24C-156 (4) I�, , 0 / Z7, 4 �" 1^ A (11 Jk
A. General Notes
1. Construction shall be in accordance with all applicable codes and regulations having 5. On-site verification of dimensions and conditions shall be the responsibility of the Contractor. Noted rmensions take
J urisdiction. Provide products of acceptable manufacturers which have been in satisfactory precedence over scale. The Contractor shall compare and coordinate drawings and site conditions and report discrepancies to
use in similar service for three years. Use experienced installers. Deliver,handle, store, and the Architect for adjustments before proceeding with the work. Dimensions are from rough framing unless noted otherwise.
install materials in accordance with manufacturer's specifications. The Contractor shall 6. The Contractor shall promptly correct work rejected as defective or not conforming to Contract Documents and bear costs of o E
provide all permits and arrange for all inspections. architectural services thereby made necessary. CD
2. The Contractor shall take reasonable precautions to protect all employees on the work site, 7. The Contractor shall be responsible for the removal of rubbish from the site. Final clean up is broom clean with windows Q E
all materials and equipment incor orated therein as well as other property at the site. An
p � p p y y washed. @)
damage or loss to any of the above caused in whole or in part by the Contractor or any of 8. Building materials and components shall be protected from rain, snow, and other moisture sources during storage on site and U
his/her Subcontractors shall be remedied by the Contractor. construction. < a
3. The Contractor shall carry Liability Insurance to protect him/her from claims which may 9. Construction shall be in accordance with the requirements of the EnergyStar program to the fullest extent possible including �
arise out of or result from the Contractor's operations under the Contract. framing, air sealing and HVAC detailing. z
4. If, within one year after the work has been accepted by the Owner, 10. Local, sustainable and non toxic materials are preferred. E
any of the work is found to be defective, or not in conformance 11. DEMOLITION- Remove building components as noted on drawings. Store cabinets for reuse.
F m
with the Contract Documents, the Contractor shall correct it V)
promptly and at his own expense after written notice. Y Ln
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SKYLT
GREEN HOUSE
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RECEIVE NEW CARPET KITCHEN2 U Z
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ry
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CHANGE i i c P Q Q z
SALVAGE
D CLOS MILLWORK PORCH (n W
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REMID SOFFIT DN
' CAR I ii RAISED + + + + I /
DN RDEOMO E HEARTH //
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CLO LIVING ii FP ° � w
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SALVAGE LTS I U LU
BATH1 FOR REUSE i 8� U-)O
g 66
BDRM —REMOVE DR++ i i DINING p C~I)
DEMOLITION LL
�+ REMOVE i i i i i ++ I ENTRY ti
CLOSET
—REMOVE PERMIT SET
� + � DATE DRAWN:
"SCREEN"
01-12-16
REVISED:
EXISTING SECOND FLOOR PLAN ��� TO BE REMOVED EXISTING FIRST FLOOR PLAN
EX1
City of Northampton 212 Main Street, Northampton, Na 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: �O �y'1
The debris will be transported by: k6+e, hN4na `nom
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Sign-ature of Permit Applicant
City of Northampton _
} Massachusetts / _ ���'t•,
1 DEPARTMENT OF BUILDING INSPECTIONS r-x
-`' 212 Main Street • Municipal Building
Northampton, MA 01060
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 Qt LAY the project until such time as the proper permits
and inspections are made, a
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
Address of work location
I
I
t
The Commonwealth ofMlassachusetts
Department of Industrial Accidents
- Office of Investigations
600 )Washington Street
;r Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1 Please Print Legibly
Name (Business/Organization/Individual): ,rfpvJydpOOl 1��S%Cv�,,'V Coll
Address: y'o` e1�►�w�
City/State/Zip: 1noHn„ 0 160 Phone#: PIS 6 Lf 01 30 5'76 3 6
V]e ou an employer? Check the appropriate box: Type of project(required):
1 am a employer with _�2 .— 4. 0 I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.F-1 I am a sole proprietor or partner- listed an the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. UDemolition
working for me in any capacity. employees and have workers' 9. F-1 Building addition
[No workers' comp. insurance comp, insurance.
required.] 5. We are:a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 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.
lContractors 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. �,-�
P y M�
Insurance Company Name: v va l n S u It ewlc.e
Policy#or Self-ins.Lic. #: �rW C_ qOG 76'30 76 ;�14 P- Expiration Date: A6 aU 1(o _
Job Site Address: 6 AYNVAQ� ^ S� City/State/Zip: 1�e_ r (��0� 616 66
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 ofperjury that the information provided above is true and correct.
Signature: Date:
Ceq
Phone#• a576 41950 5 7S Y307
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 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: �/ a 1 le, ., O Ck C✓ 0661061
License Number
Address tell Expiration Vate
456 1490 575 LI30 7
Signature Telephone
9.Registered Hume lmproveirient Cantractor_ "__ _. ; _ _, �:- Not Applicable £ q
kK6 u)E,e n 12r S Q—Aw C1644 6+ry e6 e V_X 14 7 6 L
Company Name Registration Number
16/q I!
Address Expiraticfi Datef
Telephone ash 3p
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...... £
R :`Name Owner°Egemptl6
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.
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition New Signs [O] Decks [[] Siding[O] Other[p]
Brief Description of Propgg��e d
-f
Work: ?S?iw� �2 i lun WA»S
Alteration of existing bedroom Yes No Adding new bedroom Yes . V No
Attached Narrative Renovating unfinished basement Yes —No
Plans Attached Roll -Sheet
sa: if New house and-or=addition fo exlstlng'h`ousiria, conplete: lie following:
a. Use of building :One Family V/ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? b
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.BUILDING PERMIT
as Owner of the subject
property (( ^^
hereby authorize L qq Ak%C "A 1 L Y�
to a ehalf, in all matters relative to work authorized by this building permit application.
Sigm Owner Date
����� o�►( asZ4am YAuthorized
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.
f
W m
Print Name
Signature of Qwav*gent Da(e
r
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Informatio -
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage s -- - — ----� _ --—
Setbacks Front
Side L:= R:= L:= R:=
Rear 3 t--- I•---
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved � d
Parking)
#of Parking Spaces
Fill: t
(volume&Location) 1 11 l
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES,'date issued:r-
IF YES: Was the permit~recorded at the Registry of Deeds?
NO Q DONT KNOW e YES 0
IF YES: enter Book Paget and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW YES
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 9
IF YES, describe size, type and location: f
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 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
j
�I
r--
I., ,. - - Department use only
Fv J� II L� t i f.
t r n r�r r ra. r
City of Northampton status of�4rrn�t �' i �'J f
N ,,eF,rir tirr Ft� 4 r 3 i L fr st �r
�a Building Department ;'Ccrb Cut/Dri+teway Psrmif
3 2018 s
�� r r rr , i t r i r r i r
212 Main Street SewerlSepticAvaifa611rty� F Ir
1
Room 100VaterlVrfe7�Avaiial]ihty t f r4
Northampton, MA 01060 TwalSefs ofi5#rttctcsral Fta�s >> �'
e 413-587-1240 Fax 413-587-1272
___ —__fe—�J.u.____ �._——1P.�!3=—i�1.'J.._:��____ -=-+•'y�l°n4:E,:,_�!Y'=_'�.y
-
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��Qth�Y—.S..�.CI��_. ,.r._::,u::-:.==rh-__.��.,�i.l� =�i::.:,uyi��r_��;�;_1'�;.•!_.r
—
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
!Thissect�orrtorbe.c.om lefediti.:'-office;_
Pro Address: -- -=
=Ma :_.::-!:_:::_.-,_:_._,::
�0 �4 t j Zone Overlay Disfrrct
-Elm Sf Dlstnct r CBrDIStnCt 1
SECTION 2.:-PROPERTYOWNERSHIP/AUTHORIZED AGENT'-
2.1 Owner of Record:
0.r-4
Name Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
t�,l ,a.�• PC-k 23 A,,1,xtrtd— /'Cl +teell qW Rk �lo�a
Name(Print) Current Mailing Address:
ql 3 v SG 4930 ce-11 5 75 L ,Aa 7
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use'Only
completed by ermit applicant
1. Building C�D �j d (a) Building Permit Fee
J
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
ThisSection For Official Use Onl
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/In spector'of Buildings: : Date
File#BP-2016-0908
APPLICANT/CONTACT PERSON WILLIAM ROCK
ADDRESS/PHONE 23 Amherst Rd PELHAM01002(413)256-4930
PROPERTY LOCATION 40 ARLINGTON ST
MAP 24C PARCEL 156 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid o
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE NON BEARING WALLS&KITCHEN CABINETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 050081
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
pproved 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
o ' io
Sinaure oilding fi 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.
40 ARLINGTON ST BP-2016-0908
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 156 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-2016-0908
Project# JS-2016-001539
Est. Cost: $5200.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM ROCK 050081
Lot Size(sq. ft.): 34194.60 Owner: SARVET BARRY&DEENA
Zonin-,: URB 1002 Applicant: WILLIAM ROCK
AT. 40 ARLINGTON ST
Applicant Address: Phone: Insurance:
23 Amherst Rd (413) 256-4930 Workers Compensation
PELHAMMA01002 ISSUED ON.111312016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE NON BEARING WALLS & KITCHEN
CABINETS
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 1/13/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner