29-244 (3) 78 OVERLOOK DR BP-2017-0821
GIS a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 29-244 CITY OF NOR'T'HAMPTON
Lot: -OW PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
ate_o _HANDICAP II MP BUILDING PERMIT
Permit# BP-2017-0821
Project# JS-2017-001375
Est.Cost: $,2100.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group JESSE BABCOCK 107350
Lot Size(sq. R.): 15028.20 Owner: CARPENTER SANDRA R le RICHARD B
zoning: Applicant: JESSE BABCOCK
AT: 78 OVERLOOK DR
Applicant Address: Phone: Insurance:
77 OVERLOOK DR (413)530-3680
FLORENCEMA01062 ISSUED ON:12I30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:HANDICAP RAMP ON FRONT OF HOUSE, BUILT
WITH PT LUMBER
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 Sienature:
FeeType: Date Paid: Amount:
Building 12/30/2016 0:00:00 S65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
File d BP-2017-0821
APPLICANT/CONTACT PERSON JESSE BABCOCK
ADDRESS/PHONE 77 OVERLOOK DR FLORENCE (413)530-3680
PROPERTY LOCATION 78 OVERLOOK DR
MAP 29 PARCEL 244 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid (..)i{ ,
Bui(dim° Peanit Filled out •tytY� tt".
Fee Paid ii
Typeof Construction: HANDICAP ' -M' GF FRONT OF HOUSE,BUILT WITH PT LUMBER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 107350
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intennediate 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
/gmolition En lay
4 i 9. tom
/ � '
Si_ ' reo• :ui rtng Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with alt 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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
qEG 29 212 Main Street Sever/Septic Availability
1 �ws Room 100 Water/Well Availability
• Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
73 62vu/o,( e4-7tie Map Lot Unit
A/J7-e4ct it/4 U/O& Zi Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
5 � Carei Be-✓ 7g &icy/at %
Name(P int) Current MailingAddress:
5.71'-"cia 761b
:97r Telephone
Signator
2.2 Authorized Aaent:
4Lo� 77 ✓a/fE ��f
Name(7 / Curren Mailing Address:
�`-/ 3a9n
Signet i Telephone
S TION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building gj /QJ/ 60 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) . /J4, C/ Check Number 553 �,��
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTIONS.DESCRIPTION OF PROPOSED WORK(check all aDOHcable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing E
Or Doors ❑ /
Accessory Bldg. ❑ Demolition ❑ New Signs 0.1 Decks CI Siding CII Other[E'q
Brief Description 99f Propposed �r v. /` .60"/
v � /�� � �
Work: N2nd C�/� //A:M % -40x4! 0-F k�-C h'
P /
Alteration of existing bedroom Yes ' No Adding new bedroom Yes `:/ No /
Attached Narrative Renovating unfinished basement Yes r� No
Plans Attached Roll -Sheet
6a. If New house 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 stones?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance, Masscheok 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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i, �' z tet. ,as Owner of the subject
Property ���7'''' NN �!!
hereby authorize J2 fcc. /,/ildo��
to act • my behalf, in all matters relative to work authorized by this building permit application.
://-r.%✓ L.I Ali*
Signature 04.. er Date
I, 1:281-e— % 2 ,as best of m knowledge Agent hereby decbre that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed andel:�/_Pe pains and pena `s penury.
L. /.,/V ,KuS ,•. &T. ez" ........
Pant N. 3 iwv sir
ler
Signature s+.' her/Agent to
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This ixtlumn to be Blied in tin
Building Department
Lot Size
Frontage
Setbacks Front
Side 1.: R:
Rear
Building Height
Bldg,Square Footage Y.
Open Space Footage 70
dui area minus bldg&pared
parking)
9 of Parking Spaces
Fill:
Ivobm,e&Location)
A. Has aSp^�ecial Perrnit/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 O YES U
IF YES: enter Book Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 13 YES 10
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. 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:
F.. Will 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? YEP O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
Si Licensed Construction Supervisor:�+ Not Applicable
Name of i'cense Holder: 5W ®/li,bicI t� c—License Number
/0757-07
7
frix
ors
Address L� / Expiration Date
WI 130 fOW
Si ure Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
S /a.odT Ory/.lit LI-C /777°5
Company Name Registrar n umber
,ir fgVe4Ce ,A srfla
Ad re s Ale Exp -ho Date
fr
4107 Telephone %S 5P 76 0
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 buildin ermit.
Signed Affidavit Attached Yes 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 10833.1.
Definition of Homeowners 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 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 all such work performed under the building permit
As acting Construction Supervisor your presence on the job sire 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 for you under this permit_
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,(Nt) of
Northampton Ordinances,Stare and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature -„ _„
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: 7, avec/4_ 62‘,-,,,/c //'°A
The debris will be transported by: , 550c,:s ruiXv// k//c ezeerc
The debris will be received by: tcr�c/clrs�
(/
Building permit number
Name of Permit Applicant 4-S5-e- A�lo��
/77 � 1 /
Date 7 ig�of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
;P4� -h Office of Investigations
f 1101.111 1 Congress Street,Suite 100
x waitBoston,MA 02114-2017
kW0 www.mass.govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information (.q Please Print Legibly
Name (Rusiness/Organiration/Individual): ,..1 <R��t.�d-� //(� � „
Address
a/or'/oa t 60.iiC -......... ...vm.
City/State/Zip: MI`eneC. A 07.90,7.- Phone#: Ver -530 3610
Are you an employer? Check the appropriate box:
Type of project(required):
O I am a employer with 4. 0 i am a general contrsub-contractors and 1 6. 0 New construction
ployces t bol andor partner-
These
have hired the
2. I am a sole proprietor or pattncr- listed on the attached sheet. 7. 0 Remodeling
ship and hake no employees These sub-contractors have 8. 0 Demolition
working for me in anycapacity. employees and have workers'
b 1 9. 0 Building addition
(No workers' comp.insurance comp-insurance.*
corporation
Ion required.] 5. a We area corporation and its Ion Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their I I.a Plumbing repairs or additions
myself: [No workers' comp, right of exemption per MGI. 12.0 Roof repairs
insurance required.] c. 152.81(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box el must also till out the section below showing their workers'compensation policy information.
'Homeowners who submit this atlidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating such.
:Connectors that check this box must attached an additional rheet showingthe name of sub-contractors and state whether or not Mose entities have
employees lithe subcontrauorshavccmployees they mug provide their workers'comppolicy 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 3 or Self-ins. 4: _ Expiration Dare:
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 of 3/101.c. 152 can lead to the imposition of criminal penalties ofa
fine up to$1.500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa 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.
do hereby certify frider the pains and Remain afDularr that the
informationprovided above is true and
correct.Pienattlroi ate: 0�6
. /47- :7
Official use only. Do not write in this area,to be completed by city Or town official.
City or Town: .... Pi: mit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector &Plumbing Inspector
6.Other
Contact Person: _ Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employees to provide workers'compensation for their employees.
Pursuant to this statute_an employee is defined as`_.every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as-an individual.partnership.association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise.and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
Or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.'
MOI,chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152.§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence ofcmhpliancc with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and if
necessary, supply sub-contractor(s) name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited liability Partnerships(LLP)with no employees other than the
members or partners_arc not required to carry workers' compensation insurance. If an LL.0 or lIP does have
employees.a policy is required. Be advised that this affidavit may he submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy.please call the Department at the number listed below. Self-insured companies should enter their
selltinsurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the Gent the Office of Investigations has to contact you regarding the applicant.
Please be sure to till in the pennidlicensc number which will be used as a reference number. in addition,an applicant
that must submit multiple permiVlicense applications in any given year.need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write'tall locations in j (city or
town).-A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on 61e for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call,
The Department's address.telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel k 617-727.4900 ext 7406 or 1-$77-MASSAFE
Revised 7-2013 Fax if 617.727-7749
www.mass.gov/dia
City of Northampton
r^M
7 kr Massachusetts 4.95--.:A '0`
y c
a �° D212 ENT OF BUILDING INSPECTIONSgu
;
41r)(k 2 2
212 Main Street • Municipal Building D
-eta'i Northampton. MA 01060 .kEic iC
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION 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
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 backfill), sonotube holes jbefore pour), a rough buildina insnection
'before work is concealed), insulation inspection (if reauired) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
a - - - in a '• aa -n r- I is r- • a'a ; - ifi • • r-n a ' - w•r ; • ',
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
I, 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
j✓e t7' 'i q, C /e*Gv,� /i2-. d/'Oi
//// ������ City of Northampton
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