17D-026 a _(�
General Notes
1. Construction shall be in accordance with all applicable codes and regulations having jurisdiction. Provide products of acceptable manufacturers which have been in satisfactory use in similar service for three years. Use experienced installers.
Deliver,handle, store, and install materials in accordance with manufacturer's specifications. The Contractor shall provide all permits and arrange for all inspections.
2. The Contractor shall take reasonable precautions to protect all employees on the work site, all materials and equipment incorporated therein,as well as other property at the site. Any damage or loss to any of the above caused in whole or in part
by the Contractor or any of his/her Subcontractors shall be remedied by the Contractor.
3. The Contractor shall carry Liability Insurance to protect him/her from claims which may arise out of or result from the Contractor's operations under the Contract. o
4. If, within one year after the work has been accepted by the Owner, EQ EQ W__ ~
-- a E
any of the work is found to be defective, or not in conformance 2'-OI" _ 4'-1" R.0 NEW WNDW ~ z
6'-0" R.O. 2 +— -
with the Contract Documents,the Contractor shall correct rt NEW72x80H SLIDER -'� NEW HEADER AS REQUIRED 4'-8" _ Z o
promptly and at his own expense after written notice. NEW HEADER AS REQUIRED /� w5 EXH. U _
5. On-site verification of dimensions and conditions shall be the
i EXT'G PIPE HOOD RANGE Q Y
responsibility of the Contractor. Noted dimensions take i ��� z
precedence over scale. The Contractor shall compare and \� DW DISP. GFI I �� D LU E
coordinate drawings and site conditions and report discrepancies to NEW it z_ � , t z
the Architect for adjustments before proceeding with the work. RAID. _ _ i ' a
Dimensions are from rough framing unless noted otherwise. LOC. NEW POST (OPP. SIM.) N DW M
6. The Contractor shall promptly correct work rejected as defective NEW POST IN BSMNT TO FOOTINGS �S RA- � ---- Q
or not conforming to Contract Documents and bear costs of '„ 3» - _s--------====-z=====
(2)9� x1� LVL ABV - - ------
architectural services thereby made necessary. Jill
7. The Contractor shall be responsible for the removal of rubbish
from the site. Final clean up is broom clean with windows washed. III KITCHEN
N 1 -8 z
8. Building materials and components shall be protected from rain, DINING r Q
II J NEW HRDWD ! e
snow,and other moisture sources during storage on site and EXT'G HRDWD IIII Q 1 w
_ 0 o
construction. REFINISH (3) COATS 6 ere e�� R 1 o
9. Construction shall be in accordance with the requirements of the II POLYURTH
EnergyStar program to the fullest extent possible including IIII ---- Q z
framing,air sealing and HVAC detailing. II ___ Q p z
10. Local, sustainable and non toxic materials are preferred. MW BLW z o-6 W
11. DEMOLITION- Remove building components as noted on II �� O Z U_
3'- 2'-8' l.- w w
drawings. Store appliances for reuse _ n V) a
P M O F1' a
o II i
0S—M
LIGHTING/ ELECTRICAL KEY IIII BLW BLW �I W
0 -- J
SINK ', �1aJ15 �WS WALL SCONCE � Q
J �N� Q RECESSED DOWN II
XP PENDANT I) 8 W
RAD. - II
DW SURFACE MOUNTED z
REMOVE
REOLOCATE OsM 111 City f Northampton
ry OR= g
(I DUPLEX RECETACLE IIII Building Department a O
QUAD.RECEPTACLE
II Plan Review ; w 0 O �
212 Main Street O
O
GROUND FAULT L --- OJ W
J
m
II Northampton, MA 01060 u_ LL J
SWITCH IIII Ur 0 L\
uJ
V TELEPHONE —____— � z U)
DINING KITCHEN _--_-__-_� O z
Ln a
- - - - LU
FRIG R J
EXT'G
TALL CAB. DATE DRAWN:
CHMNY 10-05-15
`,—� REVISED:
CHMNY FRIG — —
2 P FLOOR PLAN - DINING/KITCHEN PERMIT SET A i
EXISTING FLOOR PLAN ,�1T0 BE DEMOLISHED _1/4" 1'-0" TOR REMOVED /2 - 1'-0"
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:- '4 s
✓ � 01 0 6`A
The debris will be transported by: S Se- C'
The debris will be received by: 6((
Building permit number:
Name of Permit Applicant
( O�S IS
Date Signature of Per ' Applicant
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ss '11�
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 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 m e
�
�
I, M"' 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 ( b / � / )Z61 5
Address of work location �- S ��� c J /-tv
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
x 600 Washington Street
r Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� i Please Print Legibly
Name (Business/Organization/Individual): f`t h ✓C, , � �c`L , /}'} K I
Address: q) V (2zmL x � 6�'I` f—L�v✓'e ,►G fie. d U
City/State/Zip: Phone #: 413 - 5-.), 2
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
ployees (full and/or part-time).* have hired the sub-contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7. C Remodeling
ship and have no employees These sub-contractors have 8. [g'bemolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
comp.
[No workers' comp. insurance insurance.$
required.]
5. ❑ We are:a corporation and its 10.[�E ectricaI 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. 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains a d penalties ofperjury that the information provided above is true and correct.
Si ature: Date:
14 1
Phone# 3
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:
License Number
Address Expiration Date
Signature Telephone
9 Renistered:Homeamproverrient Contractor: _ _ _,..... _...___ Not Applicable £
Company Name -Registration Number
S L✓.v"w,e- S k u s�Lj -?-GVY4 o kI b I r) 1- l— 1 -3
a o l b
Address ;/\_L��� Expiration Date
x0 6 1DF1 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...... £
1L. .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 a responsibility for compliance with the State Building Code,City of
Northampton Ordinances,St an L o aws and State of Massachusetts General Laws Annotated.
Homeowner Signature
I
i
I
SECTION 5-DESCRIPTION OF PROPOSED WORK(check alt applicable)
New House ❑ Addition ❑ Replacement Wjpdows Alteration(s) Roofing F7
�-,� Or Doors L�
Accessory Bldg. El Demolition Y New Signs P, Decks [M Sidi [p] Other[0]
Brief Description of Pruposed w rt�t v�ar,. ut�w
Work:- -ynay E"4."sa;u 11-�L(Il- / ReL.-Id-t C)Qa'r..`-"5 0162 - �n�L�siv- ndu✓
/ r
Alteration of existing bedroom Yes I/ No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes V" No
Plans Attached Roll -Sheet
T•- _-.,,
sa; if"New"house and�or:add1. ion'. '
"exiif ".housin " .corn fete fhe foUowln
a. Use of building: One Family Two Family Other
1
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? 3
f. Method of heating? C4- f,C-in^ 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 V No. Is construction within 100 yr. floodplain Yes ✓No
j. Depth of basement or cellar floor below finished grade 5 t,
k. Will building confc n 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, as Owner of the subject
property
hereby authorize
to act c}a-ry y behal ll matters relative to work authorized by this building permit application.
J / ,U
Si a of ner Date
as Owner/Authorized
Agent hereby declare thaz the statements bnd 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
Signa re of Ow r/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomp e`t(Yfni ation '4
Existing Proposed Required b l?ligg--•
This column tj be pilled in by
Building Dep4tment
Lot Size
Frontage -- •-- -�
Setbacks Front
Side L:' ( R:= L:= Rf—'
Rear !
Building Height (—
Bldg.Square Footage % j
Open Space Footage �—�
(Lot area minus bldg&paved
Parking)
#of Parking Spaces t-----# !
Fill: - -.�_,._ ..__._.�,...w..-..._. w.�.x.,..�.,_�.__.,.._...�...�.�..._.....M
(volume&Location) 'k I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (D-**' DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location: j
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 9 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
i
1 Oepartmert use Drily
r u r Y ri A I r
r 2 ity of Northampton Status of
E P�rfritt b y r
DLS LS uilding Department Gtrrh CurEDri�ce�vay Perml# t
212 Main Street SewerlSeptieAuaira611tty t
OCT 5 2015 i
Room 100 Water/V�elt;Avatl'a6111ty�
rthampton, MA 01060 Twa Sefsot Strtrctr;rai Platys
i r
41 -587-1240 Fax 413-587-1272 P[of/sife Plans
L Z Y
Electric,Plumbing&Ga nsp6Cliona
Northampton,MA 01060
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE,INFORMATION
,= This secfiorr to be completed by office �:
1.1 Property Address:
Map Lot Unit.
Zone Overlay Distrtct
_E1m,St Dlstnct .. . . CB D;istnct
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT'...
2.1 Owner of Record: `A y ,/
Name(Pri Current Mailing Address:
Telephone
Signatu
2.2 Authorized A en
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ., (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
Cv �
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) `i Check Numbe.r
This Section For Official Use'OnIY.
Date
Building Permit Number: Issued:
Signature:
Building Commissionedlnmpector`of Buildings: Date
File#BP-2016-0458
APPLICANT/CONTACT PERSON NAYAK ANAND P&POLLY FIVEASH
ADDRESS/PHONE 77 STRAW AVE FLORENCE01062
PROPERTY LOCATION 77 STRAW AVE
MAP 17D PARCEL 026 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Rn;lrling Permit Filled out
Fee Paid
Typeof Construction: REMODEL KITCHEN ENLARGE WALL OPENING,ADD NEW WINDOW& SLIDER
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
INF9,XMATION 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
iti Delay
Si ature 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.
77 STRAW AVE BP-2016-0458
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-026 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2016-0458
Project# JS-2016-000755
Est. Cost: $27500.00
Fee: $179.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group Homeowner as Contractor
Lot Size(sq. ft.): 16335.00 Owner: NAYAK ANAND P&POLLY FIVEASH
Zoning. URB(100)/ Applicant: NAYAK ANAND P & POLLY FIVEASH
AT: 77 STRAW AVE
Applicant Address: Phone: Insurance:
77 STRAW AVE
FLORENCEMA01062 ISSUED ON:1011312015 0:00:00
TO PERFORM THE FOLLOWING WORK.REMODEL KITCHEN, ENLARGE WALL
OPENING, ADD NEW WINDOW & SLIDER
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 10/13/2015 0:00:00 $179.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner