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24C-127 (4) Pan for Washing Machine 1 Blocking 7' -8.75" I i' DiaAnchors @ 6' O.C. W/ 7" i Additional Foundation 18'-11.5" 3'-11" 10" Min Pier Varies 12" Min, 18" Max EmbedTyp & Support Wall Under At Deck Typ UNO Washer& Dryer Only 8 " Foundation Wall Typ UNO 6" Max --- ------ - -- 4" ____i_______ l l — 2' r 4 Typ UNO 2'-7" #4 @ 4' O.C. Typ ' ' I ' -9.75" 8" Typ - Min 4' Typ 2", Typ 1 1„ T 6" I ► t 5'-1.7 yp y a ter- - 5' —1 -10 � � . � ►� ��►�► � ► -14 a• 4 T �' I 7'_ 5'r -- � 4t, TYP ■ U N O �.. — f I a. : 1'-6" Typ 1' -6" o 7' -3.5" i Demo Existing Foundation t. Wall To Interior Grade ■ 4' -8.75" I ___4____L 1--- [-1' II 6" Wall - 1' Footing �I 1' -4" T yp �1 �► ; 1' -4" Footing Typ UNO — A Footing & Foundation Wall Section . E . L _ T , Extend Bulkhead WalisTo Scale:z" = 1' 1' Foundation wall Elevation 3' -10" with # 4 Dowels @ 2' O.C. I 4x4 Architectural Post i Drilled ( and Grouted Into PA i , Bulkhead Walls Double 2X10 PTL Header PI l W/ Plywood Spacer 2X8 PTL Floor Joists @ 16" O.C. Embedded Post Connector — 8 "X8" PTL Post Notched for Header 1 10" Min Precast or CIP Pier 13' -10" LI 2 - #4 Rebar \ 4' Typ \ T / \ Precast or CIP 1' min ` Pier Footer 1 I 1' -6" Min I-- L _ - Pier Foundation Section Typ [.....____ 7' -9.5" -i Scale:? = 1' Scale: - = 1' FP Notes: Project/Address Owner Contractor Title Sheet 6 All Footing, Pier and Foundation Wall Concrete is 3000 PSI 108 Franklin Street Colin Milberg Renaissance Foundation Plan Norhampton, MA 10160 Lisabeth Kirk Builders Date: 8/31/2012 ofXSheets 24' -8" r ____#_!! :" „- / 4'-.25” 2X4 PTL SedP atei i'� Expansion Joint 16" Footin T 6X6 10/10 Welded g yp 0 4 ' Dia Anchors @ 6 Wire Mesh l O.C. W/ 7" Embed g 4 8" Foundation Wall Typ --H Varies 12" Min, 18" Max A _- 12" Max Compacted Control Joints ----- -- / } Subbase M. At Mid Slab 2' I / / Transition Slab Compacted 11'- 15.75" 9 , #4 Rebar @ 4 O. C. 4 Subgrade 8 " 4" concrete floor slab Min 4' Typ 2 _r " 1 „ I� 1 z 4 "Typ 4" a 7 1 4 Typ ---1 y 4 ', 1' -6" qv i F 9.25" y / 1 / , ' _L 3'- 7.75" 1'-4" --1 1'- 9.25" /! / 1/ / Ai/f! //J /zA A Garage Footing, Foundation 1 ----- I Wall, & Slab Section 2X4 Framed Wall Typ Scale:4" = 1' Unconditioned Garage ; Scale:2' = 1' Notes: Slab Concrete 3500 PSI, Walls and Footings 3000 PSI Project/Address Owner Contractor Title Sheet 108 Franklin Street Colin Milberg Renassaince Garage Foundation 5 Driveway is top soil & pavers over 3" surface mix over 4" crushed stone W/ fabric above & below Norhampton, MA 10160 Lisabeth Kirk Builders Date: 8/31/2012 Plan ofxSheets .., .Y , .. Plot Line e , f 24'I� 1 ' TYP R7 '7/7'/ y , / Try /r , >' --r /'r7 , r ✓r ` , / / j // `r J s s tr r / J i /;, > r fr, ,✓ >r > r%/I >` / f/ ✓r ia ! , n �f/ /, f / r r ;/, r r //,/; J f `Jr V > ./ f . r / r . ' I JJ // f i� / ! ,•r %/0 , r �/ /� ✓ 16 Yr2 1 >, . Proposed one story!,; ,�f/ .441`"J 22 -5.2 �, a >; single car garage ✓r / / { , > ✓ „,,',1':::1;24 Proposed Driveway ✓/ r , 384 sqft add //,2 > 11 > r r /-',/,,,,//7 f f 180 sgft add 1 4 Cii) I 9' -10.5” ' �,f',7":,f <,? ` r' ; !f r r ' ' j wii " j / � i` f / ,,, , rrr //,/' J .... 0 d i -"------------------________ 4' r 6 i , 't .,..,.z.,_..Z.Zz2,_-_:::L_,-,f,_,Zz222,,, ■ LINO 46' -4.4" �7 -3." 0 1' Proposed ° 0" 1 ' TYP 6' -8.9" � " 3' -3.7 �� se 1.0 o h opod 2 1 s ft t 5 ` .1 ` � • sto addition 0 " , �' , - ft add i / /// / / / /. Ts• 00 0 7' -6 1 i ; s 225 w 17' -4.9" (1) D_ ,� a+ - s =r�' ; r I �,- n � C 71' -.8" yi..- is .10 ,.` P 7c am -2,/,', � m ' s f► j 5 o'i / - ,.- -- — gle dwelling uni y 0 51 Y , 1 1.0" ° ° N N /,', , Existing two sto sin W cl 0 0 ii ° ° N 4 =�' a o 7 ,-:c, Lo , 0.--0 l _ .,. C 9- - - -L. I n- 0 ca N t i Y 33' -7.8" c /� _ ____. 1 TYP J „,■,fi _______ 2 0 Roof 8' 11- Overhang > 3'- 10.0" 5' -3.0.. — — 1 I L 1 . € �;� � 12' -5.2" " 22' - 3. 0„ 1 , 1 vik Plot Line I Existing Drive Entrance 1 II No Curb on Western — — _ W estern Ave Scale: 3 = 1' Project/Address Title Sheet 108 Franklin Street Colin Milberg Mark McLeod Site Plan 1 1 Norham• ton, MA 10160 Lisabeth Kirk Dan Milber• Date: 8/21/2012 ofXSheets File # MP -2013 -0024 ✓ p_EG A Y ' APPLICANT /CONTACT PERSON MILBERG COLIN T & LISABETH C KIRK I L(, N6.2 1 , ADDRESS/PHONE 108 FRANKLIN ST (413) 586 -1932 () ��r„ "� r J � �� ^(� PROPERTY LOCATION 108 FRANKLIN ST MAP 24C PARCEL 127 001 ZONE URB(100)/ — tkE t - SG( re_NtE'J THIS SECTION FOR OFFICIAL USE ONLY: t` (• "�' 12 'AE' e PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 598 Fee Paid �U Kl Typeof Construction: ZPA - RELOCATE DRIVEWAY & 2 STORY ADDITION 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 INFQRMATION 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 ?A.:.3// 2_ 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 the Office of Planning & Development for more information. RED.- 1 AUG 212012 n,� File No. el sg p `1 =BJi mx Fb tja » . T (WT W.., PMI` T IQA K 2) Please type or print all information and return this form to the Building Inspector's Office with the $15 filing fee (check or money order) payable to the , City of Northampton 1. Name of Applicant: � ;v M. c, 2S Address: 1 U R i \;f Std Telephone: % —S - — elephone: � � � j q3 2. - Owner of Property: Address: j O: FruM /C 5 ��c 7 t Telephone: 3. Status of Applicant: Owner K Contract Purchaser Lessee Other (explain) 4. Job Location: 10 Fa-r1 1cl iy\ 6a e" �S? 14i ` ,5 , 4 ,N"` i• a K F •Par(ee10.��amk* la . ti �)?ar�et ' '©tstrictls) n ;lm Street Dtstt ict . In Central .Business,.Dstriic_ t. "' - O B FILLED IN B THE $t)ILD'ING'DEPARTMENT ) 5. Existing Use of Structure /Property: S rY1lC lr;tUvt I y 1.1.1 mO_ 6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary): FWD 5 4bcy P i4 f'n 0 !Vl t')Ve.. c c'i ve..l.'cy • 7. Attached Plans: Sketch Plan Site Plan X Engineered /Surveyed Plans 8. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW Xs. YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and /or Document # 9.Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , date issued: (Form Continues On Other Side) 8/4/2004 W:\ Documents\ FORMS\ original \Building- Inspector\Zoning- Permit- Application- passive.doc Sii $ S 10. Do any signs exist on the property? YES NO /C IF YES, describe size, type and location: • Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES NO X IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUIRED BY :ZONING Lot Size S J I S ig5 1 Frontage aC> .2o Setbacks Front 33`— 7" 15 � ti Side L: {(7 �� R: L: Fit i -7 R: t{ i ' L: R: Rear 53 . , , Building Height 24 o 1 Building Square Footage 4 25 % Open Space: (lot area / b30 minus building & paved 7 57,n- ( d FL parking _f # of Parking Spaces # of Loading Docks n _ b Fill: 0 (volume & location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: S/6 /20l2. Applicant's Signature c NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards, Department of Public Works and other applicable permit granting authorities. W:\ Documents\ FORMS\ original \Building- Inspector\Zoning- Permit- Application - passive.doc 8/4/2004 City of Northampton Massachusetts wv rr:. ( DEPARTMENT OF BUILDING INSPECTIONS x' `° 212 Main Street • Municipal Building Northampton, MA 01060 ' Colin Milberg 108 Franklin Street Northampton, MA 01060 24C -127 August 23, 2012 Dear Mr. Milberg, I have reviewed your zoning permit application regarding the addition, garage and driveway at 108 Franklin Street. Your proposal is approved provided you obtain a driveway permit from the Northampton Department of Works. Prior to a certificate of occupancy, you will also need to close off the existing driveway in accordance with their requirements. You may need to provide an as -built survey for the new garage foundation if you cannot provide clear evidence that it meets the setback requirements (such as locating the lot pins and stretching a line between them). Feel free to contact me if you have any questions. Respectfully, Louis Hasbrouck A ti, Building Commissioner City of Northampton (413) 587 -1240 Ihasbrouck(a city.northampton.ma.us Louis Hasbrouck From: Louis Hasbrouck Sent: Wednesday, November 14, 2012 9:26 AM To: 'stephen @renbuild.net'; 'carolyn @renbuild.net' Cc: Charles Miller Subject: 108 Franklin Street Attachments: 24C -127 108 Franklin2012- 08- 23.pdf Stephen, Carolyn Here's a copy of the August zoning approval for 108 Franklin Street. I'll approve the foundation permits but you may need to present an as -built survey for the garage unless you can establish the property line with pins and a string to show the required setback (see letter to Mr. Milberg). Let me know if you have any questions. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg 212 Main Street Northampton, MA 01060 (413) 587 -1240 1 Renaissance udders PO Box 272, Turners Falls, MA 01376 Phone (413) 863 -8316; Fax (413) 863 -9712 www.renbuildnet Stephen Greenwald, Project Manager License #013302 Massachusetts - Department of Public S ;ifct} Board of Building Regulations ,tnd Standards Construction Supervisor License License: CS 13302 STEPHEN J GREENWALD * \ 1 ..‘, . 390 MAIN RD GILL, MA 01354 -- - - -� --'- Expiration: 8/17/2013 t'nmmissiuner Tr#: 20115 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS Renaissance Builders Home Imporvement Contractor's Registration #106490 Fully Insured A` c ° CERTIFICATE OF LIABILITY INSURANCE ii�5�2oi2 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Robin Sargent NAME: g Berkshire Insurance Group, Inc. (A/C. No Exf): (413)773 -9913 IA/C,No): (413) 774 -3872 117 Main Street E -MAIL rsar ent @berkshireinsurance rou ADDRESS: g g p' com INSURER(S) AFFORDING COVERAGE NAIC # Greenfield MA 01301 INSURERA:Peerless Insurance Company 24198 INSURED INSURER B Continental Indemnity Company 28258 Gill Building Corporation dba INSURERC: Renaissance Builders INSURERD: PO Box 272 INSURERE: Turners Falls MA 01376 INSURER F : COVERAGES CERTIFICATE NUMBER:12GL , WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVn, POLICY NUMBER (MM /DD/YYYY), IMM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ r A CLAIMS -MADE rX I OCCUR OBP8862956 8/1/2012 8/1/2013 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG _ $ 3,000,000 7 POLICY I I I PF 1^ I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ — ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS -MADE AGGREGATE _ $ DED 1 l RETENTION $ ( $ B WORKERS COMPENSATION X I nc L MITS I I O R AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500, 000 OFFICER /MEMBER EXCLUDED? IN N / A 4 68473940101 1/1/2012 1/1/2013 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Operations usual to a building contractor. Project: Milberg Site Work. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Colin Milberg 108 Franklin Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE Robin Sargent /RMS`�`" ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD r:. .'1 • • (SUBJECT TO ATTACHED CONDITIONS 1 & 2) Permit No. D3 -13 Conditions: Driveway Permit In lieu of plan approved by the City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections, any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: Petitione nature Name: Colin T. Milberg Address: 108 Franklin Street Northampton, MA 01060 Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. For Commercial and Industrial applicants, a plan showing the proposed driveway with grades, location and Planning Board permits are required. • Cc: Building Inspector u V Permit No. D3 -13 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 08/30/12 Check #: 1597 FEE: $250.00 THE BOARD OF PUBLIC WORKS Driveway must be staked and house & lot number posted The undersigned respectfully petitions your honorable body for: A new driveway, replacing existing one. Permission to install a driveway at: 108 Franklin Street Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All Drainage shall be directed off the driveway surface to adjacent land and not on the existing Roadway. Driveway surface to be paved as soon as possible if the grade of the proposed Driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City of Northampton in the event of a washout of this driveway. Code of Ordinances §350 -8 8 providing standards for private, individual driveways as amended by the City Council on October 15, 2009, must be followed. By: Colin T. Milberg Telephone: 108 Franklin St, Northampton, MA 01060 ' 13)586 - 1932 • .ture: - Proposed Location Inspection By. it ` e (� . $ 3 �"�� Gravel Base Grade Inspected By: Final Approval: THE BOARD OF PUBLIC WORKS voted that petition be granted. Edward S. Huntley, P.E. Director of Public Works Cc: Building Inspector 0 iJ tU-Akrin (on 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, 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 pie. Date Address of work location -, • .. T l - . \ The Commonwealth of Massachusetts Department o �. = De Industrial Accidents P f IA � � -� i t. _ . 4 ' Office of Investigations ==fill=.-- 600 n tt.rr 600 Washington Street : c!:l= y _ Boston, MA 02111 �, : • www.mass.gov/dia gov /dia • -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information - Please Print Legibly N e ( Business /Organi�ation � ,-i �; r l o - }br" \ el � . Cr) Kc f ScroCe a 9i 3ev.S J . • Address: PO - Sox 272 City /State/Zip: %icrne` Pails/A44/010 6 0 Phone. #: t i t /3 "t 3 — 83/6 - Are you an employer? Check the appropriate box: • •Type of project (required): / 1.15g I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub- contractors 2.0 I aai a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship .and have no employees These sub - contractors have. 8. Demolition • working for me in any capacity. 9 employees and have workers' - [No workers' comp. insurance : Du$ding "aildition [No CQIl]p. Iran .. required.] 5. 0 We are a corporation and its 10.0 Electrcal repairs or additions 3.0 I am a homeowner doing all work officers have xercisecl their 11.0 Plumbing repairs or aririitaons 1. 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' 13.0 Other .. • . comp. insurance required]. • 'Any applicant that checks box #1 must also fill out the section belowshowmg then workers' coition 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. . * C o n t r a c t o r s t h a t check t h i s box must a t t a c h e d a n additional s h e e t s h o w i n g t h e name of t h e sub - contractors a n d s t a t e whethe or not those entities have employees. If the sub - contractors have employees, they must provide their workers' camp. policy number. I am an employer that isproviding workers' compensation insurance for my employees Belo w is the policy and job site information. • Insurance Company Name: L-oo Pc? $&.\ .. c iv r ., CO 61:;.0 11>r Policy # or Self -ins. Lic. #: q 1 : 9 73940 ) 0 t Expiration Date: 1 /i 1 2.0 i3 Job Site Address: i dK Fromm aik Q-�, -4 City/State/Zip :'./ dL4AF00n MAI 00 Attach a copy of the workers' - compensation policy declaration page •(showing the policy number and expiration date). Failure to secure coverage:as required Mkt& Section' 25A of MGL c 152 can lead to the unposition of ad:Min l penalties of a fine up to S1,500.00 and/or one -year imprisonment, as well as civil penalties is the form of a STOP WORK ORDER and a fe 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 Investisations of the DIA for insurance'coverat a verification: . .. ; , _ - I do hereby certi; fy under the parns•and penalties of per,/ury :that the informat on provtded_above isirue_andcorrrrt Signature: • Date: - • Phone it: `tt 5C3 -05314 - • 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 #: • F- i SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S __ Not Applicable ❑ Name of License Holder : J � l 6 (attsua i 0 1 3 U � License Number `n � ocz d 6 — i l l , M f } 1 �f 07/2013 / Address Expiration Date % / 3 Si Telephone #f 1 41isteced l fcttire lm�roit line O rEf�eite ,. � ' ` u. ` al : Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVITi(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 pemvt. 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 A SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) , New House ❑ Addition ® Replacement Windows Alteration(s) El Roofing gi Or Doors I Accessory Bldg. © Demolition El New Signs [0] Decks [Z] Siding [CI] Other [0] i �p rt O % ' ■ Brief Description of Proposed `1 r r . [ Work: Fi�,rnA ib-cp: lr',c- AAA'1 ), t Cree-SO4� 41n t Gr 4� 5o, ¢ (.c,rc 2 CQnstr aJ' ,, Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes ?4 No Plans Attached /ta�cyh� Ryo 111 - Sheet y y� , 1� j ! (* r �F 6a. WINt ciViiii griffi ridaidVfi .ii i ealii 6r`I >6116ii t1sti: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: 5 Number of Bathrooms 1 ' S c. Is there a garage attached? /VC) d. Proposed Square footage of new construction. 1 OUn Dimensions 24 ‘'( I b 1 envy c f 2'1 Id AA •Ron e. Number of stories? I f. Method of heating? Pr,r.eil b.JO C r w /y Fireplaces or Woodstoves 'IJd' Number of each g. Energy Conservation Compliance. tiO Masscheck Energy Compliance form attached? h. Type of construction .wrc F,, 'r, el co,, -c)°^ d 4, ''"' cf"" i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade / g l I 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. )rC S ignature of Owner Date I, ( (4 r IL , 2 4 as Owner /Authorized Agent hereby declare that s tements 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. Cit •\ Vic:l Print Name / q% '1 t. s ignature of Owner /Agent 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 inby ; i Building Department r t Lot Size s � S-m ?� w j F � . Frontage r to 1A __ Y Setbacks Front' l 443-1 1 Side L: 4 " 9 R:I29 L:!'� 7 R:i 9 Rear 1S j x Building Height2't-C!f Bldg. Square Footage 1 O 1 1-1 % IA t 44 1 j i Open Space Footage %_ ,___.�; t (Lot area minus bldg 84 paved ! , 1 parking) # of Parking Spaces = — _ Fill: 5 C.,j_Jd P ;+e"ky ..il (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued:! c03/ I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW c., ' YES 0 IF YES: enter Book Page ? and /or Document # s 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 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 4j 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 0 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 Co IF YES, then a Northampton Storm Water Management Permit from the DPW is required. k City of Northampton A " b • - � "°�� "� : uilding Department ��: = = , _ * ��-� ° 3 V _ 212 M ain Street mr "��� 3 20 2 R 100 r ; , 4 ,- ,4 3�, i o amp MA 01060 13 -1; 7 -1240 Fax 413- 587 - 1272 O Fg U I S)NO Mp 010 TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMIL s+' es APPLICATION Y DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 1 e,. , q-1,4„(31,4. i " Map Lot" Unit s AAA C �l%� Zone Overlay District Elrn St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: �% /� ... a4t3 sss6 193 ) SiD ~£fl 2 SSA �/T 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 Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2.0 2. Electrical (b) Esti mated Total Cost of Con struction from 3. Plumbing Buil Perm Fee 4. Mechanical (HVAC) 12 171 5. Fire Protection 6. Total = (1 +2 +3 +4 +5) Check Number / � -'r® Phis Section For Official Use Only Date Budding Pemmit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0556 APPLICANT /CONTACT PERSON RENAISSANCE BUILDERS ADDRESS/PHONE P 0 Box 272 TURNERS FALLS (413) 863 -8316 PROPERTY LOCATION 108 FRANKLIN ST MAP 24C PARCEL 127 001 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 /6 7 7 0/ Fee Paid Typeof Construction: CONSTRUCT FOUNDATION FOR 24 X 10 ADDITION, 24 X 16 DET GARAGE & 100 SO FT DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 013302 3 sets of Plans / Plot Plan THE FOLLOWING WN PRESENTED: ONHAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION ,�( �� � t� Approved Additional permits required (see below) YT P (� E C r J F i PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan R ROL 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 ii(0412. 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. 108 FRANKLIN ST BP- 2013 -0556 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 127 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2013 -0556 Project # JS- 2013- 000312 Est. Cost: $20000.00 Fee: $124.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENAISSANCE BUILDERS 013302 Lot Size(sq. ft.): 9191.16 Owner: MILBERG COLIN T & LISABETH C KIRK Zoning: URB(100)/ Applicant: RENAISSANCE BUILDERS AT: 108 FRANKLIN ST Applicant Address: Phone: Insurance: P 0 Box 272 (413) 863 -8316 Workers Compensation TURNERS FALLSMA01376 ISSUED ON:11/14/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT FOUNDATION FOR 24 X 10 ADDITION, 24 X 16 DET GARAGE & 100 SQ FT DECK 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 11/14/2012 0:00:00 $124.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner