24C-115 (4) 144 FRANKLIN ST BP-2016-1251
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C- 115 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pern,it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory: renovation BUILDING PERMIT
Permit# BP-2016-1251
Project# JS-2016-002150
Est. Cost: $15300.00
Fee: $107.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: IRWIN ACHMAD 100992
Lot Size(sq. 1): 6011.28 Owner: KEFER JENNIFER&CHRISTOPHER HAYHURST
Zoning: URB(100)/ Applicant. IRWIN ACHMAD
AT. 144 FRANKLIN ST
Applicant Address: Phone: Insurance:
7 Spring, Street (413) 977-1925 O
EASTHAMPTONMAO 1027 ISSUED ON:4/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-FINISH BASEMENT & INSTALL WINDOW
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 4/29/2016 0:00:00 $107.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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a"rf n nt City of NorthamptonsFoPe5t „li u'F'tri I I Building Departmenturb UU'u, rlye-�-. t'ai IF��" f`CI r 262016 212 Main Street S`ew ri,S ptieAyaifa�(i[ty
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE,INFORMATION
Th�sysect�on-�to,be complet:eciNby
1.1 Property Address: tr I F
MR
Y A �"1 K •i Ma:p �' 1-otF '� i*�.. 7 R Un1t - J
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N • Zo e s n F� yeday DtStCICt a
Q i o tr SEIrfi St Qrsfrtcf 5
SECTION 2.=PROPERTY'OWNER.SHIPlAUTHORIZED;AGENT.-
2.1
GENT.2.1 Owner of Record:
i y {-
�� � �1
Name(Print) Current Mailing Address: -�
Loll 111-92-3V
telephone
Signature
2.2 Authorized Agent: ( }� y y- t (�
!�` y W , N e �1 a e s 1 f .�`i 4 �' t C�n u{ In a TA V-t J ►O
Name(Print) Current Mailing Addresi:
Signature Telephone
SECTION 3-*ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building -� t c c.�. (a) Building Permit Fee
2. Electrical , E . a (b) Estimated Total Cost of
t Construction'from' fi
3. Plumbing 1-00 Building Permit Fee
4. Mechanical(HVAC)
167
5. Fire Protection
6. Total=(1 +2+3+4+5) t 0 U a �' Check Number
this Section For Official Us 'Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/lnspector.`of Buildings: Date
^
' m ^
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'n�is column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot=a minus bidg&payed
#of Parking Spaces
(volume&Location)
A. Has aSpecial Permit/Variance/Finding ever been issued for/on the site?
~��
NO �_x=�� DONTKNOu/ v�� YES \/-�
��
IF YES, date issuedJ
IF YES: Was the permit recorded atthe Registry nfDeeds? '
NO K J DONTKNOY/ YES '
��
IF YES: enter Bonk Page and/or Document#
�� ��
B. Does the site contain a brook, body ofwater orwetlands? NO �~��� DON7KNOVY Y�� YES \�� �
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained -«~� Obtained �~� Da� e |s�ued'
�~� ' .
C. Doany signs exist on the property? �� ��� YES �^� NO �^�
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size' type and location: '
E. Will the construction activity disturb(clearing, gradingexcavation,orfilling)over 1acre oris itpart ofocommon plan
�ha�wi||dia�udbovar� acna? YES [�� NO D K~~3
' �
IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Aiterafion(s} Roofing ❑
Or Doors (;�_
Accessory Bldg. ❑ Demolition ❑ New Signs [aj Decks [Q Siding[Ct] Other[M]
Brief Description of Proposed
Work: 'e t-. `' I <_� � �1 4 '"• )_� � � � 1`
IV JL
Alteration of existing bedroom Yes No Adding new bedroom Yes No °
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rall Sheet ! 1'
sat tf'New house and or addift'66" existi0410usinl"Comr�defe_fhe fotlawlrg:
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 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTI-(ORIZATION-TO,BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR,BUILDING PERMIT
I, Gt i K f S f`l yf l2 � 7-L�-f✓ K15.65 Qf - as Owner of the subject
property
hereby authorize
to act on my behalf,in ail matters relative to war s--authorizeti'by this building permit application.
f
J12-11d
gnature of Owner Date
I, } r �„� 12�� �.�, 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.
v �1
Prin me }�
•�'•_,,/ _,�, � � i �, t cep .
Signature of OwnerlAgent �� Date 1—
1
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: T d JV ✓� /�C, 1.� �n X
License Number
A IV
Address Expiration Date
Signature Telephone
9_Rhe-gisfered Home Improvement Contractor _...._ __._ Not Applicable £
\ 00 -_
Company Name Registration Number
Address Expiration Date
—Telephone–,t
SECTION 10-WORKERS.'_COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c..15 2,§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 Holne .�tivner
U011.
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
' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,.1174 02111
` www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): V w . <1 ,r.,,z
Address: - � Set ,
I , f
F — a t v b �-
City/State/Zip: `c '1 \1N, '� Phone#: C 3
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors ❑New construction
2.TI-C17 am a sole proprietor or partner- listed on the attached sheet. 7. .Remodeling
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity. employees and have workers'
comp. insurance.$ 9� ❑Building addition
[No workers comp. insurance p
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.❑ 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.] I T" - r t r
*tiny 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
flue 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:
Phone#: K c "t - 1- t
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#:
City of Northampton
Massachusetts y=sly s SlG?{
3 s DEPARTMENT OF BUILDING INSPECTIONS
r'. 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 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 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
I
I
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MG:)L 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 --r—�
The debris will be transported by: V3 m
The debris will be received by: 4
Building permit number:
Name of Permit Applicant
� y
Date Sign-ature of Permit Applicant
2016 00007219
Bk: 12254Pg: 58 Page: 1 of 1
RESTRICTIVE COVENANT. Recorded: 04/2612016 09:53 AM
BUILDING ZONING
That Jennifer Kefer and Chris Hayhurst, owner(s) of the real estate atCW144 Franklin
St Northampton, MA , more particularly shown as (deed description, deed date, book &
page) hereby Covenant and Agree that C3 , -, K l I I F ':�- f" I R a q 4
The basement space at 144 Franklin St Northampton, MA will be used as storage,
office, studio or recreation. It will not be used as a sleeping space without first obtaining
a building permit and meeting all the requirements of the Massachusetts State Building
and Health Code for a newly created bedroom."
Executed as a sealed instrument on this date of March 1, 2016
Owner's name and signature
Jennifer Kef�r—
Owner's name and signature
Chris Hayhurst
REGISTER
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Sizes and Dimensions
a a 41
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to Inside Face of Well Foundation
ter) 33-1/4" Single modules work well with W,20"&24"
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Dome Cover °
a a
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yam...
82-112"
a °
a a
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Limits the accumulation of snow, o o'
leaves and debris.Constructed of i
polycarbonate,this high impact cover
is UV-resistant and designed for 51-3/4"
durability and long life.Dome is
designed to withstand a 40 PSF load
and is supplied with quick release
hold-down clips. a °
36-3/8"
IMPORTANT:When using a dome cover
with a casement window,the window well a a
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not interfere with the window operation. 21"
Phone:(800)854-9724•E-mail:residential@bilco.com •www.bilco.com
STK-FLYER-R 11
Copyttght 2014.The BkA Comparry. ,, .
sw Massachusetts -Department of Public g afet„
Board of Building Regulations and Star I `s
Construction Supers-isor
License: CS-100992
IRWIN H ACH}'• O
7 Spring Street
Easthampton Mg--01027
r
Expiration
Commissioner 02/066.
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 176764
Type: DBA
Expiration: 9/2512046" Tr# 245145
TOOLBOX HANDYMAN SERVICES l
IRWIN ACHMAD a
7 SPRING ST �—
EASTHAMPTON, MA 01027 - — —
Update Address and return card.Mark reason for change.
SCA 1 0 20M-W11 � Address 0 Renewal ❑ Employment n Lost Card
P�`�ie ��%orrnma�acaea�.c�C%��cz�rzc�t
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
E IMFROVEMENT CONTRACTOR before the expiration date- If found return to:
W- xpiration.
stration• 176764 Type: Office of Consumer Affairs and Business Regulation
9/25/2015 DBA 10 Park Plaza-Suite 5170
Boston,MA 02115
TOOLBOX HANDYMAN SERVICES
IRWIN ACHMAD
7 SPRING ST
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature- --
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