25A-131 Jeffrey Bott Contracting Nancy Mihevc /Debbie Kehini
32 Pine Street 51 Day Ave
Florence, MA 01062 Northampton, Ma 01060
413 584 6251
Deck Project:
Phase 2
20' -11 3/4"
8' -0" 10' -0"
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Existing Deck: Two steps down to Pool level \`���` \ \ \ \ \ \�� _
12' x 28' o Itt§X‘ \ \ \`i�` \ \ \ \``
,-,. SX. 111■ _
NI *V
`` \\\\ \\ \ �` 4 94 Concrete piers
\ \ \ \ \ \ \ \/ 20" at bdSe tubes
k \ \ \ \ \ \` 48" below grade /
7 each
French door into house `
\ \ \\ . Beams:
existing • -% • 2 -2x10 pt 6'9" spans
Existing House
oig
L Existing Above ground Pool 2x8 pt joist 16" on center
approx 16' by 30' 10' span with 1' cantilever
Deck surface:
5/4x6" Trex decking
Rail system:
•
TradeMark Select
post to post 6' between posts
i
// N
v, / /
7 Steps to grade
, 6-4—e Front/ Side Porch p g � e d
;--oc--(7--MC 6,L7-/
. _ _ The Commonwealth of !Sfassacnlcse s
_ ;. -i"- D p r t-re nt of Industrial .-I cczderts
— Office of Ir_ vesti.-ario. =ts
- 600 I7 asking ton Srreet
_- -- Boston, MA 02111
=
www_mass.gov/dia
Workers' Compensation Insurance ffldavit: Builders /Contractors /Electricians; Plumbers
Applicant Information Please Print Leaib1v
Fame (B usinessiOrgantzaron fIncividual): :.,_`4 { 4- ._°.• .. : T .'i is-...., .
... `. , 'i_ _ y` ti «., , . `I_=
x
Ci*. tate, /Zip: 1--- L_ � C � '' 1 '\','.----
L-- ice' *" " , z .) i c,G Phone g: 3 I 'I L.' j .,.r . c-, :
Are you an employer? Check the appropriate box: Type of project (required):
1. yi I am a ernployer with �- n I am a general contractor and I ❑
employees (full andior part- tune)_* have hired the sub - contractors 6• New copse ucdon
2. ❑ I am a sole proprietor or parmer- Iisted on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have S. r j De:noliaon
employees and have workers'
working for me in any capacity. 9. Building addition
[o workers' comp. insurance coma- insurance.-
required.] 5. W e are a corporation and its I 0. [] ElectncaI repairs or additions
3.
❑ I am a homeowner doing all work officers have exercised their 110 Plumbing repairs or additions
myself. o workers' comp. right of exemption per MGL .,
1_ 0 Roof repairs
insurance required ] ' 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 ^il out the section beiow showine their workers' compensation policy inforrnation.
Homeowners who submit this affidavit indicsan_ they are doing ail work and then hire outside contactors 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 whetter or not those a [pries have
employees. lithe sub- contactors have employer, they must provide the h workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job sire
information. r Employer-C-5 // �j
InsuranceCorn_an C-1 4T e•V7 /1 v24r'I Ga
Policy 1 or Seif -ins. Lic. #: Oa- Se" ° ( 2- Expiration Date: to l25 / /2....
Job Sire Address: 5 1 DA AV E-
• City/State /Zip: (2 $d ec)
Attach a copy of the workers' codpensation 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 andior one -year imprisonment. as well as civil penalties in the form of a STOP WORK" ORDER and a fine
of up to 3250.00 a day against the violator. Be advised that a copy of rhs statement may be forwarded to the Office of
Investigations of the Di^. for insurance coverage verification.
I do hereby cer riff under the pains andpenalries of perjury that the information provided above is true and correct.
vs Li <(2I,,
Si?1att re: 411v fNif Date:
Phone Li� 8 ki b2g. 1
1 �
l i Official use only. Do not write in this area. to be completed by cin- or town ogiciaL
1
City or Town: Permit - License
Issuing authority (circle one): j
1 1. Board of Health 2. BuiidIng Denar lent - . Ciry Town_ Clerk Electrical Inspector 5. P!u:: b ng Inspector
I
6. Other II
■
l - ,' i; Contact Pe- sail:: Phone -:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : V eM/ e OAt
License Number
32. F'fE 5c'�fZ �t.�� �e1� c�- on4 . G s o5 3 15'7
Address Expiration Date
S 84 C.25-1 J j
Si 4 Telephone / 1 1' 1
YYY
9. Registered Home Improvement Contractor: Not Applicable ❑
( 0 t2- 2:1
Company Name Registration Number
Address ,cam Expiration ate
3Z 5t' �LySe.e"Ct- r ift ft Telephone S €
-
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 T No ❑
11. - Home Owner Exemption
he current exemption for "homeowners" was extended to include Owner - occupied Dwe ' s of one (1) or two(2) families
an• • allow such homeowner to engage an individual for hire who does not posses cense, provided that the owner acts
as supery : CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Ho : ner: Person (s) who own a parcel of land on w • e /she resides or intends to reside, on which there
is, or is intended to be, a o • two family dwelling, attached or • ached structures accessory to such use and/ or farm
structures. A person who constru ore than one horn. • a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the • •'ng Off • , on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed u • e building permit.
As acting Construction Supervisor yo •resence on - 'oh site will be required from time to time, during and upon
completion of the work for which permit is issued.
Also be advised that with re - - nce to Chapter 152 (Workers' Compe : ' • n) and Chapter 153 (Liability of Employers to
Employees for injurie • t resulting in Death) of the Massachusetts General . • • otated, you may be liable for person(s)
you hire to perfo work for you under this permit.
The undersi q• ed "homeowner" certifies and assumes responsibility for compliance with th- tate Building Code, City of
North.... on Ordinances, State and Local Zoning Laws and State of Massachusetts General La • • notated.
Homeowner Signature
I
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing r
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks 64 Siding [p] Other [lam]
Brief Description of Proposed
Work: t=- rk V C•k I7 2-50 Sc p- • G.‘ 5,0s. 4. Pvp\
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes >C No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
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
I, /v iv N C y t R , as Owner of the subject
property � ��
hereby authorize Z3 v"Q
to act o y behalf, in all matters relative td.work authorized by this building permit application.
i c71
6"" ._ / / "
9
Si nature of Owne Date
1, Se..-Pra✓ S o ` \ , as Owner /Authorized
Agent hereby declare that4 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 Name `
77-4
Signatu AlVwniii -nt 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 11 10411-312° 0 : 31100
Frontage is
Setbacks Front )5'0 ( 27Li
Side L: $ R:5 L:,--k-01 t, err
_ .„ _
Rear 17.5.
Building Height
Bldg. Square Footage oO 1. % rSO• i7
• Open Space Footage %
(Lot area minus bldg & paved j:0 /
parking) 31 3) %CO
1
# of Parking Spaces
(volume & Location) •
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO tli) DONT KNOW 0 YES 0
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® 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 c3) DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
0 , Date Issued: i
C. Do any signs exist on the property? YES 0 NO 0
_
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: 1
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 G
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,i,-.,_:--.7..- _ i _ ,_ .
c +
i
[ r. .
, .
��' Department us only
. + City of Northampton Statusn Perm 4 - . . , `� 1,
uilding Department G D n v e n a prow- 4 .
•
_ - 212 Main Street Sewer /Se Y,Viab §4 -,,
Room 100 W at e r/Welt 4lva lab : 4 k , 4 ,
Ile 1 2 LU11 No hampton, MA 01060 T e • k ` F . .4
f Strutu .
phone • 13- 87 -1240 Fax 413- 587 -1272 P ) r a s
pNsPEG 0" s rS ecify #,
1"...7Sl A TION 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
s t tJ -A1/41 kilt- Map Lot Unit
l �T Pm M Zone Overlay District A 01060
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
t AhcLi f t / 16 1) C , v bG ^,G
C, / PetO tu 5 t D o,vs
Name (Prim) Current Mailing Add ss: Ss loll
' L
. _ - - _ II Telephone
Signature
2.2 Authorized Agent:
Te FTC- -� B .5 PiN. - PI-09-0A C�
Name (Print) Current Mailing Address:
Sign:' 1 Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building
/ C, 7 ga (a) Building Permit Fee
2. Electrical i� (b) Estimated Total Cost of
w/A Construction from (6)
3. Plumbing iti/ Building Permit Fee
4. Mechanical (HVAC) � * OD
A(
5. Fire Protection ,
6. Total = (1 + 2 + 3 + 4 + 5) 8, Cf gQ Check Number SS . L5 A y, ea
This Section For Official Use Only
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # eggAivJj
APPLICANT /CONTACT PERSON JEFFREY BOTT
32 Pine Street FLORENCE (413) 584 -6251
PROPERTY LOCATION 51 DAY AVE
MAP 25A PARCEL 131 001 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 55 iL9n
Fee Paid
Typeof Construction: EXTEND DECK ALONG SIDE OF POOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 053157
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOMATION PRESENTED:
L7Approved 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
Demo ' ion Delay
Sn of Bui ding 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.
51 DAY AVE f • BP- 2011 -0822
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A - 131 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Fein,it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit # BP- 2011 -0822
Project # JS-2011-001351
Est. Cost: $11480.00
Fee: $69.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JEFFREY BOTT 053157
Lot Size(sq. ft.): 39683.16 Owner: MIHEVC NANCY T & DEBORAH KEHNE
Zoning: URB(100)/ Applicant: JEFFREY BOTT
AT: 51 DAY AVE
Applicant Address: Phone: Insurance:
32 Pine Street (413) 584 -6251 Workers
Compensation
FLORENCEMA01062 ISSUED ON :4/15/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: EXTEND DECK ALONG SIDE OF POOL
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: J L fid Li-! ' 1 CIViVk
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final: /�,�/ �BZ`1
Rough Frame: VK ° Z —/ /
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: o j‘—°4 — // CfVI/
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND RE
4/ iS
Certificate of Occu.anc : (nature:
FeeType: Date Paid: Amount:
Building $69.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner