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24D-098 (2) 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 rewires 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 ------ - - - - -- hermit- s- in-conjunction_to_thebuildi -ng 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. - Date Address of work location . • The Commonwealth ofMassachusetts Department of Industrial Accidents _W4 Office of Investigations 600 Washington Street Boston, MA 02111 - , www.m /dirt • Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (- Please Print Legibly �wl Name ( Business /Organization/Individual): f t51 g 1 'C2' Address: (9 L ,+‘ (( ; Pd1 City /State /Zip: Pe 4, rkO to3aPhone #: `I ( Q') 2 S Are you an employer? Check the appropriate box: Type of project (required): i' 1. I am a employer with 4.. El I am a general contractor and I . 1 employees (full and/or part-time).* have hired the sub- contractors 6. I:3 New construction 2. J (J �L_an_, a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship .autT have. no employees These sub - contractors have. g_ 0 Demolition working for me in any aci employees and have workers' Y c a P ty. $ 9. 0 Building addition [No workers' comp. insurance comp. ; nsurance_ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeownerdoin work 9 c � v d — —f 1. 0 glumbgrg 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 infomnation. t Homeowners who submit this affidavit indicating they are doing an 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 formation 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 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, tie advised that a copy of this statement may be forwarded to the Office of Investinations of the DIA for insurance coverage verification.. I do hereby_ certify under the pains and penalties o � perjury that the information provided above_i _true a correct. // ,S�rri �+o �1r Si • .. ture•��� ff,,— � I �� �� late: L - Phone #: _-' t (( - C / 2 �N — Official use only. Do not write in tf17S.arreu, to be c ompleted by city or town offciat City or Town: Permit/License # Issuing Authority (circle one): I.. Board of Health 2. Budding Departmen - t 3. City/Town Clerk 4. Electrical. Inspector 5. Plumbino Inspector 6. Other r Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction rv r e 4 C 2--- Not Applicable El Name of License Holder : � �� / J ______ _ ____________ ti ___ n H __ , t( ,_, _u_un„ qs9ct A.. I Expiration Date dred01 .AlkO (Oa ? _ 1 ° te e Telephone Si (' 2 ( 2 te 111111111110 - ' ______ , C� q 9. Registered.Home imProvementContr = ,<„ < .4n, ;. Not Applicable ❑ Company Name Registration Number Rt cce - K I� e — Addr s L � {�� f ! Expiration Date 48v �lP- I,TC < < Telephone q(? 2-? 70.E a ,v 0 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 ❑ 13» H w t ge>,lltp, :ile 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 ' amp o n • r mances, a e an. . - . +- . , . ener-al- Laws - Annotated. Homeowner Signature , s SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ixt Roofing ❑ Ur Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[] Siding [0] Other [0] y, Brief Description of Proposed (( a(0.� t (1--8 4- ( i _ -t � 7,r ( A) � ( C Work: R (�/1'k�.� -�G / T�Lt. � i I Q.(,)t,'",_, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes __72K_No f 1 ( 0 t) Plans Attached Roll - Sheet r 6a if.Nei/ house anctor addition to a istinq haLlslnci, "comptetethe fotl r lrin : a. Use of building : One Family k Number Family Other b. Number of rooms in each family unit: F-�' Number of Bathrooms C c. Is there a garage attached?//10 ,, / d. Proposed Square footage of new co 4, '� Dimensions e. Number of stories? / t � f � - - -- f. Method of heating? ( '"- H 1 .-- 1 .-- / -t f n ` Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck /4.------- ' Masscheck Energy Compliance form attached? h. Type of construction /VA 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 (1 s k. Will building conform to the Building and Zoning regulations? L Yes j% 'No .,/ I. Septic Tank City Sewer Private well City water Supply v SECTION Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject p roperty hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I �� r` ` `'P ` 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. c14 1/-.TopIN — V�) Print Na,' ®_ ' 1 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 Frontage Setbacks Front Side L R. Rear Building Height — Bldg. Square Footage _ % Open Space Footage (Lot area minus bldg & paved m , packing) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW • YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 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 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: Are any propose c anges to or a Itiori`s oi`slgns intended fa ? YES 0 NO S IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, cavation, 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 Water Management Permit from the DPW is required. A x City of Northampton Staff i 1?�ermit g 'Ar` , Building Department Girb � > ya 212 Main Street se.4 W• a a il ftW i , x Room 100 ���� � ����la� t� ��' �� � �� �� f Narthampto� -MA-41 f6n i _ .,;. .516 ans phone 413 - 587 -1240 Fax 413 - 587 -1272 P e p s 4 1 f x 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 5 . 7 tJa9 (•(r' `Os4 1 K () Map L.) Lot 0 q8 Unit 0 /� ,f� f fin t4 Zone Overlay District 1 /' l ' /11/4- EIm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: j' 8() itzi.rzif, I c ( P4 - - -- -- -e-a _R iLe-e- p-eveto44---AA-19-io5iR ' Name (Pri Mailing Address: iilb _ �� /,�li • Telephone II f i L-( "7 ? (—° Signature I t ` l / .5 V 2.2 Authorized Agent: 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. Budding 9 0 ® (a) Building Permit Fee 2. Electrical 1 c0 0 (b) Estimated Total Cost of Construction from (6) 3. Plumbing 4 0 Building Permit Fee 4. Mechanical (HVAC) 0 0 f`� 5. Fire Protection lam/ �j 6. Total = (1 + 2 + 3 + 4 + 5) F 0 Check Number 0 /P / ' This Section ForOfficlal Use Ot fy Date Building Permit Number: Issued: Signature: Building 'Commissioner /Inspector of Buildings •' Date File # BP- 2010 -0580 APPLICANT /CONTACT PERSON CHRISTOPHER RICE ADDRESS /PHONE 64 BUTTER HILL RD PELHAM (413) 256 -3080 PROPERTY LOCATION 57 WOODMONT RD MAP 24D PARCEL 098 001 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 /a1j[ Fee Paid /°�� Typeof Construction: REMOVE WALL & ADD 1/2 BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 49847 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Signa re 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. 5TWOODIt4ONT RD r BP- 2010 -0580 GIS #: COMMONWEALTH OF MASSACHUSETTS 3`: 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 -0580 Protect # JS- 2010 - 000827 Est. Cost: $12500.00 Fee: PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHRISTOPHER RICE 49847 Lot Size(sq. ft.): 11804 .76 Owner: RICE CHRISTOPHER H Zoning: URB(100)/ Applicant: CHRISTOPHER RICE AT: 57 WOODMONT RD Applicant Address: Phone: Insurance: 64 BUTTER HILL RD (413) 256 -3080 PELHAMMAO1002 ISSUED ON:12/4/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REMOVE WALL & ADD 1/2 BATH 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 12/4/2009 0:00:00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 4 eve _ KITCHEN BEAM 2 Pcs of 1 3/4" x 9 1/2" 1.9E Microllam® LVL T User. 4 J- Beam®6 1 2/8/2 009 .35Seral 4:50:14 NumbePM r. THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE Page 1 Engine Version: 6.35.0 APPLICATION AND LOADS LISTED • • 11' 9 1/2" 4 Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 8' Primary Load Group - Residential - Living Areas (psf): 30.0 Live at 100 % duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(pif) Floor(1.00) 0.0 60.0 0 To 11' 9 112" Adds To DEAD LOAD FROM WALL ABOVE SUPPORTS: Inout Bearing Vertical Reactions (Ihsi Detail Other Width Length' Uve /DeadIUpiift/Total 1 Stud waft 3.50" 1.61" 1415/974/0/2389 L1: Blocking 1 Ply 1 3/4" x 91/2" 1.9E Microllanl® LVL 2 Stud wall 3.50" 1.61" 1415/974/0/2389 L1: Blocking 1 Ply 1 3/4" x 9 1/2" 1.9E Microllam® LVL • -See (Level® Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Location Shear (Ibs) 2321 - 1950 6318 Passed (31%) Rt end Span 1 under Floor loading Moment (Ft -Lbs) 6650 6650 11775 Passed (56 %) MID Span 1 under Floor loading Live Load Defl (in) 0.210 0.382 Passed (L/654) MID Span 1 under Floor loading Total Load Defl (in) 0.355 0.573 Passed (L/387) MID Span 1 under Floor loading - Deflection Criteria: STANDARD(LL:L1360,TL:L/240). - Bracing(Lu): All compression edges (top and bottom) must be braced at 11' 10" o/c unless detailed otherwise. Proper attachment and positioning of Lateral bracing is required to achieve member stability. ADDITIONAL NOTES: - IMPORTANT! The analysis presented is output from software developed by iLevel®. Allowable product values shown are in accordance with current iLevel® materials and code accepted design values. iLevel® Engineering has verified the analysis. The input loads and dimensions have been provided by others ( ) and must be verified and approved for the specific application by the design professional for the project. -THIS ANALYSIS FOR iLevel® PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. - Allowable Stress Design methodology was used for Building Code UBC analyzing the iLevel® Distribution product listed above. -Note: See iLevel® Specifier's/Builder's Guide for multiple ply connection. Operator Notes: 30/12 LOADING g) 8TRIB, 60 PLF DEAD LOAD FROM WALL ABOVE PROJECT INFORMATION: OPERATOR INFORMATION: CHRIS RICE iLevel 57 WOODMONT ST 1000 Lincoln Drive East NORTHAMPTON, MA Suite 3B Marlton, NJ 08053-0805 Phone : 800-678-8787 Copyright © 2009 by iLevel ®, Federal Way, WA. Microllam® is a registered trademark of iLevel®. S: \Jobs 2009 \iLevel Downloads \Cowls Building Supply \KITCHEN HEADER.sms I eve 2 360 Route 101, Suite Bedford, Route 1 03110 - 2 Tel (866) 295 -2170 Fax (603) 218 -6167 December 9, 2009 Cowls Joe Baillargeon 125 Sunderland Road PO Box 9676 North Amherst, MA 01059 Re: Sealed Calculations iLevel® Project #: R09- 129071 iLevel® Service # for Calc. Pack: SR- 143535 57 Woodmont Street North Amherst, MA 01059 Enclosed are TJ- Beam® calculations for joist and beam applications that have been prepared for the above referenced project based on information provided by Joe Baillargeon, Cowls The calculations can be identified by the date and time in the upper left hand comer of each sheet: 12/8/2009 4:50:14 PM Many uniformly loaded joist and beam calculations can be verified by referencing the applicable span charts within the appropriate product literature. These common conditions covered by span chart literature may not have been addressed via individual calculations within this package. Each analysis reflects the iLevel product, depth, and size that can structurally support the input loads shown. The professional engineer's seal on this letter verifies that the analyses presented conform to accepted engineering practices and use code- accepted product design values. Although I have not personally reviewed the project plans or visited the jobsite, we guarantee that our products, as shown in the attached calculations, have been engineered to support the design loads provided in accordance with iLevel criteria. All notes and design load information shown on these calculations should be reviewed with the building designer and/or the local code official to ensure that the loads, spans, and other conditions are correct and/or acceptable for the specific application. Building inspectors and/or owners should identify the "Silent F1oor®, "TJI ", "Microllam LVL ", "Parallam PSL ", or "TimberStrand ® LSL" markings on iLevel® products to confirm that this letter is valid for the products actually' installed. Please feel free to contact me if there are any questions regarding the analyses, I can be reached at 1- 866 - 295 -2170. Sincerely, Kathy J. Do 4104 , PE t' Structural Frame Engineer _..,. Northeast Division DODMONT RD BP- 2010 -0580 t: COMMONWEALTH OF MASSACHUSETTS Block: 24D - 098 CITY OF NORTHAMPTON -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) =g or y : BUILDING PERMIT mit # BP- 2010 -0580 out # JS- 2010- 000827 .. Cost: $12500.00 e: PERMISSION IS HEREBY GRANTED TO: )nst. Class: Contractor: License: se Group: CHRISTOPHER RICE 49847 of Size(sq. ft.): 1 1804.76 Owner: RICE CHRISTOPHER H °nine: URB(104 Applicant: CHRISTOPHER RICE AT: 57 WOOL)MON T rRD l pplicant Address: Phone: Insurance: 54 BUTTER HILL RD (413) 256 -3080 PELHAMMAO1002 ISSUED ON :12/4/2009 0 :00 :00 TO PERFORM THE FOLLOWING WORK :REMOVE WALL & ADD 1/2 BATH 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:P.. [1-G ' Rough: /2 NO - House # Foundation: ...„ Driveway Final: Final: j �s /O 6k Final: / Rough Frame: ,7 C / , ..i4i F i det tv Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: dr k /g— `y 61.7". 6& Final: 1 2-/I-0 7 ; Smoke: Final: r j< of ttpea L THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc / signature: FeeType: Date Paid: Amount: Building 12/4/2009 0:00:00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo