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0P SMITH COLLEGE
Facilities Management
Smith College
Northampton, MA 01063
T (413) 585 -2400 F (413) 585 -2398
August 4, 2011
'LC
/NIir, ? ?20I1
City of Northampton
Building Inspector's Office - asr3c sNSpEcrioNs
212 Main Street ,ov rr�o,oso
Northampton, MA 01060
Dear Mr. Holsbrook, Mr. Miller and Ms. Church:
This letter is to confirm controlled construction intent on Duckett House (41 Elm Street) by the owner;
The Trustees of the Smith College. Smith College has authorized Goodnow Construction to make safe
and replace in kind two egresses from said building, with your permission and the Historical
Commission's approval. This general maintenance is the owner's responsibility under Massachusetts
Building Code 780 CMR 103.0, 103.1 and 103.2.
Please contact me at 585 -2412 or jlucey @smith.edu, if you have any questions.
Sin -rely,
amen Lucey
Manager of Building Trades
GOODNO V
CONSTRUCTION
413- 296 -4387
"It's Al! Goodnow"
225 Old Chesterfield Road
Williamsburg, MA 01096
Job location:
The Duckett House
41 Elm Street
Two small front porches
To whom it may concern.
I Douglas Goodnow plan on remodeling just the rotted areas of siding, bead board, and any rott
internally. Most of the work will be with the roof, gutters and Exterior walls. Most of the woodwork on
the porches will be reused and if any needs to be replaced, it will be matched exactly to original look. All
materials being used will be red cedar siding, and if any profiles need to be matched they also will be
cedar. Thank you , Douglas Goodnow..
SMITH COLLEGE
Facilities Management
Smith College
Northampton, MA 01063
T (413) 585 -2400 F (413) 585 -2398
August 4, 2011
City of Northampton
Building Inspector's Office
212 Main Street
Northampton, MA 01060
Dear Mr. Hasbrouck, Mr. Miller and Ms. Church:
This letter is to confirm controlled construction intent on Duckett House (41 Elm Street) by the owner;
The Trustees of the Smith College. Smith College has authorized Goodnow Construction to make safe
and replace in kind two egresses from said building, with your permission and the Historical
Commission's approval. This general maintenance is the owner's responsibility under Massachusetts
Building Code 780 CMR 103.0, 103.1 and 103.2.
Please contact me at 585 -2412 or jlucevtsmith.edu, if you have any questions.
Sincerely,
James Lucey
Manager of Building Trades
The Commonwealth of Massachusetts
Department of Industrial Accidents
- Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information , Please Print Legibly
Name ( Business /Organization/Individual): O �n S 4 t , `
Address: c� ,�� LAC (. � I.�s � ur j41A-A- P-0
City /State /Zip: turf i 1 , dAr P1 A Phone #: R - ter' 3r 7
Are you an employer? Check the appropfiate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
epafroyees (full and/or part- time).* have hired the sub - contractors 6. El New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. „ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.E 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 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 nacre 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 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 $1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: -� 1 '�-'�- - Date: / g/1
Phone #: 4 1/j° 4 't-/ 3 7
Official use only. Do not write in this 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 #:
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No I
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 6-401 f L' as Owner of the subject property
hereby authorize � � &CVO AfeW
act on my behal , i all matters relative to uthorized by this building permit application.
7- 13 /1
Signature of Oiler Date _ ...... .. ........_ .
I, / o v. `° v _ G . of iL � ' . �!� r ` ..._ ... _ ..__._ .._... , 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.
( AL" s � Cc , roe,../
Print Name
t%rture of owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
License � I �� g
pt, faS lS�cd...
Number
Address Expiration Dat
ld ir 3 7....
natur Telephone
SECTION 13 -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 0 No 0
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
C. er- 5 t l _._ a � . Not Applicable ❑
Company Name:
Responsible In Charge of Construction
aS 1,t. 8_0
Addre
ignature Telephone
•
1
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L.' R........_.. _ L :.............: R.
Rear
Building Height
_..
Bldg. Square Footage .
Open Space Footage
(Lot area minus bldg & paved
parking)
# 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 YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained
, Date Issued
C. Do any signs exist on the property? YES C NO 0
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
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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
t
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE i+„ . —
Interior Alterations xisting Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ME Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ '
Brief Description Enter a brief description here. Re_th c&-j 1AI tte-A P ®r (-- A J f e c �. {
Of Proposed Work. LL „ , 6 ) „ "i✓' e^�. 1r
p �! r � n ...__ At t!1 ____..tUI' -i ....` $6rn'e" .... � iS C ' ` , 5 ... s" -i ll) � 1 J
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational 2B r ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
s Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
-
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: . ___ .. .... ............ _____ Proposed Use Group:
_
Existing Hazard Index 780 CMR 34): ..,_ _.._.., _ . __ Proposed Hazard Index 780 CMR 34): . _ ,,
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 S t
1 51
_.. 2
2nd nd
3rd ..... ,._... 3 rd
4
4 th
4 th
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private El Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
•
Version1.7 Commercial Building Permit May 15, 2000
C7epartmertt use oOly ,, t
- City of Northampton Sta F at l er it '
ECEI I =: 1 • • ' epartment Ct r utlDnyeway l ermtt �
M -in Street Sewer /Septt radabt ty�
Ro ( u m 100 1�ltater/#�1(ell �Cvatlabllity
C�Oikhamp • n, MA 01060 Two Sets of S uctural Plans
phone 413 - 587 - 1 40 Fax 413- 587 -1272 Plot/Sife !darts`
DEPT. OF ,
Other.Speclfy
— NORTHAV
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
e -a Map - 3 [. Lot 2 Unit
p . . )o .s )S ,t/ C ,./(12 Zone Overlay District
✓ _.F Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
.. ... `C nl ca �t,.� _ 124 A dam �t
Name (Print) c/ f j /L/n � 3 11 6 Current Mailin Address.
,des z-1
Signature S'b £ . V 751 ^1 1 / Telephone
2.2 Authorized Agent
b au /wS
Name (Print) / Current Mailing Address
Signature �/ r." , i, ■ Telephone
SECTION 3eSTI ATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /}b ° (a) Building Permit Fee
2. Electrical Q (b) Estimated Total, Cost of
Construction from (6)
3. Plumbing Q Building Permit Fee
•
4. Mechanical (HVAC)
�ry
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) fj g Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Date
Building Commissioner /Inspector of Buildings
File # BP- 2012 -0076
APPLICANT /CONTACT PERSON DOUGLAS GOODNOW
ADDRESS/PHONE 225 OLD CHESTERFIELD RD WILLIAMSBURG (413) 296 -4387
PROPERTY LOCATION 41 ELM ST Duckett House
MAP 31B PARCEL 224 001 ZONE URC(100) / /EU
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
✓Building Permit Filled out
✓lee Paid I+ j T I 2 J 76 a of
Typeof Construction: Repair Porch
New Construction
Non Structural interior renovations C(yU,-E
Addition to Existing
Accessory Structure 1 I-2A \ "
Building Plans Included:
Owner/ Statement or License /
3 sets of Plans / Plot Plan
THE F LOW NG , TION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATIO P '1 SENTED: 4k . ff o
Approved .4k Additional permits required (see below) '� pp,, B OARD PERMIT REQUIRED UNDER: § rJ"` 1 N C
C1 - .
cv
PLANNING j. )
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan 5 (r0 W
Major Project: Site Plan AND /OR Special Permit With Site Plan 1 LL, .4NC)
ZONING BOARD PERMIT REQUIRED UNDER: § t `
-
� ` lA
Finding Special Permit Variance* �rufU
Received & Recorded at Registry of Deeds Proof Enclosed a 'CY( ��
Other Permits Required: ��'
J CO OQ
Curb Cut from DPW Water Availability Sewer Availability cif U
G
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee /
*.•tc
Permit from Elm S tttrrreet Comm ion _ Permit DPW wrm Water Management
emolition Del.
i
..„... . 2 ..,-V ' ( ..., P
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.
41 ELM ST Duckett House BP- 2012 -0076
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 224 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Porch Repair BUILDING PERMIT
Permit # BP- 2012 -0076
Project # JS- 2012- 000114
Est. Cost: $9500.00
Fee: $57.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DOUGLAS GOODNOW
Lot Size(sq. ft.): 51400.80 Owner: SMITH COLLEGE OFFICE OF THE TREASURER
Zoning: URC[100) / /EU Applicant: DOUGLAS GOODNOW
AT: 41 ELM ST Duckett House
Applicant Address: Phone: Insurance:
225 OLD CHESTERFIELD RD (413) 296 -4387
WILLIAMSBURGMA01096 -9318 ISSUED ON:8/22/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: Repair Porch
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 8/22/2011 0:00:00 $57.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner