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_. __1l____..____.._-__._._____._____________________.___________-__________
NORTH HAMPTON
1
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Drawing Title;
SECTION - 2 DATE: 05.02.07
SCALE: 1/8" = 1 -0'
ALEX
0
Quick Open Space Calculations Coverages
existing 1240
Lot area existing proposed existing 590
8581 2069 2549 existing 70
existing 106
Open Space 6512 6032 existing 63
total 2069
Open % 75.9% 70.3%
new 480
new
new
total 2549
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DEPARTMENT OF BUILDING INSPECTIONS /=
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 to
act as has/her construction sup,*.,-.�'Sor. Tfie 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 foundationflootings (before backfill),
sonotube holes (before sour) 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
1, 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
a 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Le ibly
Name(Business/Organization/Individual): s > /jam�L
Address: _096 Sj /�r/i! Jl
City/State/Zip Q U33 Phone#: ` /-3 �� ✓�
Are you an employer? Check the appropriate bog: Type of project(required):
4. I am a general contractor and I
1.❑ I am a employer with 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
0�,rI am a sole proprietor or partner- listed on 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' 9. ❑ Building addition
[No workers' comp.insurance comp.insurance.$
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 11.0 Plumbing repairs or additions
myself. [No workers' co right of exemption per MGL
comp. 12.0 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.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
xContractors 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
Investieations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penal ' s of perjury that the information provided above is true and correct.
Signature: Date: �I
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 ❑Q
Name of License Holder: 0 G`�O��' "� �/Ar� 6S v
License Numb r
Address / Expiration Date
Signature Telephone
9 Rec(istereil Home Ir►aroverient:Gontcactor r i .�, _ � #.,� k: .. Not Applicable ❑
��,n/�; 99
Company Name Registration Number
Address Expiration ate
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...... ❑
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 I7
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Deck Siding[o] Other[01
Brief Description of Proposed ,
b
Work: $x:14f.—A 2u,-� X Z6, 14Er-K ,r(1 zxtZ`►.r 15n A ✓,n� r�1JL '�ib' � '
Alteration of existing bedroom Yes_ to Adding new bedroom Yes C�t No
Attached Narrative Renovating unfinished basement Yes _�No
Plans Attached Roll -Sheet
sa If-NevinioaseY?'and..oadditiar> a'-'ez�sfFia haescc>a'aomi fefhfaiLtouv�nc:
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? /V U
y � <
d. Proposed Square footage of new construction. f o s' Dimensions-Z-e2 .x -Z-'--� C317
e. Number of stories?
f. Method of heating? L✓ Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. A42 Masscheck Energy Compliance form attached? .N
h. Type of construction �j?, ,",
i. Is construction within 100 ft.of wetlands? Yes _ fo. Is construction within 100 yr. floodplain Yes -
1/
j. Depth of basement or cellar floor below finished grade ;I', G
k. Will building conform to the Building and Zoning regulations? (:: /es No.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a OWNER,AUTHORIZATION-,TO,BE COMPLETED WHEN
OWNERS AGENT OR-CONTRA CTO PPLIES FOR BULDINGPERMIT
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
o° I, as Owner/Authorized
Age t he dec re that t statem nts and information on the foregoing application are true and accurate,to the best of my knowledge
and be ief.
Signed under the pains and penalt'es of perjury.
l k �llLA ,
Print Name
Signature wner/Agen - ' Date
^ , .
. . ^
m/
~
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
�-/ 6
Frontage
Setbacks Front
Rear
Building Height �
/
< h6 P»0Qx
`(
Bldg.Square Footage OX
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has u Special Permit/Variance/Finding ever been issued for/on the site?
��
�~\ �~�
NO _��� DON7KNOVV YES �~�
IF YES, dutaissuadk
IF YES: Was the permit recorded ut the Registry ofDeeds?
NO DON7KNOVV 0 YES
IF YES: enter Book Page and/or Document#| �
�� ��
B. Does the site contain a brook, body ofm/oterurxvedands? NO DON7KNOVV �_/ YES �_/
IF YES' has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained x~� O�ta�oe� � �~� Date
x�� �~� . �
C. Do any signs exist on the property? YES K } 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
IF YES, describe size, type and location:
'
E. Will the construction activity disturb(clearing,gradiexcavation,or filling)over 1 acre cxbit part ofa common plan
that will disturb over 1 acre? YEG K ) NO-�~1,
�� —Imp-
IF YES,then a Northampton Storm Water Management,Permit from the DPW is required.
Department use_anly '-
City of Northampton StatusoiP�rmIE
Building Department CurECutLDrEVewaPerm { x
212 Main Street Sewer�SepttcA 116btlCty `
Room 100 VUafeilWell AyaJ6610t4 °
Northampton, MA 01060 Tva�a Sets'of Struttrat Plans
phone 413-587=1240 Fax 413-587-1272 PtotEStte Plans a
Other Specify
r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOV IS ONE OR TWO FAMILY.DWELLING
SECTION 1 -SITE INFORMATION
is e n to be corttp[eted b offFce
1.1 Property Address:
AM t Unit
C � � t} - verFa 'District
District ttCB D�sfnct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 11
N
Name t) Current Mailing Address:
Telephone
Signa
2.2 Authorized Agent:
Name(Print) C15rrent Mailing Address: r
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 Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section ForOfficial Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-0168
APPLICANT/CONTACT PERSON G NICHOLAS WOHLERS
ADDRESS/PHONE 388 EAST STATE ST GRANBY (413)467-1540
PROPERTY LOCATION 24 ORCHARD ST
MAP 25C PARCEL 166 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
T_ypeof Construction: CONSTRUCT 20 X 20 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 053982
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Co ion
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.
6 �
BP-2008-0168
GIS#: COMMONWEALTH OF MASSACHUSETTS
y CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category BUILDING PERMIT
Permit# BP-2008-0168
Project# JS-2008-000251
Est. Cost: $6000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: G NICHOLAS WOHLERS 053982
Lot Size(sq. ft.): 8581.32 Owner: KONHEIM ALEXANDER CARL
Zoning URB Applicant: G NICHOLAS WOHLERS
AT. 24 ORCHARD ST
Applicant Address: Phone: Insurance:
388 EAST STATE ST (413) 467-1540
GRANBYMA01033 ISSUED ON.911112007 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 20 DECK
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 9/11/2007 0:00:00 $50.003672
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
24 ORCHARD ST BP-2008-0168
cis #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C- 166 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0168
Project# JS-2008-000251
Est. Cost: $6000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class:_ Contractor: License:
Use Group: G NICHOLAS WOHLERS 053982
Lot Size(sq. ft.): 8581.32 Owner: KONHEIM ALEXANDER CARL
Zoning: URB Aprlicant: G NICHOLAS WOHLERS
Applicant Address: Phone: Insurance:
388 EAST STATE ST (413) 467-1540
GRANBYMA01033 ISSUED ON:9/11/2007 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 20 DECK
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:
DriN eway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
THIS PERMIT MAY BE REVOKED BY THE CITY O NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. '
Certificate of Occupancy s` il4natnre: w _
FeeType• Date Paid: Amount:
Building 9/11/2007 0:00:00 $50.003672
212 Main Street, Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo