16D-004 (11) File q BP-2016-1431
APPLICANT/CONTACT PERSON JOSEPH AIMUA
ADDRESS/PHONE 83 SUPERIOR AVE INDIAN ORCHARD (413)222-1044
PROPERTY LOCATION 202 NORTH MAIN ST
MAP 16D PARCEL 004 001 ZONE URB(751/URA(25)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLE OU[, ��q I`
Fee Paid ?J"7 " - 0
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLITION OF SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 40915
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
- 0- ay
Signature ofBui ling if' ial 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 MGG 40A. Contact Office of
Planning&Development for more information.
202 NORTH MAIN ST BP-2016-1431
GIS tt: COMMONWEALTH OF MASSACHUSETTS
Map:Block: I 6D-004 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
Pennit# BP-2016-1431
Project w JS-2016-002464
Est.Cost: 51000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH AIMUA 40915
Lot Size(sq. ft.): 43995.60 Owner: EMERSON MARIE G TRUSTEE C/O LARRY EMERSON
zoning: URB(75)/URA(25)/ Applicant: JOSEPH AIMUA
AT: 202 NORTH MAIN ST
Applicant Address: Phone: Insurance:
83 SUPERIOR AVE (413) 222-1044
INDIAN ORCHARDMA01151 ISSUED ON.•6/372016 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLITION OF SHED
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 SI 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:
FeeTVpe: Date Paid: Amount:
Building 6/3/2016 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
�'-- - City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
Ir'! L 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
pct c n : ;, lorthampton, MA 01060 Two Sets of Structural Plans
" k•A‘lr'TON "''„pti„nc 4 1587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify.
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
WI 7.1 Property AdlIdress. (� This section to.be completed by office
/'19'(1--1} AiN 111 -c I Map Lot Unit
Nof;tih✓vt P�, 1J/ /i11 fit DKg.0 Zone Overlay District
/ Elm St.District CB District.
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: bVppi f)ni
Jostru 9� -Atufl S3 Suveiz////-t+12 7���1l�✓u (,� nLtytm�
Name , Current Mailing Addret.413) Q2 _/o / 'y irr9 ryif/
�- Telephone
eignat?7-.1.-
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
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) j)() CheckNumber 3J
is Section For Official Use Only S
Date
Building Permit Number: Issued:
Signature:
/ Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
ibis column to be filled in by
Building Department
Lot Size _.__ . .. : _. .... __...
Frontage
Setbacks Front
Side L R -- L _ R
Rear _ .... ...
Building Height - -
Bldg.Square Footage % _
Open Space Footage -
---
(Lotareaminusbldg&paved _. . - .
parking)
#of Parkins Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:'..
IF YES: Was dhe permit recorded at the Registry of Deeds?
NO i DONT KNOW (9 YES Q
IF YES: ente Book Page t and/or Document if
B. Does the site con win a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a per it been or need to be obtained from the Conservation Commission?
Needs to be obtain-• Obtained 0 , Date Issued:
C. Do any signs exist on the pr.•erty? YES 0 NG O
IF YES, describe size, type and to .tion:
D. Are there any proposed changes to or addi '•ns of signs intended for the property? YES (9 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, exca -ton,or filling)over 1 acre oris it part of a common plan
that will disturb over t acre? YES 0 N• 0
IF YES,then a Northampton Storm Water Management•- it from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs [173 Decks [q Siding [O] Other jQJ
Brief Description of Proposed t J ' - b f h, sirU
Work: J`
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the following:
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?
I. 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
I, , 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
, 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
8.1 Licensed Construction Suoervison Net Apolicabie £
Name of Licence Holder:
License Number
Address Expiration Date
Signature Telephone
9.Reaistered Home Improvement Contractor : _.. Not Applicable E
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
H. -Home Owner Exemption
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 eneage an individual for hire who does not possess a license,provided that the owner acts
ass. tensor. R 780. Sixth Edition Section.iO&.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
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction1($upervisora 11Yi (���pp 1 Not Applicable ❑
Name of License Holder'. �JoSE-` PatA1u4k 4 ocI is
License Number QTiti`" ..r+r`
s (
e'*
%‘AW-L010- A3s . iss titctln9, Me- olli I 4-e�i-5 0071 301/6
Address v Expiration Date
(41 ) 122- to4y-
Signet Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
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 0 No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 Emplo)crs to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may he 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
101
clkSee
•
0?6tU`
. \ The COMMOnwealth of Massachusetts
Bt.:- Department of Industrial Accidents
• ,tL
SVOffice of Investigations
S, § 600 Washington Street
k ;g: Boston,MA 02111
,y www.mcass.gov/diva
Workers' Compensation !nsuara>voe Affidavit: Bal7derrs/Coatractors/Llectridsus/Flu tubers
Applicant Information Neese Print Leg➢biy
Name (Business/Organization/Individual): iT'sePµ ta-MU ii
Address: g (.V o<2- ttMtM.
City/State/Zip: IMDE4 J 011c/M'�f Mp1161 Phone #: ct70 Z22 — int 7
Are you an employer? Check the appropriate box:
Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
Ployees(full and/or part-time).* have hired the sub-contractors
2.I✓I I 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 hive workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.E I am a homeowner doing all work officers have exercised their 1L Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] ' 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 info,matioa
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.Lie. #: 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 DLA for insurance coverage verification.
I do hereby cer%• . r the pain• and penalties of perjury that the information provided above ' true and correct.
Ik
1/
Sianam �Ikre: ' � Date: .� rtv
Phone#:
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 eT
,aaaxmmrv? of ac-zn*urc rms=dcxrovs 1
312 M2?Il Northampton,
o HVMA Ott Building % 4"
Northampton, MA 01060 "0:5.. 8
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 I
(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
1, 1.05(1 M MLitt t1 understand the above.
(Home owner/resident's signature requesting exemption)
I will call to scheduleeall required building inspections necessary for the building permit issued to me.
Date La11-1[G }�
Address of work location a.0).. r Mottih "",``��
1
1461tkevvvilit7 al 0CD60
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 bbyl MGLL c 111, S 150A.
Address of the work: 9D . lV+okv, (�F� Uoa DG
The debris will be transported by: ��� y� Y " Q
The debris will be received by: w1 (
Building permit number:
Name of Permit Applicant J 094/-1
Date Signature of Permit Applicant