Loading...
17A-224 (12) 198 NORTH MAPLE ST BP-2017-0851 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-224 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BASEMENT RENOVATION BUILDING PERMIT Permit BP-2017-0851 Project# JS-2017-001427 Est.Cost: $6000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOUIS J GINGRAS 087279 Lot size(sg. It): 6316.20 Owner: MCKEEVER JAMES P Zoning; URB(l00)/ Applicant: LOUIS J GINGRAS AT: 198 NORTH MAPLE ST Applicant Address: Phone: Insurance: 244I-IAYDENVILLE RD (413) 586-7420 LEEDSMA01053 ISSUED ON:l/11/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:BUILD STORAGE ROOM IN BASEMENT 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: OI: 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 Occu.anc si•nature: FeeType: Date Paid: Amount: Building 1/11/2017 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2017-0851 APPLICANT/CONTACT PERSON LOUIS J GINGRAS ADDRESS/PHONE 244 HAYDENVILLE RD LEEDS (413)586-7420 PROPERTY LOCATION 198 NORTH MAPLE ST MAP I7A PARCEL 224 001 ZONE URB(100)1 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED 0 Fee Paid Building Permit Filled out Fee Paid Typeof Construction: BUI n#3 AGE ROOM IN BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 087279 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: I./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 . p= de %� /%7 Signa ure .tuil.ing 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. r r' � ePaSt4rlentEseanly} City of Northampton dPermn T " '��' �' I.F3 Za] Building Department gCodreutl �errnl��-� ? ' ' .)� I 212 Main Street sewlsepfi$`Aa115iII�ty a Room 100 Water e�if'Avatlab IIM +� !� kikl s Nrrthampton, MA 01060 Tworitaien VARIPlaBs° 587-1240 Fax 413-587-1272 o SFiew't st=n tt_ '�� r ,,�k E s, APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION h Thrs sectiortto be complefed by office 1.1 Property Address: ->- _ in ant-r/J rM/°« SY' Maw ° ,,,r-s Ln� Unit ' u ir5lidd,M a ' F Coat EA` ' /"rAr -Zone. I rN' Dve`rla�btstncf �' I 2EIm 5[ OSU ct - i r �B Drstnd- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Own of Record: � 198 4444 mthb yycef /�r'I}r� print) ,,,,/� Current Mailing Address: \vvt M( ct•�L,f Telephone Cry Signature Mi?',59 y^�a co 2.2 Authorized Agent: Name(Phot) Current Mailing Address: Telephone Signature SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Estimated Total Cost of - Official Use Only ' completed by permit applicant - - 1. Building es G, p Op . pp (a)Building Permit Fee 2. Electrical (b) Construction from(6) 3. Plumbing Building Permit Fee gE 4. Mechanical(HVAC) 5. Fire Protection /jr ,/,,G 6. Total=(1 +2+3+q+5) Check Number ! (/ /'' ,7a5 I This Section• For OffiDatecial Use Only Building Permit Number Issued: - Date Signature: Building Commissioner/Inspector of Buildings Section 4. ZONING Alt Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be ailed in by Building Department • Lot Size 1 I Frontage ( I 'SetbacksFrontFront L_JI Side L. -I RC L:L__ R. • Rear L� 1 1 Building Height Bldg.Square Footage % f'� 1 r—t _ Open Space Footage (lotar¢mnushldg&paved J L_ parking) • #of Parking Spaces —I I .__ -_ — Fill: (• (volume&Location) A. Has a Special Permit/Variance/Findingp� ever been issued for/on the site? NO Q DONT KNOW `O' YES Q IF YES, date issueda IF YES: Was the permit recorded at the/Rye�gistry of Deeds? V NO Q DONT KNOW YES Q r • IF YES: enter Book Pagel and/or Document#I B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO gi 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 qt IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing, grading, e cavation,or filling)aver I acre or is it part 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 all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [q Siding [O] Other[C] Brief Description of Proposed v j L Q 5IO4.4a Ae, 2.✓ just riI'- r Work: Y Alteration of existing bedroom Yes X No Adding new bedroom Yes 2( No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet calf New house and or addition tO existing housing,complete the following: a. Use of building:One Family Two Family Other b. Number of roams 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? I. 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 OWNERS AGENT qOR CONTRACTOR APPLIES FOR BUILDING PERMIT (� ,as Owner of the subject prope hereby authorize 1.8 v/5 ?, C' "64 Ai to act on my be , in all matters relative to work authorized by this building permit application. /16/4(11(6 Signalur Owner Da LO N)) '7 INC 4-4 ,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. Lev;s 7. 6L4'C/t 9s Print Name r-r Signature of Owner/Agent Date SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable £ Name ofucense Holder_ L'2"J$ tT, &s t-N661S e ,5 r as?,,.?.71 License Number r ,SYN kinsigffiNfr) L4d0 /Cd , LE4Yjj "IA. &165- ! a-jl(� l`f Address Expiration Date —meg, s Fa, - 7 y. fi Signature Telephone $.Registered Homeimprovament Cotihaetor. __ ji Not Applicable £ J, 6;-'G,'AS f .3.3 94 q .0 ,Mlemr Registrtion Number a Li If tiG k4YOA•n LI-E Aar 41-05 ,•-tg. o1of1 1 7 17 Address Expiration Date Telephoneaft? 574-74, SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,925C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result in the denial of the issuance of the building permit. Signed Affidavit Attached Yess_) £ No £ 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 1083.5.1. 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 he responsible for all such work performed under the building permit. As acting 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 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, 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 150k Address of the work: /4r Nolc-rI4 MAPLE S r, ftffF,vak The debris wiii be transported by: Lovij 67A-6.44es The debris will be received by: tr4LISY /(dC*L&i416 Building permit number: Name of Permit Applicant Lpv S S 6.7""6-,14S I /0/ 7 Date Signature of Permit Applicant LIN\ The Commonwealth of Massachusetts • Department of Industrial Accidents M T7=-F Office of Investigations C- �,yl_• 600 Washington Street 117 Boston, MA 02111 d14: www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I—BO� 5 1. 6' A -of Address: p2Yl{ M4y,3#N ) L4c 4g City/State/Zip: 1-4545 M4, d/15- 3 Phone#: 4/3— 5 8G79 oL-O Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction ,, , employees (full and/or part-time).* have hired the sub-contractors 2.LJ I am a sole proprietor or partner- listed on the attached sheet. 7. 2 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 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 MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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. 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 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$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 and penalties of perjury that the information provided above is true and correct. Signature: /. . Date: Phone#: �f/ ^ 54.4 ' 7 ct 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 Northampton �SY CA Massachusetts h * F� Q(fra DEPARTMENT OF BUILDING INSPECTIONS l+ ro eo 212 Main Street • Municipal Building '.. .fie`. Northampton, MA 01060 s yAsa- y y 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 (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 inspections are made 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 ROSEBURGJFRAMING SYSTEM® RIGiRFPr Joist rAneLVL quality engineered wood products for today's builder® RIGioRIM''ii Rimboard /ewe 7 s 1.,6 TA/ /-/A/7 /�� / f N ,n A'4iJ ..,,IP \ / 1 j +)� /� I SleJ� � Mrlr' l.. C3NI v,' r r 1v . ' /V0-rE ; tip-11 — n <_4;./- Job Number_ Ei Roseburg ' + A II rrst Prodct uCm •u 'un Location 1__. ' .... Sheet of _ N Ipy99 Old Hwy 99 South Technical Representative Dillard OR 9]262 r TR 9'J0 64].2612 t EX h 6/9 2612 EM M rwr A rp oomm 738Www ROSObUrg com