a general Conti actor and I employees (full and /or part -tee) - have hired the sub- contractors 6 ❑ New construction am listed on 1 4-,,, at sheet i - ri RemodeI_n_g i 2. XI a a sole proprietor or partner - ship and have no -- ployees These subcontractors have g. ❑ Demolition working for me in arty y capacity. employees and have workers' comp. irlst2"allce. 9. ❑ B iiId addition I tom' o workers' cow: insurance required] 5. 7 We are a corporation and its I O_❑ Electrical repairs or additions 3. ❑ I am a homeowner dome all work rk officers have exercised their 1 I.❑ Plumbing repairs or additions myself [No workers' comp. ins ance re rift of exemption per MGL 12.[] Roof repairs letL] t c. 152, §1(4), and we have no q)// employees. [No workers' I3. Other !I(T21 •� i�S comp. insurance required.] -- ----- •:,toly applicant mat caerz Dom r.1 must azo WI out me lemon oe :ow snowmg Meer wu b.... compensation policy miormanoa t Homeowners who submit this amdavit indica* at. they are doing all work and then hire outside contractors must submit a new aim indicating such. :Contractors that cheek this box mastattached an additional sheet showing the name of the sub- contactors and stale whether or not those entities have employers. If the sib- contractors -have employees, they must provide their workers' comp. policy nut be. Iam an employer that is providing workers' compensation insurance for my employees Below is the policy and job size _information. Instn ance Company Name: Policy # or Self -has. Lic. #: Exph Date: Job Site Address: Cite /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 tinder Section 25A of MGL c. 152 can lead to the imposition of crinai al penalties of a fi ne up to S1,300.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a Erne of up to $250.00 a day against the violator. Be advised that a copy of this statement rn y be forwarded to the Once of Investizations of the DIA for insurance coveae verification. I do hereby ce� s under the pains and penvl es of perjury that the information provided above is true and correct. •f S1Q*at,r-°` _ - ,l vow' - V ' . Date: i 0 Phone #: I L1 /3 5 Xarer ij n O iciai use only. Do not write in — this area, to be completed by thy or town official Ci' or Town: -- ___ _ -- P� tint- tZicense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone ._: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su pervisor: Not Applicable ❑ Name of License Holder : S1 }I &Vvt Z,(CJ� i i 1 1 O `S 2.135t 634;c11 / ,� License Number - 7 ° C4e Mif�"lti►^► /s ff�, �-1At V 3i/ 20i, Addr- / Expiration Date o o�'v,',� . , . ,t . LA / . ,, , Sig . re 'l/ 57 5-- )-�- j s' I Telephone 9. < Registered 'Home Ireprovement Contractor. Not Applicable ❑ 1 Company Name Sctw Registration Number . c,; 6 . C . € CjiiJ oio Address Expire ion ate 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 SA No ❑ 11. - Home Owner Egelmp -ti©n 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 Slate of Massachusetts General Laws Annotated. Homeowner Signature 1 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 14 Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks fl Siding [0] Other [O] Brief De cri iRn of Proposed L 1 j 4 i 19 c J Work: N. ; ii =m isu STer 1 1 1 ., -k GYP,, c W4 / LA dress; h ci r e , N 1/0 eI�` - ir:c... Alteration o f ex bedroom „., Y No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa, If New and Or add on to existing housing, c o mp lete the foll a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new constr .. Dimensions e. Number of stories? • f. Method of heating? ireplaces 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 wetlands? Yes No. 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, W Ilse, w, MA RI S , as Owner of the subject property hereby authorize j1 - 11 Zt/ oil a Vt b to act on my be in all a ers relative to work authorized by this building permit plication. ►� � Signature of Owner Date 1, , vet 7 u cc.VI i A o , 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 Na Jr Wi 1, A / -v / - , 010 Signa re of Owner /Agent . Date i Section 4. ZONING I All Information Must Be Completed. Permit Can Be Denied Due Td Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size _.. _... I Frontage .. _. Setbacks Front Side L ..,...._._. L: R ....._. Rear I _ ,__ Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved narking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO cA DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Oa" DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO i:® 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 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grad''a, ex avation, or filling) over 1 acre or is it part of a cumnron plan that will disturb over 1 acre? YES 0 NO 440 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department .Curb Cut/Driveway Permit 212 Main Street Sewer /Septic.Availability rv � Room 100 Water/Well.Availability ,� } V Northampton, MA 01060 Two Sets of Structure t Pla " 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 This section to be completed by office 1.1 Property Address: / Map Lot Unit Li 5 J AA S tx- ki ,k+i, Av., pta-, , f4 Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Wii1 /i cA Ws JA -ksx, S-h -t Name (Print) Current Mailing Address: (7 r � Telepho e Signature 4'13 -'S g- y _2 7 22 Authorized Agent: 5 Iie M 70C vt Zo Gr x =S , a OKic , Icy 44 4 �► - a-, !iii Name (Pr', / Current Mailing Address: Signature S Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 3161 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ®.� Construction from (6) 3. Plumbing Building Permit Fee A 4. Mechanical (HVAC) 5. Fire Protection i./ 6. Total= (1 +2 +3 +4 +5) 311,, I Check Number 65-9 y 5 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of buildings Date File # BP- 2010 -0920 APPLICANT /CONTACT PERSON STEVEN ZUCCHINO ADDRESS/PHONE 70 Gleason Road NORTHAMPTON (413) 584 -3878 PROPERTY LOCATION 45 JACKSON ST MAP 24A PARCEL 187 001 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 Fee Paid Typeof Construction: CONSTRUCT CLOSET IN BEDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 021356 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9 MATION PRESENTED: L 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 ta Signature of Building 0 ficial 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. • 45 JACKSON ST BP- 2010 -0920 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 187 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 -0920 Project # JS- 2010- 001357 Est. Cost: $3161.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEVEN ZUCCHINO 021356 Lot Size(sq. ft.): 6490.44 Owner: ADAMS WILLIAM R Zoning: URB(100)/ Applicant: STEVEN ZUCCHINO AT: 45 JACKSON ST Applicant Address: Phone: Insurance: 70 Gleason Road (413) 584 -3878 N O RTHAM PTO N MA01060 ISSUED ON: 4/20/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT CLOSET IN BEDROOM 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 4/20/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo