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07-009 (5) 422 NORTH FARMS RD BP-2007-1168 Ms#: COMMONWEALTH OF MASSACHUSETTS Map:Bbok:07-009 CITY OF NORTHAMPTON Tat-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) ata BUILDING PERMIT Permit# BP-2007-1168 Project# JS-2007-001862 Eat.Cost:$10000.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Coast,Class: Contractor: License: Use Grow: Homeowner as Contractor_ Lot Size(sa.R.): 1032372.00 Owner: WADE ROBERT N&AUDREY S Zoning:RR Applicant: WADE ROBERT N &AUDREY S AT: 422 NORTH FARMS RD Applicant Address: Phone: Insurance: 422 NORTH FARMS ROAD (413) 584-3492 () NORTHAMPTONMA01060 ISSUED ON:6/1/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:CONVERT GARAGE TO FAMILY ROOM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: `� AA Footings: Rough:4-43 0/ ought'] ai' House# Foundation: I 6rugul Driveway Final: Final: Fioal:4/ /4/ ii Wilt- Rough Frame: Q r` 11 lig 7 LW 1$ Gas: Fire ✓Dep(partment Fireplace/Chimney: _.. . Rough:gj ' f 57 14 Qpi Insulation: p/c /0-2 3-07�j� Final: Smoke: Final: 0l 3-9/-O$ '""-r-�"r THIS PERMIT MAY BE REVOKED BY THE ITY OF NORTHAMPTON UPON OL.9TJON OF ANY OF ITS RULES AND REGULATION �/ fee Certificate of Occupant signature: FeeTvpe: Date let: Amount: Building 6/1/2007 0:00:00 $50.001141 . • 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Building Commissioner-Anthony Patillo 0 3 vx y m nP • • - • File#BP-2007-1168 APPLICANT/CONTACT PERSON WADE ROBERT N&AUDREY S ADDRESS/PHONE 422 NORTH FARMS ROAD NORTHAMPTON (413)584-3492 0 PROPERTY LOCATION 422 NORTH FARMS RD MAP 07 PARCEL,009 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid eBuilding Permit Filled out !p,(j y Fee.Paid //7l �` Tvpepf Construction: CONVERT GARAGE TO FAMILY ROOM New Construction Non Structural int for re ovati ns Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING 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 //My 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. • tpsb m ' \t' �"i City of Northampton 5', .a,y,,,�.,y'�6 `� \ �- Building Department 212 Main Street • Room 100 MpV Northampton, MA 01060 ?AO)k x ' a phone 413-587-1240 Fax 413-587-1272r�� ` • "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 g2 2 Y70"z-t4 F39 r M S to Map - " lot Um[ rLc^a'^2Av1 zone OverlayDislda �-2 I Y>'b4' 0 l o C0 0l EImSLDrsbtct Ce DistdR_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT � 2.j1 Owner of Record: ) .O Name nt) {,,r /y �� ��✓(/ Current Mailing Address: // t-/ (i^ Telephone ✓ez( 2 �/z/ 3� Signature -JO 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1, Building }} (a)Building Permit Fee 000. 00 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection rrc� 6. Total=(1 +2+3+4+5) Check Number II Li uO'UO This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date S Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department - —' Lot Size — Frontage - Setbacks Front Side L:-- R:_ G - R:'_' Rear Building Height Bldg.Square Footage Open Space Footage n/o (Lot area menu bldg&paved _ parking) #of Parking Spaces — Fill: _— __._ --_ -- (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? --- NO 0- DONT KNOW 0 YES © - -----IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T 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 © DONT KNOW e YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained © Obtained (3 , Date Issued: C. Do any signs exist on the property? YES O NO e 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 bS IF YES, describe size, type and location: • �+, E. Will the construction activity disturb(gearing,grading,excavation,or filling)over 1 acre or is it pad of a common plan that will disturb over 1 acre? YES O NO 0 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 [0] Decks [p Siding[0] Other[0] Brief • rDescription of Proposed CON VH-1- 4-APZALTE TO fAfMl(,y Roo wk Alteration of existing Bedroom Yes )( No Adding newtedroom Yes " No Attached Narrative Renovating unfinished basement Yes Be* No Plans Attached Roll -Sheet sa tNiV=hotiseandaredditGiWixTstiiikfWOUiRraWaXkPhelollowlii4: 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? f. 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. s�tru ion ^ se i . 'sm .' --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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work .I orized by this bu J g permit application. Signature of Owner Date IIIIIMIIIIIIIMINIMI I. Ro IF Cr WAD-6 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. kov.rtt W tk Q t \ Print Name J Bl o-412-J °L! ;Lf- -(-C OS/36)07 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Nang of License Molder: License Number Address ..— Expiration Data Signature Telephone S_kfidiafeia`d HoM`eiitpto'Vemoid C9idr8ctuP y., ULx,*MTn!)))ffifitti".S „ , Not Applicable 0 Company Name Registration Number Address Expiration Date ._., Telephone___ SECTION 10.WORKERS'COMPENSATION INSURANCEAFFIDAVIT(MALL.e.152,§25C(0)) 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 ❑ No ❑ 14 :Hotnee OwnerEtenxiutfon The current exemption for"homeowners"was extended to include Owner-occupied Dweliinas 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 108.3.5.(x 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 fann 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 nermitr 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,von 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 andel Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature_-12(!—i-p' II 'c-' -4,4 •\ The Commonwealth of Massachusetts Department of Industrial Accidents Pre.-- n..1n'ati F Office of Investigations • I 600 Washington 0 Street11 Boston, MA p2111 wwm:mass.gowedia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationrpI-P'� Please Print Legibly Name(Busgn iness/OrganivationdividuaqK : f'' 611.7+ LJAQ+ .._ Address: City/State/Zip:_ ___,,, _u,,,, Phone.#: Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. t.❑ Iamaemployer with 0 employees(MI andior part-time),* have hired the sub-contractors 6, ❑New construction listed on the attached sheet, 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employeesThese sub-contractors have S. ❑Demolition workingfor me in anycapacity. employees and have workers' P ry 9. ❑Building addition (No workers' comp,insurance comp.insurance,: required.) 5. 0 We are a corporation and its I0.0 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' conte, right of exemption per MGL 12.0 Roof repairs insurance required]t c. 152,§1(4),and we have no employees,[No workers' _ -ISE Other _..... _. comp.insurance required] - 'bleu-apple=mirex ox rrasth ta o oute section belowshowing their workers'compensation policy info nation. . -- t Flom r,vxs who submit this affidavit indicating they are doing ail work and then hire outside tontractots must submit a new affidavit mditating such. :Contractors that check this box must attached an additional sheet showing the more 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .. Policy#orSelf ins.Lic,#: Expiration Date:_,_ Job Site Address: City7StaterZip: 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 MGI,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:r trance coverage verification. I do hereby certirfy under the pains and penalties of perjury that the information provided above is true and correct - �'Sispauire: ✓' - ` `Z"'L��-�`L/ Date: 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): I,Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® y e (rtfp of Northampton _a" C•SV 1 '79 $i assiimusdts lc Bar DEPARTMENTGF BUILDING INSPECTIONS '"-"�__ -J INSPECTOR 212 Main Street • Municipal Building Northampton,MA O1060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup. .i tor. 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). sonatube 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, adore 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 I, to13(l kJ ADE 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. t Date 0430107 Address of work location '47+2 Na(2TH cAR.vkAs FNCE Descript A: 1 Fr/B 2376 sqf B:Wood D 396 sqft 16 C:Wood D 14 224 sqft 5 `l D:Wood D 72 CIARAE- 12 250 sqft E:Wood D cou r« 396 sqft 1 FOB T O F: Wood D 33 B 33 cAmiLy 33 E 300 sqft 10-001A0 12 EF 5