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31B-023
Joanne Shea 19 Aldrich Northanpton.hia 01060 413- 586 -2158 • Cellar Stars Five new 2"x 8 "x 11' - Floor lout at 16 "o c Clumne-s . Foundation .\ Foundation i / aihtiou Bean 3 new 24" x24 "x12' / deep counete footings .4 steel lolly cohunns 6 "x 6 "x New Center Bean Chimney J 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 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 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 , The Commonwealth of Massachusetts -- Department of Industrial Accidents . Office of Investig,ations E--Wie.uV,' 600 Washington Street t i; , - ENE --• i .# „ 1/4,.. .- z .-..... : , Boston, MA 02111 , . www.mass 0 ,--- -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letriblv .' Name (BusinesilOrgarliiation/Individual): .f. -e- .•..,' .I. .. - ' .. -•. - _.... _ e , C. i" ‘1--e..) • )5.- ,,. Address: i9, 0 - is c x - 13 r • 0io50 City/State/Zip: iNiti...A 0146.. Phone.#: J4 (3 — /.'CL? Are you an employer? Check the appropriate box: • Type of project (required): • 1. ET I am a employer with Q._ 4. p I am a general contractor and I 6. 0 New co ' 'on have hired the stib-contractors employees (full and/or part-time).* listed on the'attached sheet 7. 0 Remodeling 2. 0 I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. 0 Demolition employers have workers • working for me in any capacity. 9 0 Building additiOn [No workers' comp . insurance required.] . 5. 0 We are a corporation and its 10. repairs or additions 3. 0 I am a homeowner doing all work officers haVe4xercised their . .,. 11.E3 Phnnbing repairs or additions myself No workers' comp. right of exemption per MGL 12.0 Roof repairs . • insurance required.] t • p. 152, §1(4); and we have no employees [No workers' 13.1);', Other S' r a. 0 • V • comp. insurance recpfired.l. . 1L ./Q p t ,s *Any applicant that checks box #1 must also fill out the section below showing their worlcets' compensation policy information. 1 1. Homeownert who submit this affidavit incficating they are doing all work and then hire outside contractors must subtnit a new affidavit indicating such. 1 Contractors that check this box must attached an additional sheet showing the nal= of the 50i-contractors and state wile:tb e'. or notthose entities have employees. If the sub-contractors have exoployeeS, they must provide their woricers comp. policy number. 1 am an employer that is providing workers' compensation insurance for my einployees. Below is the policy and job site information. . Insurance Company Name: A SS 4j6:11471--e..) kyl p / e ye kS "TA) C OR_ A4)Ct) r Policy # or Self-ins. Lic. #: 5 pe) ?"..k5 301 a() i ( Expiration Date: - S / /I/ /a Job Site Acidress: tel AI-'L. 44- - . City/State/'Zip Mel cy 0 620 - : Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage . as requited Mid& SeetiOn 152 can lead to the iiiiPOsitiOriOldiMin4i penalties of a fine up to S1,500.00 and/or one-year irnprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of rfifeiiiiitioniaf the for insurance : CON;eATE ' 7 • ---.-- _ .1" do herebycertiAl under the painsttnd penalties of:perjury Mat the information providitittbalizzaeorrecl. _ Si . • tire: • • I. ________ — / ( , • 1 Phone ii: /I/3 — &IC/ 7 i 1 - 1 C I ' - • Official use only. Do not write rn this area, to be completed by city or townofficial • 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: r ^i l.P Not Applicable ❑ ,� Name of License Holder : I) f1 \ Q V. 'lam (,t) S 5 S 0 " ,t i 8' License Number 0 ' 2 ) 0 y 3 . - 2cil' 3 J,JA /0 00 (9 IOS0 (T /9q( / 9 . Address Expiration Date f L Vt Signature T e ; ,W"• -,:� _= NotA Applicable ❑ :u�R� � � , viii: "�` ,d en# Oon4ra or� . ` >.�" � ��.... ° , �,� �.: • ~ PP \e S\ D nre i .�') r,.^ 14-. 4- CA-'� i 4 1 1 1 Company Name Registration Number \C t?. D6x fi r') NteiJ ..-) `11 a n to Sea ) el ( Re) ( Address Expiration Da e Telephone 4('3 - k&? -- ? 1'{ ? 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 ❑ , 4-!.:.-t o m e a E x em ption 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 ED Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [D Siding [p] Other [I] Brief Descrip on of Proposed ,, `` Work: ( A ___ e _ a • • A. , t_ _ di c P >►lr- .1 Alteration of existing bedroom Yes No Adding new bedroom Yes No 1 0 G� Lrj Attached Narrative Renovating unfinished basement Yes No A `) (V1 be.J2- tr Plans Attached Roll - Sheet \ Q .0 C © h, YV A.)' i 3 64)ft ew house a" di on toexlst €nq house i mDfete th a fotiawi a: 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 1, 1. AYQ ^S `N-f , as Owner of the subject property hereby authorize 1 0Q \,Q - 0 ok,t,,i7 `e fit to act on b half, in all matters a to work authorized thorized by thi iding permit application. ‘s' Signature ner Date (� � '� 7 t, Y E.- , as Owner /A� th ent e declare that the statements and info on the foregoing application are true and accurate, to the best of m`y'krtsswfedge Signed under the ains and penalties of perjury. ° Ck c \e Print Na ei,..-C--"– [ l'ICY & - 3 — I I Signature of ne ent j Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inco plete Information 1 Existing Proposed Require by toning This col to be fille lidil Building artment 6 ' Lot Size i 1 .:„, i " Frontage `. _ H 1 i Setbacks Front {,---1 ; i i I Side ! L: ! R ' L :i R :' Rear 1 = 4 Building Height —" � , Bldg. Square Footage 1 = % 1 = 1 __ . Open Space Footage % (Lot area minus bldg & paved 1 .. 1 1 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Spe- at Permit /Variance /Finding ever been issued for /on the site? NO ISI DONT KNOW 0 YES 0 IF YES, date issued: 1 1 IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book Page i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ,d! DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained i Obtained ,Date Issued: C. Do any signs exist on the property? YES 0 NO ♦! IF YES, describe size, type and location: ' 1 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: I E. Will the construction activity disturb (clearing, grading exc - ation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES i NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 4 , 1- 4 - Ci of Northampton St s ' i. A RE CEIVED B (ding Department Main Street j : 5y �S s @ w, Room 100 . o ampton, MA 01060 g { • • • • • I - • 13- . 87 -1240 Fax 413- 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: A ‘, ) R.a L� �� This section to be completed by office Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: D /V A /A) 'e--- S L t, eo._. 1 `I 1o‘ 1,) 124 "_. /Aia "'IL-hi 'l ✓ -- Nam rint) 1 Current Mailing Address: Telephone Signatur 2.2 thorized Agent: p & \f t 14 6,tz k P o. go x 2 3 /4)..44f.� /v, rnV 010 s 0 Name Current Mailing Address: � 1- - ''' ' , ' .�- f- 7 " t„LA,, A1l 3 - G„ ZI 7 — 3 1 t{ `t 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 I a ° 4'c 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) <5 1 1 hi • Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -1086 APPLICANT /CONTACT PERSON DALE HAWLEY ADDRESS/PHONE P O BOX 273 HUNTINGTON (413) 667 -3149 PROPERTY LOCATION 19 ALDRICH ST MAP 31B PARCEL 023 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 99 9C CO Q Fee Paid j Tvpeof Construction: REPLACE GIRDER BEAM,FLOOR JOIST,SET FOOTINGS & LOLLY COLUMNS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 055048 3 sets of Plans / Plot Plan THE FOLL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 emolition Delay ignature 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. 19 ALDRICH ST BP- 2011 -1086 GIS #: COMMONWEALTH OF MASSACHUSETTS Map :Block: 31B - 023 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -1086 Project # JS- 2011- 001750 Est. Cost: $11450.00 Fee: PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DALE HAWLEY 055048 Lot Size(sq. ft.): 3136.32 Owner: SHEA MICHAEL H JR& JOANNE SHEA Zon ing: U RC(100)1 A F',e ieant: nALE HAW . FY AT: 19 ALDRICH ST Applicant Address: Phone: Insurance: P 0 BOX 273 (413) 667 -3149 HUNTINGTONMA01050 ISSUED ON :6/23/2011 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE GIRDER BEAM,FLOOR JOIST,SET FOOTINGS & LOLLY COLUMNS 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: O K t-,sry (f'f Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final• 04644, THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE - T O► .,. Certificate of Occupanc A0011111117, • nature. * /14" 4."444.4 FeeType: Date Paid: Amount: Building 6/23/2011 0:00:00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner