29-417 (6) �.
City of Northampton
5f
r >" Massachusetts f
A
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
w Northampton, MA 01060
INSPECTOR
Leary Building Corp. October 14, 2014
1039 E. Mountain Road
Westfield, MA
Subject Location: 88 Brookwood Drive
Map Block: 29-417
Mr. Leary,
Your building permit application and plans dated 10-14-14 have been reviewed and approved per this
memo.
1. Appropriate clearances must be maintained above all stoves.
2. Exhaust hoods over 400 CFM require makeup air.
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(c)-northamptonma.gov
Thank you f r your c operation o these m ers.
uck Miller
City of Northampton
Assistant Commissioner and Zoning Enforcement
-----� -- - ""b"_•"�.. Yet.�. ��,.. l
1 Congress Street,Suite 100,Boston,Massachusetts 02114-2017
http://www.mass.gov/dia Invest./SWO ID#•
AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE
OFFICERS OR DIRECTORS
Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, x'1(4) by adding the following paragraph:
"This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of
the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall
apply only if the corporate officer provides the commissioner of industrial accidents with a written
waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the
purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set
forth in section 25C."
___Pursuant to ivi.is.i.. c__152; §i(4) as amended -:ttWe the andf-rsigned officers of-
Leary Building, Inc. 1039 East Mountain Road, Westfield, MA 01085
(Name of Corporation and Address)
each holding at least 25% of the issued and outstanding stock in said corporation, do hereby invoke the
right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a
workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the
undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for
any injuries that may be sustained while in the employ of the above-named corporation.
Further, I/we the undersigned do understand that, should the above-named corporation hire or have in
its employ any employee(s) in addition to the undersigned corporate officer(s) or director(s), said
corporation is required to obtain workers' compensation coverage for the employee(s) as prescribed by
M.G.L. c. 152, §25A.
I/We the undersigned have read and understand the statements and obligations as delineated above and
I/we have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or
not to be exempt from the provisions of M.G.L. c. 152.
Signed under the pains and penalties of perjury:
Timothy A. Leary, president ___.__D711519014
Signature Print Name&Title Date(mm/dd/yyyy)_
✓❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name&Title Date(mm/dd/yyyy)
❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name&Title Date(mm/dd/yyyy)
❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name&Title Date(mm/dd/yyyy)
1:11 wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Instructions
on back. Form 153—7/2010
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Apppllicable/�❑
Name of License Holder: Q &y �U-!
License Number
/D 3�� E_ /1'l0��.�U•u �0 Ego i FrGI�� �1�4 oio�S� 1111 gzaa
Address CEPAtion Date
s
f3 33&
Sign ure el
9.Registered Home Improvement Contractor: Not Applicable ❑
Na E11-WK Jtie I 3-1 7-An
Company Name Registr t n Number
S 616TEAJ MA Pic'Z w (O
Address Expiration JPate
Telephone/1�1/ ()
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. - 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"bomeowner"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 13
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [Q Siding[O] Other[CA
Brief Description of Proposed
Work: LCIfl6N "bel_ r��(t�ia�U(n(lis T [�:IUV�'�I.aPli�
Alteration of existing bedroom Yes A No Adding new bedroom Yes D< No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing 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 a as Owner of the subject
property
hereby authorize
to act on my behalf,in all afters relative to work authorized by this building permit application.
Signature of Owner Da et
/j�8 1,4-�:A� LLA " g0'Cbix� C as Owner/Authorized
Agent hereby declar that t stateme s and in ormation ori the foregoing applicaf n are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
�A2
Print Name
Signat a of Owner/Ag t Date
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
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. HaXei ial Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, ed:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 9 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO �QJ
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, xcavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
L,—lq Department use only
f Nor thampton Status of Permit:
2014 ",t'd g Department Curb Cut/Driveway Permit
_121 Main Street Sewer/Septic Availability ng&Gas if'`Sje t'Gny oom 100 Water/Well Availability ton,w,C'08U
orthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 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
G 4L--500b b(- Map Lot Unit
4
G� Zone Overlay District
U,4�N
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
. ZlLl a:r, I Telephone
Signature
2.2 Authorized Agent:
LEAQ-4 , i• /0-9cf (% Anoopu, Fill,
Name P'nt Current Mailing Address:
i (a
Sign fur. Tele ne
SECTION 3-ESTIMATED ON TRUCTION COSTS 7
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building S 10 (a)Building Permit Fee
2. Electrical Qp p (b)Estimated Total Cost of
�tJ Construction from 6
3. Plumbing c 90 Building Permit Fee
4. Mechanical(HVAC) J
5. Fire Protection
6. Total=0 +2+3+4+5) '1jD o 07 Check Number `C
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0428
APPLICANT/CONTACT PERSON TIMOTHY LEARY
ADDRESS/PHONE 1039 EAST MOUNTAIN RD WESTFIELD (413)336-2611
PROPERTY LOCATION 88 BROOKWOOD DR
MAP 29 PARCEL 417 001 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: REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 104806
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION 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 soli el
Signature of Building icial 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.
88 BROOKWOOD DR BP-2015-0428
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-417 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-2015-0428
Project# JS-2015-000772
Est. Cost: $30000.00
Fee: $180.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIMOTHY LEARY 104806
Lot Size(sq. ft.): 12850.20 Owner: FOSTER MARY P
Zoning: Applicant: TIMOTHY LEARY
AT: 88 BROOKWOOD DR
Applicant Address: Phone: Insurance:
1039 EAST MOUNTAIN RD (413) 336-2611
WESTFIELDMA01085 ISSUED ON.1011412014 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN
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 10/14/2014 0:00:00 $180.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner