18c-042 (4) 685 BRIDGE RD BP-2015-1160
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-042 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2015-1160
Proiect# JS-2015-001439
Est. Cost: $120000.00
Fee: $1400.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11543.40 Owner: LANGSTON ROBERT&NORA
Zonin-,: URB(100)/ Applicant: LANGSTON ROBERT & NORA
AT. 685 BRIDGE RD
Applicant Address: Phone: Insurance:
80 DAMON RD #5111 (413) 588-7414 O
NORTHAMPTONMA01060 ISSUED ON:9/29/2015 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 STORY ADDITION(2
BEDRMS,1/2 BATH& 2 FULL)& CONSTRUCT 21 X 20 DET GARAGE & REMODEL INTERIOR
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 9/29/2015 0:00:00 $1400.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2015-1160
APPLICANT/CONTACT PERSON LANGSTON ROBERT&NORA
ADDRESS/PHONE 80 DAMON RD#5111 NORTHAMPTON01060(413)588-7414 Q
PROPERTY LOCATION 685 BRIDGE RD
MAP 18C PARCEL 042 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid Z7—
Building
—Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 2 STORY ADDITIONQ BEDRMS,1/2 BATH&2 FULL)&CONSTRUCT
21 X 20 DET GARAGE&REMODEL INTERIOR
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
INFOR ION 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
Demoliti Del
7-5 �/—6-�r//
Signature of Building 6ffi6ial 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.
`rte � Department use only ti ,;ii
t
City of Northamptontatus ofPerrnit �,! 4'!
Building Department i
Curb CutlDr(yeway Perini# �t r ' —
212 Main Street
SewerlSepCc Auaira'bllrky � + ,L. '
� I
Room 100 /VaterlUU`e�t�,va�iatiiltty
!
Northampton, MA 01060
p �Twc7Sefsof 5tructc�ral Plarts ... ._. � , ,
phone 413-587-1240 Fax 413-587-1272 Plof/slte plans
Other 5,pecify'" t 1 i �t
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTIONI -SITE,INFORMATION
Th(s secborrfo be copff
mleted by o (ce -:
1.1 Property Address:
IIS J
-
. _;_
` y
01 !
Elm St Distract '
SECTION 2.=PROPERTY'OWNER.SH..IP/AUTHORIZEDAGENT'
2.1 Owner of Record:
M,o(A -1 6-jy o p N i-T-
Name
Name(Pri Current Mailing Address: Nvz—t +A,�,W/IV N of 0�')
t �� Telephone
Signature i�-
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
c
2. Electrical r (b) Estimated Total"Cost of
t Construction from fi
3. Plumbing rdD _5� Building Permit Fee
4. Mechanical(HVAC) JcZo ( 0Q S;C AT7AC`REl7
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Off CW''Use Onl
Date
Building Permit NLmber' Issued:
Signature:
Building Commissioner/Inspector.of Buildings: Date
Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information
Existing Proposed Required by Zoning
Tbis column to be filled in by
Building Depa=ent
Lot Size
Frontage
Setbacks Front EMI FIT
Rear FRO
Building Height
Bldg.Square Footage 0%
Open Space Footage % —7�
(Lot area minus bldg&paved CL:n--V,-
#of Parking Spaces
(volume&Location)
A. Has a SpecialPennit/Yariance/Findingever been issued for/on the site?
x—� ��
NO ��/ DONTKNOY/ \�� ` /ES �_y
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds? /
NO `_'� ) DON7 KNOW 0 ,ES
IF YES: enter Book Page' and/or Document#
��
B. Does the site contain a brook, body ofwater orwetlands? NO �^� DONT KNOW �~/ YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained /—� 0�btained ' Date Issued:
- .
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there anyproposedchangestouradchtionsofdgroiotendedforthep,uperty? YES 0 NO
IFYES, describe size, type and location:
E Will the construction activity disturb(clearing, gradingon. orfi|Ung)over 1acre or|eupart ofocommon plan
,
that will disturb over I acre? YES y ) NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required. |
/
| 1
kits VefiaK
se WUW
�-ST L 133g
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable
1,914 e g9�
New House F-1 Addition Replacement W,ifidows Alteration(s) Roofing
Or Doors
Accessory Bldg. Demolition New Signs [0] Decks ([] Siding [&Tr Other[❑]
Brief Description of Pro osed t;C—kOS°�Nc a EiCfi N k`
Work: VmTA - 1 rue., A,,-,R4
Alteration of existing bedroom Yes No Adding new bedroom ✓ Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -SheetT
sa, ewf..house.and-or.a idmo exisfrn h"ous�n corriT ete fF a followln'': t ��
a. Use of building :One Family Two Family Other
14
b. Number of rooms in each family unit:_ Number of Bathrooms ��
c. Is there a garage attached? 0
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of.heating? 4vi7 Iia^f a C— 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 v---N o
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building andel Zoning regulations? ✓ Yes No.
I. Septic Tank City Sewer ✓ Private well City grater Supply
SECTION 7a-OWNER AUTHORIZATION-;TO BE COMPLETED .WHEN
OWNE5J AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, G 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/A #erire
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 Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Regis.#erect Homeamarovemenfi Contractor Not Applicable £
Company Name Registration Number
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 ( wnerXgempt1on
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"c fies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature,
i
i
The Commonwealth ofMassachusetts
Department of Industrial Accidents
i Office of Inyestigations
�. 600 Washinkton Street
r Boston, 3f,4 02111
www.rnas$.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizationAndividual):
Address:
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F-] I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I 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'
[No workers' comp. insurance comp. insurance.$ 9. Building addition
required.] 5. F� We are:a corporation and its 10.❑ Electrical 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 12.0 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 We 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Of
leial 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#:
City of Northampton.
�{ Ix Si
Massachusetts Sys w crc
'.i DEPARTMENT OF BUXLDING XXSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 r� •.�1�.
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 i
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 permit nd inspections as required can DELAY the project until such time as the proper permits
and insp Ions are made
understand the above.
(Home owner/resident's slg ature requesting exemption)
I will call to schedule all required' uilding inspections necessary for the building permit issued to me.
Date
Address of work location
I
• I
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: % in k ti , An
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
,f
iJ
I
Date Sign-ature of Permit Applicant
685 Bridge Rd Fees
Areas Per SF
basement 14 14 196
18 18 324
20 12 240
760 $0.20 $152.00
1st floor rear 14 14 196
Kitchen 15.25 16 244
Lounge 18.25 18.5 338
front 20 28 560
1338 $0.60 $802.58
2nd floor BR(over lounge) 18.25 18.5 338
BR (front) 20 28 560
898
attic BR 20 28 560 $0.60 $336.00
storage 18.25 18.5 338 $0.20 $67.53
porch 26 6 156 $0.20 $31.20
$1,389.30
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