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37-041 _ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �i-, Northampton, MA 01060 ss �� INSPECTOR David Fortier September 4, 2014 32 Laurel Street Northampton, MA 01060 Subject Location: 22 Old Wilson Road Map Block: 37-041 Mr. Fortier, Your building permit application and plans dated 8-15-2014 have been approved as drawn, noted, and per this memo. All work must meet all applicable codes whether noted or not included within this memo. Please follow up on the following items: These items will need to be accomplished as the project moves forward and before rough inspections; 1. Stamped engineering for all non prescriptive materials and or systems. 2. A smoke detector in the bedroom and a smoke/CO within 10' of the bedroom door. 3. Crawl spaces venting must comply with R408.1, R408.2, and R408.3 4. Crawl access must comply with R408.4 5. I-joist cantilever must meet manufacturer's requirements. Note:July 1 begins enforcement of the 2012 IECC with MA amendments and fire protection for non- dimensional lumber floor system frames,the new Stretch Code is pending. As of August 4th 2011 the 8th Edition MA code is the 2009 IRC with MA amendments. In the following are some generic requirements which seem to be problematic. This is not intended to be comprehensive, nor is it a substitute for purchasing and reading the MA codes. Read only international codes are available on line at http://publicecodes.cyberregs.com/icod/one must also consider the MA amendments to these codes which can be found at www.mass.gov/dps/bbrs . The current relevant building codes are: 2009 IBC, 2009 IEBC, 2009 IMC, 2009 IRC, 2009 or 2012 IECC,AA115, MA amendments. Relevant items must be submitted to the building department for approvals before inspections and or Certificates of Occupancy can be issued. Feel free to call if you have any questions. My telephone number is 587-1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting we close for walk-ins at 12:00 noon on Wednesdays. My email address is: cmiller(aD_northamptonma.gov Thank you for your ooperation on these matters. 4kKi gW City of Northampton Assistant Commissioner and Zoning Enforcement .S' F 4� § AVAKF l,erl s y s ' nl Ok txj IIdTINv qA jot jr)o 36` Ag s�- i t City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: ag At'or� The debris will be transported by: OA„ I FQA-'V�9� The debris will be received by: V$('r wz) &�UYeti +Itc Building permit number: Name of Permit Applicant O �Rti Date Signature of Permit Applicant City of Northampton Massachusetts .: I 7� DEPARTMENT OF BUILDING INSPECTIONS ✓ h, 212 Main Street • Municipal Building s Northampton, MA 01060 t?yY` V r 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): 01 ,aj U Q aj6 i gA Address: 3 /-AURRt, �i,, City/State/Zip: P4 Phone #: 1-1Q b Y(� Are you an employer? Check the appropriate box: Type of project (required): 1.E, I am a �with employer 4. ❑ I am a general contractor and I 6. F-1 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, ❑ Demolition working for me in any capacity. employees and have workers' 9 ® Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We area 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: V 7 Policy#or Self-ins. Lie.#: -1A j o � 1 2 1 4 Expiration Date: Job Site Address: � � ! C �,GI✓ ,� n City/State/Zip: ��Ai`I�_Iv N� 016/ 0 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 he pains and penalties of perjury that the information provided above is true and correct. Signat ure: Date: � � � 1q 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 £ Name of License Holder: `�fit) ` �U2� G Q— \S 0 U License Number aTi A'Vo--MA), 41 0 u U I, ho I I(, Address / Expiration mate Ju '- r— 4- Signature Telephone 9..Regi tered Home Improvement Contractor: Not Applicable £ � n3ggq Company Name Registration Number '7110 1,16 IV Address C / Expirati Dat , . �Z GA Joe r, I'Lf'f�a 1 LJA 10f W. lFf 040 Telephone W 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. uome Owrier:Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellinlzs 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 CR Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other(0] Brief Description of Propo.Wd Work: C.ij A-Al 6>& t-��t5i &z,DouoA 10 oFFKa Ann a 17 y a q'& 467 5k 66da-o Alteration of existing bedroom 'A, Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Lion to existing 6a.:If New house and or adtl housilng,`'complete the followlng: a. Use of building: One Family k 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? DAD It 0 44rt a''&W41 _ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction VJ 60 1) 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 Zas Owner of the subject property hereby authorize 1 to act on my behalf, in all matters r6lative to work authorized by this building permit application. Signs a of Owner Date � aver/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. 0AVc3 foA 16A Print Nam*ofner/Agent Signature Date ` Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tliis column to be filled in by Building Department Lot Size Setbacks Front Rear Bldg.Square Footage -rr Open Space Footage % F—i (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? ��/ x~� DON7KNO . Y�3 x~��� NO �� VY �1 IF YES, date issued:,! ! IF YES: Was the permit recorded at the Registry ofDeeds? NO �_�� � DONTKNOVY 0 YES 0 —=— --- IF YES: enter Book Page and/or Document# «���� �� B. Does the site contain a brook, body ofvvaterorwetlands? NO �~��� DON7 KNKNOW YES �~� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtained �~t Obtained x�� Date � �~� �_� ' �� C. Do any�8nsexist on the pmper�? 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 0 IF YES, describe size' type and location: � } �������������������.� E Will the construction activity disturb(clearing, grading, a8on. or filling)over I acre orioit part ofa common plan tha�o@|d��urbover1aoe? YES 3 NO �/«J ' `~� ._~ |F YES, then u Northampton Storm Water Management Permit from the DPW iorequired. ^ '' D p m e art eh#use only C_ City of Northampton Status of Permit �" s I Building Department Curb Cu#/Dn�eway Perrrstt AUG �� 5 X014 212 Main Street Sewer/SeptieAyaitability Room 100 1Nater/i/Ite7lAvailability ;scion rthampton, MA 01060 Two Sets of S#ructural Plans Electric,Pw ti -587-1240 Fax 413-587-1272 P[ot/Site plans ' t Other Speoify ' APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: This secfion to be completed by office o� V L Q UV I L�6/f� �� Map Lot Unit ................... ............ = Zone Overla District y__ _.- Elm St'Distract: CB Distract . SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: �i/ TelT n1� — /�J'ilJ� -- Signature f Lw 2.2 Authorized ent: A u 13 t 15& �A u� 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 lJ® (a) Building Permit Fee tf 2. Electrical (b) Estimated Total Cost of `{ , a 0 Construction from 6 3. Plumbing ®� �q Building Permit Fee c V 4. Mechanical(HVAC) 5. Fire Protection (� 6. Total=(1 +2+3+4+5) �d v D Q Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector'of Buildings Date File#BP-2015-0227 W � S APPLICANT/CONTACT PERSON DAVID FORTIER t� ADDRESS/PHONE 32 Laurel St NORTHAMPTON (413)586-8965 PROPERTY LOCATION 22 OLD WILSON RD MAP 37 PARCEL 041 001 ZONE 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: CONSTRUCT 18 X 24 MASTER BEDROOM ADDITION&CONVERT BEDROOM TO OFFICE New Construction Non Structural interior renovations Addition to Existing - AccessoU Structure Building Plans Included: - Owner/Statement or License 008026 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO JkMATION 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 De o ' ' n 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. 22 OLD WILSON RD BP-2015-0227 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-041 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2015-0227 Project# JS-2015-000424 Est. Cost: $88050.00 Fee: $528.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DAVID FORTIER 008026 Lot Size(sq. ft.): 91476.00 Owner: LEBIECKI ROGER S&JANE Zoning: Applicant: DAVID FORTIER AT. 22 OLD WILSON RD Applicant Address: Phone: Insurance: 32 Laurel St (413) 586-8965 WC NORTHAMPTONMA01060 ISSUED ON:91512014 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 18 X 24 MASTER BEDROOM ADDITION & CONVERT BEDROOM TO OFFICE 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 9/5/2014 0:00:00 $528.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner