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24D-047 (2) 24 STODDARD ST BP-2017-0490 GIS#: CC IMONWEALTH OF MASSACHUSETTS Map:Block:24D-047 CITY OF NORTHAMPTON Lot:-001 PERSONS Ct '.TRACIING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE AC DESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:Bathreno BUILDING PERMIT Permit# BP-2017-0490 Project# JS-2017-000810 Est. Cost: $6500.00 Fee: $6500 PERMI,' TON.15 HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sy ft.): 14157.00 Owner: sr.',.FSSINGE,R PETER M Zoning:URB(10011 Applicant: . ;HLESSINGER PETER M AT: 24 Si JDARD ST Applicant Address: Phone: Insurance: 24 STODDARD ST _ (413) 585-5851 () NORTHAMPTONMA01060 ISSUED 6H:10/13/2016 0:00:00 TO PERFORM THE FOLLOWINt, ORK:NEW BATHROOM POST THIS CARD SO IT IS VISIBLE r THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground; Service: Meter: Footings: Rough: Rough: }Pub:U Foundation: Dri,may Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED DV - E CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATE" . Certificate of Occupancy Signature: FeeType: Date Paid: inunt: Building 10/13/20 160:00:00 "s01s 212 Main Strec.. e(413)587-1240, Fax: (413)587-1272 Louis :ck—Building Commissioner File#BP-2017-0490 APPLICANT/CONTACT PERSON SCHLESSINGER PETER M ADDRESS/PHONE 24 STODDARD ST NORTHAMPTON (413)585-5851 0 PROPERTY LOCATION 24 STODDARD ST MAP 24D PARCEL 047 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buii�din� Permit Filled out 47 (jl��-f/� Fee Paid Tvpeof Construction: NEW BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 Demolition Delay /3/! Signature of Building Official 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. (21r m r7"- L ,, ;_ ? Departno'ul{ seont OW Of WOr`tw'npton Status of Pcrma eertF — "�17 �cu k c�ibpmeway a rT,t = BuildingRuilding Department Fit it' ' 912 Main &ftOt Sewe r5 tic ArailapA¢y Room 100 ]W3fer eJlAvafldbllly ` �� OGT I3 urthamptcn MA 01060 �IwD Sefr of Shucur lP' r pnc r41 -587-1240 Fax 4'J 3-587-1272 Pio Ste:Pla,orns perr 01 - . f<s )Cthiri,irpe if/ s ,. , •APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE CR DEMOLISH A ONE OR TWO F,CMILY CWELLSPt3 SECTION iSITE NIlFORM4TIOM I 7A Properhr Address Ynl- s [ion to be cornpletad by orrice VI STOD•MeD S } . Ntap Cot` Unit `...' NOWCH 'P 1OlV l\ Zan - Overia}+%D nc4?: .(- Im St Cstncin C@D=lnct SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Pe .ev lri. ScLVecstn5er sAl4At Name(Print) Curnt reMallin Address / / 4ihane 585 ) 4l3 z2•S�SI PII) leIepSignature 2.2 Authcrtzed Agent: Name(Pant) Cure-t Mailing,Adddress: Sisrmmre Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS item Estimated Cost(Dollars)to he Official Use Only com.leted by permit applicant 1- Budding 4 2 P belt Ie)Budding Permit Fee 2. Electrical' }, $ I c OQ It (b)Estimated Total Cost of I Constructlen from(6) 3. Plumbing $ 300C' — � a uilding Permit Fee 4. Mechanical (HVAC) i. Fire Pref .,tion I — a m fi- Totzl= 1 +>+3W+5 --4 �� �,i:;hack Numbar This Section For Official Use Only Building Permit Number Issu ssued', ___._...._ Sgrature'. _ Building Cornmissionerticspector of BuUings _ pate ___11 'mail 4 4ti s>nut « - _ Section 4. ZONING AU BefermaBon Must Be Compte ed Peck:'?t Can Be Denied bcce 1 con.p(ete to ormatt e Existing Proposed Required by Zoning This phone to be tiled in by Building Deuanment Lot di From.e —. _.. __ _ Setbacks Egon Rear —... --- Budding thighs – — Bldg.Square Footage - — 0 1 „^_ r _ Open Space Footage _ ro ---- (taros minus Mdg&patil __ -__ — pzk., N of Parldng Spaces .- _ --- Fill : – .. .. '^�/ Glume&kocalion) A. Has a Speiriat Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the pe mit recorded at the Registry of Deeds? NO 0 DONT KNOW CR YES Q IF YES: enter Book Page I and;or Document B. Dues the site contain a brook, hod sr water or wetlands' NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to S brained from the Conservation Commission? Needs to be obtained 0 Obtaine. Q Date Issued C. Do any signs exist on the property? YES IQ ‘0 C) IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? NO 0 IF YES, describe size, type and location: E Will the construction activity el turb(clearing, grading, excavation, or filling)over I acre or is it part of a coni on plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Norihampion Storm Water Management Fermi(from the DPW is requireo. t f SECTION 5-DESCRIPTION OF PROPOSED WORX fished;all;macabre) New House H Addition Fl Replacement Windows AUeration(s) Roofing H Or Doors Accessory Bldg, U Demolition El New Signa (Cal Decks ID Siding t(Wl Other Brief Description of n of Proposedo Worry NW Alteration of existing bedroom Yes '_ No Adding new bedroom Yes )1t- No Attached Narrative Renovating rerfnleted basement Fes Y. No Plans Attached Roll -Sheet Ga,If Me 2 house and or addition to exist¢n hou_sino icomoDete the foilowin"i, F a. Use of building._ s Family Two Family Other b. Number of rooms in ea family unit -,_ Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new C ,.auction Dimenafons e. Number of stones? f Method of heating?_ _ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance__ _. check Energy Compliance form attached?_ h. Type of construction Is construction within lab ft of wetlands? Yes No. Is con action 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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Clymer of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application_ Signature ot Owner >es c �� ,Z H 6='to E}eY /(n/.0Sr',... ,holt �rr�:{f lAe`ovi#?S4nlirs t$+ litir_L:'..... ._. .� I. 7 e v t". Sc.,\\e5'�'I4SQr as Owner/Authorized Agent hereby declare that the statements and formation on on the foregoing application are true and accurate,to the best of my knowledge and belief, Signed under the pains and penalties of perjury- P ell- '1 '"ac. tesSi Pint Name 7 J03//t �5ign afDwr,.r/A 03 /i6 SEC I iOIV B-CONSTRUCTION SERVICES 0.1 Licensed Conskruction Huoervisort Not Applicable £ Name of ticnmsa Hoar' _ ..... _ Licence Number Address Expiration Date Signature Teltephanee 9. Reaistered Home Improvement Contractor _ _ Not Applicable f Company Name Registration Number —....— ... _ —....i. ._ ..........� Address ExoiraGon Dae Telephone SECTION 10-WORKERS'C OMPENSA71ON INSURANCE AFFIDAVIT(MCI.L.a 152,§25C(6J) Workers Compensation Insurance affidavit must be completed and submitted with this application_Failure to provide this affidavit wilt result in the denial of the issuance of The building permit _ Signed Affidavit Attached Yes.._.,. E No £ Afl. :Bone avvi er Esemttion' The current exemption for"homeowners"was extended to include Owner-oecuuled 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 980. Sixth Edition Section 108.3.5.1. Definition of Homeowner Person(s)who own a parcel of land on which heisbe resides or intends to reside,on which there Se,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 net 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 tinder the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,doling and 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)c(the Massachusetts General Laws or to .d von may be liable For person(s) you lure to perform work for you under this permit The undersigned "homeowner"certifies and assumes responsibility for compliance with the :Plate Building Code,City of Northampton Ordinances,State a Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature When son 4:'fn:The neconveaffi of theas.saachnisens i, f -71 Department a fIna strand Accidents �iii.—xd �r Office ©fThvesei arae.re.s �r -t` n 'i 'h `5 1; ew a Washington Ste vas 4 - c' Boston, M 02111 ;: -" www.enuss5.COVhijda Wlerke& Compensation Einsaurarsnse 4rffia¢dwvit: Btralers/CoutneAPrstEketlidansiThunthers Applda.aua¢Infforrattmoan ({}'� (( Please hit ILezihily Name (Business/Organizationmidpiytdduai): Pe+-€t/ JAYLKS Sjvtt r— Address: Z� 5±2'01eiCci rf/ 5-e_;Siytstateizig._AbU✓i^V.,(w,9t)v� 014 Phone #: 913- 5 5-$S`) Lf t3 222 35'cicell/ Are you an employer? Cheek the appropriate box: .. . Type of project(required): 1.J I am a employer with 4. 1...._ I am a general contractor and t employees (full and/or part-time).* have hired the sub-contractors 6. New constnstion 2.❑ Z am a sole proprietor or partner- listed on the attached sheet, 7. xi Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 D Building addition [No workers' comp. insurance comp. insurance.$ fired.) 5. ❑ We are a corporation and its 10.-1 Electrical repairs or additions 3.y I am a homeowner doing all work officers have exercised their 11.1 Plumbing repairs or additions myself. r o t trkers' cos right of exemption per MGL Y [V comp. 12.7 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.! J Other, comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnalior II-To meowmers who submit this affidavit indicating they are doing all work and Merinos outside contractors must submit a new affidavit indicating such. tContracten that check this box roust attached an additional sheet showing the name of the sub-contractors and state whether or not those entitles have employees_ If the.sub-contactors have employees,they mast provide the¢ worker'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site informadoyr. 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 under Section.25A ofMGL c. 152 can lead to the imposition of criminal penalties of a this 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of fivvestigxflnns of the DIA for insurance coverage verification. py�I do hereby cer under t e pains and penalties of perjury that the information provided ahove is ue and correct. Sinnature: 'l��!r:L7/. Date: /0//3 a 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 1.d a 'mW ek 6 -s rap N.-.1n awe ..etactSteek, -ere-Tett" /Ate fet � r massackusetts z .,_'.'past w o rr 3 4a r,.. s'TRBs � atF �� �z12 Main Street o municima1 Building N 'tF rpton M3 01060tome, r' INSPECTOR Louis Ha5brcuck Chuck Miller Bulking Commissioner Assistant Commissioner HOME OWNER E aTMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 908.3.4 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 shalt 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 f"oundationlfootines (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 inspectionsrfl e made /f/ I 3( 1, - /1 _ understand the above. (Home ktieer/resident's signature requesting exemption) I will call to schedule all required building inspectns necessary for the building permit issued to me. Date /0/4 Z/./6 Address of work location Otil StAJ aj St• , WCA V\\4LIVpfan 0I06U 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 cctt111, S 150A. Address of the work: 24 5-ocf 'a j S�, NUr L' ICccy/ k 11M4 The debris will be transported by: Mysj-Q The debris will be received by: Valley recyc (tL Building permit number: k- Name of Permit Applicant P19X e1�eg�t aG� — /Mr__ Date Signature of Permit Applicant . 1- c . ,s „ - 7.. a h r°F N1 a� 1VJ . 3 r r•9 tfiXi a ��� 8 • . lit allir- 4 , i . „... „...,,, s ' f 1r ( r • e 7Ir;' t r y J A, :. . . ^l +R'. - t r 111 -0 T' F •7 i' �,� 5 -sem 7. • - i _:;i,� it _ _ l 4t.“ . :., , , . ,. . , .. ,.,,.. i i :1 : .s. 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