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16b-060 (4)
9 HAYWARD RD BP-2016-1529 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 16B-060 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: ROOF BUILDING PERMIT Permit# BP-2016-1529 Project# JS-2016-002601 Est.Cost: 513200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES FLANNERY Lot Size(sq. ft.): 15333.12 Owner: JASPER KAREN M&JANET BEATTIE zoning: URB(100)i Applicant: JAMES FLANNERY AT: 9 HAYWARD RD Applicant Address: Phone: Insurance: 56 CHESTNUT PLAIN RD (508)294-4052 WHATELYMA01093 ISSUED ON:6/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:Strip roofing and install new asphalt shingles 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 6/242016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner Department Use only I City of Northampton Status ofPertnd: SII I`1 22 Building Department CuibCyfPerrnway Permit. 212 Main Street SeaeriSepJDAyallebiMy Room 100 WamrfWell AveIabygy. Northampton, MA 01060 7642644a ofSliudurai Plans., phone 413-587-1240 Fax 413-587-1272 Othx8pe ity APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOIJSH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1/PProperne Address: This section to be completed by office -( Nitit,'cod ICJ Map Lot Unit Zone Overlay District Elm St DYbict CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: criemrte Le I 9 LJCO / Name(Pn ) Current Mai' Address' J40�j / SPZ-}0/3 °---2%.J40°---2%. (/i//'i1,(, Signature / �t Telephone 3- 2.2 Authorized Mont: ,TATnF C T. F-CNw4/E4e/ 1. Lave{ield St City), fit/9- oioz3- Name 7`n/( Current Mailing Address: 1/3-203 Sok zs-71- TOC Z ti Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building P13, zoo oo (a)Building Permit Fee 2. Electrical al (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee ,y/ 4. Mechanical(HVAC) ! C o a 5. Fire Protection 6. Total=(1 +2+3+4+5) /13 ,200 . 00 Check Number I/ O ' This Section For Official Use Only Building Permit Number: Date L��'/�/� Issued: / 22 / Signature: -S.''''-`"� ` �� e ; /a Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Infonnatton 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 -- Side L: R:. Ls • R: _.. Rear l.. - i _ _I Building Height - -'I Bldg.Square Footage % - Open Space Footage ..__ % (Lot area minus bldg&paved ' --- parking) #of Parking Spaces Fill: i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW l�Y YES IF YES, date issued:. T IF YES: Was the permit recorded at the R istry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page, and/or Document#, B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: I C. Do any signs exist on the property? YES O NO Q" IF YES, describe size, type and location: : ' D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 13( IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it pad of a common plan that will disturb over I acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Sr Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [CH Other[oj Brief De cription of Proppsep / Work: C - CQi rtS 1- -Le /LC c✓ 01 d_ rash, 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? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. 010000laln 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 ESQrP 94 H ' e I ,as Owner of the subject property hereby authorize ITtu)W s T. F[_sisiuAlE�l to act on my behalf,in all matters relay to work a by thisbuilding permit application. ' Sign4of Owner Date I, TAslES 3- FCgruuE4/ .. . ,as Owner/Authorized Agent hereby declare that the staterAents aria-information on the foregoing application are true an accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. TAMES S. ptmviv&€ Print Name nlrn` Le 1 j/ro Signatu oto er/Agent [ Date SECTION 0-CONSTRUCTION SERVICES SA Licenced Construction Supervisor: ��Q��,/// Not Applicable 0 /. Name of License Holder ldakit s J' r"j' .� 103 O'O 1 / License Number sty c esrn)u-r pLaxti .P 1/2./h7.- Sod 1052 E Date Sign re Telephone 9.Reaistdred Home ImprovementCorltractor- Not Applicable 0 PEO( PEE PEEFogAtifria Ioofzru€ L4.0 /83(998 Company Name Registration Number ZLave-field Si tasl'haJnpI'n Head- e1o2-1- 1/11119- Address Expiration Date Telephone 4(32033--scee SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c,152,§25C(61) Workers Compensation Insurance affidavh 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 H No 0 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occunied 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 saperviSqr,CMR 750, Sixth Edition Section 108,5.5.1. 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 faun 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 Officials that he/she shall be responsible for aft 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 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: q fhl\/iJoo6 aR The debris will be transported by: JA-NtF_S FfJ/w UER^/ The debris will be received by: VACLe y Lee ye L A)6 Building permit number: Name of Permit Applicant 0311)1E S S. P-44141E-7 UPI )1 Gi nd5H1 Date Signature of Permit Applicant • The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Smite 100 - - Boston, MA 02114-2017 wwivmass.gor/dia Wasters'Compensation Insurance Affidavit:Buildelis/Cootraetors/Eleetricians/Plumbers. TO Rh:FILED WITH THE PERMITTING AUTHORITY. paulieaat Information Please Print Leeibl' Name (Rosiness/Orgattiamiondndivhhtal: PEAL PerionnamtCe PrO / 1 LLC Address: 1 La e74e%/ Sf j ' 1 J City/State/Zip: i-AL MaOYt3N m4- 016 23-phone#: 4/3-263 -588? Arc vim an employer?Cecvk the appropriate bat Type of project(required): I®I mm a employer with L. ..-__emloyees l full and/or pan-tinsh' 7. ❑New constnlction 2.❑lamahole peomict or or ri nil eN lip ti, IVL'no lUll 0)005working gin mein 8. ❑Remodeling any capacrt9.[No wmkerv'conn..n.+nmw nydrt" • 3.91 con a homeowner doing all wort:myself.INo swill:end comp.insurance required. 9. ❑Demolition 4.9i am ahom n r and will he hiring coniractors to conduct all work on my mopeds. I will 10❑Building addition e e lhat all conlraewrs either have workers compensation insurance or arc sole I L❑Flee trical repairs or additions pmpntiore with no employees. 12.9 Plumbing repairs or additions 5.9 I an,a genual eonmamnrmd I hired the sub-contractors limed on the attached sheet_ 17.' Roof repairs lueseauh-emnmelnrs have employees and have workencomp.i Ma:owe 6.0 We are a c ration and its mice+siwve exercised did!itghl it e:cotillion per WI.c. l4.❑other U_,w n4k and we have no employees. No workers'crimp insurance mgni e I I 'Any applicant dun checks box el PILL41.i: IIIoul theCon heli,ShOlVingt - k : compensation policy innumation. 1 I lonwowners who submit[Ds affidavit indicating they me doing all work and then him outside ert metro's MOM submit new pild:wit indicating such. 1Convnetors tiro cheek this has must aaaebed an additional Mice showing the name orthe sob-mnunctms end slate whether or not those entities have employees. 11 the sub-conmwwrs have employec>they^nut provide their worked comp.policy number. !em an employer that is providing nvorke's'compensation iusnmmrfor my employees. Below is the policy and job site infiormation. �j Insurance C'ompatty Name: B&CLSff-zeL H79-77-/in L4 / 6&N;ea Policy#or Selt ins. Lie.#: fez WC�'9,�X41 / Expiration Date: 1/a 7- / Job " P(cr`O7& 774 OIa&z Attache Address the work .s oO I� �_ i g policy _ a copy of work i compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foal ola STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the 011ice of Investigations of the DIA for insurance coverage verification. !da hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si 9laNre: _ Date: 00(0 Phone#: 4 ' Z03 Olfcial use only. Do not faire in this area,to he completed by city or tmvn official City or Town: Permit/License# Issuing Authority(circle one): I.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 Massachusetts 2/1 - 0� KY # lau,x. OEPAR14EaT OF BUILDING INSPECTIONS 4 M 212 Main Straet • Municipal Building JF :�'� Northampton, !p 01060 „ ,�MhC 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 reauiredl 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, 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