24D-044 CITY OF NORTHAMPTON
Construction i'ebris Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work
--------- covered--by a Building Permit shall be disposed of in a properly licensed disposal facility,
as defined by M.G.L. c. 111 § 150A.
Address of Work: / V j-/,
--- --The-debris-will be..transported by: , %U�
The debris will be received at ( c1
Signature of Permitt pplicant -✓ -
'Date / / .Z. �/.7
Building Permit Number:
•
•
•,
1�
the steps using P.V.C. lx material. Please note: DCCSI will provide general clean up and
waste disposal. DCCSI carries all necessary licenses and insurance. Certificates are available
upon request. Any work not outlined is not included. Changes and or additions to the scope
of work or any work required as a result of concealed conditions such as water or insect
damage will be billed on a cost plus 20% basis. Painting, staining, painters prep, caulking
and nail hole filling is not included.
Based on a total estimated cost of construction of $8,288.00 a deposit of $3,000.00 is
required before the building permit is applied for and work begins. A second payment of
$3,000.00 is required once demolition, footings and floor construction is complete with the
final payment of $2,288.00 is due upon completion of work and the final inspection by the
city of Northampton
Respectfully submitted,
Dave Chicoine
Signature indicates acceptance of terms` as outlined
Michael Klein Berndt -2 '"
AC-1J f t y`#1 ,-f 'et 'L'r'vt
Dave Chicoine Construction Services, Inc. `A,
16 Edgehill Place
Amherst, MA 01002
413/246-7536
Michael Klein Berndt
14 Stoddard Street
Northampton, MA 01060
Front Porch Rebuild
Pro posal/ Estimate
July 12, 2013
Dave Chicoine Construction Services Inc. (DCCSI) proposes to provide a carpentry service to
complete the following. Provide basic plan view and elevation/ section drawings to satisfy the
city of Northampton building department and obtain the necessary building permit. Provide
temporary support to retain the existing roof and beam structure. Remove and dispose of the
existing posts, rails, decorative head brackets, flooring, floor framing, steps, lattice, lattice
trim and metal support posts. DCCSI will excavate, install 10"diameter sonotube forms,
backfill, schedule and stand the footing inspection and site mix and pour bag-mix concrete
mix to create 4 new foundation piers. DCCSI will frame a new pressure treated southern
yellow pine floor system with the same pitch and hip detail as the existing with necessary
corrosion resistant fasteners and joist hangers. DCCSI will also frame a new set of stair
stringers with the same rise and run as the existing using new pressure treated southern
yellow pine framing materials. DCCSI will install new fir flooring using "blind nailing"with
stainless steel# 6 nails. The fir flooring will be installed in the same direction as the existing
to help facilitate drainage. DCCSI will install 4"x4" Douglas fir posts at existing locations (
under probable joints in the existing beams) and at the top and bottom of the steps (both
sides). The posts at the floor to beam areas will be wrapped in solid pre-primed pine boards
top to bottom with a P.V.C. 1"x6"wrap creating a plinth or base detail at the bottom. The
other posts will remain 4"x4"with no wrap. Note: DCCSI will try to salvage the existing
decorative head brackets for re-use. Replacement synthetic (Fypon or equivalent) brackets
are available and the cost for a specific size is included in this estimate. The exact bracket
style must be determined if replacements are used. DCCSI will replace the existing railings
with similar details using 2"x4" Douglas fir horizontal top and bottom rails. The top rail will be
top beveled and the bottom rail will be milled to act as a baluster stop as in the existing.
DCCSI will use a 3/4"scotia molding under the top rail with fillet strip material to retain the
baluster tops. DCCSI will construct the new rails at the code compliant height of 36" above
the porch floor. DCCSI will use the same details on the rails at both sides of the steps. DCCSI
will install southern yellow pine or fir stair treads as steps with pre-primed solid pine risers
and provide lattice to close in the sides of the steps and the area under the porch with
privacy grade white vinyl lattice. DCCSI will trim the perimeter of the porch to hide the floor
framing using pre-primed solid pine and also trim the bottom of the lattice at the porch and
•
City of Northampton
�' �`° Massachusetts , , s r{,
DEPARTMENT OF BUILDING INSPECTIONS � .1 .1"
� 212 Main Street • Municipal Building ':6:4„, �°�x�
Northampton, MA 01060 `�' kt TO
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
•
The Commonwealth of Massachusetts
3
Department of Industrial Accidents
Office of Investigations
=_ew
br M 600 Washington Street gr=
4Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual '✓G
Address: °/'✓ 7. 74--W13/? /41 -7" Le". ∎ 7
City/State/Zip: Phone #: (1/f
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a Y em P to er with 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
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. em loyees and have workers'
[No workers' comp.insurance mp. insurance.
$ 9. El Building addition
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 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13. Other /e?
comp.insurance required.] 6 u, �.
*Any applicant that checks box#1 must also fill 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.
$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$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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: (1//,? � 2( —7 cy—
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.Buuilding Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
-
Name of License Holder• C j C-p%/t f ✓ a ‘.
License Number
j272 /:*G1/!) e/
Address Expiration Date
(71/.1 4' 4( 71- 1(
Signature Telephone
.9r;Re istered Home,lmprovement Contractor." _a ..° Z:.,• ,;/ Not Applicable ic ❑
Corttpra" Name Registration Nu ber
/
Address v/ � , L( Expiration Date
/7 °,r-//1-4''7)/ .lam .1 �9/ L' Telephone 71-17
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L cv152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
l,tegi onie,Owner;Exemptio-n
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
•
W
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) e ,
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Ea Siding[D] Other[
Brief Description of Proposed / / ,r tea,, ,�'
Work: G4 / t� /-a4 `f pJre �? ,z/®0!1 l/troQ/
Alteration of existing bedroom Yes No Adding new bedroom Yes No `�`t Rf�'_j
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
,yl+:` ^"-. t°9? xi�am. g 6 '. °'c, '*.`+, 't. .'wu,„ �+:'' "".q',q �msa+,.."M',4s
6a lf...t4ew:house.and or::addition.to existing¢housing,`�complete.the:following:
a. Use of building: One Family Two Family Other /(V//1
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each '
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a=OWNERAUTHORIZATION TO BE COMPLETED.WHEN
,OWNERS AGENT Ok;CONTRACTOR APPLIES FQR`BUILDING PERMIT
I, , 1—<_-.4 / `0 p 0 J?/ , 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.
some. ( rA 4L
Signature of Owner Date
1, Y-4-- c ri`!j>,4,;r,. , as Owner/Authorized
Agent hereby declare that the statements and in rmation 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 Name
Signature of Owner/Agent Date
I i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
r
Existing Proposed Required by'Zoning
This column to be filled in by
Building Department ,';,+is ":t
1
Lot Size r 1 ; / i 1
f
Frontage i .l , i
Setbacks Front € I I l
-- I
Side L:__ R: L:+ . R I ,
Rear I I I —
Building Height ------ i
Bldg.Square Footage { ¢ % I
Open Space Footage ___
(Lot area minus bldg&paved i 1 1 i
parking)
I i I I r
#of Parking Spaces .--
Fill: _______.__ __.� _._._.. �_ ___.. ,. ___.e
(volume&Location) I' ,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:l I
IF YES: Was the permit recorded at the Regist of Deeds?
NO Q DONT KNOW 0 YES 0
, I i
IF YES: enter Book ` Paged and/or Document#i
B. Does the site contain a brook, body of water sr wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be ob ained from the Conservation Commission?
Needs to be obtained 0 Obta ned , Date Issued:
C. Do any signs exist on the property? YES 40 NO 0
IF YES, describe size, type and location: 1
D. Are there any proposed changes to •r additi ins of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and loc. ion:
E. Will the construction activity disturb(clearin gr.din, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 •
IF YES, then a Northampton Storm Water Ma . cement Permit from the DPW is required.
‘ A(7/ 10,,, f?4, �
, . ,.. ,
Ok.(r'05f,; )r/o—,ovii;-6.,c----
Departmeptt use orl+ ,
_D _ �� �c; _`� City of Northampton S atus o Pe . 4% ' 4 . ' 4,� % i
Building Department C rb c /Urlue ay -; it.�4 .,�
'` 212 Main Street Sewer!eptivalla®tlt+ � �� a !
_ OCT 23 2013 1 - X4-141 -ice �0
Room 100 Water lNel1 Ayaile I '", „
Northampton, �� ��, �r - � b 4 ,
MA 01060 Tw Sefs3Of•Str-u u aI Pians
Electric, Plumbing&Gas lnspectp ne 413-587-1240 Fax 413-587-1272 Pl;.,1„:',t te P at s �
Northampton, MA 01060
APPLICATION TO CONSTRUCT,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 , ,- 1 '•,I„4, f� v x,*r.-° a� n: t •% _. in s.`? `,0 �a 'k`r'Y *i
�` ( , 1--.-7 �M�� �i ��� s"r LOt: �a�' _ �e s^•��yTtlt"'-"•,•--•-•? *��""` +�-�
v/ '�'S����,`,�f 'Y k, 'y. 't-1'U' '�i' Y!"5°;.17`5 44` k.. z"}u'M1k'.L0.5 if 35k,k
5 l t, j1, .� x: %
Zones : - Overlay Distract '` ,,„ "' ,,.
9
y;Elrn St District r .' .` .... CB�Di
SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT',
2.1 Owner of Record:/A € / /-:- /e--/ /, 7,-,, Olke-74 ',1 7-14' e-/410//.,.$41 J.-12 Current Ma
d Add ess: ✓ 4_7, `O q/
Name(Print)/v //1 iC �/V i.3 0"/' ( Telephone
Signature l t r " 7■',/, fJ
J 4 2.2 Authorized Agent:
1 _1"-- 74---fi,-- ..e-f 41/ ‘—// X-4,
Name nnt) 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 d (a)`Buildmg Permit"Fee
2. Electrical / ' (b)Estimated Total Cost of'
Construction from j6).
3. Plumbing Building�Permit Fee
4. Mechanical(HVAC) �� °Q
5. Fire Protection
y
6. Total=(1 +Z+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number. . IIsssued:
Signature:
Building Commissioner/Inspector of Buildings Date
•
File#BP-2014-0503
APPLICANT/CONTACT PERSON DAVID CHICOINE
ADDRESS/PHONE 16 EDGE HILL PLACE AMHERST (413)246-7536
PROPERTY LOCATION 14 STODDARD ST
MAP 24D PARCEL 044 001 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 / Q� C�
Fee Paid /Q J
Typeof Construction: REBUILD FRONT PORCH FLOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 061582
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION 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
D olitio Delay,�
,/,-,7- /4 -/77---.13
Signature o 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.
14 STODDARD ST BP-2014-0503
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-044 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2014-0503
Project# JS-2014-000856
Est.Cost: $8000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID CHICOINE 061582
Lot Size(sq. ft.): 7100.28 Owner: KLEIN-BERNDT MICHAEL&SUSAN
Zoning: URB(100)/ Applicant: DAVID CHICOINE
AT: 14 STODDARD ST
Applicant Address: Phone: Insurance:
89 BARDWELL ST (413) 246-7536
SOUTH HADLEYMA01075 ISSUED ON:10/25/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD FRONT PORCH FLOOR
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 10/25/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner