23B-064 IS BERKSHIRE TER BP-2016-1564
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map- Block:2313-064 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2016-1564
Project# JS-2016-002674
Est. Cost: $3500.00
Fee:$65-00 PERMISSION IS HEREBY GRANTED TO:
Const.Class_ Contractor: License:
Use Grouo: KRIS THOMSON 084152
Lot Size(sq ft.): 2047310 Owner: CROWTHER WALTER R 7g&KAREN,
7onine-UR13(1001/ Applicant: KRIS THOMSON
AT: 15 BERKSHIRE TER
Applicant Address: Phone: Insurance:
362 KENNEDY RD (413) 549-1027 O
LE EDSMA01053 ISSUED ON:6/30/20I6 0:00:00
TO PERFORM THE FOLLOWING WORK: CREATE A 7' and 9' OPENING THRU A BEARING
WALL FROM DINING ROOM
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 ii Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: O_: 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 6/30;201 6 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272.
Louis Hasbrouck-Building Commissioner
File a BP-2016-1564
APPLICANTd/CONTACT PERSON KRIS THOMSON
ADDRESS/PHONE 362 KENNEDY RD LEEDS (413)549-1027 0
PROPERTY LOCATION 15 BERKSHIRE TER
MAP 238 PARCEL 064 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid WPCK- iri ti 4 f l C —
Building Permit Filled nut
Fee Paid
Tvmeof Construction: CREATE A 10 FOOT WIDE OPENING ON TO LV ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:,
Owner/Statement or License 084
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
4,.4proved_ -Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Pian 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 03 Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
demolition ee-lay
Airy
"rir ure But din_' Pricier 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.
L. Fg ; 4, �[,atfinent Us"dnnly 1i le
E City of Northampton sPa i c�aermn� a" '4 �"s-- t` t,
ci ' Building Department i06'"�a eway��Fmit, . �
'„� - 212 Main Street Sewaaaaeepwa aaaa llayt it s �'
evl � F " � 'Room 100 otovgitll r6f ksiM
4.7 z d„, Northampton, MA 01060 TSN "s'E�s`*p,,€snutup-a�"t e�ans � -w� e4a r ;P
a 8 phone 413-587-1240 Fax 413-587-1272 P[uSis Plans r c -C,, + tr
APPLIC TION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: s'' Thbecomptefeddby office
15 `F,eCk5k\ ir�el rr L 'g gil5-T �s g omr
( OLem+. L 'Sven Dista t.r - -
1 } 4 t r r
�! q / n� as r e. Hifi y Y
Y b'r"2 v1 C C'. _AA 0,.. . V Ca Z �"�, �-' � 4, k
�'�IM,at o t,��t+ a ,,'F ice D,stn�. r i
SECTION -PROPERTY OWNERSHIP/AU
2THORIZEOAGENT
2.1 Owner of--cord: +.
•
u . a R ��`��� ``` r^ .6 ' C. _ s k,. :rc / --
Name d ' 1 Current Mailing Address:
,(�,( Teiephone�t,. ZZ 9n a59 /
gn e
2.2 Authorized Agent: 1)
Kr(5 -1-tott vh so n S.6a K2%N.0 c(ri LA . L-.4.64s A4o . 01053
Name ino Current Mailing Address:
41 3 - G,R S cA? 7
Sipnatur Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be : Official Use Only
completed by permit applicant
1, Building 3 GOo '(a) Building Permit Fee
2, Electrical 50 b _(b)Estimated Total cost of
Construction from(6)-
3, Plumbing Building Permit Fee
4. Mechanical(HVAC)
5,Fre Protection
6, Total=(1 +2+3+4+5) 3. 00 Check Number c..3a y-3 $60 6
- : - This Section For Official Use Only
Building Permit Number - - Date
Signature: _ .
Building Commissmner/nspec:or of Buiidings Date
6-io -i6 0leo.
Section 4, ZONING All Information Must Be Completed. Pernat tan Be Denied Cue To Incomptete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size I _...---11 1 E • _�
Frontage I .--. ('--- - i L t
Setbacks Front I_—.I I ! C—I
Side 11.-1 RA I L: i A:Ia J I (
Rear I___J 1-1 f
Building Height Lbw.I I I
Bldg.Sguare Footage 7 1 .7 % nn >_,➢➢ 1
Open Space Footage
. Oda area minas Wg&paved I I r_ I i I I
pazMng)
#of Parking Spaces �._.. I Ii 1 I _
Fill:
Helene&Location) .� �� �r
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES Q
IF YES, date issued:+
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW 0 YES 0
IF YES: enter Book 1_ _ Pane _ and/or Document#( i
8. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW V YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission? I
Needs to be obtained 0 Obtained Q , Date Issued: 1
�^7� I
C. Do any signs exist on the property? YES Q NO F;.Y., I
IF YES, describe size, type and location: I E
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location: ii E
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES (9 NOCC
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) -.
New House ❑ Addition ❑ Replacement Windows Alteratian(s) t Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [CI Decks [la Siding ICU Other[DI
Brief Description of Proposed
Work:
Alteration of existing bedroom_Yes 't No Adding new bedroom Yes °lk No
Attached Narrative Renovating unfinished basement Yes ex. No
Plans Attached Roll -Sheet
Be:If New houseand-oraddition to ex[sffnc t ousinq, complete the fdllowinq:
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 Woodatoves 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.
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
•
/"'aril hc.2 'f7"L ,as Owner of the subject
property v I, U
herebya o e I< L.
to act ehalf, n I matters el.tivo.. wor orized by this building permit a a icat°
ignatvre of Owner . Date
I, f f 9--VA 6%44 66l - 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.
C r S ` '`b[nitS Olaf
Print Name
2--1/ I to
Signature of Owner/Agen ate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:/ s^i Not Applicable £
Name of License Holder: et S i (10 f14SO ` r5 •0t4151—
License Number
3 (o2 �etlnec}v i - • Ot0S3 4/9/
Address Expiratiote
4r 3-695• x'#27
Telephone •
9jAitifistefed-Home llij ro elifeitvratractori- , -ate, Not Applicable £
1115 43
Company Name Registration Number
27 11
Address Ex it n Date
Telephone
SECTION 10-WORKERS(COMPENSATION INSURANCE AFFIDAVIT(M.G.L-c:152,§250(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 Lar.... No £
11.-IIorne Owner Er iatiOli
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.CMA 780. Sixth Edition Section 108.34.1.
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- ear •eriod shall not he 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 maybe 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, - _
_ The Commonwealth of Massachusetts
Department ofIndustrial Accidents
__0k.
Office of Investigations
=7 .,,O600 Washington Street
_a'_c Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information '/ Please Print Legibly
Name (Business/Organization/Individual): kr l S�LIOhncD h v pe," 1 l✓l1 _
Address: 3 le 2 K,t IAAn A c 9_A I
City/State/Zip: ) e o,A5 , _L1 F . 0 1 0 '5 3 Phone #: 41 '5 ' (o'7 S - -45:
Are you an employer? Check the appropriate box: Type of project (required):
I.jam a employer with Z 4. El am a general contractor and I
employees (full and/or part-time).
have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. JJ'JRemodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. a Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance; 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 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' 13.0 Other
comp.insurance required.]
*Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information.
the meowners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit indicating such.
tContracton 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. 1I
Insurance Company Name: " Iy1 r..•e - t1 rmaic 1 jj6'\
Policy#or Self-ins.Tic. #: LS LOU 13 - 0&0(e 09 /• 1 - ) L Expiration Date: </c) J (7
Job Site Address: 15 he 14.4 Li -ref v• Icwen.c¢ . City/State/Zip: ✓ 40-. 0 06 Z_
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.
I do hereby .tilfr and the •, . and penalties ofperjury that the information provided above is/true and correct.
Signature: ()/Date: �Z9 / I Les
Phone#: 4/3 • 695 -Giza?
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 ,S ?�,
yy
I ! g4
II: r i ~t DEPARTMENT OF BUILDING INSPECTIONS B1
, rs 212 Main Street o Municipal Building J D
Northampton, MA A 010 OBuilding Pa. 1
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
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 •
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: IS $e✓ ks\e. rY c.
The debris will be transported by: p LPSec (Uy •
The debris will be received by:
Building permit number:
Name of Permit Applicant /y11S (51MS6-2-)
61ZA) / 6
Date Signature of Permit Applicant
"��� a s d qw� 30 Nevem(
City on Northampton
BC 1 i C H /\ /
Building Department
Plan Review
_ 212 Main Street ---
Northampton. MA 01060
2-- U i�A
ffn
i Al [—Lel
Co&a?goer t cp,csei eir rrt/�
e
th- a2 ikiej
-\.,Niaev. LVDncLLAncl DN K (- .
•i5 6Pan
8er re_ �Yf • TGt�st are IoC l� v wills
We LLSill 1tn5-i'cs1( 2 9-19..." LV t._s
f �OPehG e
4r-tit-ctn. s?av\
I � i