36-159 Oct 21 09 12 :54p 8604295725 8604295725 p.2
Other:
• Gutters and downspouts will be installed on both ends of the carport
• Where the carport meets the existing home, the siding on the home will he
removed and step flashing installed along the roof line of the carport, and the
siding reinstalled
• The utility wires from the utility pole leading to the home may need to be
repositioned.
• '1 'he carport will be wired with two over head exterior fluorescent lights over each
hay
Oct 21 09 12:54p 8604295725 8604295725 p.1
Carport Installation
1112 Burts Pit Road
Florence, MA
October 19, 2009
General Description:
Contractor will install for the homeowner a two bay carport attached to the existing single
family home at 1112 Burts Pit Road.
The carport will be installed on the east side of the home and will measure approximately
23' wide and 24' deep by 9.5' to roof ridge, 8 foot wall height
It will be constructed of wood framing, pre- engineered truss roof system, asphalt 30 year
shingles. The carport will have no enclosed sides and a cement floor. The carport
enclosure will include the existing steps to the home.
Specifics:
Flooring:
The floor shall be 2500 psi concrete with fibermesh reinforcement poured to a depth of
6" The pad shall measure approximately 23' wide by 24' deep. The resulting debris shall
be removed from site and disposed of off site.
Support Footings:
A total of ten sona -tube footings 10" wide by 48" deep. The cement ;hall be. 25-00 psi
concrete. The footings shall be placed approximately five feet apart.
Support Posts:
Shall be 6 "x6" pressure treated pine fastened to the sona -tubes
Trusses:
Pre engineered pine truss. at 16" on center
Decking:
The roof decking shall he 4x8 CDX plywood ,
Roof Material:
GAF 30 year, architectural shingle, color to be determined. A ridge vent will be installed.
Trim:
The trim shall be Azec trim board color white.
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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
regulation Th e ins ction_-procesa reeires 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
--------- - - - -pe nits -in conjunction._ to the- buildingpermir _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
21- c - 4(4- n I understand the above.
(Rome owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
T —_
Address of work , )
location / / /z-- ' 2a'' /• T , </
J The Commonwealth of Massachusetts
Department of Industrial Accidents
1 =Nom ' Office of Investigations
— 600 Washington Street
t, - 1- 1 0-= z ' Boston, MA 02111
-`,��, www.mass.gov /dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):
Address: -
City /State /Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required): I'
1. ❑ I am a e Io. er with 4. fl I am a general contractor and I
y 6. ❑ New construction
employees (full and/or part-time).* have hired the sub- contractors
2. El I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling
ship asrcl have. no PTMployees These sub - contractors h 8. ❑ Dernolon
working for me in any capacity. employees and have workers'
wor
8 P ty 9. ZBuilding addition
[No workers' comp. insurance comp. .;nsuranr-e_:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3 I am a homeowner-doing-all-work- work _. - - - -_ _ - - -o_f cer have rcised err _ _ - 1 - 1 - . -Q - Plumbing 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. ❑ Other
comp. insurance required.].
*Any applicant that checks box #I must also fin 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 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
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 51,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and afire
of up to $250.00 a day against the violator: 1 e advised that a copy of this statement may be forwarded to the Office of
Investitiations of the DIA for insurance coverage verification
.
I d hereby certify under the pains and penaftr s of perjury that the information provided above _is_true_and_correct __ _
Signature: _ Date:
Phone #:
O ff i c i a l u s e o n l y . Do n o t Willi i n this areaJ be comp e ed by city or town offu iaL
City or Town: Permit/License #
Issuing Authority (circle one):
- . I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
6
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9..Registered Home Improvement Contractor Not Applicable ❑
Company Name Registration Number
Address Expiration Date
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 IX No ❑
11.. - Ho � em p i 4n
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.
Alco be advieed that ninth refer -nretn Chapter 157 (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 under this permit -- ---- - - - - --
The undersigned "homeowner ",certifies and assumes responsibility for compliance with the State Building Code, City of
T irt hampton U ` -- ma Sta' - an • o . - . ' . !-- . ," . # w o .- - o - s-General- Laws- Annotated.
me owner Signature . ' '''% / 6Kls - « 1-
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ® Replacement Windows Alteration(s) Roofing n
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [L Siding [D] Other [D]
Brief Description of Proposed r
Work: / tit e/. f <,2_3 X -2
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes v` No /
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house' and:or .addition to existing housing, complete the follollrinq:
a. Use of building : One Family V Two Family Other
b. Number of rooms in each family unit: , f S i i) } Number of Bathrooms 1 XI 4 1
c. Is there a garage attached?
d. Proposed Square footage of new construction. , f_5 - 5:2 4'. 77 Dimensions
e. Number of stories?
f. Method of heating? fr'9 Fireplaces or Woodstoves / Number of each 4
�� 47,
g. Energy Conservation Compliance. i ✓A/ Masscheck Energy Compliance form attached? A //T
h. Type of construction l l"4/)2
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 ') C rI i U t ' =j
k. Will building conform to the Building and Zoning regulations? X Yes No .
I. Septic Tank City Sewer X Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, - , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
, 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.
Print Na)ne
SiOature of Owner /Agent orate/
°t
• f
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 leo
Frontage /CU' 7 1
Setbacks Front
Side L. / L:j° R: 20,
_4(1
Rear
Building Height 9 7 _40
Bldg. Square Footage
Open Space Footage _
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(voltam & Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Leeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ^ Pagel and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained
Obtained
0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D — Are there iiijiproposeifetiaTigeditia - 161 -- the property ? YES 0 NO 0
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
�- Darnext (3se onfy
City of Northampton Status of Pernr#
. - , 'Building Department Curl CutCC%xekay P rc r
212 Main Street SertuerlSeptt�raalabli#
4 }
� Room 100 Wa �eE�AVa�lab
- L ' ` � (orthampt n, MA 01060 3 e OS tcturaUPta , '
phone 41,a-58' Fax 413- 587 -1272 Pl�ti e Ptarts
APPLICATION TO ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: /
/ Z. 13a rs a i f /t - / Map Lot Unit
`!u r kic'e "{ e /(Jo Z. Zone Overlay District
Elm St District CB District
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
f ti e-1 ( k. ,b. , ��rr
Name (Print),,(/, cA,e e fS rts,KorCurrent Mailing Address:
��O`�'° - dalL_O \cc"' . f Telephone
`Signature ('S%3) - yytz a jz. &/.2 i G r- 3 3 .Po'
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. Building - ,j G, (a) Building Permit Fee
2. Electrical ... (b) Estimated Total Gust of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) o c' 0 Check Number /Of 51 °
This Section Fnrffficial 4gP �11t1
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP -2010 -0498
APPLICANT /CONTACT PERSON BURROWS BARBARA M & MICHELLE D KWASNEY
ADDRESS /PHONE 1 112 BURTS PIT RD FLORENCE (413) 587- 9952 0
PROPERTY LOCATION 1112 BURTS PIT RD
MAP 36 PARCEL 159 001 ZONE SR(100) / /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /�`
Fee Paid 7
Typeof Construction: CONSTRUCT ATT 23 X 24 CARPORT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO IffiKATION 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
0 % / t_r
Signature of Building Officia 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.
IliMattESM Ral BP- 2010 -0498
GIS #: COMMONWEALTH OF MASSACHUSETTS
M ap;Block: 36 - 159 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 -0498
Project # JS- 2010- 000687
Est. Cost: $7800.00
Fee: $110.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10497.96 Owner: BURROWS BARBARA M & MICHELLE D KWASNEY
Zoning: SR(1000WSP 11 Applicant: BURROWS BARBARA M & MICHELLE D KWASNEY
AT: 1112 BURTS PIT RD
Applicant Address: Phone: Insurance:
1112 BURTS PIT RD (413) 587 - 9952 ()
FLORENCEMA01062 ISSUED ON :11/6/2009 0:00:00
TO PERFORM THE FOLLOWING WORK :CONSTRUCT ATT 23 X 24 CARPORT
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 11/6/2009 0:00:00 $110.40
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo