17C-154 (6) Job Description - Ed Cohen, 88 High Street, Florence MA 01062
Originally set out to simply remove and replace the sheet rock in one of the upstairs
bedrooms and hallway area. However after finding much of the plaster and lathe damaged
I decided to remove all of the material to see what is going on structurely. I thought
that this would be a good time to file a permit. I will take this opportunty to better insulate
and see if any of the under structure needs repair and/or visual leveling.
Cl ity of Wart4ainptan z r
�A35AC}'1[Sttt9 _
-, DEPARTMENT OF.BUILDTITG INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northampton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/her construction sups: .`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 structtres. 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
req ired can DELA the pr ' until such time as the proper permits and inspections are
m e
I, understand the above.
ome 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
4
GI(-�] Jaf �Inrfljant}�tolt - _-
A E -qlcaaacllnrcI10
DEPARTMENT OP DUIU0r)\G INSPECTION'S -
212 Maio Strect Municipal Building
Northampton, Mass. 01060
.i
«rOMCCR'S C0iN1TENSt'%'IZ0N MSUaA-NCE Al,I �lV17'
(ti ccnsxJpermittcc)
with a pluncipal plate of business/residencc at:
,I
(p'none-."!)
(sTl-txt/c�ty/ atr�zjp)
do hereby ce •. under Lhe paiuis and penalties o`P e rJ�Y: :hat
( ) I = an employer providing the followinc- workcr's cotnocnS-n;ion coverage for in)
employces wor-Ung on tstis job:
(Incur---n~Conr ) (Pclic: l;usnbcr) (�,ptrtior Dzr`)
( ) I am a sole propr general cootractor or homeou�ver (cu cie one)) and have hired
the cona-actprs LSt--d below rrbo hive the folio%VIDQ worker's car)nensauion policies
(Nt a c of Con- tMaor) (1RR x1111 CotAD1 I}'�hGUCi ?�`t1II]LCI) (Tv-)4-jun 1tc)
(Name of Contrctor) (tnsurancc ComDaatiiPo!ie \uacrr) (—L-vDir.:tion Date)
(Name d Coacmclo,) (Insurance Compac)-Rotic)- Numbu) (E.rpirdoo Date)
(1qame of Contractor) (Insurance Company/PoUcy Numbcr) (Expitatioo Datc) .
(an�.eh addi:ocat rScC if to mcvd;iarorm.c7 oa peztninins to.L ocLn:�)
{ ) I am a sole proprietor and have no one worldDg for me.
I am.-a home owner perfornamg all the work myself:
NOTE:pl=..lx evrarc Ih,.K( 7C bemeo+DCf�Kbo =p Icy pesoos lA dJ -• c=.;=joo c rn,air-ark c-a.d..�1LZ of
not most
'b-'O L--VJ itt vl-hi the bomcwwocr ttrido a m the p-vt .9putcn:rl thccn am cot Cx-.Ry ocm=6=cd to be
-nPioy--unCe the..any O=P==:Lim Act(GLI51 31(5) aPPU=600 by s bomcom-aa fm a lac=-or pcmil=yd=-the
lcp!n,^+,or ea-Toyer under the Workela Comp.-tioa Ad
[undcst1nd d1d a copy of thu=U-coeaa my be 1`6-vded to the Depeltmco¢or 1.6us ic!Acndcsd OIL-eC In.-+u+uA for the
oovcasc v'cir-t=tioa-�d th1 L-1—to ro=om)-011 bz cr s.oction 25A oC MGL 151 cw t¢d to the i2rxistsoa orcimiO- Pcnzitia
eomiamg era rroc orup to S 1300.00 anNor 6mpri-�oruP to voc yar r-od 6%i1 PCOA-ltia in tSc form of a Slop work order nDd a
r,=orSIM.00.d_y cFyina
For u-only -
permit Numbcr —
�{aP^_- Lot
Sim-ttiut of Lic=nscc/Pcm-iucc J
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
J2earsfere `14ome Not Applicable .❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION<INSURANCEAFFIDAVIT(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...... ❑
..
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-vear 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 buildine 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 assu ponsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and L 1 Zo sand 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 0
Accessory Bldg. ❑ Demolition New Sig s jO] Decks t0 Siding[0] Other[[:0
Brief Description of Proposed
Work:
Alteration of existing bedroom_Le!�Ves No Adding new bedroom Yes N
Attached Narrative �s•S Renovating unfinished basement Yes _ /�No
Plans Attached Roll Sheet
6a iV'I+ lbmRlsting hons�Ka ar. ru a ovsr t g:
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.SOILDINGPERMIT
I. as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner 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.
Pnn ame C
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 %
(Lot area minus bIdg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Vuhonne/Findi ng ever been issued for/on the site?
NO ��
�� ���� ����
DON7KNO� YES
IF YES, date issued:';
IF YES: Was the permit recorded ucthe Registry of Deeds? '
��
NO �� DON7KNOVV 0 YES
|FYES' enter Book | Page and/or Document#'
' �
�� ��
B. Does the site contain u brook, body of water orwetlands? NO x���� VV �~�D�N7K�� YES �_�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobmobtained �-� Obtained /�� Date
v�� U ' �
C. Do any signs exist on the pvupert �� ��yY 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,gradingexcavation,or filling)over 1 acre orioi1 part c�u common plan
that will disturb over 1 acre? YES K ] NO ����
��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton � 5i� �� �
Building Department
1212 Main Street
�G6 Room 100
Northampton MA 01060
phone 41;3-587-1240 Fax 413-587-1272 ` +� � � ��
APPLICATION TO-Cd NSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -_SITE INF:ORMATION-
This-section to be coropfefed by office
1.1 Property Address:
Q J` ,
Map t Unit
S
Zone ' Over�ay,Dastcrct -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone (Ott -q
Sig ature /
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION"3-ESTIMATED CONSTRUCTION>COSTS-
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
1. Building Hwy" (a)-Building Permit Fee
2. Electrical H� (b)"Estimated Total"Cost"of
Constriction from 6,
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +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#BP-2007-0122
APPLICANT/CONTACT PERSON COHEN EDWARD N&
ADDRESS/PHONE 88 HIGH ST FLORENCE (413)585-9326 Q
PROPERTY LOCATION 88 HIGH ST
MAP 17C PARCEL 154 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tytneof Construction: SHEETROCK&INSULATE UPSTAIRS BEDROOM&HALL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF,MATION 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 Co si'on
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.
. rd.
BP-2007-0122
GIS#: COMMONWEALTH OF MASSACHUSETTS
oo ,_ 4"Ifft� CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0122
Project# JS-2007-000183
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13590.72 Owner: COHEN EDWARD N&
Zoninp,:URB Applicant: COHEN EDWARD N &
AT. 88 HIGH ST
Applicant Address: Phone: Insurance:
88 HIGH ST (413) 585-9326 ()
FLORENCEMA01062 ISSUED ON:81912006 0:00:00
TO PERFORM THE FOLLOWING WORK.SHEETROCK & INSULATE UPSTAIRS
BEDROOM & HALL
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 8/9/2006 0:00:00 $50.001132
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo