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32A-185 (8) 9 POMEROY TERR BP-2017-0192 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A- 185 CITY OF NORTHAMPTON Lot:-00! PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit# BP-2017-0192 Project# JS-2017-000313 Est.Cost:$25000.00 lee:$200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW CAMPAGNARI 076047 Lot Size(sq. ft.): 14810.40 Owner: WINTERBERRY LLC Zoning:URCUPOV Applicant: MATTHEW CAMPAGNARI AT: 9 POMEROY TERR Applicant Address: Phone: Insurance: 128 FEDERAL ST (413)237-5872 SPRI NGFI ELDMA01105 ISSUED ON:12/I/201 6 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMOLISH HOUSE 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: FeeType: Date Paid: Amount: Building 12/1,20160:00:00 $200.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0192 Q. nn /`Q APPLICANT/CONTACT PERSON MATTHEW CAMPAGNARI � � �.lfin/ ) ADDRESS/PHONE 128 FEDERAL ST SPRINGFIELD01105(413)237-5872 Ftlii �`- PROPERTY LOCATION 9 POMEROY TERR SOF45 MAP 32A PARCEL 185 001 ZONE URC(100)/ n u\ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT j /i1 42,010b b Fee Paid �fli Building Permit Filled out Fee Paid Typed Construction: DEMOLISH HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 076047 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INRMATION PRESENTED: Approved Additional pennits 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 ii a lay 7(/ 7--- /'—7 Si_ ,nn/_O rata l 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. s RE,., - 7ap ment use pray iD,/ I' ihlontampion Status orFerml 1 1 2018 ulldlnc2 Deaahlmeni C Iv b CutD ry y Permit _ 219 Main g r 9f S v S pti A allab ty Goo"t 10,0 L! Af/ IIA rarabarty peri Norm-air-0N:51 v 'NeNo ^I Ion, p,/,av ur I 01050 I Sets cf S cuPiens `phone 413-557-1240 Fax M3-587-1%72 1P1otSe Flan= OtnerSp=sI y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMO: USis A ONE OR TWO FAMILY CW=LING SECTION 1 -SITE INFORMATION 1.1 Property Address: Tv==eprmn to be conpl...,d by office'jJ/I�, 52 -Rep Lae = Unit " T`��l - Zona Overlap District Blin St-District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: COilAtaL �(.c_ red ta•4-1 yr SpF610 U olio, Name PrintCurren[mailing AC itTelspnone SlgnaWre 2.2 Authorized Aoent: fill &i /z0 dzT 2a/ 5T S a 011g' Namer tint) Currem Marling Aa Ore 232 41372- nature Teleohone SECTION 3-ESTIMATED CONSTRUCTION COSTS , Item Estimated Cost(Dollars)to be I Official Use Only completed by permit applicant 1. Building �� ��� (a) Building Permit Fee 2 Electrical I (b( Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) it ZOO 5. Fire Protection 6. Total=(r+2t3 +4*s) St 2S, o00 �,CheckNumber x#01 43/adv This Section For Official Use Only Building Permit Number: Cate Issuu ed: Signature: Building Ccn missloner/Inspector of Buildings Cate 1 Email : 444nve4.40P e yam. cni Section S ZOPfibIG An Infcrna len Must Be CCT pleted Fermi:Can Be Denied Due To:nccmplete Inforrmalcn E sig IProposed I Required'by Zoning 1 This colcc to be flied in by I Budging Deportment 1 ({II - 1 'otSIZe ... _ Frontage I � _— —_ Setbacks Front _.- ',. Sid= L . .c_ _ I. .. R _ __ Rear ----- Building_F,e:oht _ Bldg Square Footage —_ Open Space Footage % _— — ;Lot area vusbldg&paved —..-.., k 1 ' fParking Spaces J Fill: A. Has a Specia.. Permit/Variance/Finding ever been issued for'on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? I NO 0 DONT KNOW 0 YEs .0 IF YES enter Book Pae and/or DocumentI B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 I IF YES, has a permit been or need to be obtained ained f om the Conservation Commission? Needs to be obtained 0 Obtained Date Issued: ____ C. Do any signs exist on the property? YES 0 NO 0"--- IF YES, describe size, type and location: D. Are there any proposed changes to Dr additions of signs intended for the property ? YES 0 NO @"-- IF YES, describe size, type and Location: Will the construction activity disturb(clearing, rabble, exc_vation, or filling]over 1 acre or is it pad of a common plan that will disturb over 1 acree YES O N0 9-- IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SEC TION 6-DESCRIPT!QN OF PROPOSED WORK(check all applicable) New House ❑ Acidi:ion LJ Repfacarnent Windows Nt'ationrej...... I Roofing Or Doors E Accessory Bldg. ❑ Demolition LJ New Signs [O) Decks f= Siding jMl Other[O] Brief Description of Proposed wi�''I OF #E� aG Work: /_i-M/r.4'T7 /� '—P'I�✓^-' (tClfEs' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet so. If Meer house nd ar edditlan to e ieUeca housing: come eta the foiiouvene: 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 a. Number of stories? E Method of heating? Fireplaces or Woodetoves Number Of each g. Energy Conservation Compliance. Massoheck Energy Compliance form attached? h. Type of construction i_ Is construction within I GO ft of wetlands? Yes No, Is construction within IOU yr. floodplain Yes j. Depth Qf basement or.o;ttarios 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 a Owner of subject fl property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date INIMMOMMOREMISINalar I, .d ill% /z . a I a„( (rte/✓.,.,. . ICC as Owner/Authorized Agent hereby declare that the statements and i• ormaiion on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties ofpe.'jury, Z Lir' Xfu• Pint Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVOCES e.5 License::Construction SSuo=Msor: //������y yip NotApplicable £ GII/ZI LCJ 4010 "octet es 076047 Nuns or Licenss HOIG�r License Number /28 !Was] h7"- 5 Plitt 011 ' 1 Expiration c7 Aa Expiration Dare 14We ,aie,Z32 72 Signature none 9. Registered Home lmorovementCon actor , - q Not Applicable I ry (.it#046COM /67 GZ Company Name Reg:station Number /2e bier( 'ii 6,oa9 m4 0woe _ /o• i3 le Address Expiration Date TeMphone 237 6n-- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 15Z,§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 pnilding permit Signed Affidavit Attached Yes _ No _ 11; - Home Owner Exenmtion The current exemption for"homeowners'was extended to include Owner-occupied Dwelltnes of one(1) or two(2)fam lies and to allow such homeowner to engage au 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. - on which there Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside, 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. As acting Construction Supervisor your presence on the job site y✓ii]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,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature f,' The Go m rc;ciii.. C ./_i:,.:,..a..c✓.'w.,e,`."S 2epmra rant©f Lm 5 .ial ceiciehhis Office Investigations F,, &h.?! 609 W , tin x Seined. • h- =�y Th•vw.rrwss.gav/dei• Workers' Compensation faCEP'2.DCCP. F icia. rt: Putiniers/Cortractorsdritreettrissialiskflumkein Annseant Information �y P"_ease Print Legiisl y Name(Business/Organization/Individual): a([ein owe,e aH 1I2V 4l �L— Address: 124 a2.r 5r City/State/Zip: ,!44 P .0 Phone#: 2.32 67— Are you an employer? Check the appropriate bar: Type of pre]ext(required); I.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet, 7. —❑, ,R�/emodeling 2.❑ I am a sole proprietor or partner- slip and have no employees These sub-contractors have S. _v.nemolition working forme in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance) required.] 5. e are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11._ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 121 Roof repairs • insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] `Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 7Ho=owners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit a new affidavit indicating such. -Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,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 Name: Policy#or Self-ins. Lie. #: 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 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 fore of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' under t ns and penalties of perjury that the information provided above is true and correct Signature: VD�y� Date: g .Q. 4' Phone#: 133 2— 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#: City of '. rt._ fu ton r -e'er A ' D.- FCILDINO ZNEOECTIONSf �, 212 SlainS i u -2a_ 6 'd_n_ o ../r• KM 02060 T INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER E)MPTION 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 dwefFeng, 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 (before pour). a rough buildino inspection (before work is concealed). insulation inspection (if reouired) and a final buildino 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) will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 717 Main Street, Northampton. Mk 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 854, 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: / - ✓ , Th2,e. NO. The debris will be transported by: ,,Le .fir Y tka./(O The debris will be received by: Building permit number: Name of Permit Applicant , 'ham a, _ _� mttitice4 (LC 3.416 • . ). Date Signature of Permit Applicant