32C-158 (2) •
15 Kingsley Budget Estimates
Demolition: Dumpster @ $500 500
Plumbing & Fixtures 6500
Electrical 4400
Lumber: framing/subflooring 1500
HVAC 0
Insulation 500
Doors 1100
Windows 0
Casework 2000
Sheetrock 2000
Bathroom Tile 1500
Wood Floor Repairs 0
Kitchen Appliances 0
Kitchen Cabinets, Counters, Sink 8000
Misc 1000
Paint 1000
30000
Brian Leibinger
Emily Franklin
15 Kingsley Ave
Northampton, MA 01060
To Whom It May Concern:
After purchasing 13,15 Kingsley Ave in May 2010, my intention was to rei
floor bath and eliminate the small illegal third bedroom. During removal o
unsecured floor joists fell through the kitchen ceiling, damaging walls /cabii
scope of work increased to include gutting the kitchen and replacing all joi;
bathroom and sistering joists under kitchen floor. Removal of plaster from
kitchen walls revealed the extent of knob & tube wiring and buried junctioi
decided to bring the entire units electrical up to code. I discovered that the
between units was not insulated. Plumber recommended replacing all plun
work continued plaster in other rooms was discovered to be completely del
lathe. At this point I am filing a new building permit to reflect the increase
work. I will be bringing the unit up to code (as much as existing- nonconfo
will allow) and replacing/overlaying all plaster with sheetrock. I will be IN
work myself with the exception of electrical and plumbing.
rcf
z,.
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
I, \ -er understand the above.
(Home owner /resident's signature regaksting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to rne.
Date J /c7
Address of work
location () ��K S Le- y'
/
OF "
The Commonwealth opfassachusetts
Department of Industrial Aecidents
Office of Investigations
600 Washington Street
Boston, MA 02111
, , www.mass.gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electri
Applicant Information
Name (BusineseOrganizationandivirinaD:
Address: •
City/State/Zip: Phone.#:
Are you an employer? Check the appropriate box: Type of pro
1. 0 I am a employer with 4. 0 I am a general contractor and I
6. 0 New
have hired the sub-contractors
employees (full and/or part-time).*
listed on theattac.hed sheet. 7. 0 Remo
2. 0 I am a sole proprietor or partner-
ship and have n "loyees These sub-contractors have. 8. 0 Deinc •
emolo_yees and have workers'
working for me in any capacity. 9. 0
[No workers' comp. insurance - comp....insurance.;.: - ,
required.] , 5. 0 We are a corporation and its 10.0 Electr
'3. 1J am am a homeowner doing all work officers haVe4xercised their 11.0 Phil
myself [No workers' comp. rieit of exemption per MGL
12.0 Roof]
insurance required.] t • : c. 152, § 1(4), and we have no
einployees. [No workers' 13.11 Or
comp. insurance reqUired.).
Any applicant -that checks box #1 must also fdl out the section below showing tbeirworicers' compensation policy information_
t Homeownera who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new a
1 -Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or n
employees. If the sub-contractors haVe employees, they must prcrvide their workers' conm. poliCy number.
l am an employer that is providing workers' compensation insurance for my einplOyees. Below is the
information.
Insurance Company Name:
Policy # or Self-Ms. Lic # Expiration Date:
Job Site Address: City/State/Zip:'
Attach a copy of the workers' compensation policy declaration page (showing the policy nuMber a
Failure to secure coverage as required Maar' SeCti6ii'25A 152 can lead to the ±othtion Of ci
fine up to 51,500.00 and/or one-year imprisonm* as well as civil penalties in the form of a STOP WO
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded n
the for insutance coverae verificion. - -4 77 -
f ro here,byc under the pains.and penalties ofperjury that the informationprovitledaboveistrut
Siznature: -- ?
- Date: /
Phone #: L ) 7 . . - - • •
Official use only Do not write in this area, 10 be completed by city or town'eicird
• City or Town: ". Permit/License #
Issuing Authority (circle one):
: 1 . Board of Health 2. Building Department 3. City/Town Clerk 4. ElectricalInapector 5. Plun
6. Other
Contact Person: Phone #:
,4011111111111111111111P
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Registered HHome Improvem Ca it actor .£.., x w e � Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G!L. c. 152, § 25C( 8)j
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 ❑
° .s e g Y I
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 Law and State of Massachusetts General Laws Annotated.
Homeowner Signature
F
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑
Or Doors D
Accessory Bldg. D Demolition ❑ New Signs [0] Decks ID Sidi
Brief Description of Proposed C`,t. t -e-A0V cLG""' re SL�p` ti' C k k+
Work: --- - -3-, Kq GkeC. #SI `1- P tNw.71 -f., Les e_ re S e_
Alteration of existing bedroom Yes i No Adding new bedroom Yes +)
Attached Narrative Renovating unfinished basement Yes _
Plans Attached Roll - Sheet
6 a iftt4166 ilzrWit r i !pia` itir i it le it t :
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
g. Energy Conservation Compliance. Masscheck Energy Compliance form ati
h. Type of construction
i. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floor
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,
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, < &! 1. 2 ..\- : ^ Qom'
Agent hereby declare that the statements and info tion on the foregoing application are true and accur
and belief.
Signed under the pains and penalties of perjury.
`3�- tom,,, 5 Le. 1\3 .-... v—
Print Name * 2.c.) / J
Signature of Owner /Agent Date
f
k
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 I I l I
Frontage f , ! l {
1
Setbacks Front j 1 i 6
Side L: I R: I L: R:! j , , I j
-�
Rear
Building Height "— = I
Bldg. Square Footage = 1 j % F =1 t
i
Open Space Footage %
(Lot area minus bldg & paved i --
parking)
# of Parking Spaces l 1
Fill: j —...11.....---..„....,—..-1
(volume & Location)
I
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued: i
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I I F Pa e j and /or Document #
a g K
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ,Date Issued
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: t
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0
{
IF YES, describe size, type and location: j
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.
*n
City of Northampton g
Building Department
212 Main Street
Room 100
2 p CV Northampton, MA 01060 a
��� phone 413 -587 -1240 Fax 413 -58 k 274
IAI
APPLICATION TO CONSTRUCT, ALTER, REP .1' IP � • VATE OR DEMOLISH A ONE OR TWC
SECTION 1 - SITE INFORMATION
1.1 Property Address: Vct ley Acki This section to be cor
MA O ( 0 D Map Lot
Zone Overlay d
°Etm St District e
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
C c F, 15 V.teti5 t ey AVE AJ 4
Name (Print) Current Mailing Add i 3 C y /
Telephone (
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official U
completed by permit applicant
1. Building 3 QOV (a) Building Permit Fee
2. Electrical 3 coo (b) Estimated Total Cost of
Construction from (6)
3. Plumbing a 000 Building Permit Fee
4. Mechanical (HVAC) ) ® 165j
5. Fire Protection f � 4 r /�
6. Total = (1 + 2 + 3 + 4 + 5) 9 x Check Num (5tsr C!�
� -36 6 This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/lnspector of Buildings
" I
File # BP- 2010 -1023 511A00,
APPLICANT /CONTACT PERSON LEIBINGER BRIAN & EMILY FRANKLIN O N
ADDRESS /PHONE 15 KINGSLEY AVE NORTHAMPTON (413) 464 -1673 0
iS SG4
PROPERTY LOCATION 15 KINGSLEY AVE
MAP 32C PARCEL 158 001 ZONE k t"
Nea
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid )
Building Permit Filled out Zf l( (y 9 F (,1�f1
Fee Paid r
Typeof Construction: RENOVATE 2ND FLR BATH,AMENDED 7/26 RENOVATE KITCHEN,
LEFT UNIT, REPAIR INSULATION,UPDATE ELEC& PLBG
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
INFORMATION PRESENTED:
pproved Additional pewits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Pla
Major Project: Site Plan AND /OR Special Permit With Site Plai
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 Availabi
Septic Approval Board of Health Well Water Potability Board of He
Permit from Conservation Commission Permit from CB Architecture Coi
Permit from Elm Street Commission Permit DPW Storm Water Mana
Demolition Delay
3a
Signature of Build O ff i cial Date
g g
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all 2
requirements and obtain all required permits from Board of Health, Conservation Commis
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Con
Planning & Development for more information.
15 KINGSLEY AVE '; g N O
GIS #: COMMONWEALTH OF MASSAC(
.Pap:Block: 32C - 158 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACT
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL
BUILDING PE
Peiniit # BP- 2010 -1023
Project # JS- 2010- 001510
Est. Cost: $30000.00
Fee: $180.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): Owner: LEIBINGER BRIAN & EMILY FRANKLIN
Zoning: Applicant: LEIBINGER BRIAN & EMILY FRANKLIN
AT: 15 KINGSLEY AVE
Applicant Address: Phone: Insuranc�
15 KINGSLEY AVE (413) 464 -1673 ()
NORTHAMPTONMA01060 ISSUED ON ::5/21/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK: RENOVATE 2ND FLR BATH,ANI
RENOVATE KITCHEN, SHEETROCK LEFT UNIT,REPAIR INSULATION,UPDATE'
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 /Chimne�
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/21/2010 0:00:00 $180.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner