35-289 (8) V
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r ; GENERAL NOTES:
THIS PLAN SET,COMBINED WITH THE BUILDING CONTRACT,PROVIDES SUIL:
PROJECT. THE LEAD CARPENTER SHALL VERIFY THAT 51TE CONDITIONS,A
THESE PLANS BEFORE 5TARTIN6 WORK.WORK NOT SPECIFICALLY DETAILE
QUALITY AS 51MILAR WORK THAT 15 DETAILED.ALL WORK SHALL BE DONE II
c BUILDING CODES AND LOCAL CODES.
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O y WRITTEN DIMENSIONS AND SPECIFIC NOTES SHALL TAKE PRECEDENCE OV!
n° NOTES.THE SALE PER50N/DE5IGNER SHALL BE CONSULTED FOR CLARIFIC
ENCOUNTERED THAT ARE DIFFERENT THAN SHONN,IF D15CREPANCIE5 AR
W QUESTION AR15ES OVER THE INTENT OF THE PLANS OR NOTES.CARPENTE
¢c 15 RESPONSIBLE FOR ALL DIMEN51ONS(INCLUDING ROUGH OPENINGS).
Q ALL TRADES SHALL MAINTAIN A CLEAN NORK SITE AT THE END OF EACH Wt
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3 PLEASE SEE ADDITIONAL NOTES CALLED OUT ON OTHER SHEETS.
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Building Departure t
Plan Review
212 Main Stree >
Northampton, MAO 060 }
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PROJECT FLAN � a�
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IN6 DETAILS FOR THE RENOVATION OWNER: JENNIFER AND PERRY FRIEDMAN
D DEMEN51ON5 ARE CONSISTENT WITH p O
>SHALL BE CONSTRUCTED TO THE SAME PROJECT 9 SYLVAN LANE > z
ACCORDANCE WITH INTERNATIONAL ADDRE55: NORTHAMPTON MA
BLDG PERMIT:
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R SCALED DIMENSIONS AND GENERAL
TION IF 51TE CONDITIONS ARE ') N
DE516NER: DAN BRADBURY
FOUND IN THE PLANS OR NOTES,OR IF A 13 U Ul
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OR SUB-CONTRACTOR SHALL VERIFY AND BUILDER: VALLEY HOME IMPROVEMENT n-U
tK DAY. VENDORS: _ _m
PLUMBING FIXTURES:
CABINETS: "R1 L 03 C
COUNTERTOP5: /��7• j Q
TILE: rV�RJ 3
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The Commonwealth of Massachusetts
Department of Industrial Accidents
r•�{� 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): �OL,�'fu,
Address: `-�� w`-��
City/State/Zip: `�h}one#: ` �%�— I
Are you an employer? Check the appropriate box: Type of project(required):
1.M I am a employer with 1 2� 4. ❑ I am a general contractor and 1 6 ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
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.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.[1 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' 13F1 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 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: ,�V b ' i a_ 1 v0J-\C-e L t C e
nol.c;r#er self ins. Lic.# �J� '� �� Expiration Date: a I
Job Site Address: ��`a �\A_ n Lone, City/State/Zip:T-Aue cr �` 6� Qt 0&2_
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 the pains a d penalti, perjury that the information provided above is true and correct
Si mature: ,;: �..� Date:
Phone#: vs—
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`: N` Not Applicable ❑
Name of License Holder: ( \ \ �,'�lXlA x -�` 1 J®(0 L7D10
License Number
Vi�k 010(n `7 20(,S
Address Expiration Date
Signatu Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name) % Registration Number
V•o ,Zo�, kNo-, ng t= Mop a����` - -11 rl
Address Expiration Date
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....... 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 suvervisor.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 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 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 V" New Signs [[3] Decks [C] Siding[r-1] Other[C]
Brief Description of Proposed
Work: %ATASLMnM
Alteration of existing bedroom Yes_1�1 No Adding new bedroom Yes 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 900 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, t�f'r 4-- Perms err 1 t",4 r�Ce•Y, as Owner of the subject
property �0—uf'L4 here by authorize r
to act on my L half, in all matt relative to work authorizeb by this building permit application.
I A A AAA, X2:!,
ature of OwnV Date
I, Ocurl --yy tt.pep w..1wiy— zrn(— as Owner/Authorized
Agent hereby declare that the ste,tements an ormation on the foibgoing application are true and accurate,to the best of my knowledge
and belief.
0r!ed uFtdei.,iIer,a!ns_`iy;-'�1.'rena!t;- ofnaPJflrl/
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Signature of OwnerlAgenf — ///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 Deputnent
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. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained C) Obtained ( , Date Issued:
C. Do any signs exist on the property? YES 0 NO /V
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,excavation,or filling)over 1 acre or is it part of a common plan
th-2t kefiil diefi irb ovei'1 acre? YES mo (/0�
IF YES,then a Northampton Storm Water Management Permit from the DP1/V is required.
I til Department use only
City of Northampton Status of Permit:
JUL z + 20155 �'; Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
f rthampton, 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
This section to be completed by office
1.1 Property Address.
Q ��`'� ._ Lon- Map Lot Unit
\ �X l � Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
(Print) Current Mailing Address:.
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Telephone
Si nature
2..22 Authorized Agent: f
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Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIft+iATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building oc (a) Building Permit Fee
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2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing I Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection --
6. Total=0 +2+3+4+5) '�i� Lwc> Check Number (�
This Section For Official Use Only
Date
Building Permit Number: Issued:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0081
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE01062(413)584-7522
PROPERTY LOCATION 9 SYLVAN LN
MAP 35 PARCEL 289 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 4:2 14
Fee Paid
Typeof Construction: REMODEL BATHROOM
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License 106006
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
De Delay
Signature of Buil mg�OffGal 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.
9 SYLVAN LN BP-2016-0081
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -289 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2016-0081
Project# JS-2016-000152
Est. Cost: $22000.00
Fee: $132.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 106006
Lot Size(sc. ft.): 32713.56 Owner: FRIEDMAN PERRY
Zoning: Applicant: VALLEY HOME IMPROVEMENT INC
AT. 9 SYLVAN LN
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:712312015 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM
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 Sip_nature:
FeeType: Date Paid: Amount:
Building 7/23/2015 0:00:00 $132.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Northampton Building Permit
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Demo existing bath,remove all fixtures
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m Floor and Dust Protection z
Frame half wall for shower enclosure i
a Rough Electrical by Tim Rocket including bath fan
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m Rough Plumbing by Paul's Plumbing
Insulate any exterior walls opened in demo > W
m / Install drywall..coat and prime LU 17 'm
Install Wedi shower pan and enclosure ¢ a
y Install Ditra tile underlayment and floor tile
c /' Install Shower wall tile and deco accents
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Floor tile allowance
y Shower Tile allowance(floor+wall+accent)
N Lay.faucet allowance W
Toilet allowance
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c i Shower head.valve and trim kit allowance
m o 0 0 Install double vanity+med.Cabinets by Gerry(allowance) = Z
— Vanity top and sinks+wall caps and threshold(allowance)
0 Install glass shower door and half wall(allowance) ;
Install bath accessories(allowance) Q
Finish Electrical(Rocket)
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Finish Plumbing(Paul)
° Prime walls and trim
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Admin
^�_� Deliveries and hauling
1 1102100H Sani can
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E GENERAL. NOTES: o
THI5 PLAN SET,COMBINED WITH THE BUILDING CONTRACT,PROVIDES BUILDING DETAILS FOR THE RENOVATION OWNER: JENNIFER AND PERRY FRIEDMAN E
�` PROJECT. THE LEAD CARPENTER SHALL VERIFY THAT 517E CONDITIONS,AND DEMEN510N5 ARE CO SIB WITH Z =
" THESE PLANS BEFORE STARTING WORK.WORK NOT SPECIFICALLY DETAILED SHALL BE CONSTRUCTED TO THE SAME PROJECT q SYLVAN LANE
_; ' 1 _ t QUALITY AS 51MILAR WORK THAT 15 DETAILED.ALL WORK SHALL BE DONE IN ACCORDANCE WITH INTERNATIONAL ADDRE55: NORTHAMPTON MA O C4
BUILDING CODES AND LOCAL CODES. Q C" >
0 0
BLDG PERMIT.
g3 ti WRITTEN DIMENSIONS AND SPECIFIC NOTES SHALL TAKE PRECEDENCE OVER SCALED DIMENSIONS AND GENERAL E p(V
Q$ NOTES.THE SALE PERSON/DESIGNER SHALL BE CONSULTED FOR CLARIFICATION IF 51TE CONDITIONS ARE DESIGNER: DAN BRADBURY C4 in
ENCOUNTERED THAT ARE DIFFERENT THAN 5HOWN,IF DISCREPANCIES ARE FOUND IN THE PLANS OR NOTES,OR IF A AA`` 0 r •-
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QUESTION ARISES OVER THE INTENT OF THE PLANS OR NOTES.CARPENTER OR SUB-CONTRACTOR SHALL VERIFY AND BUILDER: VALLEY HOME IMPROVEMENT
m y LIN 15 RESPONSIBLE FOR ALL DIMENSIONS(INCLUDING ROUGH OPENINGS). m N
yALL TRADES SHALL MAINTAIN A GLEAN WORK SITE AT THE END OF EACH WORK DAY. VENDORS: O Q 3
CL T
6 n PLEASE SEE ADDITIONAL NOTES GALLED OUT ON OTHER SHEETS. PLUMBING FIXTURES:
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