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32C-260 (40) ■ bC C . ..... •...■ `- 6' CO 14'-0" 1 LJ W wNC ROOM 7 _,N 1 4(), A-c, , rr- r �Zi h oe� �� .i HI OOM1 V / ii' 441 il.--J UNIT #4 M r �,� --I -� 03 635 SF R/ i1A -Ca L g •A� 1 i 420 _ _ PTO UNIT #.,_ r. c0 °1 Eal , °� 1 - 1••••• OPEN TO BELOW ' A ill ■ ■' ,o ' r1s/m a Y — RPM =gra 414,-C/t wii . loi,j1 0 1 i -6 � L it Q1 � ° i2 r +a lkici rr —ri 0 O UNIT # � 0 _ 1� ,� / -; Q,, 5� ON le 1 miw Cerl ) F-U _ ' Consulting ......... STAIR 6 BEDROOM 44" 36" J Design Ear n 1 i ■ I Amherst, MA 01004 v • ImeConsultIngDmigneom 6'--8" UNIT R 3C FLOOR ENTRY ROOF DOSING TERRACE MOW Ex Realm Mai DRAV NG DAM MIL; as• A2.2 0. UNIT RENOVATII�VS —ZIP FLOO Mien 4 Q Tt 1111 r - EXIST$G TBtRACF II n = I I tom '' � � ,� DECK Ca ' 825 Sf '11 I } / / / BEDR u lip L — i ?calif i___J 1111 ti t...4 i / & e 4\-1 ri _______ NEVN DECK a -1 AM ABOVE i I o 3' - El 1 —, - ci) dl s , ' 9 --0" it= !S!u:- II \ it IF . I a. -� ze Th - 1 I L i a L MI t t - i J - , di m. 0 0 L 1 t NEW DEOC I I BEDROOM w ABOVE L J (— — 7 �' g 111 ii>, 1 NEW �-- - r f- i,,H 1--/ EXIT 1 ! r- O I I H(Th0 t_ _ L _ ` — ' Consulting fal --.---'6( <; n BEDROOM #2 Design 675 V . \ IC 'T71 413. 253. 0090 � �� (� P.O. SOX 2943 Amherst, MA 01004 X V (P > BUIDNG ENTRY . CHIT --7V— RENOVATIONS EX$TNG TERRACE 1ST FLOOR Ratko Dew DitAWNG DAM AI*L B. !Ia — A2.1 1 INT RENOVATIONS FIST FLOOR qD 0set Nisi= A2J SCALE: IN • I' -0' ',d wial 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 hvo 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 )our), 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 iermits 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 me. Date Address of work location I * - . . , . • . The Commonwealth of Massachusetts Department of Industrial ACcidents --..: - Office of Investig,ations 600 Washington Street .... L -- • — ,z, Boston,1124 02111 www.mass.gov/dia , - - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly -: / Name (Busin' ess/Organization/Inclividual): "Ill n rle/ ,45 a 0 k,44.4. (*I - . Address: 577 -t7),lfa / 17 - /9 CAFIf-Pt / /9116' . ,6 City/State/Zip: - Phone #: ((Ls — ; Are you an employer? Check the appropriate box: Type of project (required): l 1. 0 I am a employer with 4. El 1 am a general contractor and I employees (fall and/or part-time).* have hired the sub-contractors 6. 0 New construction listed on theattached sheet: 7. "gRemodeling 2.. I am a sole proprietor or partner-- These sub-contractors ave ship and have no eloyees h 8. Derablifion empIoyees and have wOrkers' working for me in any capacity. 9 aBuilding addition [Ne workers' comp. insurance required.] , 5. 0 We are a corporation and its 10.0 /Electrical repairs or additions 3. 0 I am a homeowner doing all work officers beim 4xercised their ' 11.E1 Pluinbing repairs or additions myself [No workers' comp. nett of exemption per MGL 1-1 4, , 12.Li :cool repairs insurance requirecq t c. 152, §1(4); and we have no employees. [No workers' 13.0 other comp. insurance reqUirec1.1 *Any applicant that checks box #1 must also El out the section beloWshowhig their workers' compensation policy information. 1. Homeowneri who submit this affidivit incficating they are doing an work and then hire outside contraMors must submit anew affidavit indicating such. 2 Contmctors that ch this box must attached an additional sheet showing the name of the sub-contractors and state whetherar nottbose entities have employees. If the sub-commixes have employeeS, they must provide their workers comp. policy amber. 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 (showi.ng the policy n umber and expiration date). Failure to secure coverage as requited Mid& SeCtibir25A"OfMGL - C. 152 can lead to the iiiposition of ciiriiirt41 Penalties of a fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the forni of a STOP wolucoRDER. and a fme 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 ..,_..„ 5, . of the btA for insurance 66iiirilii iriiiffaiiiiiii ' -, , - '7, _ I de hereby , i under the .and pen - of perjury that the infOnnationprovided nbov't_t.ttnte.atuf_Corrert _ Sienatuie: At -e-el-f • . ' . 6ite; 5 . - 7 Phone #: 4 5 4 /gfi . . • Official use only. Do not write in this area, tO be completed by cky or town'officiaL , City or Town: . Issuing Authority (circle one): ' Permit/License # .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: ® J N Applicable 0 Name of License Holder : 4/C1 n pia 4.iat1s f o le y (/ (1 L( License Number 5 0 ›eret [ 5 r / N . DOT) 2 - h i l 1 Address OP / Expiration Da 3 C1 q /P/ Signature Telephone . , Not Applicable ❑ /Yz3 Company Name Registration Number Address Expi lion n to to Telephone 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 ❑ 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 ❑ r}� Or Doors 0 Accessory Bldg. ❑ Demolition E New Signs [O] Decks r id' ] Other [0] B O rief Description of Proposed / Y ` d•f d J Work: O Nil/ 44 !,4fp g , fk X /i 1J Alteration of existing bedroom Yes X No Adding new bedroom s No ■ Attached Narrative Renovating unfinished basement Yep �li 1Vo / tot. �,q yi Plans Attached Roll Sheet (_ %K I � ✓ d3 644 Wi • . • .• I li • CIS t t1[ ir1S1 ; ©rI f .. o iliti n 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 la - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, C d,(Ort- Mir -GS 161 1-L-C- , as Owner of the subject prope y her: • y authori .. iir .. :.:i N nL to - o, m m alf 11 - I ma - relative to rk authorized by this building permit application. if�� i i / 1 0 � _L:.. c 2s Si, ' '�" r �? !►• / - ` Date • w I cP R j AI , 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 pa penalties of perjury. yea 4 iJ C�le-774 hial'<l Print Nam ey c/71411 l Signature of Owner /Agent Date i . 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 1 H 1 1 i Frontage F i I ! Setbacks Front Side L:1 f R: L:E 1 R:r € [. , 1 `'_. Rear 1 . E i Building Height = Bldg. Square Footage I % i Open Space Footage % 5 (Lot area minus bldg & paved [ i S 1,j i - i parking) # of Parking Spaces Fill: 1 l (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW {h) YES 0 IF YES, date issued:I j IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW I0 YES 0 IF YES: enter Book ! Page Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q 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 0 NO S IF YES, describe size, type and location: 1 ; D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, e vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO ti! IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t • City of Northampton Building Department 1 ?- '� 4 : r��) 212 Main Street ffi �; ` 1 ROOM 100 ' Northampton, MA 01060 �y < phone 413 - 587 -1240 Fax 413 - 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO - FAMILY DWELLING SECTION 1 SITE INFORMATION M AY 2010 1.1 Property Address: r This section to be completed by office Q . 13e " /(44- 0.e ' 2' J Map i Lot Unit fi c e in, e ..„ ^ 1/ � "114-5> Zone Overlay District ` Finn St District ' . CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: lA' 0100+ LIP' .1 11 _ice 'i -/ __Li:.' 's .•0 - 00 - • 3 .1" 1 Na , e (Prin Current ailing Address: / / /js_ 2 — 6©� � ,I i ,_ I / Te l epho e 1 S 3 m Si 7�. li i � 2.2 Authorized Agent: . m. n he44-t 51 7 cePerZa / .‘ 7 At/e7:47/h4/4- 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. Building 2) (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of � / tli'd Construction from (6) 3. Plumbing M.) Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) r .�'ly Check Number /`� 6 I�7I This Section For Official Use Only Date Building Permit Number: Issued: Signature: r Z - - �.- -` Qft_ h �- i '7//0 Building Commissioner /Inspector of Buildings Date .D E r is k(' )t-ti ( iE 3 Fi. 1 ft a r ( Fn r Di(' f rzi6r_ To ex-45 ti IN Ffc71r N) s 90 POMEROY TER BP-2010-1017 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:jlock: 32C - 260 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- 2010 -1017 Project # JS- 2010- 001501 Est. Cost: $28510.00 Fee: $171.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALAN A MARTINBEAULT 86044 Lot Size(sq. ft.): 23304.60 Owner: POMEROY TERRACE LLC Zoning: URC(100)/ Applicant: ALAN A MARTINBEAULT AT: 90 POMEROY TER Applicant Address: Phone: Insurance: 517 FEDERAL ST (413) 519 -1888 () MONTAGUEMA01351 ISSUED ON:5/17/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMO SUSPENDED CEILING UNIT 2 & 3,NEW BATH & DECK - UNIT 3 -DECK REQUIRES ENGINEER REPORT PRIOR TO RGH INSP 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 5/17/2010 0:00:00 $171.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo