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37-126 26 BLACK BIRCH TRAIL BP-2018-1080 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:37- 126 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv:BASEMENT RENOVATION BUILDING PERMIT Permit BP-2018-1080 Project# JS-2018-001948 Est Cost: $11250.00 Fee:$73.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License. Use Gro= Homeowner as Contractor_ Lot Size(so.ft.): 15681.60 Owner. CHILDS NANCY& PAUL LISCHETTI zo> n� Applicant. CHILDS NANCY & PAUL LISCHETTI AT.- 26 BLACK BIRCH TRAIL Applicant Address: Phone: Insurance: 26 BLACK BIRCH TRAIL (413) 634-4080 Q FLORENCEMA01062 ISSUED ON:4/20/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-CREATE FINISHED 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: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL TTIONS. Certificate of Occupancy Shmature: FeeTvoe: Date Paid: Amount: Building 4/20/2018 0:00:00 $73.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner APR 20 -�" Department use only —'� C ity of Northampton Status of permit p c•. ,wsv=csoNs B jilding Department Curb Cut/Dnveway Permit o. u.unmosn 212 Main Street SevigAepLc availability i` Room 100 N/aterANell Availability Northampton, MA 01060 T""$eteo(slrychu iPlans" \_ phone 413-587-1240 Fax 413-587-1272 FlobSite Plans " other Specify...:. APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A OHNE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION �U 1.1 PIOpeRV Address: This section to be completed by of e 31� g;rcti Tr Map 3 ( Lot nit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: N �,cy C � .l6Zsg.� ��✓1 ;sdtie_k�� �G; 131�.< 3 ;� c �l�ztl� , F 62 . 2- Name(Print) Cunent Mailing Atltlr7s 41 10e C<) 4t3 --(2 14 tin A.2- � Telephore 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 �t y (a) Building Permit Fee 2 Electrical 7hY (b)Estimated Total Cost of Construction from 6 3. Plumbing - Building Permit Fee y� _ 4. Mechanical(HVAC) yt' 5. Fire Protection 2 Su c>J 6. Total=(1 +2+ 3+4 + 5) it, 1So, o1 Check Number "�.. This Seaton For Official Use Only Building Permit N - 4 Date `. Issued'. Signaturh0/411- Building 4IJBuilding Commi lonerunspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) All Information Mus;Be CemFlete, . Permit Can Be Denied Dae To Incomplete Information Section 4. ZONING Existing Proposed Required by Zoning This aolumu m be Fund m by Building Depvnment Lot Size Frontage Setbacks Front Side L R —.. _ L: .. .__ R: Rear '...__ Building Height --_ Bldg.Square Footage "' r"" Open Space Footage _ % - (Lot area minus bldg&paved Bodoni #of Parking Spaces - - volume.@ Locadoo) --- --.. A. Has a Special Permit/Variance/Finding ever Been issued for/on the site? NO Q__ DONT KNOW (D YES_ (D IF YES, date issued: l IF YES: Was the permit recorded at the RegisN of Deeds? NO © DONT KNOW © YES C) IF YES: enter Book -. Page and/or Document# B. Does the site contain a brook, body of water or metlands? NO O DON'T KNOW O YES C) IF YES, has a permit been or need to be ootai led from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES C) NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions >f signs intended for the propertv? YES Q NO C) IF YES, describe size, type and location: E Will 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 © NO D IF YES, then a Northampton Storm Water Managumeut Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck IIof bl 1 New House ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑ 0,Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[01 Other[O] Brief Description of Proposed p� Work'. C Pn>li 1=,4, fAoa � .a b, : " 12 � Alteration of existing bedroom_Yes No Adding new bedroom VeNo Attached Narrative Renovating unfinished basement Ves No Plans Attached Roll -Sheet Its. If New house and or addition to existing housing complete the following. a. Use of building One Family Two Family Other In, 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? 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 I. 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 Ta-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 authorized by this building permit application. Signature of Owner Date I, ; l` ( XV7/ as Owner/Authorized Agent heretoTteclare 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. Prim Name ignature of Owner/Agent Dale � SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephc is SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and SL bmitted 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...... ❑ City of Northampton in Massachusetts I� DEPkslIEUNT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Norther tan, !P 01060 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 mast he registered Type of Work: 7L�v"¢,nom, Est. Cost: P//L 2 SW,0o Address of Work: Z(o /'1 (C 'a,V.k wc,1C 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 awn 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: I 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 � Massaenusetts I c x DEPARTMENT OF BU.LDING INSPECTIONS Z 212 Main Street a Municipal Building Northa oto, , MA 01060 Massachusetts Residential Building Code Section I IO.R5.1.2 Homeowner: Person (s) who own a parcel of lar d 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 strictures. A person who constructs more than one home in a two-year period shall not be considers�d a homeowner. Section I IO.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, pi ovided that if a homeowner engages a person(s) for hire to do such work, then such homeowner ;hall 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 uch work performed under the building permit. As acting Construction Supervisor your presenc, 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 Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 700 Boston,MA 01714-2017 www.mass.gov/dia R orkere Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbus. TO BE FILED WITH THE PERMITTING AUTHORITY. AoolimmInformation 1 Please Print Leelbly Name(Business/Organizatiodqlndividual): R ( - TA; Address: 2 4r 131c, k -T aryistae/zip: / o+v - Phone#: Yl3 Are you an employer". Check the appropriate box: Type of project(required): 1.❑I am a employer with emptcyees aill author p od-t®e) 7. F1 New construction 2 I am a sole proprietor or parmenbal and bare ao emplwees working for me in $. ❑Remodeling any capacity.[No workers'comp-tmurznw required.] 3.❑1 am a homeowner doing of work myself INo workers'comp.mov.s required]' 9. ❑Demolition 4.R�mm a homeowner and will be local,contractors to conduct all work on my Hy pre I will 10 E]Building addition ®meflummnconhacromeitncharewotkeseomparromninsurownsmare,ade11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5 r I an a general wmmaaor and 1 have circa the snacnno-acmrs Hama on ar atmmhea shoe 13.F]Roof repairs 'These sub-wn[mUors here employees avd haveworkers'wmp.Nsurmce. 6 F Weare a corporation and its teems have exercised Nea right of exemption per MGL c 14.❑Other 152,§1(4),and we have m employees-[No worker'some Imvormce requhed] Cony applicant that checks box#1 must also fill out the section below showing occur workers'compensation policy information. Holowho submit this affidavit radicals,may are doing all work and then hue outride contractors must submit a new afidava lndicafing such. lCoutmcmrs that check Nis box must su ached an additional sheco showing the name of me sub-convado s and state whether or not those eombas have employees. Ifthe sub-comacmrs have employees.may most provide them workers'wmp.,shay number. I man employer that is providing workers'compensation insurance jar 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 MGL c. 152, §25A is a criminal violation punishable by 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.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 penaddes ofpeserm y that the information provided above is true and correct Signalum —4Jao,� Date' y�2t'�Is1 Phone#: H1 3 - 10 `f 1 Oficial 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all enplcyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"_.every mrson in the service of another Under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,asso�union,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver ortrustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apart ments and who resides therein,or the occupant of the dwelling house of another who employs persons to do main mance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall tot I ecause of such employmeu be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or vocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business,or it construct buildings in the commonwealth for any applicant who has not produced acceptable evident, of Lompliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states`Neither lh;commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work i mil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the con ratting authority." Applicants Please fill out the workers'compensation affidavit couplet_ly,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)morels),address(c=)an I phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)orLimited .iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workerscar ipensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this of ida it may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also In sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the p,unit or license is being requested,not the Department of Industrial Accidents. Should you have any questions re gar,ing the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legi cly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of I ovestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whica wi I be used as a reference number. In addriom m applicant that must submit multiple permit license applications it ani given year,need only submit one affidavit indicating current policy information(if necessary)and under"job Site Addn ss"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially ,tan ped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for futmeI ermits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license m permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commomvea th of Massachusetts Department of L idustrial Accidents 1 Congress Street, Suite 100 Boston, Nt t 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax N 617-727-7749 Revised 02-23-15 www.muss.gov/dia 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: The debris will be transported by: The debris will be received by: illi v .Lu7Cti d P 1 ')PCV Building permit number: Name of Permit Applicant L Date / Signature of Permit Applicant jFs.•as I it a z3Z f v L _ _ . �_ _.4 Y3 ti 26 Black Birch Trail, Florence, MA Basement Entertainment Room Description of Work: Construct basement partitions, doors, ceiling, and finishes per sketch as follows. • Partition walls to be framed of 2x6 framing lumber, 16 inches on center, with pressure treated bottom plates. • Exterior walls to be framed with 2x4 framing lumber with pressure treated bottom plates. • Ceiling to be framed below the height of gas piping. Chase to be built around heating ducts (for upstairs heat). Soffit at duct work to be not less than 6'8" high. • Electrical wiring for six ceiling fixtures, receptacles per code, and two six-foot sections of electric baseboard heat. • Insulation in partitions to 6"fiberglass batts. Insulation in exterior walls to be closed cell spray foam insulation. Ed>WY6l. polyethylene vapor barrier to be provided on warm side of insulation on partitions walls. No vapor barrier on ceiling. • Half-inch drywall to be installed on interior and exterior of newly framed walls and to be taped and sanded on interior only. • Finished ceiling and duct chase to be W drywall, taped and sanded. • Four 30"x68" interior pre-hung doors to be 6 panel composite or similar. • Interior trim to include baseboards and door casings, to be 1x4 clear pine or poplar.