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24C-154 (3) 55 ARLINGTON ST BP-2016-1103 GIs if: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C- 154 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2016-1103 Project a JS-2016-001884 Est. Cost: $100625.00 Fee:$694.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Group: Homeowner as Contractor_ Lot Size(sq.ft.): 10236.60 Owner: SCHRADER ROBERT W&CAREN M WE Zoning: URB(100)/ Applicant: SCHRADER ROBERT W& CAREN M WE AT: 55 ARLINGTON ST Applicant Address: Phone: Insurance: 55 ARLINGTON ST (413) 687-1806 O NORTHAMPTONMA01060 ISSUED ON:3/22/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 26 X 26 BEDROOM,LIVING RM, BATH & MUDROOM ADDITION & REMODEL KITCHEN, amended 8/6/16 CONSTRUCT 14 X 14 DECK 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 if 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 3/22/2016 0:00:00 $694.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1103 • O L APPLICANT/CONTACT PERSON SCHRADER ROBERT W&CAREN M WEte dlJ�1 67 ADDRESS/PHONE 55 ARLINGTON ST NORTHAMPTON01060(413)687-1806 Q ^^ ^DN' PROPERTY LOCATION 55 ARLINGTON ST T./ 'w^"' - MAP 24C PARCEL 154 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �d 0 (y t/O Fee Paid A T Building Permit Filled out Fee Paid T eof Cons Rion: C N &MUDROOM ADDITION REMODEL KITCHEN New Construction Non Str ctural interior renovations Addition to Existino Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Demoliti., Delay (S? //77 tic,. ire g •' 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. Pr (Any y ekrist/ sir epariment use only'._ L -- Cioj o Mortvn i•rpton Status of Perms - , ' AUG Building Department curb Cuuonve uap Fermlt 5 2016 z 12 Main streei Se e/$Eptly Avallabnny Room 100 UDYK Water/1Nell Avallablllty oFaINsr[cno. Northampton, MA 010&0 Two Setsof Stun-whit Plans Win 13-587-1240 Fax 4'13-5.87-1272 Plat/Site-Plans ' -_ Ofher_Spe Iry APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I SECTION 1 -SITE INFORMATION 1.1 Prcoedr Addres/s;. - lnlsn �econ to be completed by office cc 2Y Y/ U� 57:A)0/7-A4�f lulap of Unit ^) Z-- OvedayDlstrmt E_fm St Gstrc_t -�y'CH Dstrct - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record: / fa6errr 5cI141e✓ c 4r/.q ") s/2-- Name( t Current Mailing Address. //i F- (---c/C—. f03- 637 -i Ya S' Telephone Signature 2.2 Authorized Agent: Name(Pint) 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 4 I (b) Estimated Total Cost of I Construction from(6) ry 3. Plumbing Building Permit Fee /fry T 4- Mechanical (HVAC) I �N//�U S. Fire Protection 6- Total=(1 +2+3+4+5) /Co'' 00 ,Check Number 1 o I This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date a,ja 9 • Section 4. ZONING AR Information Must Be Completed, Pe rtvit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This;olumn to be in by Huldic4+Teparm,enr Lot Size Frontage - - Setbacks Front r Side Rear -K Building Height -- Bldg. Square Footage / Open Space Footage _ a (Ltareamnusbldg&p f � / parking) #of Parking Spaces --- Fill.. (volume&Location) -a- — .. --- -,- — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book - Page and/or Document# B. Does the site contain a brook, body of water cr wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained C) Obtained , Date Issued: C. Do any signs exist on the propertye YES (3 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YESLL0 uNO 0 IF YES, describe size, type and location: E. Will the construction activity dsturb(bearng, grading excavation, or Ming)over 1 acre or is it part of a common plan that will disturb overt acre' YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DEW is required. I SECTiON 6-DESCRIPTION OF PROPOSED WORK(check all an plicable) New House n Addition Reptlacement Windows Alteration(s) Rooting Cr Doors ❑ Accessory Bldg ❑ Demolition ❑ Neuv Signs 10] Decks 117 Siding 101 Other[0] Brief Description of qF� s / j' :l€ �S,Y � /K S! Work: /{f x y �k /CrJ d✓ �f G / r' IIr� h i" SeeQ' o I�Nee/ Alteration of existing bedroom Yes No �Atlding new bedroom /yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to exisfina housing-comSete the'followinq: a Use of buildi . _One Family Two Family Other b_ Number of rooms , each family unit Number of Bathrooms c. Is there a garage attach•7 d. Proposed Square footage of w construction_ Dimensions e Number of stories, f Method or heating, Fireplaces or Waodstoves Number of each g. Energy Conservation Compliance_ Masschede 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 I. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations, Yes No L Septic Tank City Sewer Private well City ater Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f(]"/�r� 5c A ,�iev as Owner of the subject property hereby authorize to act on half, all matters re tiv o work authorized by this building permi applic Jon_ fr y 5/ g�sS �6 Signe re of of pate i '.ta. ,.ytig rAxl xtest.a, b ir . ra �,•�at3 r'1,+ _SY3�ta � tib:-fr_ I, ,as Owner/Authorized Agent hereby declare that the statements and informal=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 S.1 Licensed Construction Sunerviscr: Not Applicable E Dame of Leans? Hobe^: _ License Number Address Expiration hate Signature Telephone 9 Reoistered Home Improvement Contractor - Not Applicable 2 Company Name Registration Number Address Expiration 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 dental of the issuance of the building permit Signed Affidavit Attached Yes E No E 11.- 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 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 injures 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 tit. The Commonwealth. ofSP sacdarnelts Department cfThdustriad Accidents Office of llaavestigat¢®ns IF,S a j 600 Washington Street Boston;MA 02111 -�- —' WNW.uaass.g©w/dla Workers' Compensation hinsua2ni ce nittia'dav&E: ]F udders/Contra tors/Elestotainns/]Pinntbers Applicant I nforrnati© _ Pease Print Leguibjv Name(Business/Organization/Individual): Address: City/State/Zip: Phone !r: Are you an employer? Check the appropriate box: Type of project(required): 1. I I am a employer with 4. H I am a general contractor and I employees (fill and/or part-time).* have hired the sub-contactors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet, 7. H Remodeling ship and have no employees These sub-contractors have g. Q Demolition working for me in any capacity. employees and have workers' - insurance. 9. _ Building addition comp. [No workers' comp. insurance required.] 5. Q We are a corporation and its 10.H Electrical repairs or additions 3.17 I am a homeowner doing all work officers have exercised their 11.1 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.17 Roof repairs insurance required.] t C. 152, §1(4), and we have no employees. [No workers' 13.17 Other camp.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. tContractors 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'camp.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 render 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 fee 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#: 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#: c= d. os Northampton T rrt s a hu c 4rg, - A 'NT OF L Ln NC t TIONS >�' ‘7A-g. ,10( 212 Main Street Building aor.�tiNorthampton,ocor, MA rvca 01 aiaea �j2yEse� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER ET1Eiv1PTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMP. 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." F 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 rouch 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 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 150k Address of the work: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant I Ci of Northampton /L �r bs 1 ,���c e«�er,�a 5 �R W� Q•'c� But ding Department SII LL /I �_`'�..�6 Plan Review SS f if;il� nil 57 Nere� t2 Main Street JJj .� No ampton, MA 01060 � /9, 3 `iL) {2" i` aSnwsGbe • . y r 7 I *. IL7 5;S y - !CO') r''-?I/ -.\/ r ,rt �0 �r� • o -f-' � 4; �.� . () �i .bfJ / 7 c;dry/!. 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