Loading...
25A-061 11 ....4 ... '4 z.:4 L.. "e — . C 7. ...... *0) > = ... ..., „.., 2.....„ =--Z ° —.. ... N...# ,... ... .... 0 in ...4 _... . 1.44 ...... cr 5- 0 "NOW IOW C 77' 7,7.7... '-'I V, 191_1 49st 5 1,'4" ...• (C1 r• C) .-4. . 0 2*-7 5116" 4'-'10 12" !,-)7:16" 3'-9“ l'-e 3il6" 31-:-...' 2'-1 '8 frAn > 3- ., . ,. . .... - .... 0 0 ,.....• _, 11) 77 ,,.., .. %.< i'.. --- CO%\ 0) i '3 iriL .,1111.1.1 g- •..p e— 1 1711 _.... _6 P.:1 •—.-. [ 1 •—• . (7. .. ...,. .... -..9 „...., , ,• •'.;.! ci 1 — Ga •-3 _.,.. " .... _t . .' 7.1)3-- ..-- -:. •tri :4 .--..-2:•1:------- ... N.J.- NI' ------- ' : I 4 ...e. r,_,...._,.._,„,_.,.. • r-- , / ..-74.... . -...., '..:t.., !,•""r`•- IQ •- * '.....r4 (Si . -_ t■-1 . ----- - . i •-• i t"4t!""*""'"•• i -t,• t P., - .....1 -:.. ....._ , -,....„ — -:: ' . 1...1. . • 1%1' 4'—e, 3,-.1 .3 " '1)'-7 '2;k:Pir •9'-: 3.'4" multi Acheson Company . 4phir 6 N. Main St. Williamsburg, MA 01096 11 It . ....=- II ! .. s 1 , ..- II , , / L iii mom alsomi AM Mt , is 1111 .... t e I . , i ..../ AY : ..• 1------------- - .. ....-, ,_.... ......- — . „.. NI (-NI ‘,. 0 it .... r.k" I /J%\ ... ( .,..-,. ..." ... ..„, ' ..,.. .,, -- .. .........-..e., .- II% CI \ ..,\ N,...... 1 I a Justin and Lindsey Preftakes Lindsey • . 390 Hubban 1 St. kitchen , , laTuus Acheson Company 6 N. Main St. Williamsburg, MA 01096 .--,-- \\:\ II I 11 -1 -11 ....----vr. ------- ---- ' ' II III../ I 7 L LL-11-11. Li I \ \ / tu, \47/ -% 0 (,) 1 ,i, / / 0 U' \et L9,—.....— % i I - --z t -- Justin and Lindsey Preftakes 390 littigiattaSt. kitchen 6 a z a I-1 V- N - N X O1 N I0 LA NN-I LL LO (O O1 O th C' CO N N N in L co a7 v co C M M N i ■-I O vi M •0 4-I _-I r1 CO V + • co O I co 111 M .0 0 CO LA O a co N O1 M I� O1 tO V CO V N I. Co 01 LA t0 01 d. to CO LA 'i 01 in k0 sr N tO VI l0 V 00 01 N f/1 N V V' O 01 V N N V N N N O ri ,O to M Co LO In Co l0 N N 40 V N W co CO co co (y1 O N CO 40 t0 1,1 01 N 40 00 00 N LA CO LA LA V N l0 N O N V1 N V1 LA N Ti M 6' M M N M M M M 000 M m M M M M = .--I 0 ,1 v 1 ri .M-1 .--1 .-I .-1 '-I '..I .--I .-1 .--I r-1 ■--1 e-I 4. C ai E t 0. CM 0 Ia a E E E E E E E aai o o o o o o o o 0 CL VI a a'. a a a a a a (o m c0 (a i0 m m i u°' Acheson Company 6 N. Main St. Williamsburg, MA 01096 -----"------r-'A ) - - -4 - 1 C I 1 1 1 ,,, ri IIIII2l1 ,-'`_ te 7 ' t ii •I'''\ a v V l (C? f ' •■■■•■•] . a Justin an . Lindsey Preftakes &21,' e 390 -="-'• -` • St. kitchen - . ... ., The Commonwealth of Massachusetts . Department of Industrial Accidents J:-'"---.-' Office of Investigations v- 600 Washington Street S Bi 12. L ... _ - , 4. ''".r +'- Boston,MA 02111 • - * www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information • Please Print Legibly Name(Business/Organization/Individual): �?--SU`ti GYVsk n ` Address: 6 N.1.1s.,\a., -- ..---a 0 , tCGS`-- City/State/Zip:k 1 i.\x(43.,N.S--)1/41\6) ` Ute Phone#(`-( (3) 3 7 41 L • Are you an employer?Check the appropriate box: Type of project(required): 1.[[]'Tam a employer with 2 _ 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [ Remodeling --------- These sub-contractors have 8. III Demolition ship and have no employees working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill 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: S,cc.. �°"' �'`•e�� �'''''�"`i3'". r-- -c" r G'1' Policy#or Self-ins.Lic.#: t)--)Cr~ SC5r)v C ' 1 7---c-' `c_ Expiration Date: 16 + � '3 11 13 - `�'` City/State/Zip: t30*-s IVic';' ' Job Site Address: f 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 Investigations of the DIA for insurance coverage verification. I do hereby certify ,er the p,£JE.Ides of perjury that the information provided above is true and correct. Si lit ature ` 4 Da te: 1 (tr-qii Z---- Phone#: � / 1-1 2, 711 kelt 4,✓ -Official use only. Da 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#: HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CVLR 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 permits 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 s!; „A Pe-e 11-4LS 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 f%//./3 Address of work • . location TIC) r:cl s S Agar IL... �+Dh //,4 O/O 6� The Commonwealth of Massachuserrs Depa:"rn:e'" of Industrial_4ccldents ©j2 ce of Investigations _= 600 Washington Street Boston, MA 0 111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectriciansPlumbers Analicant Information Please Print Lecribly Name (Business/Oraanization/Individuai): J 7 ,;q /ei(2727 �es _ Address: 3rr 3..; e City/State/Zip: ALe-14.0..yokaN 08 0/C6 o Phone#: 6/7. 75 5. ?7/I (cell) Are you an employer?Check the appropriate box: Type of project(required): 1.,n I am a employer with employees (full and or par-time).* 2.❑ I am a sole proprietor or partner- - ❑ I am a General contractor and I have hired the sub-contractors 6. ❑New const uc ion listed on the attached sheet. e Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition il working for me in any capacity. employees and have workers' 9. ❑Buil ling addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Elecmcal repairs or additions lt 3. am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No o workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),1(4),and we have no employees. [No workers' li.❑ Other 1 comp.insurance required.] *Any applicant that checks box#1 must also fiII out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Cont:-actors that check this box must attached an additional sheet showing the narre of the sub-cont-actors and state whether or not those entities have employees. If the sub-contractors have c.uployees,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. i.au_i._ce Company wane: Policy#or Self-ins.Lic.#: Expiration Date: Job Sire 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 crminaI penalties of a fine up to 31.500.00 and/or 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 this statement may be forwarded to the Office of Investigations of the DL4 for insurance coverage verification. I do hereby certi de the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Y/I/3 Phone 1: 6/7. 756. fn.? O Jlcial use only. Do not write in this area, to be completed by city or town officiaL City or Town: _Permit/License# Il Issuing Authoriry (circle one): 1 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector liI 6. Other i Contact Person: Phone 1 .� SECTION 8-CONSTRUCTION SERVICES - } .1 Licensed Construction Supervisor. amt of License Holder: 4 ideess Expiration Daze gnature Telephone FteoisteredHatnel r eenentCoatr er = ~' Not Applicable 0 imoanv Name Registration Number dress �C�SG�. Expiration Date 7S--\. CeC) V L['Telephone 3 2 V 6 ({6 CTION 110-WORKERS'COMPENSATION INSURANCE AFFRDA.1 E e.L.c..152,.F25C(S)) rkers Compensation Insurance affida • ust be completed and submitted with this application_ Failure to provide this affidavit will result le denial of the issuance of the build' permit.. led Affidavit Attached Yes No Cl r The current exemption for`homeowners"was extended to include Owner-occupied Dwellines 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.CM R 780. Sixth Edition Section 1083.5.1. 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 Eerfornxed under the buildine 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,von 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 • • La Zoning Laws and State of Massachusetts General Laws Annotated. 1 Homeowner Signature 7 —� 4. ZONING I AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing I Proposed Required by Zoning This coluam to be fiIl_: m by Building Departm-. Lot Size �. _. ___ ,_.-_ _ -- Frontage _ _ Setbacks Front I 1 , Side L:' R: L:' _ . - R: Rear Building Height Bldg.Square Footage �� Open Space Footage (Lot area minus bldg&paved } oarkinz #of Parking Spaces �� , : FiII: IIIII' — — (volute&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO . 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 If YES: enter Book I i Page; and/or Document#! { B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtainer! 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 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 it 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 A IF YES,then a Northampton Sto a-Er Managemenf Perriiit from the DPW 1s required. Deparirnent use-only City of Northampton Status of Permit` _ Building Department Curb Cut/Drnreway Permit 212 Main Street sewer/septic AuairabiI'y Room 100 Water/f7Vell Availability -= Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PtotiSite Plans er .Y T APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEWNG SECTION 1-SITE INFORMATION 1 1.1 Property Address: This section to be completed by office -2,(1 C> '�: ikx .tc -= " IMP Lot Unit OVA ,At >,Npv i Fri ci i 4360 Zone Overlay District 'Elrn°St District CB-District SECTION 2 PROPERTYOWNERSHIPrAuTHOR12ED AGENT 2.1 Owner of Record: i,A. k4,4 IN 'r ct t-c es ..VD 3e,i e. Si:- Ale .. o h., 41A Name(Print) ' Current Mailing Address: 4411.75's. 9719 o�060 �-� Telephone Sig 22 •R�4 = • Name( Current Marling Address: � N. Sc 4L( 1 Z ,) `� 7 `f 6 Signature phone / SECTJON3-ESTIMATED CONS tRU�N Item Estimated Cost(Dollars)to be Of5aaWse Only: completed by permit applicant 1. Building '1a�_.ButTdin Pe�rE-Fee 2. Electrical CJ fib)_Estimated Total-Cost of Z \ b G r onsttir ion-froni-(6) 3. Plumbing f v c C) =Building Permit Fee 4_ Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) I i"//O C O Cbed(Nurrtber 1 This-Section For Official:Use Only Building Permit Number. -Date- .Issued: Signature: Buifdrng Commissionerilnspertocor-:Buuaings „_ Date _ y. Acheson Company,LLC 5375 immonwealth of Massachusetts 11/27/2012 , °" CS License 100.00 6t . pic_ cpt„._______‘..i_ ii-i _i7 FSB Checking-Compa CS license renewal 100.00 la ay FLORENCE SAVINGS BANK 5375 r, 85 MNN STREET.F.ORENCE,MA 01062 53-716B/2118 I num• ACHESON COMPANY,LLC 1141r I 6 NORTH MAIN STREET. fr 1 WILLIAMS8i3RG,MA 01096-1052 1 PH.413.374-6468 11/27/2012 Y m o PAY TO THE Commonwealth of Massachusetts I 'M00.00 ORDER OF c One Hundred and 00/100 DOLLARS Commonwealth of Massachusetts Departmen CSL Renewal 3 P.O Box 414376 LL MEMO Boston, MA 02241-4376 CS license renewal AunORIZEDS1GNuTUR P00 5 3 ?Sus 1: 2 1 LB? 16881: 6 25 6Q 5 L 3?u' 11 Acheson Company,LLC 5375 Commonwealth of Massachusetts 11/27/2012 CS License 100.00 FSB Checking-Comps CS license renewal 100.00 st$------ Savings����jj�� gs No. 201244 Florence Savin Bank 53.7,6912„9 85 Main St., Florence MA 01082 DATE November 29,2012 MONEY ORDER ORDER OFE Co," ,h 0...-.<s.“2s11\'"t`,,... dtF- Y S . 1\ 1 $ 1 00.00 One Hundred and 00/100*********.*********************************** DOLLARS MEMO P. t C �'�' 4c.lc r, C 1C�►os� r -s'e-uu Ak NOT VALID OVER$1000.00 NON-NEGOTIABLE Customer.Copy DRAWERIREMITTER ADDRESS ADDRESS Acheson Company,LLC 5373 i t---- . 4 „ it fz 1_? , 2___ ok peit Cit/ _, Li,/ q...._;(/ 8 No. 204630 Florence Savings Bank 53.7,6812„9 85 Main St., Florence MA 01062 DATE April 17,2013 MONEY ORDER PAY TO THE ORDER OF $150.00 One Hundred Fifty and 00/100***********'************************* DOLLARS MEMO NOT VALID OVER$1000.00 Customer Co NON-NEGOTIABLE Copy DRAWERIREMITTER ADDRESS ADDRESS -i.-- O LA, ■ 1.it LAW •• L W ru • h HOME OWNER EXEMPTION ACKNOWLEDGEMEN 1 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 permits-in-conjunction.to_the-building_p.ermit.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. Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents = .rri Office of Investigations it ,1 i�-:: 600 Washington Street -' =z Boston,MA 02111 :.�. www.massgov/dia -Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumb.ers. Applicant Information Please Print Legibly Name(Business/Organization/Individual): ci-,--A c.,, 0 J CQf i s f,-) „/ Address: aJ ,..._ 0-`m . , - City/State/Zip: J \'' ,444.- U 0 Phone-#: (I:I 2j' 3-7 `f 6 Y6 E Are yo an employer?-Check the appropriate Log: I Type of project(required):. 1. I am a employer with. 3 4. Ejj I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. [�' emodeling ship anti have no e toy ees These sub-contractors have. 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Buildi'g addition [No workers'comp.insurance comp.insurance_. required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1-am a iomecrwner-deing a$-work- -----— - lax xeLCisec ir-_ —1-1.0 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' 13.0 Other comp.insurance required) *Any applicant that checks box#1 must also fill 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: 0,-- py S ��,, E�, �E ,(� 4- ", Policy#or Self-ins.Lic.#: L)-- '� .5;° 6o 2 6 0' 12 Expiration Date: / 2E 7 s / I Job Site Address: ‘k-'6- 7 -��i (x (, City/State/Zip:. �— t y 1 C) 6 cx 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$1;500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fire of up to$250.00 a day aganisst`.the-violator: 13e advised that a copy of this statement may be forwarded to the()Labe of Investigations of the D for insurance c. - •- •- .cation I do hereb, - under the pains %pe elites of p !jury that the information provided_above_is_true_azuLcorr-ect: _.__ ^;/ _T- Siena i 2 __._...r _ Ai,_ Date: k r v"\ DV f _ Phone#:.. _Ky ( 3 / / 7-'f b -(6 _ 1 PeOfficial use only. Do not write in this area,to be completed by city or town officiaL City or Town: rmit(License# Issuing Authority(circle one): h-Board of Health 2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector _ ___ _ 6.Other Contact Person: Phone#: -, 5-67 _ l72' i SECTION 8 -CONSTRUCTION SERVICES I 8.1 Licensed Construction Supervisor: /� Not Applicable ❑ Name of License Helder. � . G rJ ( yyN■ { I 1 r I License Number address Expiration to Sig :tare` 'I elephone Registered Home lmnravemerrt Cantracfor Not Applicable ❑ __. ._ __. ...._ 1 q G omoanv Name Registration Number Gam 7) 2 9i11 .ddress /^ /� Expiration to 6 0--- —�^ �? \l\r:5''u�v y Telephor L ) 1`t b ECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L_c.152,§-25C(5)) I corkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result the denial of the issuance of the buildpi permit.• aned Affidavit Attached Yes L�1 No ❑ 11_. . ge>rtrri 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 t.an possess individual for hire who does not ssess a license, provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 1083.5.1. 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 OiEcial,on a form acceptable to the Building Of"rtcial,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 l SECTION 5-DESCRIPTION OF PROPOSED WORK'check all applicable) � i New House I` ;j Addition 1 ! Replacement Windows Alteration(s) I I Or Doors 0 f Roofing 1 I zr I I Accessory Bldg. Demolition , , New Signs [O] Decks [= g[C; Other ED i r C' - Ere*Description of Propose,: ^ Work: Tr"t�P►Js) �fi� G �� �- o ") Alteration cf existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Rencvatine unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition,to existiinq'hauaim:I. i'ltilorete the followina: a. Use of building: One Family Two Family Other Number of Bathrooms b. Number of rooms in each family unit: C. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Weodstoves 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. flocdplain Yes No . Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes Ne. I. Semitic 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, S7/il ,"�6 f/ ec d I_I ,�( GLt `° "tZ~ ) as Owner of the subject property t authorize �J �C to act c y behalf, in all mattes relative` work auth z by this building permit application. ISis A Qwner ' � Date 1/3 I , 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. i 1 Fnnt Name I S,cnat_re of Owner/gent Section 4,- ZONING J All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information c'„e.+„"F°""µ».;``""'r, Existing Proposed Required by Zoning ""„�,�d '^ , This column to be filled in by tie IT Building Department Lot Size Frontage _.._ Setbacks Front ____. Side L._,,.,._ ...,._ R: __. L:' .,..__. R _ .,__ ._. Rear _______ _..,.. Building Height ... _.... Bldg. Square Footage % _...__._ — Open Space Footage ______ % ... (Lot area minus bldg&paved .. #> of Parking Spaces .---,„„_. _,___ Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO V DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 ie 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 (3 NO 0 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 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 cor ulron plan that will disturb over 1 acre? YES 0 NO ; IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit Building Department curb Cutprrveway Pen it 212 Main Street SeverfSeptrcrai1 _ v ` Room 100 Water eliAva. .• , Northampton, MA 01060 Tvvo Setiof Strad - :fan phone 413-587-1240 Fax 413-587-1272 Ptot/Si.te Plans Other Specify o w" APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE 0 t '4., i • SELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office "��� 5-1' CI o C� \-'‘`;� Map Lot Unit ` Zone Overlay District �-1 6 f\a< '`1 t al 06C% Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record: +\`k-- ,s_ ___),->,\-,)R(G ''" '9 .5q o (- �.` c-->k- Nam. P nt // ,-r,/<^ Current Mailing Address: d ��,f/'� �C -e / „„/� Telephone it- ` t', 4 "i y . '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_ (a)Building Permit Fee 2. Electrical + j�� rc (b)Estimated Total Cost of Construction from(6) 3. Plumbing 1 C t-' Building Permit Fee 4. Mechanical(HVAC) l r 5i GC 5 Fire Protection - ' � 6. Total= (1 +2+3+4+5) aU ,---- Check Number I This Section For Official Use Only Date Building Permit Number Issued: ALIIII! -- i Signature: Building Commissioner/Inspector of 1 �nB-1-id gs Cate File#BP-2013-0894 APPLICANT/CONTACT PERSON R DEAN ACHESON ADDRESS/PHONE 6 NORTH MAIN ST WILLIAMSBURG (413)268-0246 PROPERTY LOCATION 390 BRIDGE ST MAP 25"PARCEL 061 001 ZONE URB(100)/ RECEIVED THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION LIST APR i 7 2013 ENCLOSED REQUIRED DATE ZONING FORM TILLED OUT DEPT.OFD LP I NSPECTIONS NO'I4.r;1D I�� cnc�r �aiwi�,n� G 1 • �1�1•Ilgrrrn2 • ■� Fee Paid Typeof Construction: REMODEL KITCHEN&REMOVE WALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 83968 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 ;- . '1'0;x:- :, 44" (---7.7:1-3 tr—turofBuild.',g •fficial 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. I - -- 390 BRIDGE ST BP-2013-0894 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A-061 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 PERNIIT Permit# BP-2013-0894 Project# JS-2013-001528 Est.Cost: $6500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(scQ.ft.): 5662.80 Owner: PREFTAKES JUSTIN&LINDSAY ROBERTS Zoning:URB(100)/ Applicant: PREFTAKES JUSTIN & LINDSAY ROBERTS AT: 390 BRIDGE ST Applicant Address: Phone: Insurance: 390 BRIDGE ST NORTHAMPTONMA01060 ISSUED ON:4/3/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN & REMOVE WALL 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 4/3/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner