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43-129 63 GREENLEAF DR BP-2005-1075 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:43- 129 CITY OF NORTHAMPTON Lot:-OW Permit: Building category: BUILDING PERMIT Pe=tit BP-2005-1075 proiect# 3S-2005-1463 Est.Cost: 4000.00 Fee:$26.4Q PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sy. ft.): 30404.88 Owner: MARGOLIS BRAN M&ANNE Zoning:SR Applicant: MARGOLIS BRIAN M &ANNE AT: 63 GREENLEAF DR Applicant Address: Phone: Insurance: 63 GREENLEAF DR FLORENCEMA01062 ISSUED ON:SiWOS 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 12 X 22 SHED 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: 01: 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 stsnatura; FeeType: Date Paid: Amount: Building 5/9/05 0:00:00 $26A0 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony PatBio File#BP-2005-1075 APPLICANT/CONTACT PERSON MARGOLIS BRIAN M&ANNE ADDRESS/PHONE 63 GREENLEAF DR FLORENCE PROPERTY LOCATION 63 GREENLEAF DR MAP 43 PARCEL 129 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �� ♦ Fee Paid �$ /9 tID°L,eto Typeof Construction: ERECT 12 X 22 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: 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 Commiss 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. 4 xOY�-t--� 171Y ;City of Northampton fi�-c i r i _. Building Department �r + 212 Main Street3;� n rr.5 Room 100 +'" r*•f r 't y' +z "i2 - 11 - - c, t Northampton; MA 01060 hone 413-58A-1240 Fax 413-587-1272 --APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 11 Property Address D;, Thlssecoarttisbe comgretedIyoffipa ‘ (7/L fh/u 7!/M ,/7t21uli✓if, / '// ( /tC z ~ —T rIaY DLStcfeL -.` SECTION 2-PROPERTYOWNERSHIP/AUIHORIZEDAGENT 2.1 Owner of Record: 7370727)/ v M, '6O/ f 9 I/FF,✓v F/><,77i/f Gf Name(Pring.--,{� ,,,JJJ Current Malting Address: / q m/6_, �/ �/ii. (4 Telephone �� ��(� �i�/� Signature (//// 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 /LJ !!_0-j) (a)Building.Permit Fee 2. Electrical r(/7 (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) Check Number ''sg ,r02 -so This Section For OffidaF:Use Only Date Building Permit Numbec Issued: Signature: - - Building Commissioner/Inspector cfBuildings Date Section 4. ZONING All InformaUlln Must Be Completed. Permit Can Be Denied Due To Incomplete Information • Required by Zoning This column ro be filled in by Building Department MIS�SiC1Litll I — r Setbacks Z y� _. r. '—T .�...__ Side LJ=R: L' ci R:71-10 rrred Rear AS Open Space Footage MIENS= MEM Sum(Lot ares me bldg&paved94) vkie. • IPMPOINSMIMAniallM k Has a Special Permit/Variance/Finding ever been issued for/on the site? NO a DONT KNOW © YES 4 IF YES, date issued:'; IF YES: Was the permit recorded at the Registry of Deeds? NO es 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 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES © NO `G IF YES, describe size, type and location: r D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the mnstruction activity disturb(clearing,gradIng,Talion,or filling)over 1 acre or is it part of a common plan that wilt dsturb over 1 acre? YES a r NO IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appllcOOle) New House ❑ Addition ❑., Replacement Windows Alteration(s) ❑ Roofing ❑ � Or Doors 0 Accessory Bldg. [2/ Demolition ❑ New Signs [C] Decks [O Siding[p] Other IC] Brief Description of P uprsed Mac ,,. I2A22 ' SMel / .S7/16 Tv C' '. elfwen ofvfi' -vee Detivi,4RHE'4%j(O,t Alteration of existing bedroom Yes V No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes / No Plans Attached Roll -Sheet aa_t£Newafoasea ibtalt d rio u sine: riro5ated ar 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. Masscheck Energy Compliance form attached? h. Type of consWdion Is construction within 100 It.of wetlands? Yes No. Is construction within 100 yr. floodplain_ Yes No j. Depth of basement or cellar floor below finished grade k. Writ building conform to the Building and Zoning regulations? __ Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION'Ta-OWNER AUTHORIZATION-TO BE COMPI.ETED-WHEN OWNERS AGENT OR CONTRACTOkAPPGES FOR BUILDINSPERMIT ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are two and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Na ` r ". .. C ... If Signature of er/r gent Date SECTION 8-CONSTRUCTION SERVICES ,f- 8.1 Licenned Construction Spoervisgr: Not Applicable B ' Ramo of License Holder: _ License Number Address Expiration Date — Signature Telephone _ y : 3.'. , axr, m8k ., a-s.aa a-€ Not ApWcabe ❑ Company Name Registration Number '--" Address Expiration Date -- Telephone .._...._ SECTION.10-WORKERS'COMPENSATION INSURANCEAFRDAVIT(KR.A-c.$S2,§2SC(S)) 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 0 No ❑ � .(a tSil, �rel'(`°lttsn'tii-aa sa 1. The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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 108.33.1, 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 is 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 shah be , responsible for all such work performed under the building permit As acting Construction Supervisor your presence on the job site will he 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 respon ibility for compliance with the State Building Code.City of Northampton Ordinances,State and Local Zoni.g Laws;.k tate of Massachusetts General Laws Annotated ;<lomeowner Signature / J`^- ' {,r1 _, • i vr•rpr r • Arm 4 a. E (i ±Li of Torth:1)11} to)i 1 B= PKitt, `c : 5i aa..y4nzrt<e DEPARTMENT OP DUI LD INC INSPECTIONS yy� ' 212 Main Strcct ' Municipal Dui!dineq.,, t- Northampton, Macs. 02966 am' WORKER'S COMIPCNSATION GNISURA7rCE AFFIDAVIT. (ticascc/pcnni tcc) tpith a principal place of businesslresidenoc at: - --- (phoney')^ (sr dcitytswc'dp) • do hereby certify. under the.pains and penalties of perjury, hal • ( ) Ian an employer providing the following worker's cotnptnsathon coverage for inn , employees worl-ing on this job_ (Lnsnrnm Conpacy) (Policy Nc-abcr) {rapircor Dzt} ' () I am a sole proprietor, general coot agar or homeowner(ache one) and have hired the cousractors listed below wbo hive the following worker's compensadon policies: (Nsmc of Comm col (Ulsuranc Company/Policy Num!c) Rapirauo Date) t iamc of Ccocaor) (ins aao CompaayiPdicv Nux cr) fapir;ion Das) . _ (Name of Concano;) (I .sw-ane Compaay-/Poncy N•amr.- ) CT-Nair_:don Dalc) (Nave of Contactor) (Iusurancc Comewy/Policy Number) ttxPu-dao Dalc) tecad i;cm,/tee Je.OS,:v ta atwh;w-w penning u w0:=--eonl • Y) I am a sole proprietor and have no one woriang for me. () I anaa home owner performing all the work myself INOTF:pipta tc cc- Si ..i le hcc cn w spicy pcno r.;Th-f-f="=-J•>o c it;" .v i 4'11=Z of au occt i-atn<tvr u u'.ed v4 bcarvc raii.&or m Nu pnpa.""` mwWrnm:c•v- m1.,...11y ccczd ctlutr cglo-a,or i Cv'ockd=o.-y-.-.'ccAn(Del52t 1(5)).sppliwtiw by•bomaswae fa di , or pe:w n y n441,":e rhe I.g1 nan..ot w ealay.e under dM,Woita.(onjo ion Ana • I unenwn4 0e a nay,arum cu®w®&y M rwepp..d.d w W o Ccpuamm oriom.cn"d n • ..'Offio-M im,ncm t-W. wva6 toe PS nu[Mac taSC=t:0xn cede rctoo 25A oCMOL ISt on ted to kbc uv mm dviStS O'^-413.:1 2muno(a 6«dolt a S l,?M.03 uY✓or knaciacciaacas of up W ovc yv LodaN pea.No u rY(ofa Sp Wn'c Peck and. (gym 015100.01).Pay.prion me a Fad y' ally I Permit Number * r 'ate A t.faP=_ tve: Siyyturo .l L'II /Pcrmiuc —MEV • aterGe ,..CTity of Northampton ll Br • d JAtna,c4u ctts (/ __ "6)ti4—ra, DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMt 1083.4 to act as his/her construction sow,: Hser. 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 fegulations. 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 inspectionLThe 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 /� A' � i { understand the above. V (Hom7" e own r fr sid is signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work Iocation r' � � � � \ v \ \ 1 - ;- j°Nr �, 4sa» \ \ \ 1 \\ , ��