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362 Kennedy Rd.
Leeds,MA 01053
(413)695-6487
Tuesday,May 13,2014
Scope of Work: 23 Prospect Ave.
Kitchen:
Note:House is built of brick,with a slate roof.
- Existing kitchen cabinets will be saved.
- The two exterior walls of cabinets will remain in place.
- Cabinets on stove and fridge walls will be removed.
- Existing wall between kitchen and dining room will be removed.
- Second floor will be supported with two 9.5''LVLs,flush to ceiling.
- Wall will be built in new location,with 9.5'wide by 6'8"high opening to kitchen.
- Stove and lower cabinets will be reinstalled in new location.
- Refrigerator wall cabinets will be reinstalled in new location,with an end panel added for
the refrigerator.
- New flooring TBD.
- New counters will be stone.
- All new appliances will be stainless steel.
- Stove will be down-drafted through the basement to the outside.
- Kitchen electrical will be improved to meet code.
New and Augmented Openings:
- The opening from the kitchen to the back hall will be widened from 31"to 36"by 6'8"high.
- Anew opening will be built from the back hallway to the living room,48"wide by 6'8"high.
Improvements to Existing Y2 Bath:
Note: 1/z bath is a single-story"bumpout"
- Fixtures will be removed.
- Three exterior walls will be firred in by 2"and insulated with ridged foam to R12.
- Exhaust fan to exterior will be installed.
- Ceiling/roof will be insulated with cellulose to R40+.
- New sheetrock and trim will be installed.
- Floor will remain.
- New sink and 10"toilet will be installed.
City of Northampton
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Massachusetts mo
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DEPARTMENT OF BUILDING INSPECTIONS y :M
212 Main Street • Municipal Building �Jj :fib
ul 4s
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
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �=r f 5'1(�
Address: �7 L � -U1 Vt Q0�A 12i S i� tom. •d 10 J 3
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shi and have no employees These sub-contractors have g, ❑ Demolition
working or me in an capacity. employees and have workers'
g y p ty 9. E] Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.E] 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:
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 ertify u thepains andpenalties ofperjury that the information provided above is true and correct.
Sim ature: Date:
Phone#: ql;_ — o
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 Supervisoor�( , Not Applicablle�£
Name of License Holder: e— 7 0� 1 15 L
License Number
Addres —Expirations
5-gi Telephone
w_
9.Registered Home ImarovemenYContiractor-
Not Applicable £
Company Name Registration Number
°3/Z 7114
Address Ex ration Date NO'S e-
Telephone �1- i'►�c`ile�� h" re-nQ'r:'a
_ Zt�► �tt•.s k& L v�
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...... £
tt 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"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,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition ❑ Replacement Windows Alteration(s) ' Roofing
Or Doors (-
Accessory Bldg. ❑ Demolition ❑ New Signs (aJ Decks (M Siding(01 Other(p]
Brief Description of Proposed I
Work. I r15 v 10L I t-- '� �j�-FI•� +- G��,'G i VoL' -t
Alteration of existing bedroom Yes 0_No Adding new bedroom Yes cy _No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa If New house antl:'or:addition o exisfmg:.housing, complefe hd 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 ,f
hereby authorize � -�l'
T—1 \ o JIN! 0
to act on behalf matters relative to work authorized by this building permit application.
Signature of 0 er Date
I, _�� I r7 ��i✓ �SL 6� 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.
IC Ir^ 5 '�•t���tS��.
Print Name
Signature of Owner/Agen Date
,
'
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
nis colunui to be filled in by
TZ--A Building Department
Lot Size
Setbacks Front L7
Rear
Building Height
Bldg.Square Footage 0110
Open Space Footage %
(Lot area minus bIdg&paved
par ng)
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Va riancel Finding been issuedfor/on the site?
�_� �~�
NO v_� DONT ��
KNOW YES
|FYE5, dateioued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� D
�+� u/" / xmvvv 0 YES
IF YES: enter Book Pageand/or Document#
�� ��
B. Does the site contain a brook, body ofvvaterorwetlands? NO K�y DONTKNOYY «�� YES ��'
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �-� Obtained �~� Date
«~� �~� ' .
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 additi 0 NO
IF YES, describe size, type and location:
E. YWU the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre nrisit part ofa common plan
,
that will disturb over 1 acre? YES K i NO
IF YES,then o Northampton Storm Water Management Permit from the DPW io required.
Departreht
's' 1 1 f '" S.s�r ,i
1�s i.�phi- r '� Pt �' '�M�' f �N r''
Ity of Northampton Status ovPgrM-a � ,
> � •.1 �t<, ,,,�1 .I.1 '0'
k.
Tiding Department CtrrbaCutlt�ri dwa'.( r rttt F
,-A a`�5 ti A r
MAY ( 212 Main street $ewer/Septic Ayatta �Etty r�
/t 1
5 20J4 Room 100 �/Vater/Ul4e tAvatlaf}�ItFj 3wY 1 a
Electric, `i� rthampton, MA 01060 Two Stnf 5t tcural:PFar�s{ ; }
r� PIU""�'O r G- 41 -587-1240 Fax 413-587-1272 Ploti6ite
P",q R,�., C IOnS
' /' ��.•���
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Thtsrsecttonto be completed by'office
1.1 Property Address: F
Lot Urnt.
r "
4_ 4
y.
►!Q`,�,j ,,, �,t� Zone Overlay D�sfrtct
.............
Elm St Distrct CB Distract
SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
YA`S',S k S
Name-(Print) Current M ilin Addr
Telephone
Signatur
2.2 Authorized Agent:
KIC
Na (Print) Current Mailing Address: J 5
41 3 60 t5
Signa ure 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
3� �o
2. Electrical r (b)Estimated Total'Cost of
7 Construction from 6
3. Plumbing 1 , 00o Building Permit Fee
4. Mechanical(HVAC) '
5. Fire Protection
6. Total=(1 +2+3+4+5) 0 ou Check Number
This Section For Official'Use Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
File#BP-2014-1207
APPLICANT/CONTACT PERSON KRIS THOMSON
ADDRESS/PHONE 362 KENNEDY RD LEEDS (413)549-1027 Q
PROPERTY LOCATION 23 PROSPECT AVE
MAP 24A PARCEL 132 001 ZONE URA000)
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: REMOVE KITCHEN WALL&INSULATE 1/2 BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 084152
3 sets of Plans/Plot Plan
THE FO OWING 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 Commission Permit DPW Storm Water Management
Demol' 'o elay
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.
23 PROSPECT AVE BP-2014-1207
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A- 132 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-2014-1207
Project# JS-2014-002042
Est. Cost: $39000.00
Fee:$234.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KRIS THOMSON 084152
Lot Size(sa. ft.): 10193.04 Owner: KASSIS PETER B&ELIZABETH A FRIEDMAN
Zoning:URA(100)/ Applicant: KRIS THOMSON
AT. 23 PROSPECT AVE
Applicant Address: Phone: Insurance:
362 KENNEDY RD (413) 549-1027 O
LEEDSMA01053 ISSUED ON:511612014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE KITCHEN WALL & INSULATE 1/2 BATH
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 Siiinature:
FeeType• Date Paid: Amount:
Building 5/16/2014 0:00:00 $234.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner