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24D-012 (4) 23 HAYES AVE BP-2017-0491 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Bloek:24D-012 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategON;,,,KITCHEN RENO BUILDING PERMIT Permit# BP-2017-0491 Project# JS-2017-000697 Est.Cost:$2750.00 Fee: $65 00 PERMISSION IS HEREBY GRANTED TO: Const.('lass: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(su.BJ: 9278.28 Owner: ORENSTEIN DENISE Zoning: URB(100)/ Applicant: ORENSTEIN DENISE AT: 23 HAYES AVE Applicant Address: Phone: Insurance: 8 HANCOCK ST (413) 320-2581 () NORTHAMPTONMA01060 ISSUED ON:10/13/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN REONVATIONS TO INCLUDE MOVING GAS &WATER PIPES ** ROUGH & RN At INSPECTIONS ARE REQUIRED** POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring U.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: Hnusc# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Sinai: Smoke: Final: THIS PERMIT MAY BE REVOKED BY TIIL CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeType: Date Paid: Anmuntt Building 10/13/2016 0:00:00 «x.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis I I asbn,^:ck—Building Commissioner File it BP-2017-0491 APPLICANT/CONTACT PERSON ORENSTEIN DENISE ADDRESS/PHONE 8 HANCOCK ST NORTHAMPTON (413)320-2581 0 PROPERTY LOCATION 23 HAYES AVE MAP 24D PARCEL 012 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT ABELICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Al /_C Fee Paid �,a 111.170 `� (J/ Building Permit Filled out Fee Paid T eo Cpnstructio: ITCHEN L •NVATIO. 3 TO INCL DE MOVING GAS& WATER PIPES ._ New Construction Non Structural interior renovations /o/E$� Addition to Existing MS , ,- Accessory StnictUrre 1 _ y A in['; BuildingPlans Included: illIllMilli.MllrI A , Owner/Statement or License ' I^ 3 sets of Plans/Plot Plan a fQ.b THE FOLLO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O TION 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 •-undid*•- tela ' All, Signature of Buil.ing c)Ficial 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 40&Contact Office of Planning&Development for more information. .Lr ..—.—.. Dapartmentuseoney ���•�t f*� City of Northampton Status of Permit rT ti •. ,r /i . " -,b Building Department Curta,qutlDnJewaypermrt !� (;� 212 Main Street sewerlSep# Avaliebl" E�"" " , Room 100 Wa3eN'Nelf�Ysllatallity' ' �='�+r'" Northampton, MA 01060 Zwo,Setsof$$tructural Plans phone 413-587-1240 Fax 413-587-1272 plot/Sit :prenp . ' Othe`'SpecNy APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit z� F)c,y�.�, te- vttt-CAAhl) { j.- Zone Overlay District Elm St District _ CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f i /Evtt C. C.. ct s4E � t+ - _ S I�CL�n( CCLL St 1\,o,itic-cItdT{'l,. Name(Print) Current Mailing Address: Telephone YtJ co-1X 2-76' Signature (/ 2.2 Authorized Agent: Name(Punt) Current Mailing Address: Signature Telephone SECTION 3•ESTIMATED CONSTRUCTION CASTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _ 1. Building ((�� 1�$i (WOOp Ft) (a)Building Permit Fee K (Qua .14$'DT 2. Electrical j 5—Cr " �r� (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 11x ' - �E 4. Mechanical(HVAC) 5. Fire Protection f1�L��/ 4/ yr 6. Total= (1 +2 +3+4+5) " / Check Number L�' This Section For Official Use Only Date Building Permit Number:_ _.... Issued: Signature: .._._ Building Commissioner/Inspector of Oulldings Date Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by tUC d\ct Its(' Building Department V II I Lot Size _9 ��I _. —1r _ Frontage L_ . I I ___ I -_ ._..-_. Setbacks Front I____I L__._-_1 I I Side L: R: 1 L:C R ._. L _i Rear I I L_ —I I I Building Height r - Bldg. Square Footage I112J1 I- I % [ I 1 rI Open Space Footage / in ___ 0 (Lot areamnsbldg&paved r I 1 1_ 1 I , L ._1 parking) dof Perking Spaces I _._I t _I Fill: I. IffI . _... (volume&Location) -- l _. . A. Has a Special Permit/Variance/Finding eve been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued:[_ IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0--- YES IF YES; enter Book 1 Pagel J and/or Document k B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO J IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: E. WII 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 O NO 0/- IF /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 n Addition n Replacement Windows Alteration(s) I I� I Roofing n Or Doors 0 _..._L.-. Accessory Bldg. Demolition n New Signs [O] Decks [q Siding 101 Other[Et Brief Description of Proposed Work, w1. ,o tac. , troL''' it, t' .141 u..t c41t• -. n'j a ( cics frd'a�'• Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes " N0 NU Attached Narrative Renovating unfinished basement Yes 0;No Plans Attached Roll -Sheet 6a.If New houseand oraddition 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? by Type of construction 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, ✓,lf-t"„_ ('�-Zt.s. v..^-' ,as Owner of the subject property hereby authorize Y '6 w v '� C�•1p c ,•`> c!flt 1 C V C_ to act on my behalf,in all matters re -tive to work authorized by this building p rmit application. Signature of Owner !L Date cCi 1' 2C) -- -__ ,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 1. LC--# I )G 1 { Signature of Owner/Agent Dale SECTION 8-CONSTRUCTION SERVICES -8.1-Licensed Construction-Supervisor-. .- - — — — _. _ __ _. _ Not Applicable_c3 _ _ Name of License Holder License Number ....... Address Expiration Date Signature Telephone • Clrrlret., • 9, Registered Rome 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 105.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which lie/she resides or intends to reside,on which there is,or is intended to he,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 PH such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,duringand upon completion of the work for which this permit is issued. Also he 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,von may he liable for persons) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with tie State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Ci' Homeowner Signature /i ,,,,,,{,�, -"'�— 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: 2 3 Fick.ti-L3 A vt trc ft, a „ vCo- iv„jl The debris will be transported by: '\) s - , rc ( CI L The debris will be received by: ter f '3 I 7_c I () Building permit number: Name of Permit Applicant (rt 0 Ci 13 Z W L e --- Date Signature of Permit Applicant The Commonwealth of Massachusetts Deportment ofXndustrinl Accidents �' J Office of Investigations ib AIM 1 Congress Street, Suite 100 t... : Boston, MA 02114-2017 amu-, www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City,/State/Zip:.,,, Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.E I am a employer with 4. I am a general contractor and employees(full and/or part-thee), have hired the sub-contractors 6. New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. WitigIrwrtqleling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers` q U Building addition [No workers' comp. insurance comp.insurance.] uiredi 5. Lf We are a corporation and its I0.Rlectrical repairs or additions 3. lam a homeowner doing all work officers have exercised their I I_ilumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Ref repairs insurance required.]t c. 152,§1(4),and we have no employees, [No workers' an Other camp.insurance required.] Mny applicant that checks box tri must also fill out the section below showing their workers'compensation policy information_ Homeowners who submit this affidavit indicating they am doing fit work and then hire outside contractors must submit a new affidavit turbos-Ong such. :Contractors that check this box most attached an additional sheet showing the name of Ibe sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'romp.policy number. I am an employer drat 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: Joh 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 MOL 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 certify under the pains anti penalties of perjury that the information provided above is true and correct Signature: i.k/]: ' q • u _._ Date' 14r-/ w-' I t Phone#: 5(13 I 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): 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 J/Pr,a `. 15 SJ Massachusetts .`• _ X DEPARTMENT" 212MainS OF BUTTERED• Munci Sl BuildZONS ' - ' \t. %,.. 212 Main Northampton, o Municipal Bu13Ai ng IQ? OD NOYthampT.On, MIS OlOGO yJi, 3735` INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner AssisIsle Commissioner HOME OWNER EXEMPTION ACKNOWLEDMEN,2 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 foundat&pjfcotjngs4before backbit),sonotube holes(before pour), a rough building inspection_ (before work is concealed). insulation inspectipn (if reoulredland a final Sing inspection, The building department requires these inspections before the work is concealed, failure to secure these inspections can respit in faithre 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 (52)� understand the above. (Home owner/resident's signature requesting exemption) will call to schedule all required building inspections necessary for the building permit issued to me. Date Q}CJ l3 i90/ Address of work location