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17D-048 r=, y M1 m'a i � a t, x � IL sz- Note This drawing is an artistic Designed: 12/30/2014f� interpretation of the general appearance of' Printed: 12/30/2014 the design. It is not meant to be an exact rendition. i Manson Thelma 14111 kitchen I S.kit All Drawing#: 1 ' I a , h k K T n< ry 4 Nate: This drawing is an artistic Designed: 12/30/2(114 interpretation of the general appearance of t !Tinted: 12/30/2014 1` the design. It is not meant to he an exact rendition. i Manson Thelma Rill kitchen i.S.kit All Drawing ti 1 1 s wp , Note: This drawing is an artistic Designed: 12/30/2014 interpretation of the general appearance of' !Tinted: 12/30/2014 the design. It is not meant to he an exact rendition. I Manson Thelma RI II kitchen I.S.kit JAII Drawing# 1 r 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: l ' The debris will be transported by: � The debris will be received by: Building permit number: Name of Permit Applicant Date Sign-ature of Permit Applicant City of Northampton Massachusetts Otis _ cr�cr DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ss�w y�ti� 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 rouqh 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 op 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): Address: City/State/Zip: Phone M Are you an employer? Check the appropriate x: Type of project (required): 1.F-1 I am a employer with 4. I am a general contractor and I 6 VReemodeling 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. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.T required.] 5. ❑ We are a corporation and its 10.❑ 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 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: Policy#or Self-ins. Lie. #: 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 Investigations of the DIA for insurance coverage verification. I do hereby certify tinder the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: 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#: .I 1. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: m .4a ,, V✓ 1.,.S^0 51 --S—z-,�N y License Number Addre Expiration Date Signat re Telephone 9.Re`ggis;tered�H6rm6 Improvement Contractt�or:: Not Applicable £ i.b---I S'; S Company Name Registration Number Address Cy Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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 Hame 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)ofthe 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) Roofing ❑ Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding[❑] Other[❑] Brief Description QQf Proposed Work: >VXX }c-z %- C:�t.s Alteration of existing bedroom Yes \r No Adding new bedroom Yes No No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet sa. lf`New house and or``additon to'existing h6using; colmplefe the followi'ng!: 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 DEC 2 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN n OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT " I VIN 41r\ as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work buthorized by this building permit ap lication. Signature of Owner Date —Z 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 N e Signature of Owner gent Date � Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information � E,istirig Proposed Required by Zoning This column to be filled in by Building Department Lot Size Rear Building Height Bldg.Square Footage 0110 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces A. Has a Special Permit/Variance/Finding ever been issued for/on the site? O 0 DONT KNOW 0 YES 0 |F YES, date iouedJ IF YES: Was the permit recorded at the Registry ofDeeds? NO DONTKNOYY 0 'ES x� IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water nrwetlands? NO 0 DONTKNO\Y 0 YES IF YES, has permit been urneed to be obtained from the Conservation Commission? Needs tobeobtained «—\ Obtained �-� Date Issued: �-� «_� ' C. Do any signs exist on the pm �� perty7 YES �^� NO \�� `— |F 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, typo and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orisit part ufa common plan ' that will disturb over 1acre? YES NO K D ~~ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ — .� Departmeht use only.: , ,t City of Northamptontatus,ofPerm�t - 9 Building Department 'Curs Cut/Driveway Permit n 212 Main Street Sewer/S�ptlGAvaifa'blltty � ' ' � ' Room 100 1Naterll/VeilAvatlablhty e jNorthampton, MA 01060 ' Pt ' � phone 413-587-1240 Fax 413-587-1272 P[ lans ether Specify h 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 completetl by office Unft , �- I` � '� ; Zone Overla Distrrct Elm St Distri ct CB Distri ct SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: t�Kam. (X\_4n N S_A -1 y- 5 1ftr� Name(Pri Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing dress: S' nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building t (a)Building Permit Feb 2. Electrical (b)Estimated Total Cost of t �'✓� Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) 73 (3 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: _ Building Commissioner/Inspector of Buildings Date File#BP-2015-0697 APPLICANT/CONTACT PERSON THOMAS MALONE ADDRESS/PHONE 128 RYAN RD FLORENCE (413)885-9038 PROPERTY LOCATION 78 STRAW AVE MAP 17D PARCEL 048 001 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: REPLACE KITCHEN CABINETS SHEETROCK CEILING&ADD LAUNDRY ROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildiny,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: 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 ela l V Signature of uildmg O ficial 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. 78 STRAW AVE BP-2015-0697 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate oa:renovation BUILDING PERMIT Permit# BP-2015-0697 Project# JS-2015-001350 Est. Cost: $13600.00 Fee: $82.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin THOMAS MALONE 055236 Lot Size(sq.ft.): 5183.64 Owner: MANSON THELMA M Zonin :URB(100)/ Applicant: THOMAS MALONE AT. 78 STRAW AVE Applicant Address: Phone: Insurance: 128 RYAN RD (413) 885-9038 FLORENCEMA01062 ISSUED ON.12/30/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE KITCHEN CABINETS, SHEETROCK CEILING &ADD LAUNDRY ROOM 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 12/30/2014 0:00:00 $82.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner