23C-055 (10) 82 WILLOW ST BP-2017-0774
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23C-055 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0774
Project# JS-2017-001286
Est.Cost $700.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class Contractor: License:
Use Group; Homeowner as Contractor
Lot Size(sp. ft.): 109335.60 Owner: LEDERMAN HOWARD C
Zoning:t)Rp(100)rWSP( 00)/WP(83H Applicant: LEDERMAN HOWARD C
AT: 82 WILLOW ST
Applicant Address: Phone: Insurance:
82 WILLOW ST (413) 587-3145 1)
F L O R E N C E M A 010 62 ISSUED ON:12/12/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE BARN ROOF
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 t/ 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 12/12.20160:00:00 $40.00
212 Main Street.Phone(413)587-1240.Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
Department um only
'\ City of Northampton StetuedPennit '
`.. Budding Department cab cuvonvewayPemlt
QT%' 212 Main Street Sewer/Septic Availability a„a Room 100 Water/Welt AvallabIGy
`\ � Northampton, MA 01060 TWO Seta of Structural Plans
v �,;, phone 413-567-1240 Fax413-587-1272 PIoUSte Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION t -SITE INFORMATION
1.1 Property Address: TMs sectionto be completed by office
gL lO/LLD CO S)EST Map Lot Unit
ftoesivci, MA 0/U r' Zone, Overlay District
Elm St District CB District —
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2,1 Owner of Record:
Howard Lederman 82 Willow Street, Florence, MA 01062
Name(Pdnl)tzet C rent Maiing Address-
413-587-3145
CJ u ,t Telephone
Signature
2,2 Authorized Agent:
-J
Name(Print) Current Mang Address:
____ —
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Budding 700 (a)Budding Permit Fee
2. Electrical 0 (b)Estimated Total Cost of
Construction from(6)
3. Plumbing 0 Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection 0 O
6. Total=(1 +2+3+4+5) 700 Check Number i�
This Section For Official Use Only
Date
Building Permit Numbs . fer issued:
signature: . . /7— - U .._
Bang Commissio er/lnapectce of Bulldogs Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Ibis°Amin to be fitkd in by
Building Department
Lot Size 2.51 Acres 2.51 Acres
Frontage 247' 247'
Setbacks Front 25' 25'
Side L:190' R:801 L:190' R:80'
Rear 250' 250'
Building Height /49/
(.6, kary SBcnoW)
BldSt t3/1-K 1Y ge 2JQ3 2I6
OpenSnuF
aea minus bldg&p
aved /a o q O 7
parking)
-
�/
#of Parking Spaces AA' 1 v
Fill:
(volume&1 ocatim,)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O 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 or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtainer! O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: Standard Street Sign exists on Property
0. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(Goering,grading,,pcavation,or filling)over 1 acre or is it pan of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check an moll obit)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n✓
Or Doors CI
Acorn Bid&❑ Demolition ❑ New Signs Io) Decks ID _.. Siding IC) Other[O)
Brief Description of Proposed
Work Rawveamkpccerioti Bu,pu m.Sint of I.mrotin Pe tio.i forpworotuiemW array Euu41utm _ Tefacie 'ten
Alteration of edsting bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement _, Yes It No
Plans Attached Roll -Sheet
et If New house and or addition to existing housing,complete the following: Npt tic"(Cc bf£
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?
1. Method of heating? Fireplaces or Woodstoves _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
I. Septic Tank City Sewer Private well City water Supply__^
SECTION 7a-OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERSAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, A //awnien f t DMmmc f �.....� ,as owner of the subject
property ///�
hereby authorize N/(7 ._.......
to act on my behalf,in all matters relative to work authorized by this building permit application.
Sl,nature off Owner // Date
I, /,toeu�#ka 4-g OfRr rnv ,as OwnertAuthorized
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.
Thalletfi L.EO8 'mt?rJ
Print Name
91,10/17
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
1 Lice -ed C.ns ion 'u•8 or. Not Applicable ❑
Name o/Ucense Noldu: _....—
license Number
Address Expiration Date --�
Signature Telephone
S Reeldins Nome hnpmyeme,t Cs itsitof, 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 eilt No ❑
11. -Home Owner Exemption
The nu ent exemption for"homeowners"was extended to include Owner-uccupied 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 103.3.5.1.
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.
Asacting 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 may be liable for person{s)
you hire to perform work fbr you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Zoning Laws and State of Massachusetts General Laws Annotated
Homeowner Signature ( IL/
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: 12 (4414-0 ) Si-R £7- Ao2ENCg, I14 O/O62
The debris will be transported by: SELF
The debris will be received by: VALLE V RECita A-L REC/CwVCO 4ND
T/2/1NSFf/2 FA-C/LITy
Building permit number //��
Name of Permit Applicant /-f umiet L£DC g4111-41
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
='r'111t Office of Investigations
rc; IS
{� 1 Congress Street, Suite 100
W f,• Boston,MA 02114-2017
„ www.massgovidia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business'Organizutionflndividnai); Howard Lederman —
Address: 82 Willow Street
City/State/Zip: Florence, MA Phone#: 413-587-3145
Are you an employer? Check the appropriate box: Type of project(required):
I.0 I am a employer with 4. ❑ 1 am a general contractor and 1
employees (full andior part-time).* have hired the sub-contractors fi. New construction
2.❑ 1 am a sole proprietor or partner-
These
on the attached sheet. 7. [1 Remodeling
ship and have no employees These sub-contractors have 8, 0 Demolition
workingfor me in anycapacity. employees and have workers'
P ty. 9. ❑Building addition
[No workers' comp. insurance comp.insurance.-
required.]
nsurance.-required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.1.1 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL
121i Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
"Ary applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
[Contactors that check this box must attached an additional sheet showing the name of the sub.coutractors and slatewhether or not those entities have
employees. if the sub-contracto s have employees,they must provide their workers'comp.policy number.
lam 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 ropy 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA fbr insurance coverage verification.
/tin hereby certify under the ains and penalties of perjury that the information provided above is true and correct.
Signature: ( Date: 12/09/2016
Phone#: 413-567-3145
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 tenon: Phone#:
City of Northampton
Massachusetts Cv.• °ee.
�6 (. 0 Yi DEPAR2VaNT OF BUILDING INSPECTIONS 3`
212 Main Street • Municipal Building .an.
Northampton, MA 01060 :hi-601�o
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 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 backfll). sonotube holes.(before Pour).a rough builds g 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 insoections 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 8 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, 4aMA 1£bigtrultV` f �---1 understand the above.
(Home owner/resident's ignature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date ii/9/a0/r,
Address of work location !12, ME/(0c0 cSf2££Ti Flnkrrer-e Ma QioG2-
Proposed Project: Barn Roof
Howard Lederman Residence
82 Willow Street
Florence, MA
413-587-3145
This request for a building permit relates to a one-story segment of an existing barn structure, as
highlighted on an attachment to this proposal, measuring 30' 11.25" x 16' 5" (510 square feet),which is
in need of roof repair in preparation for a photovoltaic solar array installation planned for early 2017.
The project will consist of removing aging asphalt shingles from the roof, examining sheathing to be sure
it is in sound condition, and installing underlayment and new asphalt shingles, with appropriate flashing
where needed. The barn roof is a 6/12 pitch,and does include an existing woodstove pipe.
*etved74 -S City of Northampton
Building Department
Plan Review
212 Main Street
Northampton,MR 01060
1
____. '" __..._—_ _ _ _..___....__._'_ _.—___._. - ... .._...:_..___ �___ -...:._....._ Tom.
Proposed Project relates to this section of
the barn.
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