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10B-093 (6) -r'!ese drawiwgs are the prapreitaror worh�product avrd pronert;,t of R,�g aeaou i'e,developed far the„°rc[usi✓e use of Pegg Rean1 irle.use a{t;�ese dra!�inas av d--Oepts eowtailled therei,,.witl'-'t the written penxCssio�+of Pea g Reaves MG.is prohibited a'a v 71P be s«bject uou to a e117 v-.—r N 1J U H -ze T � � �-1 7'x�-Z 2'beans o�Cr fravuCd!tiaC! n � � T u lcC, S 3 `� �-j/,y•K r>•�OL[9h Sa{h'�tJOL5t5 �� NOTES \V\ oReplace avuf repair'-tie rot ap d or davu aged outer sill beau —�j1 4dd.Sivupsov�foist havi.�ers at azz joists to�7eavu�uv�-ctiovrs "Q �� Fdd joist blocl2iwg to all locatiows-arked g n, -lhtercorehds o f beavus are Loaded owto ed,stiv,g walls iH basevuewt b ry N- 2E-a s�2• - �e i - �ii2'x3-z;2•beavv<ouer{r-a:�uea'wall '� � � � I I I I Exc•P�-Post ` y ; -2xg PT � � —4._�.—T Imo- s•-o• g'-�,' �, C� =-s�2'x�-1!zsCCC n✓er fouv<daeiaw wall 2 18 KDJoiStr (4x)2,r3 KD Maiw Rear^hs A -These draivlwgs ave the p, eitar wovk product awd propevtu o{Peg g Feat,twc,developed for tre exc[usi ve.,eo fpeg 5 Fea.,f-.c,I ana concepts cowtaiKtd theveiv without the 8ea­ be su€yeet uou to a cta%vk r day ac,�es crk g Feaa w... Q\ WN ti N scale ji a r o e n,. PlatCovou Pc2ch O 18'wx s✓4'dsCn� /�.090 FLvestoKe ra Plati,auni EPDM silicoH.e s_al Existi vi.c,+ 4'w�hite,.11uvuiruune P✓ip Ede �� t'2'Ho-as"te und?�lauvuewt � ,� Alunliviurk FCashCvw+ �rawite SiU 3/4'Ad✓avi-tech sub-shegEhi��.g s'�irestonC.4dhesive FIAShiny Ttrpe 6 FX ST IST EXIST 0 0 a 4 b u.li All rubber roo f vi,� to be wistaUed per Firestov�e s)Deco fccgt�ovLs 9 6� -Fxistivi to revuacvi GTS as, G!!SPect for rotGlvrGt GtGTVUge. Repa ir a-- vLeeaed -New Ieckuno to be.3'X 3' PaneZs to be covtstruetea usi"_q ,5-14'X C," PT P a to d� City of Northampton Massachusetts R DEPARTMENT OF BUILDING INSPECTIONS r" 212 Main Street • Municipal Buildingvt 'b Northampton, MA 01060 sstW . oti��O 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 buildinq inspection tbefore 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 JR The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street y% Boston, MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): ��'�� u+�lG�.V�n c�l.� < Address: /o Fe"-x" P-4 City/State/Zip: tq A �G N^A Phone #: 9-7p 3,io Are you an employer? Check the appropriate box: Type of project(required): 1.Z I am a employer with 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. F1 New constriction 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, Fj Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 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.M Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.Q Other cT c c 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: J G r vu, f=e.Yh; Policy#or Self-ins. Lie. #: Z a®i i'" 6 �p Expiration Date: Vli'd' Job Site Address: f l� f Or'—O `S ��°(� � City/State/Zip: 0 O S'3 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 the pains and penalti s ofperjury that the information provided above is true and correct. Signature: Date: G �'L✓ Phone M / —,r V9 'i Z-a 3 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 £p q Name of License Holder: M r"`'Z H14-Y, CS- - V Vt U 7� I License Number Address Expira on Da e 979 3vlo 2-?32- Signature Telephone =9,.Registered Home Improvement Contractor: „ ' Not Applicable £ _1 0193t Company Name Registration Number PCB 4 (3e-.1 w, Address Expir tion ate bti MA vi 431 Telephone 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......./F 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 0 Replacement Windows Alteration(s) Roofing Q Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks (,M Siding (C]] Other(p] Brief Description of Proposed Work: �"I 1 r,r (Z' $&,,- 12.0 oy/c-' y f: i•4 � 5( ,<e ('C►•�'�ul� �CC� /sT ��oJ' Alteration of existing bedroom Yes t,/No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes t/ No Plans Attached Roll -Sheet sa.`f New house and�or add'itionfo ex''I q housirig,'comp`iete 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. 1. 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, - 4 W i k g y k �. e K�+u� rY'Lt . Y -2 - as Owner of the subject property �J hereby authorize `Z a. -/ to a5q my behalf, ' all matters relatife to work authorized by this building permit application. ignature of wner Date I, as Owner/Authorized gent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge a elief. Signed under the pains and penalties of perjury. 14 r Print Name ` Signature of Owner/Agent Date . - Section 4. ZONING All Information Must Be Compteted. 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 Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Fimding ever been issued for/on the site? x-� «—v�x� NO «�x—\ VY v��� DON7KNO YES |F YES, date issued1 � IF YES: Was the permit recorded at the Registry ufDeeds? NO �~�� DONTKNUYY 'ES � 0�- IF YES: enter Book Page and/or Document# �� �� B. Does the site contain a brook, body of water orvvedand�� NO ��, DONT KNOW �~� YES �~� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained k_/x~� Obtained �-~�� Date� ' C. Do any signs exist on the property? YES �~� NO IF YES, describe size, type and location: D. Are there any proposed changes tuor additions ofsigns intended for the property 7 YES 0 NO a IF YES, describe size, type and location: E Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre orioit part ofa common plan ' that will disturb over 1acre? YES NO 66 /F YES,then a Northampton Storm Water Management Permit from the DPW iorequired. ^ — �: Ir ry � - Department Use only. ' >? ' DCity of Northampton Status afPermd °� "' "� IJ Building Department Curb CUtlDri�ce�ivay Perrrst# n r` JUN 17 2014 x 212 Main Street SewerlSepticAvaifablllty Room 100 .1Nater/VitellAuailabllity Electric, Plumcma h G .({nspectior�s, rthampton, MA 01060 Two Sefs of Structural Plans Northampt C,1'. ,v Ii .060 �V p one 413-587-1240 Fax 413-587-1272 PIoflSlte Plans 1' APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMA TION This section to be completed by office 1.1 Property Address: �-� , '1 /►�J4�Ji�r+ Map Lot Unit Q u f c.c► e e��"` 1n7� Zone Overla District y ; 573 ._Elm St District ! � C8 DiStnct - 1 , - SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r"¢ vi h w py C_e c S. Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: 97? ? '10 273L Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 4 (a)Building Permit Fee © GAD J 2. Electrical (b)Estimated Total Cost of JV Construction from 6 U 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: — Building Commissioner/Inspector`of Buildings Date File 9 BP-2014-1352 Rol APPLICANT/CONTACT PERSON MARK HAINES ADDRESS/PHONE 10 FROST RD ASHBY (978)340-2732 PROPERTY LOCATION 1 FLORENCE ST MAP IOB PARCEL 093 000 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: ✓ PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out „2 Fee Paid Typeof Construction: CONSTRUCT ROOF OVER ELECTRIC SERVICES&REINSTALL 1 ST FLR DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 048719 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition 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. 1 FLORENCE ST BP-2014-0118 GIs#: COMMONWEALTH OF MASSACHUSETTS Man.Block: IOB-093 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2014-0118 Project# JS-2014-000231 Est. Cost: Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ERIC LILLJEQUIST 064713 Lot Size(sq. ft.): Owner: LAVIGNE RONALD L Zoning:URA(100)/ Applicant. ERIC LILLJEQUIST AT: I Fl._r)PPr\I(= OT Applicant Address: Phone: Insurance: 1 FLORENCE ST (978) 868-0387 LEEDSMA01053 ISSUED ON.81512013 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT ROOF OVER ELECTRIC SERVICES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Undergroun 1: 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. '70�usw Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/5/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Conunissioner