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17C-164 (4) Dwight Home Improvements Thomas E. Dwight P.O. Box 463 Hadley, MA 01035 (413) 584-2138,cell (413)210-8420 Ma. HIC Reg. #100524—Ma. Construction Supervisor#101668 5/2/14 Re—83 Chestnut St. Florence, MA 01062 Remove and dispose of existing roofing material on east side of home. Supply and install OSB sheathing, drip edge, ice and water barrier underlayment, Palisades titanium underlayment and 30-year roofing shingles. Install ridge vent. Labor and Materials $5,000.00 1 request that you grant a modification to waive the requirement for control construction for the project at 83 Chestnut St., Florence because the work is of a minor nature,will not affect health, accessibility, life and fire safety,or structural requirements and is impractical In that the cost of control construction is considerable when compared to the cost of the proposed work. This letter is supplied by Thomas Dwight dba Dwight Home Improvements. Thank you for your consideration. Respectfully, ' J Thomas E. Dwight Dwight Home Improvements 27 Maple Ave. P.O. Box 463 Hadley, MA 01035 . Office of Consumer Affairs&Business Regulation -HOME IMPROVEMENT CONTRACTOR kegistration: !Q0524 Type �P=� Expiration: 6/19/2014 DBA DWIGHT HOME IMPROVEMENTS Thomas Dwight 27 Maple Ave Hadley, MA MA 01035 Undersecretary Massachusetts Department of Public Safety Regulations and Standards Board of B;:�;din9 Reg ,,- Constnution SuperNisor z License. CS-101668 ,`= TIIOMAS E DWIGHT 27 MAPLE AVE = = HADLEY MA 0135 �xaIration 11122/2014 commss;oner City of Northampton Massachusetts elf _: s;Gll, ✓ G � 1��4- 1 • �' �t {` r DEPARTMENT OF BUILDING INSPECTIONS x 1` b 212 Main Street • Municipal Building 5J� bit Northampton, MA 01060 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 Department of Industrial Accidents Office of Investigations ! 600 Washington Street Boston, MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G' 4 Address: City/State/Zip: � \ Phone #: Are you an employer? Check a appropriate box: Type of project(required): 1.❑ I am a employer with 4. F� I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2I am a sole proprietor or partner- listed m the attached sheet. 7. []Remodeling \\ship and have no employees These sub-contractors have g, E] Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9 F-1 Building addition required.] 5. F� 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.F] 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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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: ��—; ' �� ,t Policy#or Self-ins. Lie. #: �<J� ��,�� \��C; O 1, Expiration Date: �0 �O l Job Site Address: % C� U�C City/State/Zip: O 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 r under the pains andpenalties ofperjury that the information provided above is true and correct. Sign ature: Date: Phone# 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.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: b IN C j r 1)\ License Numb r 1 \A(k .. V 1 1N� -,34 Ad Expirati nDa e �A\ Signa ure Telephone 9.R eal t ered Home Im''rovement Contractor: _ Not Applicable £ Company Nande Registration NumBer Address 1 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.... . £ 11 -'Home Owner E�emntion 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. l SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors is Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks (M Siding[0] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.'If Newhouse and`ol•add Pion fb existing. '6 ing; comh`lete the followfng': 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 1 v .r � as Owner of the subject property hereby authoriz vm to a al in all matters ve to work authoriz this building permit pplica ion. 17j ignatIrLvof Jwner Date as OwnerkA thorize 2 eZnt hereby declare that the st ments and information on the foregoing application are true and accurate, to the best of n1 Rft&Me6ge ana6elief. Signed under the pains and penalties of perjury. Q4 M Print Na Signature f Owner g 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 Rear Building Height Bldg.Square Footage 010 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces Fill: ilk A. Has a Special Permit/Vahance/R riding ever been issued for/on the site? x-� x-� NO v x~�� DONT KNOW «�� YES «�� IF YES, date I ' _—J IF YES: Was the permit recorded at the Registry ofDeeds? NO K J DONTKNOYY YES `� 0� IF YES: enter Book IL Page and/or Document# �� B. Does the site contain a brook, body uf water orwetlands? NO �~�� DONTKNO\� ��, YES �~� IF YES, has u permit been or need to be obtained from the Conservation Commission? Needs tobeobtained �,� Obtained �~� Date �_� �~� ' . C. Do any signs exist un the property?� YES v_� 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 0 IF YES, describe size' type and \ucation: L . ��... .......�� E. Will the construction activity disturb(clearing,gradingexcavation,orfiUing)over 1 acre oriait part ofa common plan , that will disturb over 1acre? YES NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �4[- N �*fit rr° �`�}�i y'-{l+'+.�v� S ?� �*� City of Northampton Status ofPermtt ,* �' � ��,;�I "'— Building Department Curb°Cut/Driyeyray Perrrttt u ��h c ' y fi N r' •a. �).((j.p 212 Main Street SeyierlSeQtlAvaila6Ilty '1 i��kF M1 ' 41 L F 4 Room 100 WaterlkllCeilAvallabl4ty Northampton, MA 01060 Two Sets 41$trlrGtriral Ptan$' 'N N' N x`11 phone 413-587-1240 Fax 413-587-1272 "' a� UtherzSpeciify'L ' ;.fr it Kos�t�p I f i{;a i�i r it + e f1( APP T10N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLI I - 1 S - E INFORMATION 1.1 Property Address: This sec3ron to 6e completed by office Ma Lot Unit r Zone Overlay District L Elm Sty Drstnct '. : CB;:Drstrrct L..; , SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Rem d: Name(P' t) Current Mailing Address: Telep one Signature 2.2 Authorized A ent: r-0 -_40K 4f 0 Name(Print) Current Mailing Add ss: 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 Feb 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) 1 Check Number This Section For Official Use Only Building Permit Number: �J IDat ed: Signature: Building Commiss(oner/Inspector'of Buildings Date 83 CHESTNUT ST BP-2014-1135 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 164 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2014-1135 Project# JS-2014-001928 Est.Cost: $5000.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS DWIGHT 101668 Lot Size(sq. ft.): 19819.80 Owner: ROSENBLUM JEFFREY M Zoning.URB(100)/ Applicant: THOMAS DWIGHT AT: 83 CHESTNUT ST Applicant Address: Phone: Insurance: P O BOX 463 (413) 584-2138 Liability HADLEYMA01035-9710 ISSUED ON.5/2/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 5/2/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner