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24C-054 (2) -7 ,./, c -�sY OW BY OWNER r FLUSH FRAMED BEAM WALL BELOW, ABV r - _ _ _ _ — 13 -5 , ` - `II CENTER TO CENTER STEEL POST / 1 �W i , E.O. EXT'G 1 4, -1" 13„ 4, -1" 1 4, -1" 12„ FNDTN R.O. R.O. 1' R.O. A5 KITCHEN 4 WOOD 3' 3' LOW /� PARTITION UP \ / - LIVING / WOOD 28 x 70 7 A5- _ CLOS FOR PNT o ® G -- (5)SHELVEE � � _ ° I CL i m r - -- - I 16 "D m o � z NEW STONE SLAB HEARTH E L , -%f ti,12" a °' © 1. I, I 1 DN `--, -I (5)SHELVES � i i .___ f 16 "D 32x 96 WD °' ^ I I COS MARVIN 3'x8' WD DOOR ' in IN CLAD FRAME DN = N 1 In 1T / FLUSH FRAMED CENTER TO CENTER STEEL POST EXT'G S ► P DN BEAM ABV DN ,�: -- !�� ,L s c r - - - 1i ) 10 L' - 1" q'.= 4' -1" q 4' -1" 1 i1 4' -1" 1 i1 8' -1" R.O. j R.O. 16 , 4 $ i„ R.O. R.O. STUDY 1 i WOOD ;n FRONT PORCH E.O. EXT'G FNDTN 1 1 I DN WOOD I I III/ RICE YUN ARCHITECTS Phone 413 -586 -4483 Fax 413 -584 -2898 DIPASQUALE /MCGRATH RES. 04 -21 -11 1/4 " =1' -0" PARTIAL 1ST FLR © PROPC 1/4" = 1 CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: 4 C Wood/ The debris will be transported The debris will be received at: Signature of Permit Applicant — Date Building Permit Number: j/ 1 1 �' ( DiPasquale/McGrath [page 4 of 4 } III In that this project's payment schedule is il 1I j ' not to be bank driven, CR &C is hoping to be working from ii ` 1 a starter fund of 50, 75, or 100k, which could be added to I , by clients as depleted by sub - contractor and material receipts turned in by CR &C. _J CR &C will work with customers to find immamommoo savings in both the final choices of finishes before the C ook project begins and efficiencies during construction to make O O the final cost $450,000 or less. (CR &C '/2 wage [2 men$301 RESTORATION& to start at $450,000). CONSTRUCTION If CR &C brings above listed in at $435,000 908 BERNARDSTON ROAD they will be due a 2.5% bonus (total = $445,800). If tasks GREENFIELD, MA. 01301 above (or close approximations) are completed for less than $400,000., the bonus due would be 5% (total= $420.000). 413-475-3833 CR &C const.Sup. Lic. #049 -209, HIC reg.# 132 -788 Inquiries to Bureau of Regs and Standards, One Ashburton Place - Boston,MA. Insurance inquiries to Finck &Perras- Main Street - Florence,MA. Benton i oo 'the Di' . squ. e / David McGrath , / ' If Dat e l' Date: /� / ! Date: 2 131-2,01 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 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 (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 Date Address of work location 7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investig,ations =.- 600 Washington Street Boston, MA 02111 www.mass.gov/dia • -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib 0 Name (Businessiorganizalionadivid.D: ,vi 10 rp 7 ( . ) 0k WI' 5 trig \a- h h, ( ic Address: # - ' A-0 " L°A11 • City/State/Zip: I 'CO )rr , 441 °/ Phone.#: 7ST- 3 g 3 3 - Are you an employer? Check the appropriate box: Type of project (required): 11 1. 0 I am a employer with 4. 0 I sin a general contractor and I 6. u New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet 7. 0 Reimodelinz 2. _N2 I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8• Demolition etwloyees ' . working for me in any capacity and have workers 9. 0Buildiug a [No workers' comp-. insurance required.] S. p We are a corporation and its 10.0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have xercised their 11.0 Plumbing 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' 13.0 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 afridaVit ineUcann,' g they are doing all work and then hire outside contractors must submit a new affidavit indicating such 1 C.ontractars 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. lithe sub-contractors have employees, they must provide their workers' comp. policy number Iam 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 hi:position of Criminal penalties of a fine up to 51300.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a &._e of up to 8250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of EiVistiations Of the 'DIA for insurance coverage VerifieitiOn. _ Ido here.bieerilh •%. - 1 f aa allies izltie say that the information provitlid_above:tiadlcorr_ect-11 e p Signature: • . (7 Dein. 1/451,, 4// ? 4 . y • Phone Official use only. Do not write in tit& 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: //7 Not Applicable ❑ Name of License Holder : (✓ (°�r'� / " r 1 l mik. o 44 2-69 r‘ �t License Nu � .er j OAS B v\ ow- g � h V /h ck. o t,io Address r atio Date � g6C/ c9 Signature 0, 2 , Telephone G /? q 4 8- / 0 4/.? #1-c3 S stered,tomelema ia4 Not Applicable ❑ �► J e t� t . L� , / _ice ,Yi 1 t`�� - k Company Name Rdgistra 'on u b r (c Address ' Expi tion Dat � I _ C I ALA 11 Telephone # 3 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 ❑ 11.. Home Ownerr_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 buildine 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 ❑ Accessory Bldg. ❑ Demolition New Signs [❑] Decks [[J Siding [❑] Other ED] Brief Description of 1 � _ .,� ,, . - Work: C6 me ( Pr posed ¢ i/1 1r�''d7� C�X./Yll� KIT 0‘ -f' R o o G Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a :;if [ et hot Jtl r i i+ : a�.ex til ctr tlusll z>: rl t th fa[ o na: 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 construction. 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 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 `- , 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 , 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 Nam - Sig ure of Owner /Age Date -, '' -. . / rte. / ,.. » r r Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Informa y ° .:4 , Existing Proposed Requiredy Zoning f'► j This column to + z filled in by `° ,. Building Departm�ht _ 1 y Lot Size 1 r _ , �� � { > r e Frontage Setbacks Front 1 I 1 I ._ _ £ 7 r___ _ i a Side L:1. F R:l L: R:1 Rear i , Building Height 1 J Bldg. Square Footage ; 1 - 1 % 1 1 = ' . Open Space Footage %• _ (Lot area minus bldg & paved ; _ _ ,J .. ......._.1 . parking) i # of Parking Spaces __ Fill: �� � ..� �..�..,.�..�, � ,...�.,,.�� _.r.�...�... (volume & Location) A. Has a Sp ial Permit /Variance /Finding ever been issued for /on the site? NO ( DONT KNOW 0 YES 0 t IF YES, date issued: d { • IF YES: Was t permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book € Pagel and /or Document # B. Does the site contain a brook, body of water or wetlands? NO CV DONT KNOW 0 YES Q 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 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 I0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r 0§ii,..94'-i" City of Northampto pro" s '�` � .� z�` � � . - i � �� � n - \\ : u ilding Department = r p - �$ 212 Main Street aki $ tt 7g . ,y ,.'t '. Room 100 � - .E ®. � �""-� v`i"'�'%'Northampton, MA 01060 4 0 phone 413 - 587 -1240 Fax 413 - 587 -1272 -� .'if :,z ., `� , ` ..ya�g�� *.�>.� �n� e B ru" iy APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 0 ('OI0 b 7 CIA — ,) i � t ly / , T bo This section to be completed by office 1.1 Property Address: 5 Wood l / 6utti e'1 v-e--ni.L-t_ Map Lot Unit e A Zone Overl District �,� Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: m/Z 1 d/ � k ir� -A1 S /�5 /r\ 411 Name (Print) / Current Mailing Address:,/i i Telephone / ' `Q Signature 2.2 Authorized Agent: y,� —r • g"� TO .. Fe/# 5 kA Name (Pnn))' /. Current Mailing Ad res ,,n a / 3 d Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Taal ( (b) Estimated Total Cost of O(/yyi tj (d Construction from (6) 3. Aumbing •1 Building Permit Fee 4. Mec i I (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �,�� Check Number ,Vo L This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date • File # BP- 2011 -0753 WO( DOSS TH IS iVntfi � 5 APPLICANT /CONTACT PERSON BENTON D COOK C) PJ S-maclk 0 o D (611 - 1 s . ADDRESS /PHONE 908 BERNARDSTON RD GREENFIELD (413) 475 -3833 0 cf P l f CAT E" PROPERTY LOCATION 55 WOODLAWN AVE MAP 24C PARCEL 054 001 ZONE URA(100)/ ul(�.�t,fi( 6- "TO SE F H() ffi-Z £G1 THIS SECTION FOR OFFICIAL USE ONLY: 1 ,,, PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out G Fee Paid Q �J Typeof Construction: COMPLETE INTERIOR DEMOLITION & ROOF FRAME New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 049209 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 Signature of Building Official Date 3/ 1 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. 55 WOODLAWN AVE BP -2011 -0753 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 054 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit # BP- 2011 -0753 Project # JS- 2011- 001246 Est. Cost: $9200.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BENTON D COOK 049209 Lot Size(sq. ft.): 14636.16 Owner: PASQUALE MICHAEL Zoning: URA(100)/ Applicant: BENTON D COOK AT: 55 WOODLAWN AVE Applicant Address: Phone: Insurance: 908 BERNARDSTON RD (413) 475 -3833 () GREENFIELDMA01301 ISSUED ON:3/25/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:COMPLETE INTERIOR DEMOLITION & ROOF FRAME POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiri D.P.W. Building Inspector Underground: Service: ,/ 44: Meter: 1 / lin Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Uil: Insulation: Final: Smoke: Final: Q k L/— 90 -(I THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU TIO S. 4 / 1 4 4. 4 .6 fac4 Certificate of Occupancy nature: FeeType: Date Paid: Amount: Building 3/25/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner