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36-075 (11)
363 WESTHAMPTON RD BP-2017-0263 01S#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-075 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv' Deck BUILDING PERMIT Permit# BP-2017-0263 Project# JS-2017-000454 Est. Cost: $4500.00 Fee:$73.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin Homeowner as Contractor lot Size(so. ft.); 93697.56 Owner: HOENER VIRGINIA Conine" Applicant: HOENER VIRGINIA AT: 363 WESTHAMPTON RD Applicant Address: Phone: Insurance: 45 PINE ST ,....... (413)584-6489 Q FLORENCEMA01062 ISSUED ON:912,2016 0:00:00 TO PERFORM THE FOLLOWING WORK:BUILD 23X 16 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# 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 9E/2016 0:00:00 $73.00 212 Main Street,Phone(413)537-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Siiv, gof File#BP-2017-0263 APPLICANT/CONTACT PERSON HOENER VIRGINIA ADDRESS/PHONE 45 PINE ST FLORENCE (413)534-6489 0 PROPERTY LOCATION 363 WESTHAMPTON RD MAP 36 PARCEL 075 101 ZONE THIS SECTIONFOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid _ Y, '73 Buildinv Permit Filled out Fee Paid Teof Construction; BUILD 23X 16 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildins Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER Intermediate Project_ Site Plan AND/OR Special Permit With Site Plan Major Project Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER § Finding Special Permit _ Variance. Received& Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit front CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 1-molition I- .v Sig:tore of Buil.in Oficial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. REG:-°'-!7-71_, Ks'n-tieParhneDt use only ~•ur.., AUG i q I City of Northampton Building Department Curls"«r e y p$flpit ry 212 Main Street Sevtgr/SepbcA '=•i _ I`"' Room 100 i r{r Aveilab "ity . ' Northampton, MA 01060 t Sets ofSQ ttural Plans phone 413-587-1240 Fax 413-587-1272 -"..SitaP*q;, r E OtGF `fit APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION . 1.1 Properly Address This 2[ This section to be completed by office i p')),�✓✓, i °116L J16L Map Lot Unit /�/�t, /14 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reca/� �/ � VY11,, , c-i . )-/DeiL � 4' < �o//UC St �N.tic n/L 1 .44,O a It-Name( t) 1 Current MalN/i Addr ej 47v/j Telephone Signature 2.2 Authorized ,ent: 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 G/ <66 (a)Building Permit Fee / 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 7,--74. Mechanical(HVAC) •/ 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number /d p y3 This Section For Official Use Only Date Building Permit Number Issued. Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information 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 %C /!7 Side L: 7 I qC L: `7J R: 70 Rear 370 Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Spe al Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page an r Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO C IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: E. Will the construction activity disturb(dearing,grading,ex tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Atteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [Ci Decks [Iv' Siding[CI Other jDJ Brief Description of Proppsed Work 122 by//4 N '23) X /a r >70ecL Alteration of existing bedroom Yes„4GNo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba. IFNeWthouse.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? Fire. s or Woodstoves Number of each 9. Energy Conservation Compliance. /asscheck Energy Compliance form attached? h. Type of construction ! ..-----. i. Is construction within 100 ft. of we • is? Yes No, Is construction within 100 yr. floodplain Yes No j. Depth of basement or.: n r floor below finished grade It. Will buildi • ••nform to the Building and Zoning regulations? Yes No, I. c-ptic Tank City Sewer Private well City water Supply _ SECTION Ta•OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,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 i ✓ f n 7 1, Jinn) +T /-1) e-1? -'t-" ,as Owner/Authorized Agent la*6y•- - that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and be1lie. Signed' the •ci nd penalties of perjury. Print Name \! 1(tDse4- {AN`(R -Cr-- Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone B.Renistered 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 Rome Owner Exemp it= tion 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 twoily dwelling,attached or detached structures accessory to such use and/or farm structures.A person who construct more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to tie Building Official,on a form acceptable to the Building Official that he/she shall be responsible for all such work perfbrmed under the building permit. As acting Construction Su,:rvisod your presence on the job site will be required from time to time,during and upon completion of the work for w ich the permit is issued. Also be advised that with refe(ence '• Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resplting n Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for ou um er t is permit. The undersigned"homeowne ' -rti i es d assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, `•1- . • `c.�Zo 'iv Laws and State of Massachusetts General Laws Annotated. Homeowner Signature _ ..- ,, . City of Northampton 212 Main Street, Northampton, 1VLA 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 111111, S 150A. Address of the work: 1C /4,4-1,14e474, ,�•l /744-1-->4 1.11/ B/e ! The debris will be transported by: r�w�/a,✓' The debris will be received by: 1. Building permit number: vName of Permit Applicant blir3„,J,4 tic c,, .41/3 -3 6 26//, 1/11 Date Signature of Permi Applicant n Z 2"IP FOUND Z FLUSH IP TO BE SETz Q 425.48' m 334 E cN 29,17509.h9 Z 199.0- _ ' z , of co o n o � oND o ni Z •0 I ._ I �' V ba �Y+/ry REMAINING LAND N D o � R„ 2.151 ACRES± I N CO ilj -C D -,_ . . a k Oc 430.55' ` r t ,_IP TO BE S _. (_ N 2937540.91 IP TO BE SET BASE BENT E 334415,81 1 IP FOUND GARAGE I iH I II �G4RAGF1 -,\ Th e 'Comm�o 5n ealtV of Colas elatsewj ,§3 patcua nt offryhd uV it AJccrdents _I --, -- 'l'q ,fificrfi fier,7 Office o er lesti er tars '6., - �,le 600 W r daiusgetutm Ntheel ed ly cad?rmarfil Boston, MA 0211.: wwww.thaasag dire Workers' Cnmpeneadkaal gsscarancef:fldn it: Passu[YeasiContrnctorelEi•eceridimaasinrambers Atnuniicent Ptmfformet n Tense Pr(nt Leekhiv Name (Business/Organization/Individual): Address: City/State%ip: Phone #: _ employees mh and/or art-tale).* P 6. El projectNw . s r Ara you an employer?err Check the appropriate riate box: Type of (required): L 1 1 I am a employer with 4. P I am a general contractor and[ pi y (Thll p, have hired the sub-contractors con�tnlcnon 2. I am a sole proprietor or partner- listed on the attached sheet, i. Remodeling ship and have no employees These sub-contractors have B_ Li Demolition wooing for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance _ comp. insurance,t — edJ 5. _ w are a corporation and its 10.010.0 Electrical repairs or additions --y 3.tig f am a homeowner doing all work officers have exercised their 11.n Plumbing repairs or additions myself. [No workers' comp. right of exemption per MEL 72.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13_U Other comp. insurance required.] 4Any applicant that checks box 01 must also 511 out the seeds below showing rhefr workers compemnion policymfonamion. bio meowners who submit this affidavit indicating they are doing an work and then hit outside contractors must submit a new affidavit indicating such tConnactors that check itis box must attached an additional sheet showing the mime of the sub-contactors and state whether or not those entities have employees. lithe sub-contractors haveemployees,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 Nanus: 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 sec 'e coverage as required under Section 25A of MGI..c. 152 can lead to the imposition of criminal penalties of a fine up to$1,5t 0.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a floe of up to$2 1.01 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvestigatio s o the DIA for insurance coverage verification. /�/h do hereb ,crh' i oder the pains and penalties ofperjury that the infirrmatic n provided above is hnel ue and cancel./ --Si_ attire: j - _. Date:.... Phone#: Official use only. Do not write in this area, to he completed by dry or town 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 Ynspector 6. Other Contact Person: Phone #: r CCity oz Nor halm`ton ¢ 'ti Massachusetts 3F le f� y�r � s-s q< tT s ' N •r.s T'r,1cs ' trY "f ""'y Jai 2 ;,fainSt o @ p.._ H�_1. tn5 keit ni ooktkakstot M1- 61060 'ti INSPECTOR Louis Hasbrouck Chuck Miner Building Commissioner Assis?'ant Commissioner HOME OWNER E cMf 'ION 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 I 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 reguiafons. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footinas (before backfill), sonotube holes (before pour), a rough buildina inspection (before work is concealed), insulation inspection (f required) and a final buildina 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 Sl _.