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24C-064
i r st a ... =1 g g i 8A m �m > =4 m x - O OOx t' Mg K in Is %.. L z � Y+tY{{mo�t� �rfi"1M k � �4 x3 fit 4 f - rx I, MASTER BDRM 3`_1112" T-0Irr 8M D - i I O - i _ Cn I I ; n -- I O yj O O �� -- - 3-'S 114" 3`-5 t1 "' li CASEY RESIDENCE INTEGRITY xi d W CONTRACT& Development&Construction,Inc. tTj N '� W 88 MASSASOIT ST.,NORTHAMPTON,MA BUILDING PERMIT 110 Pulpit Hill Road y w Z Amherst,Ma 01002 SET 413-549-7919 FAX:413-549-7918 r�/ ,� MASTER BATH RENVOATION EMAIL:INFO @INTEGBUILD.COM --A D —� A I1 II O 1 O rn 0 LI C O O V-0, ix,'y"' _g i rv` r- r sal _ e f r{ 1 � F.R i y Y re _ CASEY RESIDENCE INTEGRITY r�i d x ,�., CONTRACT 8Z Development&Construction,Inc. W 88 MASSASOIT ST.,NORTHAMPTON,MA BUILDING PERMIT 110 Pulpit Hill Road Amherst,Ma 01002 y SET 413-549-7919 FAX:413-549-7918 ,�� MASTER BATH RENVOATION EMAIL:INFO@INTEGBUILD.COM I - - -- - - li T qv { _ v o G) - i � -1-I O O - 1, I - I � I II Z I R �i li'I a T-3 la- 2'-1012" M 61 N �t fTi ..a I 4�< i I i Nix 1 C 71 it .. 0 L To REVAI Z -' M TI I ,. r ! ( _ O 0 HEAT TO REMAIN i Z 4"-10" 2`-01b2" I ! I ! � I N) INTEGRITY Cn CASEY RESIDENCE r�i d x CONTRACT& Development&Construction,Inc. y ,n 88 MASSASOIT ST.,NORTHAMPTON,MA BUILDING PERMIT 110 Pulpit Hill Road Amherst,Ma 01002 SET 413-549-7919 FAX:413-549-7918 MASTER BATH RENVOATION EMAIL:INFO@INTEGBUILD.COM 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 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 Date Address of work location • 77te Commonwealth of Massachusetts Department of Industrial Accidents . Office oflnvestig,ations 600 Washington Street Boston,MA 02111 www.mass, dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information y , Please Print Le�ibIy Name(easiness/organization/Individnat): .1 £G 17'1 r (}. X 1��(f L`� -Address: ' City/State/Zip: A�'V "� ,iWa- � 0C' ZPhone.#: e you an employer?.Check the appropriate'box: Type of project(required):, /J ❑.. I am a general contractor and I 1. �am a employer with 4 - g ❑ employees(full and/or part time).* have hired the sub-contractors 6. New construction 2_[] I ani a sole proprietor or partner- listed on the attached sheet. 7�,gRemodeling ship and have.na loyees These sub-contractors..have. .8. ❑Deinolii ion working for me in any capacity en_VI9Yees and have workers'. 9 $ut1 _ °addition [No workers'comb.insurance - comp.msuiance#_. _ re ed 5. ❑ We are a corporation and its 10 ❑Electrical repairs or additions officers havezxercised.their 3.❑ I am a homeowner doing all work ,:. . 11.❑Plumbing-repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑.Roof repairs c: 152 1(4y,and we have no insurance requied]� � '§ employees.[No workers' 13. Other comp.insurance required}. 'Any app&cant-that checks box#1 mustalso 0 out the section belowshowing d=ir workers'compensation policy information: t Homeowners who submit this affidavit.indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Kant actors that check this box must-attached an aMuonal sbeet showing the name of the sub-contractors and state whether-or not tbose entities have employees. If the sub contractors have employees,they must.provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees Below_ is the policy and job site information. f , Insurance Company Name ( dL AM Policy#or.Self-ins.Lic.#: Z � a�2 2-V Z�5,4txpiration Date: (C l Ciy/Saeip Job Sit-Address:_ � .".(A Attach a copy of the workers'compensation policy declaration page'(showing the policy number and'eapiration date). Far7ure.to secure coverage,as requirdd under Secho 3°25A ofMGLc 152 can lead t6 the imposition'of cnri Tonal penalties of a line 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 fTne of up to$250.00 a-day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Tnvestisatioris ofthe DIA for insuranc e coverage verification hereby certr under the ai and penalties ofperjury thaf the information�rovuled above is true_aridcnrrect. Si tore: Date: Phone#: Official use only. Do not write in this area,to be compTe—t.d by city OT town e7ciaL .City or Town: PermitUcense# 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable,❑ Name of License Holder: te►l)` � �J v �—(Uri "" ' License Number Addre I Expiration Date 611-2,-5z(�(- ��, Signature Telephone 9:Registered Home`ll ripidiri nest Coritracteir• z .. _ Not Applicable ❑ Company me Registration Number r2 Address Expiration Date TelephoneLl t 3 ✓ "�— �- 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...... ❑ . .. ..._...... . 11: • gomeOwlner Exempts©>�= 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 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,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 SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [-� Addition Replacement Windows Alteration(s) Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[01 Other(p] Brief Description of P d , { Work: (VCV� Alteration of existing bedroom Yes—\K–No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa:tf.New house artd or add Barr°to exi fi ng'hOUS1 complete the°.fottawrnq 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN 1.OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT J , U ficyt Z ) as Owner of the subject property hereby authorize to act on my behalf, in all gatters rela' to work a thorized by this building permit ap i ation. SigngturJ of Owner Date I, i),n ka- C5�Et_f� as Owner/Authorized Agent hereby declare that the stat ments 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. V1 alp ; Jue Print Na Signature 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 in by Building Department Lot Size Frontage Setbacks Front Side L _ R L.L�__ � R:` Rear Building Height I----� Bldg. Square Footage # � � % i Open Space Footage % -- (Lot area minus bldg&paved ---w? parking) #of Parking Spaces `-----I �� Fill: _ volume&Location .- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW )o YES O IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page?` and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ( DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , 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 NO IF YES, describe size, type and location: i 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. _ .. Department use only � . i of Northam ton StatUs,ofP6oit tY p k `= uilding Department Curb y ewa tt i 212 Main Street Sedwetl�S ptic�yalial glty � �� ,a naa xavza� R' FEB 2014 Room 100 ular glrvtt ±l�ty , k o 1hampton, MA 01060 ',fs�dtttrt Plans Electric I :.,ter 587-1240 Fax 413-587-1272 PluitePlan r ` 3 '� {;� L C QI75 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: Map Lot Unit ;Zone Overlay District Elm St District' CB District SECTION'2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Na (Print) ` Current Mail% 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 ermit applicant 1. Building (a)'Building''Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing 2 tce-'C~) Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=0 +2+3-+4-+5) I/ !k-cc) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-0852 APPLICANT/CONTACT PERSON INTEGRITY DEVELOPMENT&CONSTRUCTION INC ADDRESS/PHONE 110 PULPIT HILL RD AMHERST (413)549-7919 PROPERTY LOCATION 88 MASSASOIT ST MAP 24C PARCEL 064 001 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 Fee Paid Typeof Construction: REMODEL MASTER BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 90514 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INS F(}�IATION 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 D on Delay V Si ature of uilding 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. 88 MASSASOIT ST BP-2014-0852 GIs#: COMMONWEALTH OF MASSACHUSETTS MaR:Block: 24C-064 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-2014-0852 Project# JS-2014-001489 Est. Cost: $17600.00 Fee: $105.00 PERMISSION IS HEREB Y GRANTED TO: Const. Class: Contractor: License: Use Group: INTEGRITY DEVELOPMENT & CONSTRUCTION INC 90514 Lot Size(sq. ft.): 17031.96 Owner: CASEY MARK A&MARY ELLEN Zoning URB(100)/ Applicant: INTEGRITY DEVELOPMENT & CONSTRUCTION INC AT. 88 MASSASOIT ST Applicant Address: Phone: Insurance: 110 PULPIT HILL RD (413) 549-7919 Workers Compensation AMHERSTMA01002 ISSUED ON.2/7/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL MASTER 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 2/7/2014 0:00:00 $105.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner