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32A-076 (5) Harlow Builders 336 Coles Meadow Rd. Northampton, Ma. 01060 (413) 374-5326 CSL #52460 HIC # 111205 Submitted to: 12/17/15 The City of Northampton Building Department. I request that you grant a modification to waive the requirement for the control construction for the (bathroom renovations) at (35 Market St.) in Northampton because the work is of minor nature,will not affect health,accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. "Mass Amendments, section 107.1 allows for an exclusion from control construction for this project. Respectfully, Scott Harlow Harlow Builders 336 Coles Meadow Rd. Northampton, Ma. 01060 Install wall or 1332 DH 1332 DH ceiling fan Plumbing 2011x1 g Chas Chase Vanity 0 4'x 21" Electric Q Vanity cabinet Heater ' 0 Electric Heater 5' Claw Foot Tub 0 4' Shower r 2668 2468 Make door 2nd Floor Megan's smaller for Bathroom electrical 2030 DH 6-5" ceiling height 8 Ceiling Height 0 ® —Electric Heat � J 0 a 4'-6" Claw \ Foot Tub 2066 71-111 EXISTING ,� �l C C' 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-b-y, MGL c 111, S 150A. Address of the work: r The debris will be transported by: ��w �v..laeT- The debris will be received by: Building permit number: Name of Permit Applicant Sc� 1ow fob Date Sign-ature of Permit Applicant City of Northampton Massachusetts r DEPARTMENT OF BUILDIN($ SNSPECTIONSy `r I r � ' 212 Main Street • Municipal Building Northampton, MA 01060 ssw L1�t' INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT l The State of Massachusetts.allows the homeowner the right unge. F 780CMR 108.3.4 to act aEatwo- year construction supervisor. The state defines "Homeowner"as, " Pers'on(s) who owns a parcel he/she resides or intends to be, a one or two family dwelling, attached or detached structu accessory to such use and/or farm structures. A person who constructs more than one home 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 pout. a rough building inspection before work is concealed insulation ins ection if required) and�a final building inspection. The building department requires these inspections before the work is ncealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. I 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 reggl'red 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 1, 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 4ddress of work location i i The Commonwealth ofVlassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r Boston,MA 02111 vww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationadividual): \k-4�1 1�1Epw Address: tpA &yn wo XNA , pb City/State/Zip: Phone#: 913 §,VJ0` '4 G,5_ A;rI an employer? Check the appropriate box: Type of project(required): 1. m a employer with 4. Q I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. New construction 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for mein any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 7 We are:a corporation and its 10.❑Electrical repairs or additions 3.Q 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 12.7 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fHo 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: M Ikkl Policy#or Self-ins.Lic. #: W Q,S©vz.'3 d `a S>OI DOC> Expiration Dater I� Job Site Address: `3S— r��lc �� 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 under the pains and penalties o per' ry t t the information provided above is tfue apd correct. Signature: c/ Date: /7P,` Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL 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 87 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: ��l \ ,t,W S7 S? 1(j 6� kew,off License Number Address Expiration Date Signature Telephone 9 `IReaisfered?Home: Not Applicable £ Company Name q�Jl_C3 Registration Nu ber Address Expiration bh, 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 Ho ne QImer Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwelling 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. CAM 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 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, i I SECTION 5-DESCRIPTION OF PROPOSED WORIC(cheek all applicable) New House Addition ❑ Replacement Windows [Alteration(s) F7 -- Roofing Or Doors 1-7 Accessory Bldg. ❑ Demolition Rr New Signs [CD] Decks (Q Siding[0] Other[C �" Brief Description of Proposed Work: a V-orno Alteration of existing bedroom Yes No Adding new bedroom Yes V111, No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rolf -Sheet sa If;New house and.oradditior to'ezistenghousin'ct, compfetefhe foalowlnc a. Use of building :One Family Two Family Other Yctr^�1 b. Number of rooms in each family unit: 9 Number of Bathrooms c. Is there a garage attached? d`1 O d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of.heating? ��eC-I C 1C Fireplaces or Woodstoves `(1'O Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction W�►•-� 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 TO.R.BUILDING PERMIT' 1, as Owner of the subject propert hereby authorize Sc�►i rv,v� to act o y half, ' a!I relative to work authorized by this building permit application. Signature of er Date 1, ,1t1L.�• 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 Name Sign 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 Vs coluniA be filled in by Building ep ent Lot Size Frontage l -------� '� Setbacks Front Side L:' R:` I L:~ R:I i i i Rear —r Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: r fE (volume&Location) A. Has a Special Permit/Variance/Finding ever b e issued for/on the site? NO Q DONT KNOW Q ES Q IF YES, date issued: IF YES: Was the permit recorded at the Regi ry of Deed 7 NO 0 DONT KNOW Y Q IF YES: enter Book j Pagel 3 and/or Document#1 5 B. Does the site contain a brook, body of ater or wetlands? NO O DONT KNOW Q YES 0 t IF YES, has a permit been or nee o be obtained from the Con ervation Comri'nission? Needs to be obtained 0 Obtained Q , Date Issued¢ C. Do any signs exist on the prop ty? YES Q NO IF YES, describe size, type nd location: f D. Are there any proposed cha ges to or additions of signs intended for the p perty? YES O NO 0 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 1 acre? YES O NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ii �I t Y - a M1 peparfinent use only ity of Northampton Status ofPermrt I - Liming Department 9y Perrrtif 212 Main Street Sewer/SeptieAvai(a611rty v.1$ Room 100 N aterlUMA abihty - r J ampton, MA 01060 Twa$e#sofS#tctural Ptarts phone 413-587-1240 Fax 413-587-1272 Ploflsite Plans "�T t APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -.SITE.INFORMATION Th►s section-to be complefed by office 1.1 Property Address: — -- _ Zone- Overlay Disfricf L - Cpl _ -:. -- - r , EIm St Dist[ict . SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED:AGENT 2.1 Owner of Recor Name t Current Mailin Address• N13- ND r� Telephone Sig atur 2.2 Authorized Agent: Name(Print) Current Mailing Address: Sign ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building l /,b :w® (a) Building Permit Fee 2. Electrical Lj rzOp .(b)'Estimated Total Cost of Construction from fi :: 3. Plumbing Building Permit Fee w 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2 +3+4+5) Check Number D " ThisSection For Official Use Onl Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings: Date i File# BP-2016-0817 APPLICANT/CONTACT PERSON HARLOW BUILDERS ADDRESS/PHONE 336 COLES MEADOW RD NORTHAMPTON01060(413)586-0465 PROPERTY LOCATION 35 MARKET ST MAP 32A PARCEL 076 001 ZONE URC(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:_RENOVATE UNIT 2&3 BATHROOMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052460 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 D elay 2�7 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. 35 MARKET ST BP-2016-0817 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-076 CITY OF NORTHAMPTON Lot: -00 1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS hermit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0817 Project# JS-2016-001375 Est. Cost: $12000.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HARLOW BUILDERS 052460 Lot Size(sg. ft.): 3702.60 Owner: SULLIVAN ANN&LINDA RAINVILLE C/O MEAGHAN M SULLIVAN zoning:URC(100) Applicant: HARLOW BUILDERS AT. 35 MARKET ST Applicant Address: Phone: Insurance: 336 COLES MEADOW RD (413) 586-0465 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:1211712015 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE UNIT 2 & 3 BATHROOMS 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 12/17/2015 0:00:00 $84.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner