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23C-018 Npl 70' - �+ S ( 7A5 1 i -2 j 277.6}�23 . ,223 23A-305 -- ' A7.a }� � 33.21 23C_105 _.?2 1 7 17 47 6 rya 23D ( 1 70 75.00 _ 75.00" /140 rr J It - _82.97 �J 277.6 23Cyy18 .1f4o.00 J � 542.e6 ! 70 } 74.5 /90 23D-17� ri 1 � 1 75.00 l t` U - 36 1 wvo , 266.5 i }� 302.60 288 57 23A-312 l 5 2aa i r r � J ` i i 23C-023 , r i 'I J 23C-107 r 1 I } t 28.A0 r r J J r 'r -Q15 1� 23C-106 ; 23C-02A l C 23 670 f //��__ } !295.96 331.04 77.26 i ' 640 796.36 r' 796 3a J - - j 1 23G 9 t 23C-1O j f 331.36 7725 f /77-25 j` 1 } 23C-11Q 216} I t�17`3r' I . r City of Northampton Massachusetts �wS 'A-_ 're tyt DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 5J{ :fib ,..n 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) 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): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): l MA I am a employer with 1 _ 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, F-1 Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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 13.7 Other employees. [No workers' 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: l M<nV J4 L — Policy#or Self-ins. Lic. #:Y)e_L,500 :5 D©OO A44, ` zO l of Expiration Date: t J � Job Site Address: �/o �0�� r U G1r_ 57 City/State/Zip: (.Z(ZE'1 L-t' 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �( Date: l l Phone# 41 3 6,- L-6 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 Superviisso\r: Not Applicable £ Name of License Holder: t?,-{� V e. � ° License Number 5r r-Loyeqv­e, o i o6Z C.1 6 49`5- 3 f'"7 Address -- Expiration Date Signatu Telephone f; -jot, 1 tj 9..Re6istere/d,H'ome Imarovemenit do-ntractor: ,. _.,., „, Not Applicable £ Company NArft� Registration Number orb Address Expiration Date Telephone f 53� 6 7 Z0 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 :H6M Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwelli of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a lic se,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. e mi Homeowner:Person(s)who own a parcel of land on which he/she sides or intends to reside,on which there is,or is intended a one or two family dwelling,attached or detached str tures accessory to such use and/or farm structures.A erson who tructs more than one home in a two- e eriod shall not be considered a homeowner. Such"homeowner"shall submit t Building Official,on a form eptable to the Building Official,that he/she shall be res onsible for all such work erforme er the buildin mit. As acting Construction Supervisor your presence e j 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 orkers'Compe on) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death) the Massachusetts General Annotated,you may be liable for person(s) you hire to perform work for you under t ' ermit. The undersigned"homeowner"certi and assumes responsibility for compliance with t ate Building Code,City of Northampton Ordinances,State a Local Zoning Laws and State of Massachusetts General La otated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg.,Q Demolition ❑ New Signs [❑] Decks [0 Siding [❑] Other[❑] Brief Description of Proposed Work: f�... lqc�, iz o'f't eCA 5ILt.1� 51 c�a Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and o'addition to existiir ` 'hodsin com lefe the follow s a. Use of building:One Family Two Fat-nil Other b. Nu er of rooms in each family unit: Number of Bathrooms c. Is there a arage attached? d. Proposed Squ footage of new constru on. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compli Masscheck Energy Compliance form attached? h. Type of construction i. Is construction withi 00 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basem t or cellar floor below fin ishe rade k. Will building nform to the Building and Zoning regu ns? 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 �,,tnV as Owner of the subject property hereby authorize to act on my behalf, in all matte r ative t work thorized by this building permit application. Z- d Signature of Owner Date as Owner/Authorized Agent hereby declare that the litatements 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. e '1 Print Name 1 Signatur er/ e t Date ` ^ , - Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 'nis column to be filled in by C Building Department Lot Size Frontage Setbacks Front Building Height Bldg.Square Footage 0110 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (,volume&Location) A. Has a Special Permit/Yariance/Rnding ever been issued for/on the site? �� �� NO �8� DONTKNOYY �_� YES «�� |F YES, date issued: � IF YES: Was the permit recorded at the Registry ofDeeds? NO D IF YES: enter Book Page and/or Document# �� �� B. Does the site contain abrook, body uf water orvvetiands7 NO ��� DONTKNO\Y ��, YES �~� IF YES, has a permit been or need tobe obtained from the Conservation Commission? Needs to be obtained ~��~\ Obtained »~�~�� Date� ' . C. Do any signs exist nn 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 r NO PON IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading oavadnn.or filling)over 1 acre urisd part ufu common plan ' that will disturb over 1acre? YES K l NO K6� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ '' Y _ City of Northampton li Building Department ly + 1i aey� PF errl 212 Main Street Seyuer(SeptieAvalfa �►ity ;' � : `�} ��f 4 ' Room 100 1Nater%thtetCAVallablllty ` JUN Z _ , orthampton, MA 01060 TwanSe#s of5trtictural —1��93-587-1240 Fax413-587-1272 PlotlSit Plans _ �' 's kk ping&Gas ns Electric,Plum MA 01060 a ' �m ton, APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: This section to be completetl by office n. A-10 n.! 0 7—V C, /L S-r Map Lot Unit i h e Zone Overlay D►strtct Hiji ,Elm St Ristnct :: >:: CB Dlstnct ' SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: `� I�3 Telephone Signature 2.2 Authorized Anent: Name Print) Current Mailing Address: 'Aj±g_ 4A S-3 5 d 9 7-L, Sign a 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 �o (b)Estimated Total Cost of Construction`from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) AJvti 5. Fire Protection 6. Total=0 +2+3+4+5) �' y DAB Check Number This Section For Official'Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector'of Buildings Date File# BP-2014-1373 APPLICANT/CONTACT PERSON JEFFREY BOTT ADDRESS/PHONE 32 Pine Street FLORENCE (413)530-6920 Q PROPERTY LOCATION 110 NONOTUCK ST MAP 23C PARCEL 018 001 ZONE URB000)/ 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: REPAIR BARN STONE FOUNDATION ROTTED SILLS&REPLACE SIDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 053157 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO�TION PRESENTED: FO pproved 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 Demoli ' Delay 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. 110 NONOTUCK ST BP-2014-1373 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23C-018 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-2014-1373 Project# JS-2014-002323 Est. Cost: $12000.00 Fee: $72.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JEFFREY BOTT 053157 Lot Size(sq. ft.): 10497.96 Owner: SULLIVAN MICHAEL E&MARTHA S JENKINS Zonin-: URB(100)/ Applicant: JEFFREY BOTT AT. 110 NONOTUCK ST Applicant Address: Phone: Insurance: 32 Pine Street (413) 530-6920 O Workers Compensation FLORENCEMA01062 ISSUED ON.612412014 0:00:00 TO PERFORM THE FOLLOWING WORK.REPAIR BARN STONE FOUNDATION, ROTTED SILLS & REPLACE SIDING 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 6/24/2014 0:00:00 $72.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner