30A-042 (2) �a P l g l y REMOVE EXISTING FLOORING
/ AND 5U13 FLOORING
2668
V
CONTRACTOR: Z V CL05ET
RAINBOW HOME IMPROVEMENT 26Eo 2665
5 -5, „ x2,-8
125 RYAN ROAD X to 2668
FLORENCE, MA X
413 341 3838 LU DEMO EX5TING
C NON-WOOD
LIENT:
FLOORING
MICHELLE DEROUIN Q
13 LEXINGTON AVE O ORIGINAL FLOORING
NORTHAMPTON, MA TO REMAIN
LL-
Work to be completed as follows: Q BEDROOM
x 10'-1
DEMO and FRAMING Cl
"
_
Existing non-wood flooring in bedroom to be removed down to sub
flooring. Original wood flooring to remain. In existing hallway/ closet "
wall a new wall will be constructed up to ceiling height, to create new
bathroom space. Sub flooring in new space to be removed to
accommodate plumbing rough ins for toilet and new sink. Original
door to remain. Overhead attic access to be re-framed to
2840DH
accommodate new wall configuration. On first floor, new plumbing
chase will be framed in to accommodate new properly vented
sewerage and water supply runs from basement, up to the new 2nd NEW FULL HEIGHT WALL
floor bathroom.
NEW
FIXTURES AND FIN15HE5 EXHAUST FAN
All newly framed walls will be sheathed using 1/2" gypsum board. All 2668 5'-4"
seams will be taped, and sanded to a smooth finish. All new walls A =
and ceiling to be primed and painted to match existing as closely as LU NEW WALL MOUNT 51NK
possible. In 2nd floor bedroom new tongue in groove fir flooring will ca ® NEW MEDICINE CABINET
9 9 9
p 6E O '--4665
be installed to match existing as closely as possible. Entire flooring CIL m NEW VANITY LIGHT
surface in bedroom will be sanded and sealed using a water based Q 2668 NEW GFGI OUTLET
sealer, with a satin finish. Some variations in flooring color may
occur due to the differing ages of the old versus the new wood
flooring. In new bathroom floors will be tiled with a ceramic mosaic �
tile. New baseboard will be installed, to match adjacent existing as
closely as possible. New toilet and small, wall mount sink with faucet NEW FIN15H
will be installed. New vanity light and medicine cabinet will be NEW TOILET FLOORING TO
installed. New towel bar and toilet paper holder will be installed. New Q MATCH EXISTING A5
J
GFGI outlet will be installed near sink. New exhaust fan to be BEDROOM CLOSELY A5
installed an vented through roof soffit. All walls and ceiling in new 1L „ C LO5 LY
bathroom will be painted to client preference. A 1"I -9 x 10'-1
CV Q
0
"
28400H
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �D M M kLO I�Qi ('iS 2 3
License Number
?� P-�1 ov-ey L-o- M Pk D 1 D Z _ I - 19- 2-01b
Address Expiration Date
(4I3)
Signature Telepho
9.Reaistered Home Improvement Contractor: Not Applicable ❑
,(Z 11: CP14 vuLAI ib +7 5q5
Company Name Registration Number
1 2 L pt v► IZ 1c- :i - 1 ,4
Address (41-3) Expiration Date
l ay w t_e MA b Telephone 3 Z41 - A b 3 Y
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) 77-1
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 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) Y9 Roofing ❑
Or Doors M
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [❑ Siding[0] Other[Q
Brief Descrip on of Proposed 7Z, ('�
Work: Ai.hOn��Z� Y)It �j AY-OPM Obi 'ZND - )6oY aL bOM$ • IHts V-epA
Alteration of existing bedroom Yes No Adding new bedroom Yes 1O No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.if New house and or alddition to exist!na housing, complete the 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
I, M i e e g U 12-i hi 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.
A Ill
Signature Vt owner Date
I, 1—OM w e- • 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.
Print Na
- 2-ci
Si atur wner/Agent Date
Section 4. ZONING At(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
Side L: R: L: 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 DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book Page and/or Document#i
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW @ YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on 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 0 NO
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 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
EAJGf Northampton Status'of Permit:
ii ng Department Ctirb'Gut/Driveway Permit 8 2014 �'" Main Street Sewer/Septic Availability Dorn 100 Wated Well AvailabilitPlumbing&Gas In pton, MA 01060 Two Sets Of Structural Ptans rthamp h�MM- 1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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 completed by office
( 3 I C' 1 In9 JA Ave, Map Lot Unit
Iv d r 4,,o o h p jvr4 M A D r 0 b v Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
M
14,14 e.11 e D /3 x k a b N Ave . A
Name(Print) Current��i�g Ad re y Z
` Telephone -'))
Signat re
22'Authorized Agent:
.2
IOM Mmcue , K— 11A( ^i'nlnl MP I M bMVP '(Nj'F 1210 P-44-644 Q-J
Name(Print) Current Mailing Address`
'Signature telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building to $ 00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
f -7 00 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=0 +2+3+4+5) =3 v Q Check Number
This Section For Official Use Only
Building ermit Number. Date
9 Issued:
Signature:
Building Comm issionerfinspector of Buildings Date
File#BP-2015-0190
APPLICANT/CONTACT PERSON THOMAS MALONE
ADDRESSIPHONE 128 RYAN RD FLORENCE (413)885-9038
PROPERTY LOCATION 13 LEXINGTON AVE
MAP 30A PARCEL 042 001 ZONE URB(100)/
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: ADD 2ND FLR 1/2 BATH&FLOOR REPAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 055236
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
�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
D lition Delay
r� I
at re of Bui ding 6ff cial 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.
13 LEXINGTON AVE BP-2015-0190
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-042 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-2015-0190
Project# JS-2015-000364
Est.Cost: $13500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS MALONE 055236
Lot Size(sq. ft.): 6316.20 Owner: DEROUIN MICHELE
Zoning: URB(100)/ Applicant: THOMAS MALONE
AT. 13 LEXINGTON AVE
Applicant Address: Phone: Insurance:
128 RYAN RD (413) 885-9038 WC
FLORENCEMA01062 ISSUED ON.811912014 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 2ND FLR 1/2 BATH & FLOOR REPAIRS
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 8/19/2014 0:00:00 $81.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner