12C-052 (7) 20 CLOVERDALE ST BP-2019-0441
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-052 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categ_ory_KITCHEN"NO BUILDING PERMIT
Permit# BP-2019-0441
Protect# JS-2019-000716
Est.Cost: $29000.00
Fee: $189.00 PERMISSION IS HEREB Y GRANTED TO:
Const.Class: Contractor: License:
Use Group: EDWARD RICKEY 96159
Lot Size(sg.ft.): 11499.84 Qwner: ANNETTE E GRIFFIN&SUSAN D REARDON
Zoning RI(100)/URA(100)/WSP(100)/ Applicant. EDWARD RICKEY
AT: 20 CLOVERDALE ST
Applicant Address: Phone: Insurance:
P O BOX 62 (413) 695-7059
WILLIAMSBURGMA01096 ISSUED ON.1011212018 0:00:00
TO PERFORM THE FOLLOWING WORK:RENO KITCHEN
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 Denartment 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:
FeeTyne: Date Paid: Amount:
Building 10/12/2018 0:00:00 $189.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0441
APPLICANT/CONTACT PERSON EDWAI'!)RICKEY
ADDRESS/PHONE P O BOX 62 WILLI,, v4SBURG (113)695-7059
PROPERTY LOCATION 20 CLOVERDALE ST
MAP 12C PARCEL 052 001 ZONE RI(100)/URA(100)/)KSP_L 100Z/
THIS SECTION FOR OFFICIAL,USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENO KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/Statement or License 96159
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
___K_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
-ZJ
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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
ft 212 Main Street Sewer/Septic Availability�
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
.:> phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
_
10th, r
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEM)LISt I A ONE OR TWO FAMILI DW LUNG
SECTION 1 -SITE INFORMATION OCT 1 1 2018
1.1 Property Address: is y off
��� DEPT.OF BUILDING INSPECTION
2.0 /,�f / �_a , Q Map NORJWMPTON.MA01060 nit
' Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
X 26 ak&v.LA 4
Nam int) Current Mailing Addres :
k Ali 3 34//
W Telephone
e
2.2 Authorized Aaent:
epwxlQp Ptcx6t 2
Name(Print) Current Mailing Address:
5'/3�69S-x►s9
ignature Telephone
=TION 3- ATED N TR TI N T
_Z —F—
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 29 000oc (a)Building Permit Fee
2. Electrical (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) ,oo Check Number U
This Section For Official Use Only
Building Permit Number: DateIssued:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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
z
rw�
Frontage
Setbacks Front
Side L: .n. R. LL R. 4
Rear
Building Height
Bldg.Square Footage % `
Open Space Footage %
--rtti
(Lot area minus bldg&paved r
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book r Page: and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location:
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 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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROEOSED WORK(check 1111 applicabig)
New House ❑ Addition Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [i3] Decks [C] Siding[p] Other[�]
Brief Description qf Proposed n p 9 a
Work: s a �`.L K N /,AT�_;&A"' 7M...V
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
calf kAddlit t 1
a. Use of building : One Family t_ 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
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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ) as Owner of the subject
property
hereby authorize
to act y behalf, in ae6afters relative to-Ark authorized by this building permit pplication.
Sig of Owne Date
I, as Owner/Authorized
Agent hereby declare that t 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.
G�i0w�4�2,D etc Al6:e
Print Name
/o l /J,
Signature o ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sup2rvisor: Not Applicable ❑
Name of License Holder: GS ` OV 61b 9
License Number
2 - 21P 01074 '7-13 -laza
Address Expiration Date
3 $7-7U-S'.9
Signature Telephone
y Resdsterd WWtrte 1rn��Ocrltrat«tart Not Applicable ❑
_ &A,EA s A 13av� / o tiy�
Company Name Registration Number
S"• 2• Zozo
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(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 buildipg permit.
Signed Affidavit Attached Yes....... d No...... ❑
City of Northampton
5 S!
+'` ` • Massachusetts
i ' " A N
EWARTMICNT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yva Pb`
Northampton, MA 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("MC").
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: k(+,, my-zd T. Est. Cost:
Address of Work: CLWA4 e. , ` ,Qa �w MA
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:
I hereby apply for a building permit as the agent of the owner:
/0411•11e CAA Izo Ric Ker J* Go 16bSy49
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 ���5•5 X s�°'c`
G
DEPARTW NT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yvk Ob
Northampton, MA 01060 fsNjy ��J
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.
City of Northampton
Massachusetts
LEPAR224WT OF BUIZDING INSPECTIONS -
212 Main Street •Municipal Building Say cb�
Northampton, MA 01060
Debris 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.
The debris from construction work being performed at:
Zo QZoew&,A&
(Please print house number and street name)
Is to be disposed of at:
v
(P se pri name d location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
IRk
(Company Name and Address)
Signature of Vmif Appl!qdnt or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
'\ The Commonwealth of Massachusetts
Department of Industrial Accidents
0
I Congress Street, Suite 100
Boston,MA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lmibly
Name (Business/Organization/Individual):
Address: f go►�City/State/Zip: 2&fiAam5JyM " 01096 Phone#: W3 .QS•_7
Are you an employer?Check the approp to box: Type of project(required):
1.Q I am a employer with__employees(full and/or part-time).* 7. ❑New construction
2.®I am a sole proprietor or partnership and have no employees working for me in $, ®Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 0 Building addition
4.rl I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners 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 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 penalties of perjury that the information provided above is true and correct.
Si tore: 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):
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 employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding 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 legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
CS seam 201!x)1.0.10 Griffin 10-10-18
rm eamFirte 15575572016.9.0.3Florence 2:3lpm
ut6erisls Dmaltase
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Member Data
Description: Member Type:Beam Application:Floor
Top Lateral Bracing:Continuous
Bottom Lateral Bracing: 0.00
Standard Load: Moisture Condition:Dry Building Code:ISC/IRC
Live Load: 40 PLF Deflection Criteria: L/360 live,L/240 total
Dead Load: 10 PLF Deck Connection:Nailed Member Weight: 18.1 PLF
Filename:Beam1
Other Loads
Type Trib. other Dead
(Description) Side Begin End Width Start End Start End Category
Replacement Uniform(PSF) Top 0' 0.00" 14' 0.00" 6' 0.00" 30 10 Live
Additional Unidorm(PSF) Top 0' 0.00" 14' 0.00" 13' 0.00" 35 15 Snow
Additional Uniform PLF Top 0' 0.00" 14' 0.00" 0 20 Live
14 0 O
IT)
14 0 0
Bearings and Reactions
input Min Gravity Gravity
Location Type Material Length Rehired Reaction Uplift
1 0' 0.000" Wall SPF#3/Stud 2x or 4x End-Graln(650psi) N/A 1.595" 5442# —
2 14' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) N/A 1.595" 5442#
Maximum Load Case Reactions
Used for applying point loads(or line bads)b cenying members
Live Snow Dead
1 1273# 3218# 2073#
2 1273# 3218# 2073#
Design spans
14' 1.750"
Product: 1-3/4x11-7/8 VERSXLAM 2.0 3100 SP 3 ply PASSES DESIGN CHECKS
Connect members whh 2 rows of 16d common nails at 12.0"oc
NOTE:Neffs must be applied*om both sides
Minimum 1.59"bearing required at bearing#1
Minimum 1.59"bearing required at bearing#2
Design assumes continuous lateral bracing along ft top chord
Design assumes maximum unbraced length of 0.00'along the bottom chord.
Allowable Stress Design
Actual Allowable Capacity Location Loading
Positive Moment 19244.1# 38167.# 50% 7' Total Load D+0.75(L+S)
Shear 4680.# 13622.# 340k 13.37' Total Load D+0.75(L+S)
TL Deflection 0.3829" 0.7073" U443 7' Total Load 0.5D+0.75(L+S)
LL Deflection 0.2928" 0.4715" 0579 7' Total Load 0.75 L+S
Ctmtrd: LL Deflection
DOLs: Live--100% Snow--115% Roof--125% Wind=160%
Design assumes a repetitive member use increase in bending stress: 4%
All product names are trademarl-of their repedive owner
Copyright(C)2016 by Simpson Streng•71e Company Inc.ALL RIGHTS RESERVED.
"Paving Is defined as when the member,floor joist.boom orgirdec down on this drawing meaft applicable design epees for Loads,Loading Conditions,and Spans listed on this rivet.
The design must be reviewed by a qualified designer or design protmdonal as required for approval.This deagn assumes produd installation sowtdirg to the manuredurers
flasfions.
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