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38A-035 (4) r� 72 ctt,,Pr.,sT BP-2-008-0370; GIS#: COMMON`WEALTH OF MASSACHUSETTS Mapj lock: 38A-035 CITY OF NORTHAMPTON 1.ot_-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition -BUILDING PERMIT Permit# BP-2008-0370 Project# JS-2008-000372 Est. Cost: Fee: $50.00 PERMISSLON.I HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group ROBERT OBEAR 086260 Lot 5ize(sq. ft.): 11282.04 Owner: ROBERT OB IAR Zoning: URB Applicant: ROBERT OBEAR Applicant Address: Phone: Insurance: P O BOX 951 (413) 367 .424 O MONTAGUEMA01351 ISSUED ON.1011012007 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR DEMOLITION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector et'i'lumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House it Foundation: Driveway Final: Ficial: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil_ Insulation: sinoke• final: / 'f THIS PERMIT MAY BE CITY OF NORTHAMPT N U ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Co..�— a -� ertificate of Occupancy a . i nature• FeeTyhe• Date Paiu: Amoun : 1311ilding 10/10/2007 0:00:00 $50.005374 212 Main Street,Phone(4130 587-1240,Fax: (413)587-1272 Buil:ling Commissioner-Anthony Patillo i i I 1 i ' 9 1 .yam BP-2008-0370 GIs#: COMMONWEALTH OF MASSACHUSETTS I�CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS To THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2008-0370 Project# JS-2008-000372 Est. Cost: Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT OBEAR 086260 Lot Size(sq. ft.): 11282.04 Owner: ROBERT OBEAR zoning: URB Applicant: ROBERT OBEAR AT: 72 CHAPEL ST' Applicant Address: Phone: Insurance: P O BOX 951 (413) 367-2424 () MONTAGUEMA01351 ISSUED ON.1011012007 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR DEMOLITION 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 Sisnature: FeeType: Date Paid: Amount: Building 10/10/2007 0:00:00 $50.005374 212 Main Street,Phone(413)5187-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2008-0370 APPLICANT/CONTACT PERSON ROBERT OBEAR ADDRESS/PHONE P O BOX 951 MONTAGUE (413)3 7-2424() PROPERTY LOCATION 72 CHAPEL ST MAP 38A PARCEL 035 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: INTERIOR DEMOLITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 086260 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 4ATION 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 /®ib 1ioc` 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. s _ A ©jepartment etre only.- , City of Northampton ? Lvi -- Building Department Cuib G lDrtvewa Peccrut 212 Main Street SewerlSeptte A atlabrlrty $* a r �, _ J L7 Room 100 WaterlWett AvaitabtGfy y Northampton, MA 01060 T�troSetsofStructuraFPlan�= —phone Fax 413-587-1272 PtofFStfePlars � OttiecSpecify l__-_-APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION1 -SITE INFORMATION This section to be completed by,office 1.1 Property Address: /� '"` Map Lot '- unit(� 2one Overlay District.'. Elan St.Di"strict; - CB 17istrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: o d o ys o ih Name(Print) Current Mailing Address: d3 � Telephone Signature b 7-- a 2.2 Authorized A ent: Name(Print) 6urrent Mailin ddrp%\ / C Signature Telephone SECTION 3-ESTIMATED C0UCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a);Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For O :cial°Use Only Building Permit Number. Date Datled: Signature: Building Commissioner/Inspector of Buildings Date y^ ' 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 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) -V A. Has a Special Permit/Voh noe/Findi ng ever been issued for/on the site? -- °" W-11 ~~'^ ' ~~~ '-- ~~" IFYES, date issuadn IF YES: Was the permit recorded utthe Registry o[Deeds? �� xx �0 �� DON'T KNOW 'Ex IF YES: enter Book Page � and/or Dooument# � �� B. Does the site contain a brouk, body of water or wetlands? NO DON-17 KNOW �~� YES , IF YES, has permit been orneed tobeobtained from the Conservation Commission? Needs tobeobtained «~~\ ~/Obtained �~� Date i v�� � ' � C. Dnany signs exist onthe property? YES K ] NO IF YES, describe size, type and location: D. Are there any proposed changes tooradditions nf,ignsintended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb .grading, .orfilling)over acre orishpart nfocommon plan that will disturb over 1acre? YES ���) NO �^ , . IF YES,then a Northampton Storm Water Management Permit from the DPW is required. w SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wihdows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition New Signs [0] Decks Siding[0] Other[0] Brief Work Description of Proposed a q ���c I� L,CT�� h t6s- c.� cJil/ r f It . Alteration of existing bedroom_Yes No Adding new-bedroom Yes No S Attached Narrative Renovating unfinished basement Yes No J Plans Attached Roll -Sheet sa IfiNew-house�and,oW` tditi664 -existing hausinc,-co ptete fhezfiaElowirg: 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 o. s'construction wi i 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 PERM he A (Nea 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 I 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 Signature of Owner/Agent pate ff .� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su isor. Not Applicable ❑ '} Name of License Holder: b it g,6k / License Number tea. 13 f �f -/ ' I Address Expiration Date fog::� %�lG Sig to Telephone 9..ReQls�te)re tlai�ie 1m roveiir/ent Ganfracfor _ f• /� ,. � Not /App�pliccaabie Company Name Registration Number 70 zoan let-45;1� 9-1, - -o6 Address Expiration Date Telephone t36 SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.182,§:25C; 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. . 01A The Exelmlp © 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 Icense,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 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 s ..r,. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,3fA 02111 �RM gM�,,., www.mas�.govldia `Yorkers' Compensation Insurance Affidavit:'Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibIv Name(Business/Organization/Individual): / Address: 0' rO� �y City/State/zip: 'hone.#: � Are you an employer?Check the appropriate box: Type of project(required); I. I am a employer with 4. Q I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-cottractors have 8. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp. insurance. required.] 5. Q We are a corporation and its 10.F-1 Electrical repairs or additions 3.Q I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o workers'co right of exemption per MGL Y � comp. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.Q Other comp.insurance required.] 'Any appl�canrMat c ec oxmust ao t out a section below showing theit wor ers compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then''hire outside contractors must submit a new affidavit indicating such. 4Contr actors that check this box must attached an additional sheet snowing 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. /1 1 Insurance Company Name: Policy#or Self-ins.Lic.#: �/ / 4 Expiration Date: Job Site Address; �/ / f- City/State/Zip: L1�C11A /'? X4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). T 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 ' risonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day aga' a tor. Be advised that a copy of this statement may be forwarded to the Office of Investitrations of the D o a coveraee verification. I do hereby certifruAtnities of perjury that the'information provided above is true and correct Simature: Date: 07 Phone#: 6 P f" rIssuing only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: O¢� MpT0 ti$ ("' it-2 of Nart4aiitptan Z Z �` � �8S48C�liSttf9 IJ DEPARTMENT OF BUILDD\G INSPECTIONS INSPECTOR 212 Main Street • Municipal Building NorthamPton, MA 01060 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 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 he 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 made I, 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