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17C-194 (2) v July 3, 2007 Tony Patillo, Building Commissioner City of Northampton Building Department 212 Main St., Room 100 Northampton MA 01060 RE: Garage Renovation, 20 Wilder Place, Florence Contractor: Drew Walsh Owner: Scott Norris Dear Mr. Patillo: This will verify that the renovated garage at 20 Wilder Place, Florence, will be used as a workspace only. It will not be used for residential, rental or guest space, or for any purpose other than a workspace. Thank you. Si erely, / On this.3RAday of Sv` 20-L-:1- before me. the undersiane notary ppublic, / personally appeared S'y -f A. .NeRRiA (name of document sigmr). hro�ed to me through S tt No s satisfactor< eN iden of identification, 20 Wilder Place which mere moss L%L-erase. Florence to be the person whose name is signed . 586-1341 on the preceding or attached document in my presence. Yq�,,ee���i JNE 05i•O 9��i 9gy P<JB ��SSQ�IVEAL.I ��` USETI e i WED AS AN ACCURATE SURVEY AND IS NOT TO BE REM 13UILDING LOCATION ACCURACY IS NOT GUARANTEED o. i ���� ��Icy► I J d 9 L ,,Ylf Northampton, MA Property Detail Page 2 of 2 Brick Trim: 0 X 0 Basement One Story Frame One Story L Stone Trim: 0 X 0 Frame A Remodeling Data: Enclosed Frame Porch Year Remodeled: 0 lopen Frame Porch Kitchen Remodeled (Y/N): One Story Frame Bath Remodeled (Y/N): Land Data Outbuilding Info Square Foot Type Utilities Type F Q Value no Prime information Site FE 126,640 Type Qty Year Size 1 Size2 Grd RG1 � 1925 �1 400 Acreage Type Street/Road Type Acres Value no no information information Sales Info Permit Info Date Permit # Price Purp Date Type Price Validity 03/29/2004 911 4,770 NEW WIl 05/15/2001 Land + Bldg 120,000�0 05/18/2001 0897 9,000 REPAIR C 09/30/2002 334 4,000 NEW Sl http://www.northamptonassessor.us/noho/propertydetail.php?map_no=17C-194-001&page... 6/28/2007 Northampton, MA Property Detail Page 1 of 2 City of Northampton, M.A.: Residential Property Record C' New Search Property Type Classification_Code_Reference Card 1 of I Parcel - Location - Zoning - Assessment Map-Block-Lot: 17C-194-001 Zoning: Assessr Location: 20 WILDER PL Neigborhood: 5 Land: #Living Units: I Deed Book: 6640 Buildi Class: R-101 Deed Page: 158 Total: Dwelling Information Building Sketch Style: Conventional Year Built: 1923 Story Height: 2 Attic: Unfin Basement: Full Total Rooms: 6 6 EFP 66 Wr 6 Bedrooms: 3 36 306 Full Baths: 1 24 Half Baths: 0 Exterior Walls: Alum/Vinyl Unfinished Area: 0 26 UA12Fr1B 26 Ground Floor Area: 624 sz4 Total Living Area: 1284 Finished Basement Living 0 X 0 Area: Basement Recreation Area: 0 X 0 24 zz Woodburning Fireplace 0/ 0 7 OFP 7 Stacks/Openings: 154 Metal Fireplace 0/0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Warm Air Fuel Type: Oil Quality Grade: C Physical Condition: Average Addition Information: Interior/Exterior: Same Condition/Desirability/Utility: AV Vacant/Dwell/Oby Status: Dwelling Lower 1st S F 2nd Story Additional Features: IF IF http://www.northamptonassessor.us/noho/propertydetail.php?map_no=l 7C-194-001&page... 6/28/2007 Ck ��tSAMp1, � Ltty of Narf4antptan z s � � f)Raasacl�useffa � � a q _ DEPARTMENT OF BUILDFNTG INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis/her construction sup,-:: ," sor. 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 In dustrial Accidents Office of Investigations a 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): t,,, �J�t „��,4 . ­t.1 F .L��e,) T, Address: • e,.-- S . �k City/State/Zip: t--i Ntic�. oto��-- Phone.#: �t� 3 - ��� - �'�- Fyou an employer?Check the appropriate box: Type of project(required): I am a employer with 4. ❑ I am a general contractor and I�mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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 ddition [No workers' comp.insurance comp. insurance.$ g required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions 13.0 1 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 employees. [No workers, 13.[TOther 6"J, comp.insurance required.] *Any ap�lican a c ec ox must a o t out a secnon a ow s owm etrwor workers'co g mpensation 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. #: Expiration Date: Job Site Address: City/State/Zip: 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 Investi,aations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct Si ature: � Date: 1) _ Phone#: ct 1� — �-2 l — 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: ��" ��",'T' '� "�S� ✓ License Number LL ",%. Inns°✓ �� . � k �t�� ����)� � '� r Address Expiration Date / Signature f�(� Telephone S Realiteted Flbme-l'mbrovement Eonfractor ;1 _ R __ Not Applicable ❑ ( 4 57-0 s Company Name Registration Number ')— Ste.t./� %,,-v-,, S`6 . (),/--� / D Address Expiration Date 4� �k"X\-)cO-x LA% 0 ( 0 Z Telephone t3 -ViiS 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 -`Hom ne>r•Exeim o 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 w SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition [] Replacement Windows Alteration(s) Roofing El Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[ j Other[[3] Brief Description of Proposed Q-W\ >Je-k G v '441. G �1`'Sti��• �. GL`Q`C•`a ww `^'�' '^ 3 Lte'^'„ S� Work: -1 Evvd•M +Rn�✓C 1 tt iw(w� S -e�.orr`c E(ec�{ �k� -��4h l°'. �l�klce°t ` 'f�.�s Alteration of existing bedroom Yes No Adding new bedroom Yes `�No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa If tVeini house a d or addition to exEStinci hous �clr co i�pfete the#oClov MCI: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms r c. Is there a garage attached? 1 _ d. Proposed Square footage of new construction. Dimensions e. Number of stories? ')L- r f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L-t-A. i. Is construction within 100 ft.of wetlands? Yes o. s cons ruc ion wi i Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? V/ Yes No. L Septic Tank City Sewer y Private well City water Supply SECTION 7a-OWNER;AUTHORIZATION-7113 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES,FOR:BUILDING PERMIT IVP �Z "-5'- ,as Owner of the subject property (� hereby authorized.. ✓ " - c. (�� ��- to act on my behalf,in all matters relative to work authorized by this building permit applica'on. Signature o w e 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 pains and penalties of perjury. Print Na a A 4_. Signature of Owner/Agent 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 Rear Building Height Bldg. Square Footage % -7 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has it/Va nce/ for/on the site? — IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? �� NO �� DON'T KNOW 0 ,c, IF YES: enter Book / Page| and/or Document#� � B. Does the site contain a brook, body of water orwetlands? NO �~��� DON7KNOVV x-1 YES IF YES' has a permit been ur need to be obtained from the Conservation Commission? Needs tobe obtained �~� Qbtaiumd v-� Date � ! v�� v�� ' C. Dn any signs exist on the property? YES K } NO e 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 on.or filling)over 1 acre orisit part ufa common plan that will disturb over 1 acre? YES K ) NO �L4' �� 119 |F YES,then a Northampton Storm Water Management Permit from the DPW is required. r Department use only. City of Northampton 5tatusofPennit' x s r s r Building Department tud CutlD�t ,'Remrit 212 Main Street Sew&1Se06c,4 arlabidy � x ' c t x s v Room 100ater/GffetlPwailabrtrt}� �. Northampton, MA 01060 Twwo Sets ofStructuraTPCans phone 413-587-1240 Fax 413-587-1272 PlotlSEt Plans APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE O- " S114"A.ONE OR,TWO FAMILY DWELLING SECTION 1-SITE INFORMATION`. J U N 2 5 ""0 1.1 Property Address: This section to be completed bX office Vom ' L ' q 'Lot Unit Zone Overlay District Elm St:District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name( dnt) Current Mailin 4-115 ) IF Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: ( �&T g«- 5la Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Ooo. �a (a)Building Permit Fee l ( 2. Electrical (b)Estimated Total Cost of a©(J p Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) 14 ,a 00,CL Check Number f This Section For Official Use Only Date , Building Permit Number.. Issued: Signature: Building Commissioner/Inspector of Buildings Date i File#BP-2007-1260 APPLICANT/CONTACT PERSON ANDREW T WALSH JR ADDRESS/PHONE 2 SUMMER ST EASTHAMPTON (413) 522-7795 Q PROPERTY LOCATION 20 WILDER PL MAP 17C PARCEL 194 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinjz Permit Filled out Fee Paid Typeof Construction: CONVERT GARAGE TO WORKSHOP New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082029 3 sets of Plans/Plot Plan THE F9kLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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: V 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 Co sion 2� 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. BP-2007-1260 -00 ' GIs#: COMMONWEALTH OF MASSACHUSETTS R CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2007-1260 Project# JS-2007-002012 Est. Cost: $14200.00 Fee: $70.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ANDREW T WALSH JR 082029 Lot Size(sq. ft.): 5967.72 Owner: NORRIS SCOTT A Zoning: URB Applicant: ANDREW T WALSH JR AT. 20 WILDER PL Applicant Address: Phone: Insurance: 2 SUMMER ST (413) 522-7795-D EASTHAMPTONMA01027 ISSUED ON.71312007 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT GARAGE TO WORKSHOP 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 7/3/2007 0:00:00 $70.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 'f r �� -7 /0" A?7 r BP-2007-1260 20 WILDER PL CONiM V ON WEALTH OF MASSACHUSETTS GIs#: CITY OF NORTHAMPTON Map•Block: 17C- 194 L- BUlidlnq PERMIT Permit BUILDING Cate o¢rv: Permit BP-2.007-1260 # Prole_ _ JS-2007-002012 cam Est. C= $14200.00 PERMISSION IS HERE Li ease: TO: Fee_. $_ License: "nntractor: 082029 Cons--t.Class:- ANDREW T WALSH JR,_. Use— G-- °"p— Owner. N011 SC_A. Lotsize(sg f 967-72 qlicant: ANi)REW T'v�t%" JR Iry::na• l-IRPi ..... ..�� .'•+="7 �i Phone: AUp_yit ��t mass: InsqrancC- 413) 522-7795 Q 2 SUMMt9—5 _----- EA H-3T,j�.%IAC1'.027 IS��UED ON:71312007 O:OO:OU HE FOLLOWING WORK:CONVEkI• GARAGE TO WORKSHOP TO PERFORM T SO IT IS VISIBLE FROM THE STREET Building Inspector POST THIS CARD _ D.P.W. Inspector of Plumbing Inspector of Wiring Meter: service, Factings: Underground: Foundation: house# Rough: Rough: 7/���D� Driveway Final: h, Final: \ / Rough Frame Final: /// Fireplace/Chimney: Fire Department Gas: Insulation: Oil: Final: �y� dgIA( 07 tut ,,k Final: Smoke: AY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF THIS PERMIT M ANY OF ITS RULES AND REGULATION . .�'"l/� r signature: Certificate of Occu anc Date Paid: Amount: FeeT e: Building 7/3/2007 0:00:00 $70.00 2.2 Main Street,Phone(4 13)587-1240,Fax: (413) 587-1272 Building Comnussioner-Anfaony Patillo