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24A-103 (6) 415 PROSPECT ST BP-2017-1527 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24A- 103 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit tt BP-2017-1527 Project# JS-2017-002553 Est. Cost:$3300.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groum: HANS DALHANS 101628 Lot Size(so. ft.): 24872.76 Owner: NIELDS-DUFFY NERISSA&THOMAS PNIELDS-DUFFY Zoning: URA(l00)/ Applicant: HANS DALHANS AT: 415 PROSPECT ST Applicant Address: Phone: Insurance: 11 CHERRY ST (413) 977-6094 EASTHAM PTON MA01027 ISSUED ON:7/3/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE 1ST FLOOR CLOSET AND INSTALL BASEMENT STAIRS 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 7/3/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1527 APPLICANT/CONTACT PERSON HANS DALHANS ADDRESS/PHONE 11 CHERRY ST EASTHAMPTON (413)977-6094 PROPERTY LOCATION 415 PROSPECT ST MAP 24A PARCEL 103 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT CDf) Fee Paid Building Permit Filleded outt IPV Fee Paid Typeof Construction: REMOVE 1 R CLOSET AND INSTALL BASEMENT STAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 101628 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Commission Permit DPW Storm Water Management Demolition Delay 434117 Signature of Building Official Date Note: Issuance ot 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. Tk -.t.\\ dc 4E Se " I City of Northampton 44 `' g5 " A ..1 `\ e !' ��Z� -1" Building 212 MainDepartmStreet nt '" ' Room 100 ,r -r., Northampton, MA 01060 rd( x phone 413-587-1240 Fax 413-587-1272 • . trk ` ."A ,, a , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address ':� �� "J" i)This section to be completed by office L4l V Pf� t l SPD- Map �4 Lot lD 3 Unit �D r$ Ja A. t'M /V/A- O/06 0Zone Overlay District Elm St District CB.District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: iz.YfSSce , ad5 - D"4111 Lit c tante& Sir, MoYiL4a ttat4 O(oGc Na (P-1nt) ------ti _ Current Malin Atldress: yt its 2ta' _ If g -'I� Telephone Signature 2.2 Authorized ent: 1 a (' k C. 1C ,5 I1 c lnRrn --1. • -:viA-L- •-11c}pr Name(PnCurrent Mailing Addre : .--/ 9/3 q7- Loi '-{ a ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building . 7 J U ° (a)Building Permit Fee 2. Electrical N (b)Estimated Total Cost of } 1�U Construction from(6) 3 Plumbing Building Permit Fee 4. Mechanical(HVAC) 7/y� 5. Fire Protection z `! 6. Total=(1 +2+3+4+5) ' 3 3 O p Check Number I ✓� (�/a This Section For Official Use Only Building Permit Number: IssuDateed: Signature: Building Commissionerllnspector of Buildings Date Section 4. ZONING Alt Information Aust Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This<obvnn to be filled in by Building Department Lot Size Frontage Setbacks Front - Side L: R Rear _ .. , . Building Height Bldg. Square Footage Open Space Footage(Lot area minus bldg&paved parking) X of Parking Spaces Fill: - .. . _. (volume&Lawton) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? (Sf' NO ?vDONT KNOW © YES O ......._.. ..... ........ IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page , and/or Document if B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: . .. C. Do any signs exist on the property? YES O NO ® IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO C'.7 IF YES, describe size, type and location: E. WI!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? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ea SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors O Accessory Bldg. ❑ Demolition New Signs [C] Decks [O Siding[C] Other lot Brief gg5cription of Proposed / p Work: r1afTtcVQ_ I st 1 tJ t' 6 t 'Sk-'II c1SC/HA4 ✓t� 5+4 OrS- Alteration of existing bedroom Yes x No Adding new bedroom Yes -Y No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet -r 5a. If New hooseatdl ec;�ii¢i4i'de tts�exls'ti k ;canpletelde faktdwirtq: a. Use of building:One Family fit 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 stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 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 OWNERftC AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 4 f 4s50. )4(1. - ' ,as Owner of the subject properly 1 � hereb authorize DC1\� TV) /�_f�'f�QVN to a on my behalf, in all �tteq s re tive to{/rk�auuTyorized by t is building permit(aapplication. 1.0 f Sign re of Owner Date a / S G I /1 Ft 1"S l CJ iQp ti. ,as Owner/Authorized Agent hereby declare that the statements and info nation on the foregoing appication ar t .e and accurate,to the best of my knowledge and belief. S.a-- nder •- •ains a • •enalos otperjury. Print ame� op. / ice eof �en I (1cV S ( /(/.,1�j/� Si ature of Owner/Agent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Swam-visor: Not'Applicable f roams of License Hojper-.4-4411� 'D to 1�1htvs .. {../S `{} kL26_ License Nu ber r Address Expiratlo Date rMfr g) n7 ! 6(79 y 'velure Telephone S. tate Homelinpnovem(ritt Contractor - Not Applicable £ i l fthe- f Lina94l —_ Company Name /„ /, Registration Number Address 1 n 1 J4YV 3171101 �� / w t�to �' 1 _„ Telephone�f J 1716vf1 ( — SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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 building permit. Signed Affidavit Attached Ves.)i.. £ No...... £ 11. - Horne Oaer Exemption 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 108.3.5.1. 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"ho,reuwner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be responsible for all sorb 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 injures 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 The Commonwealth of Massachusetts Department of Industrial Accidents tc7 lqt! • Office of Investigations _ y �, 600 Washington Street 4. =tiff ? Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P n' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.[ required.] 5.W We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ILO 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.❑ 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. '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. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify und, ''e pa aides of perjury that the information provided al$ve is truecorrect and Signature: i' •� Date: (7/r��/ / 7 Phone#: vJ" 1 7-i gel k" Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License It 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 �5 LS S/c Massachusetts h. d DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA D1060 sl'if7660P 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 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: y clic o\ t1J\ The debris will be transported by: AL iL Veil L`�dmr The debris will be received by: jo, lL j Reck Building permit number: Name of Permit Applicant f7), I h0 lr Date Signature of Permit Applicant • City of Northampton /r r Massachusetts r1L"r mi �c . DEPARTMENT OF BUILDING INSPECTIONS V} ; 212 Main Street • Municipal Building .i Northampton, MA 01060 6 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts ' C_ f4slot. DEPARTMENT OF BUILDING INSPECTIONS =. 42 212 Main Street • Municipal Building T L Northampton, MA 01060 adt s14C Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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 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.