23D-011 (5) BP-2007-0131
GIS#: COMMONWEALTH OF MASSACHUSETTS
hmitatommtww CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0131
Project# JS-2007-000200
Est. Cost: $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10585.08 Owner: ELDREDGE STEPHEN S&LAURIE WOJTUSKI
Zoning:URB Applicant: ELDREDGE STEPHEN S & LAURIE WOJTUSKI
AT: 20 NONOTUCK ST
Applicant Address: Phone: Insurance:
20 NONOTUCK ST (413) 585-0064 0
FLORENCEMA01062 ISSUED ON:8/9/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:RENO 2ND FLR BATHROOM
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 8/9/2006 0:00:00 $50.002209
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2007-0131
APPLICANT/CONTACT PERSON ELDREDGE STEPHEN S&LAURIE WOJTUSKI
ADDRESS/PHONE 20 NONOTUCK ST FLORENCE (413)585-0064 0
PROPERTY LOCATION 20 NONOTUCK ST
MAP 23D PARCEL 011 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENO 2ND FLR BATHROOM
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
INF ATION 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 Commissio
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.
Department use only
^` \\,7 ty of Northampton Status of Permit:
, n I„
___ -- 'BuIding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
AUG c,
+ 21.26 ` Room 100 Water/Well Availability
r
Northampton, MA 01060 Two Sets of Structural Plans
- --phone 41'3-587-1240 Fax 413-587-1272 Plot/Site Plans
r Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
2() ) v }\- J& 5c--1/4 Map Lot Unit
l )0+4.k&.CF M A cp 1,0 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Stephen Eldedge&Laurie Wojtusik 20 Nonotuck Street,Florence,MA 01062
Name(•rint) ' ent Mailing Address: 413 585 0064
NWIMMI46-'e •phone
Signatur-
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 $ 500 (a)Building Permit Fee
2. Electrical
1,500 (b)Eit Cost of
Construction stmaed Total from(6)
3. Plumbing t. n ^ Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection nn
6. Total=(1 +2+3+4+5) 1-6? Oo Check Number a ;20 Ik6 )V
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 in by
Building Department
Lot Size 9,804 Sq. Feet Same
Frontage 69 Feet Same
Setbacks Front 35' 35'
Side L:30' R: 30' L:30' R:30'
Rear 30' 30'
Building Height 2 Sty 2 Sty
Bldg. Square Footage 1761 18 °"° 1761 18
Open Space Footage
(Lot area minus bldg&paved 7243 74 7243 74
parking)
#of Parking Spaces 4 4
Fill: None None
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO O
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 Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) n Roofing El
Or Doors D
Accessory Bldg. 0 Demolition `0 New Signs (DJ Decks (D Siding[p1 Other[D]
Brief Description of Proposed N 1., tJ l(n�6 U E.GA nCCb` 11+-0* `^274 8.160.• bah , \^c.`J(, LA.
Work: LED1)40. CNOt v
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roil -Sheet
6a. If New house and or addition to existing housing, complete the following:
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 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-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, 5% ' f 1 - b L _ . £ ''Mu • as Owner/Authorized
Agent hereby declare that the statements and information orl the foregoing application are true and accurate,to the •est of my knowledge
and belief.
Sign-. under the pains and penalties of perjury. •
Print Name
—...011/4A IPARIVA _...41111.1111 imegigk
Sign.ure of.rk,,Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No X
11. - Home Owner Exemption
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"ce - - and assumes responsibi for compliance • • e r C uilding Code,City of
Northampton Ordinances, State • • al Zo "i!'1.ws .id Stet• of Mas°.ch e is G °ral Laws AI otated.
Homeowner Signature . ._�, 'Ik�ACL"416�����`�S
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.o — DEPARTMENT 01' BUILDING INSPECTIONS •
212 Alain Street. ' Municipal Building `•`-- 5.
rr
I\orlhnmpton, Mass. 01060
WO Q?IZ'S COMPENSATION EN'SU ANO:, AFFIDAVIT
I, __ �� • I I , -- —-.
(Ii ccnsxJpermi ttc )
with a principal place of business/residence at:
n 0`62
/ vo iAl ,'-c- ci\IC 9f-, .C(6ceuta, N A (phone::) q 15 ( c- -00 -i
(sarr..Jcity/s12J p)
do hereby certify, under the.pains and penalties of perjury; that
.
( ) I am an employer providing die following worker's con-Tens non coverage for my
employees wor>dng on this job:
(Ins-w--.:_n= Co ) • (Polio: Nur cr) (r:pirtior Dai.)e •
(lam a sole proprietor, general contractor or homeowner (ci:cie one) and have hired
the conn-actors listed below who have the follol.vinz worker's col pensapon policies:
)3JAS
AllA,Nbs( gk0t11
(i ieme of Cont icio") (Innlrancc Colnoarryf1 otic- Numr<') (Expt auoa Data)
&i/, 1-0‘.010AVNSIA-a- , .
--- (Name.of Contractor) (l�sirao� Campaa}fPo.lc; \utncr
r) (Expir,:tlon Date) •
(Name of Coalracto,) (Insurance Company/PoLic)• Namara) (Expiration Date)
(Name of Contractor) (Insuranca Company/Policy Numbcr) (Expiration Date).
(aasr•+,�a.dsoocaJ txd.if aoc�s._-p ca ayc?u1�inror oo pc-ia iaias to.11 Dots--.cv^s) •
•( ) I am a sole proprietor and have no one woridng for me.
0 I am a. home owner performing all the work myself.
/ NOTE:p1 .c be aorun Ltul u.tL; c homcoo+iocr3.vbo employ ociom w CID r.;.-�,-„ ars.:eiaa a.re.air�oriJ o�a�i d••c.1L.:of
not @OCc tIL.D t o t=IJ to which the bog oo^ocf rQldtp o oc Lh0 p-ou.o i,]pp�slco.:=the o i r aoc��al y ooCS:Nocd to be
eaploycs tint,-:the W 1 c -ion Act(GL1 S2.=1(5)),s-pplrnoon by•bomeoQac far a lict=c cc pennn raty n•rdcacc the
Icso-1 ct-mg or ea r eeIoyoc wader tbo Wocir-or t Coc .c .ioa Act
I uadon: ad dsd..copy of thi.ccucoo.so may be foreee.dod to tha Dcq..rtmmt of l.,.L.rri.l Accdrsu'Moo of lrar•oco for tls.
covcrase vcriGe4ioa And t1u[Lilac to teal=tovengs tmdcf soetioa 25A of MOL 152 an IQd to the iapasitioa cdaie iazl pcnnitic
coo i of•fine or Up to$I}00.00 and/0e cxzpttyoc t, of up to Doc yeor end ava pawl:ia is LSe form of•Stop Work Ordcs nod•
ilia of 5100.00 i city y.".• me
' For yl u.c only
/ //�f Prrml(Numtxs
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f=ey DEPARTMENT OF BUILDING INSPECTIONS _:!=1 /?
INSPECTOR 212 Main Street • Municipal Building ,-`
Northampton, MA 01060 .
el
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups: , sor. 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 a e proper permits and inspections are
ma
EgepI ,Q 1 Iota understand the above.
(Home o er/resident's signat reque ,`g exemptio
I will call to schedule all required building inspec ons necessary for the building permit
issued to me.
Date q V o
Address of work '' II
location M 6 noiu C cf-. .
,c( i-UAce (nik n ( ciGz____