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11C-041 (2) 51 ARCH ST BP-2016-1358 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11C-041 �ITY 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-2016-1358 Project# JS-2016-002326 Est. Cost: $4500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOUIS J GINGRAS 087279 Lot Size(sq. ft.): 10977.12 Owner: SCHALLER KYLE C&JANA L MOE Zoning URA(100)/ Applicant. LOUIS J gINGRAS AT. 51 ARCH ST Applicant Address: Phone: Insurance: 244 HAYDENVILLE RD (413) 586-7420 LEEDSMA01053 ISSUED ON.5/23/2015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REBUILD EXISTING PORCH (SAME FOOTPRINT) 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 5/23/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1358 APPLICANT/CONTACT PERSON LOUIS J GINGRAS ADDRESS/PHONE 244 HAYDENVILLE RD LEEDS01053 (413)586-7420 PROPERTY LOCATION 51 ARCH ST MAP I IC PARCEL 041 001 ZONE URA(100) THIS SECTION FOR OFFIQIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 773-- Building Permit Filled out Fee Paid Tvpeof Construction: REBUILD EXISTING PORCH(SAME FOOTPRINT) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 087279 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IP$FOFAt7MON 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 el Si e o B 1d' `Offici 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. Ci of Northampton tk�kr1, syrl s ,2 a City P Status of Permtt , ��`► Building Department -71 mr ��=} *;� GttrFa Cut/Lrlrrewa Perrrttt � *# ��, r �A �0 212 Main Street r r / Sewer/Septicl,4 .. ija llrty ;K 1 { " �Ad .. ... 9J G Room 100 YVater/i/ifellIVatlalthty�, i xst i r ri! r i` )� ylry 7tii�rr�r ,,�S:r t a y s -:,, � lti i I �rj �a ti N ampton, MA 01060 TwolSts of5#rtrclr,ral Plan 1 _� I, ,� r� ', r�, ; rQ /1STti� ph e 4 -587-1240 Fax 413-587-1272Rim 90j �0 ftfler Sp2clfyJ" e�sS ErM1rj "' ,4 — Y w f, s .1 sr F APPLICAT CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: This Secfion to be completed by office S 4 2 r 5 -/ru? f Map Lot Unit , 1I d� C� �� Zone Overlay b�strict ' a EIm St Dlstnct ,CB DlstrlCt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Z A NA r - Moe � 3'_9 Name(Print) Current Mailing Address: �✓a R Telephone Signature V 2.2 Authorized Aaent: 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 5 0, (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S 5. Fire Protection 6. Total=0 +2+3+4+5) ©4+ 00 Check Number This Section For Official Use Only . Late Building Permit Number: Date : i Signature: Building Comm issioner/lnspector`of Buildings Date . ^` ^ ~ Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Infor This column W�Ptft*T�`b Ai in y Existing Proposed Required by K Building�05u- Out Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage 01"o Open Space Footage % (Lot area minus bldg&paved r.—_ E #of Parking Spaces Fill: 11 A. Has aSpecial Permit/Variance/Rndingever been issued for/on the site? '�~� NO �~� DON7KNOVY YES �~�—\ / |FYES, date issued: i IF YES: Was the permit he RegistryofDeeds? NO K ) DONT KNOW 'ES ~� __- |FYES: enter Book L Pageland/or Dncument# �� �� B. Does the site contain a brook, body ofwater orwetlands? NO K�� DOH7 KNOW �=� YES �~� IF YES, has permit been urneed to be obtained from the Conservation Commission? Needs to be obtained «—\ Obtained »~-� Date�_� �~� ' . 8~� C. Doany signs exist on the property? YES K ) NO iFYES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: { | E. Will the construction activity disturb(clearing,g n.orfiUing)uver1aurenriadpodufauommonp|on that will YESK ) NO K��_ ' `~/ Y_-7 IF YES,then a Northampton Storm Water Management Permit from the DPW ia required. ^ ~ � � SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aRplicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) E] FRoofing Or Doors [] Accessory Bldg. ❑ Demolition ❑ New Signsi [o] Decks [Q Siding[o) Other[�4 Brief Description of Proposed r Work: X IS T 1 G. /0O/�G/j,j'I ✓S ccv�(e r OC�(�Q�f Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes Xe No Plans Attached Roll -Sheet 6a. If New house and.or"additionito ezistlng housingk complete the followind: 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. 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 1e),�f as Owner of the subject property / hereby authorize LQ jF S T G)AIG n ,457 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature o wner Date 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 Date SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor: Not Applicable £ Name of License Holder �.ovis -, License Number � LI q 14411,0 vv�LL nvA� �.>� ��s �-�h� '1 a-//j/ 17 Address 0/03 Expiration Date 44/3 67714-7 41,2-0 Signature Telephone PP Not Applicable £ 9 Registered:Home'lmprovementContractor .. ..: ,,. , ..., ':,.. . ... ': Company Name Registration Number ty 'C.E,6,5 M)9 qJ-7/ Y7 Jr Address Expiration Date ^- — � Telephone i 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 o he building permit. 77)Signed Affidavit Attached Yes....... £ No...... £ L :Home Owner Egemtit'ion 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 fob 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 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 911 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: 5) /�nGN S 7, 1. 15,OS The debris will be transported by: '"�HE'tisr T2 �G�C%�✓G' The debris will be received by: Building permit number: Name of Permit Applicant Lalli 5 Date Signature of Permit Applicant CX The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: L/ Lje� �y i� 1// L City/State/Zip: Phone#: Li l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. E] I am a gen�ral 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 tlae attached sheet. 7. Remodeling ship and have no employees These sub-contractors have $, 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. E] Building addition 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 ' right of exemption per MGL y �o workerscomp. 12.❑ 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. #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 worlkers'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 MQL 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 of perjury that the information provided above is true and correct. Signature: /e /0�`�'7�{— Date: Phone#: L)f.3 7 7 r -a 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 i T Massachusetts Y DEPARTMENT OF BUILDING INSPECTIONS 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 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 ACC>D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Chrisne Sullivan NAME: tiSlli _ Aquadro & Associatesxt:PHONE (413)586-7373 FAX (41 C 3)584-0859 No A/1_Nq._ 355 Bridge St. , P. O. Box 357 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC_# _ Northampton MA 01061 INSURERA:Preferred Mutual Insurance Co 15024 INSURED ',. INSURER B_: ------------------ ------------ LOUIS J. GINGRAS INSURER C: _ 244 HAYDENVILLE RD INSURER D: INSURER E: LEEDS MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER:CL16517071628 REVISION NUMBER: THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION!,OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RT A DL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M / D/Y / DNYYYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 500,000 A CLAIMS-MADE X PREM OCCUR DAMAGE TOREN ED — ----- PREMISES Ea occurrence $ BOP0100715251 9/29/2015 9/29/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X� POLICY E JE� C] LOC CTS PRODU _COMP/OP AGG $ _ --_ - _- -_ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ _ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ L HIRED AUTOSAUTOS Per accident)__ - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE __ ER__ ANY PROPRIETOR/PARTNER/EXECUTIVE E E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A -- -- — --------- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE-$,- -- If yes,describe under ---- "------"----- "— DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTHAMPTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025(201401) v YJ of a L �p N?✓1,�4G�p -- �a U G i Grt,4 S I �I I I I i () 4 F r ff e W i