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24D-317 (13) lcI00D5/YI ITNS C/O Mark Smith 5 Anna Street Ware, MA 010&2 1-473-537-7342 (business Cell) June 18, 2014 To the Northampton Building Department, I request that you grant a modification to waive the requirement for control construction for the project at 127 - 163 Round Hills Northampton because the work is of 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. The scope of this proposed project is the removal of existing porch flooring and stair treads, and the installation of new porch flooring and stair treads. No stair stringers or floor joists will be included in this project. No structural work is included in this project. Thank you in advance for your consideration. Respectfully Mark Smith WOODSMITHS 5 Anna St Ware, MA 01082 7.473.537.7382 ' The Commonwealth of Massachusetts -� Department oflndustrialAccidents =' Offrce of Investigations p 600 Washington Street Boston, MA 02111 www.mass.gov/dia W Compensation surance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informa 13 n \ Please Print Legibly Name (Business/Organization/Individual): i Y A U­ l� 6A- Address: City/State/Zip:- WAtt o I 2— Phone#: 5/ 3 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 employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. .Z employees a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling -- -- -- - These sub-contractors have ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance - comp. msurance.1. 9. F Building addition required.] 5. ❑ We are a corporation and its 10.El 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 -_ a�( 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. '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.#: le J -1 U�j � � � �j Expiration Date: Job Site Address: 72-140 3 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 ofihe DIA for insurance coverage verification. I do hereby rt under the d penalties of perjury that the information provided above i I true and correct. Signature: Date: zo f Phone#: `� t33 -7 3 =Other only. Do not write in this area, to be completed by city or town offrciaL ---.--- n: ------ -- -_- - - -- Permit/License#thority(circle one):Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL;:PEER REVIEW.;(780 CMR110.111 Independent Structural Engineering Structural Peer Review Required Yes 0 a No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED.WHEN. OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Q,A,R of the subject property hereby authorize.'-_ ......... .... ac behalf, in all m rs relative to work authorized by this building permit application. _ ._ Signatur 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.pams_and Penalties of_perjyr�r. .^ ___.___�•�,�,,.�, -,,,,�-�.,.,.__.__._._w�.�._�..._ -.,,__M._ _-,__..,.., Print Name i Signature of Owner/Agent Date SECTION 12-CONSTRUCTION:SERVICES 10.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION,INSURANCE AFFIDAVIT(M G L c.152x§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 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CNIR 116(CONTAINING MORETNAN 35;000 C-F:OF EN tOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): —.- Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility ..__..__.--_.__................ __....-.____._.._.___.._.__._.._.......__..._ _._...._.. _ ._._....._.. .._....... _. _.._.._..w.. ._._.__.__._ Address Registration Number I Signature Telephone Expiration Date _...................__.._.__...._.._...........____.__................- Name Area of Responsibility Address stration Number _ Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephonev Expiration Date .._._...._-,------ ....._ ..... ................_...___ ...._ ... __ __....._._.,...,....__.__..._.__ _.. _._. _____. _..._...___. _.-__..,__ ... Name Area of Responsibility t Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON,ZONING Existing Proposed Required by Zoning This column to gee filled in by Building Department Lot Size Frontage Setbacks Front _ Side L= R:( L fa R Rear Building Height _ '" Bldg. Square Footage Open Space Footage -- (Lot area minus bldg&paved parking) #of Parking Spaces ---� --- - Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF.YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book ` Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 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 0 NO 0 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 location E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other❑ - ._ _.._... ... Brief Description 'Enter a brief description here. Of Proposed Work:_ SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly El A-1 F-1 A-2 El A-3 E3 1A 0 A-4 ❑ A -5❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ - 3A El 1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: _..._........ . M Mixed Use ❑ Specify S Special Use 13 Specify: .�.-. _��...,�..�..,�._._,,....�...�,.,...,.�....-.w,. �n._....�,.__.v.„ .-r COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group _ ___. _ _ ._ __._ __' Proposed Use Group. Existing Hazard Index 780 CMR 34) Proposed Hazard Index 780 CMR 34) .._ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE.ONLY Floor Area per Floor(sf) 1sc 151 2nd _ 2nd _ ? ..._. _..............__ 3rd 3 rd - 4th __..._.. _ 4th Total Area (so Total Proposed New Construction(sf) Total Height(ft) Total Height ft- 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone ,_ Outside Flood Zone[-] Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 _ s t Department USeOnl�/ City of Northampton status of'Persnit -- Building Department ct ut/Dnveway Permit: g 212 Main Street Sewer/SepticAvalrabrPtty JUN ( 92014 Room 100 waterNUeli Avauatillity y N rthampton, MA 01060 Two Sets of StructuraGPlars J Electric.P'umrhorle1 -587-1240 Fax 413-587-1272 Plot/Stte Plans FAPPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed'byoffice Map_ a J/ Lot �� [ Unit one Overlay District © �,. ; CB District - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED-AGENT. 2.1 Owner of Record, ._w.. --'Z- Nam Name( 'nt) Current Mailing Address: - .-_.�._.. Signature �t i��4�-- Telephone 2.2 Authorized A ent - .._ . Name(Vnil Current Mailing„Address: I LA Signature Telephone SECTION 3-ES.TIMATED:.CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant - 1. Building ! r � ap { (a)Building Permit Fee - w 1 a 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 For Official Use Only Building Permit Number .`Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1364 APPLICANT/CONTACT PERSON MARK SMITH ADDRESS/PHONE 5 ANNA ST WARE (413)531-7342 PROPERTY LOCATION 127-163 ROUND HILL RD MAP 24D PARCEL 317 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out AW Fee Paid Typeof Construction: NEW PORCH FLOORING/STAIR TREADS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 104325 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATIO PRESENTED: Proved 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 ay Sig 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. 127-163 ROUND HILL RD BP-2014-1364 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-317 CITY OF NORTHAMPTON Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2014-1364 Project# JS-2014-002297 Est.Cost: $13175.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARK SMITH 104325 Lot Size(sq. ft.): 34020.36 Owner: 127-163 ROUND HILL ROAD C/O GEORGE DANZIGER Zoning. URC Applicant: MARK SMITH AT: 127-163 ROUND HILL RD Applicant Address: Phone: Insurance: 5 ANNA ST (413) 531-7342 WAREMA01082 ISSUED ON.612312014 0:00:00 TO PERFORM THE FOLLOWING WORK.NEW PORCH FLOORING /STAIR TREADS 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 6/23/2014 0:00:00 $78.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner