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35-247 ' 4 The proposed studio building at 19 Ladyslipper Ln, Florence , will not be used as an accessory apartment. The building has no water facilities, and it's sole function will be a work space. Thanks Mark Meunier 19 Ladyslipper Ln Florence, ma 01062 5869753 /6V C MAR 2 8 2003 y C V �J i a — — �� CL c c• k i I � I x St, i � �� i i �` ��.. t ,. �1�--_ �. { _ _ __ _ S '`� i �� I # � 1 � � t ( � 2 � i j r � �` t F� - _ _... j` ,'a. r �. t ,� - .. �,,` �� `'\ '•\ �`� .: C� r' C. �s ' f i { I ! If; 4 I I � f q � J - AL O r+ V d N mi SP�ct� �C�Tt�oN S TO SfG��oT 4 � Zo C,ARR CAr- S TO rr T o L�PI �� �� � '� 16 cf 3 ^J� � STS CC S To bs l 6 �� r,C L" u5�, 51 l�� ax G CC � t1 ►� � To 15 TS ( 6 o c -2/F a S/� p cf WodO a N ��bF f (� 3 LOT 28A SHED --- LOT J8 -4A u J Lo L o • �-.._ � � STUC1iU .�-_�� `N I 7 QTY PPIrV Cri of Wort 11amptan Y Y $ � � j>tiassaclp�sctts DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main S�;,ct i�= Nlmucilril Buildin Northampton, MA 01060 IV HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as !Js/her construction sups_: ,- sor. The stage defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or thvo family divelling, 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 4 I, 1 Jl o(L(/C W e -rj eL,-- 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 3 - 1 Address of work L location (�1 LoU)y (-C,pP`e,,— '�' Ntvxr� — _-- o � b (lLitll f �;�a rf llaillflftill ( � g _ 6 �ISE 9 11 C t t DEPARTMENT OF BUILDING INSPE'CT'IONS 212 Main Street ' Municipal Ek-nlclinh Northampton, Afass. 0140 WORTQ�R'S COMPENSATION 1NSURANCI' AFFIDAVIT (]i�nscci��;tn;itcc) wah a principal place- of buslesdresidence ar (phone:'} do hereby cer�i y, Under Cho PAS and poncho of PxM PHY, tha I wrl an empioyer providing the Mo•>ann v.or cKs comnens Iron cove.rti e for 1ny employees worh-ing on t'lis job. (hourinco Comywy) --- -:c c,Nuaibcr) -- - - (Expir.tor.Datc) - ( ) I art a sole proprietor, general co'ntracto- ;"r honleov"rncr (circle one) anti have flifed the contyactors hsted be1Ov-,, vi'l10 have [ire %VoFkee js CO( p 1152't1on. pCliC'm -- (NI'mic of COI1tmctor) (iI1SL'i' C:, t_,01:' -;'�:�1'oI1C'j ��l.Ill���;) _-- lI.?'•::+.LOi. Date)- (Nwnc of C,onymol (n15UL:Iw W _ ..Qok. ' -i0, bate) f , -) �3mC of C6I111?Ctol) (II1SZ1raP.0 �,Oi::�: i'ilt?(��iCT 1vnlrl Y�r) + - , + -: I-'IItt' (Name of Conusuclr) (ItlszIranc Com..n_I-,•,,Pokey Numb--r) (F?: ir.:;io: Date) (M"dt WItimal sma ( I and it SoiC llroptlC Oi iir1Q have no one �,"I f lli for i]1C_ ) t?iI1 <? 11O111e ow!1 I'C1fe-ID1I1: ill iI]: V,�,`i:, ii]VSClt NOTE' Ac-ac Lac-ware that.Ni ilc not uKrc 1:2-11 tluco units in"on"a}rxx—s oc a:t` .�.�:._c��z�•.urtc. r'L`cRc uc o-�((vrsallV o;r.::::r ::� legal"am;of an om>loyoc uodcr tf.o Wuiccet Coca;x ration/cL I undo tt+n l tliil a copy of the cintca mt cnxy bo fo x+v tod to t r[Y.Sxi tn7 of of Ina u rial A it nt� (fiico of I: ur n=o for U. coverige vaifieatioc and tlLt failure to t.nue coverng--ur r zceU, 15A eI MOL 152 can lend to the innposifion of r 1 pa 5lt:es co ti_tting of a fm,of up to S1,500.00-r.x imprison-11.-:1 of up t)cr-.}`ar naj civil pc a16c3 in d<fo n of n Stcp\Vc 0�1�v:d a f of SI00.0t1 a city Irr.ix-t rnr. roc cSq;u Lix7tal uic only' �� Pcrmtt Ntuntr:r - Sit;nature c�ti tc�n•,cJPcrmtttr: --- - SECTION:$; CONSTRUCTION:SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number r Address Expiration Date Signature Telephone f Witi��a i � „ Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION;IU 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...... ❑ O� wane gem �4 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 fo-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 «DESCRIPTIONOF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. )9. Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ] Brief Description of Proposed Work: /1%1' 1`t T i U 01 0 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll❑ - Sheet 0 sa 1fNew ho"use ' dor ac!'dition toexsting=iFio`u`sing _conpletthe=ffol'lowing a. Use of building : One Family Two Family Other X1 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. Mascheck 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 OWN EFtS,AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT e ° 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 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. Print Name Signature of�Agent Date 3 Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Fronta e �d 1440 Setbacks Front /CO Side L: R: L: 6p O R:i !� Rear Building Height c, Bldg. Square Footage j % Z� Open Space Footage ,,,�� ��!! (Lot area minus bldg&paved ;b;o parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 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 # B. 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: C. Do any signs exist on the property? YES 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: '-�Cityr:Of`Northampton tus P a �B,�,ilding Department - 212 Main Street Se er .e, lc 1 Room 100 a erlWe v -Qrthampton, MA 01060 phone 413.587.1240 Fax 413.587.1272 it an Other}Speal�. �°q,, APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property This-sectionto be completed by office P3W € � 'a!�' 1 /�(�( `/ ✓— M! r1 Map . / lot Ovi� _�� FJnit Fk.o v ej%c M 4S 5 C)I Zone Overlay Distnct Elm St, District CB D�stY,�ct SECTION 2 - PROPERTY OWNERS HIP/AUTHORIZED'AGENT 2,1 Owner of Record: PAIR— Name(Print) Current Mailing Address: 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. Elecirical (b) Estimated Total Cost of Construction from 6 3. Plumbing ____ (�Y—W Building Permit Fee 4. Mechanical (HVAC) l Z ct c7 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) (3 .'j L> Check Number l This Section For Official Use Only Building Permit Number Date Issued: Signature;. Building Commissioner/Inspector of Buildings Date File#BP-2003-0769 APPLICANT/CONTACT PERSON MEUNIER MARK ADDRESS/PHONE 19 LADYSLIPPER LANE (413)586-9753 Q PROPERTY LOCATION 19 LADYSLIPPER LANE MAP 35 PARCEL 247 001 ZONE SR 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: CONSTRUCT 16 X20 ARTIST STUDIO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildinp,Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE F LOWING 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 ssion ` a 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. BP-2003-0769 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Build ft Category: shed BUILDING PERMIT Permit# BP-2003-0769 Project# IS-2003-1265 Est.Cost: $13950.00 Fee: $32.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.1): 51836.40 Owner: MEUNIER MARK Zoning: SR Applicant: MEUNIER MARK AT. 19 LADYSLIPPER LANE Applicant Address: Phone: Insurance: 19 LADYSLIPPER LANE (413) 586-9753 Q FLORENCEMA011062 ISSUED ON:411103 0.00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X20 ARTIST STUDIO 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: Receipt No: Date Paid: Check No: Amount: Building 4/1/03 0:00:00 1908 $32.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo