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25-007 (5)146 RIVERBANK RD BP -2017-0064 GIs s: COMMONWEALTH OF MASSACHUSETTS MayRlock: 25 - 007 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 Permits BP -2017-0064 Rough: Project JS -2017-000116 House# Est. Cost: $20000.00 Fee: $130.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group Homeowner as Contractor_ Lot Size(sa. ft.): 24001 .56 Owner. HAYWARD HELEN A tonin : Applicant: HAYWARD HELEN A Rough Frame: AT. 146 RIVERBANK RD ApplicantAddress: Phone: Insurance: 71 FORT MEADOW DR (978) 562-3582 (l HUDSONMA01749 ISSUED ON., 712012016 0:00:00 TO PERFORM THE FOLLOWING WORK. REPAIR FRONT PORCH & CHIMNEY & INSTALL REPLACEMENT WINDOWS/DOORS 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: Cas: 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: FeeTvoe: Date Paid: Amount: Building 7/20,/20160:00:00 $130.00 212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner File tt BP -2017-0064 APPLICANT/CONTACT PERSON HAY WARD HELEN A ADDRESS/PHONE 71 FORT MEADOW DR HUDSON01749 (978) 562-3582 0 PROPERTY LOCATION 146 RIVERBANK RD MAP 25 PARCEL 007 001 ZONE ENCLOSED Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: proved 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 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 molition Delay 7" Signature uil ing 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. SECTION i - SITE INFORMATION 1.1 Property Address , This section to be completed by office / G/•, �1/' /( GY -Map L6f ;' Unit i I =Zone Overlay Dtstr¢t Elm St. District'. CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ��la/ P/Y F/J ��i/L✓/�/�l�� OL✓ C Name (Pn'ntJ Curren) Marling Atldress:�rD_7 (Jr'dJ� Telephone ignature 2.2 Authorized Arent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS '% Cry Item Estimated Cast (Dollars) to be Official Use Only - completed bpermit applicant 1. Building i� -70 �� X (a) Building Permit Fee 2, Electrical (b) Estimated Total Cast of Construction from 6 3, Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6, Total = (1 + 2 + 3 + 4 + 5) e Check Number r This Section For Official Use Onl Building Permit Number Date Issued: Signature: Building Commissioner/Inspector of Buildings Date A Section 4. ZONING ( All Information Must Be Completed. Permit Can Be Di We To Incomplete Information At A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued:', IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONTKNOW ©�� YES Q _...__ IF YES: enter Book I I Page_ and/or Documentpl i B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q 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 0 NO IF YES, describe size, type and location:. D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: , E. Will the construction activity disturb (clearing, grading excav n, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Existing Proposed Required by Zoning Skis colmnn to be filled mby Budding Department Lot Site, Frontage Setbacks Front Side Rear � �I L= R: I�,—s t.12_I� (���;,I L:l=� R= Building Height VA2 Bldg. Square Footage % Open Space Footage (La are a minus bldg&paved arkin % -~ # of Parking Spaces 1--—J Fill: (volume & iocadon (� t I At A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued:', IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONTKNOW ©�� YES Q _...__ IF YES: enter Book I I Page_ and/or Documentpl i B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q 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 0 NO IF YES, describe size, type and location:. D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: , E. Will the construction activity disturb (clearing, grading excav n, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. N M SECTIONS- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ ReplacemenjW' doves I Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0j_1laeks [M Siding [0] Other [0] Brief Description of Proposed /J j �![bti Work'. �A'c`� CMCrI/� C✓/ll�fi[fS 'f .p0f7Yt'S r�.X �C11. "f' fir' ✓/ (`No � Alteration of existing bedroom _Yes Adding new bedroom Yes N �Na Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet ea:-If New house and or addition to existing housing, cample te the following 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 stories? f Method of heating? Fireplaces or Weodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. 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. Will building conform to the Building and Zoning regulations? Yes No. 1, Septic Tank_ City Sewer Private well City water Supply SECTION 7a- OWNER AUTHORIZATION- TO BE COMP LETED WHEN OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject Property / �y//// T ��.// //� /, �/ ��J �if � hereby authorize /9l// �N 77�.- 7 / ! a L' in S relati a to work authorized by this building pemnit application. two acctt on my behalf, in all Jv'ue-v Y trP —/ Signature of Owner 1' Date I, G' FS — 7 _.3 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. A"" A {,��,_ 4.�G QCT i da/5 Print Name Signature of Owner/Agent Date SECTION 6 - CONSTRUCTION SERVICES 81 Licensed Construction Supervisor. 1 ! Not Applicable £ ,//%Jf �/ Name of License Holder' �✓ �3 6`/�(,yedc/ c- (iw/114k1J �,4 License Number Adtlress Expiration Date Supra Telephone 9: Re lstemtl Hornet rovemenfLontractor FST C�Yy ��' Not Ap licable E r c 40IT2 Company NameA Registration Number 7f/G/G.0 `�T �9IP �{'�/CYFr/1E%! � Addr/ess Expirratiion Date /iiePhone "�v'Y'��� tY SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. e.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result 11: --Rome Owner Exemption The current exemption for "homeowners" was extended to include Owner -occupied Dwellings ofone (1) or two(2) families and to anew 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. Aperso r who constructs more than one home in a twh Year period shall not be considered a homeowner. Such "homeowner" shall submit to the Bmiring 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 ofthe work for which this pe out 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 maybe liable for peraon(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. C64_� Qi The Commonwealth of Massachusetts Department oflndustrialAccidents UIVI Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (BusinBess/Organizabon/Individual): Address: t, 3 iXV,, CC d/ , /-/ %4L' c / /� City/State/Zip: / IYI hk e/'� U Phone #: Are r an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 0 4. ❑ I and a general contractor and I 6. ❑❑� construction employees (full and/or part-time).* have hired the sub -contractors /NNeyy++ 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub -contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, msurance.t 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.0 Other employees. [No workers' comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. thio meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. LCormactors that check this box must attached an additional sheet showing the name of to 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. Lie. #:4 /< / SO A 3 Je, 'e7 Expiration Date: /v7 I7 Job Site Address: rr'ltL /790 � City/State/Zip:�� l/'Z�✓/� �� 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 under thepains and enalties ofperjury that the information providedT above is true and correct. Sienature G — Date: n:1 / a-190 -- SfJl/—/30 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 4. f INSPECTOR Louis Hasbrouck Building Commissioner City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, MA 01060 Chuck Miller 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 before the work is 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 14- I, `rte Cv understand the above. (Home owner /resident's si ature requesting exemption) I will call DDto schedule all required building inspections necessary for the building permit issued to me. Date aa,4 /, Address of work 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 MGLLc 1111, S 150A. t,l Address of the work: I 4� 'ea" tl ZV- The debris will be transported by: 15v� F1% The debris will be received by: %%% T*✓/ 57-e�SfLa� Building permit number: Name of Permit Applicant OeA �i �4 A� a x Date Signature of Permit Applicant sus -7 r'{ N ;, r 1�- RiVetf'S Eoly e 1' 31� KD S'3 so- /I/ -5� , � j sc f j-", , ILlowe 11/06/14 11:23:19 AM RESIDENTIAL PROPERTY RECORD CARO CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998 PARCEL ID: 25 -007-001 142 RIVERBANK RD PLOT: LIVING UNITS: 1 CLASS: R - 109 CARD #: 1 OF 2 CURRENT OWNER/ADDRESS NEIGHBORHOOD 10: 20.00 FINAL VALUE FLAG: COST HAYWARD HELEN A LAND DATA - ASSESSMENT INFORMATION - ]1 FORT MEADOW DR TYPE SIZE INFLUENCE FACTORS LAND VALUE PRIME SITE 12000 60,700 PRIOR COST CURRENT HUDSON MA 01749 SECONDARY 12000 30;]00 400 BLDG 157,500 119],200 117, X200 TOTAL 254,900 208,600 208,600 DEED BOOK: 56T DEED PAGE: 280 SALES INFORMATION DEED DATE: TOTAL ACREAGE: 0.551 TOTAL LAND VALUE: 91,400 LAST UPDATE/COST: 20141106 DATE TYPE PRICE VALIDITY 19990401 LAND * BLD 50,000 A LAST UPDATE/COSI: 20141106 ADDITION DATA % DATE: Lover Level Firs[ Floor Second Floor Third Roor Area DATA COLLECTION INFORMATION A Bsmnt is Fr 1 ENTRANCE COIF. UNOCCUPIED B EFP 132 OLSOURCE: C OFP 20 DATA C DATA COLLECTOR: TOR: MC D DATE: 19991204 E DWELLING INFORMATION G N STYLE: CONVENTIONAL YEAR BUILT: 1930 STORY HEIGHT: 2.00 ATTIC UNFIN Basement FULL TOTAL ROOMS: ] TOTAL BEDROOMS: 3 FULL BATHS: 1 ADDITIONAL DWELLING INFORMATION Half s: 1 25 BASEMENTGARAGE(#CARS) ADDITIONAL FIXTURES: A WALLS: ALUM/VINYL BRICK TRIM: % ] it LB UNFINISHED AREA: STONE TRIM: %Fr 6 GROUND FLOOR AREA: 675 GROUND FLOOR FINAL LIVING AREA: 1525 REMODELING DATA 25 FINISHED BASEMENT LIVING AREA: % BASEMENT RECREATION AREA: % YEAR REMODELED: MY FIREPLACE STACKS/OPENINGS: / METALETAL FIREPLACES: KITCHEN (Y/N) HEAT/CENTRAL A/C: BASIC BATH REMODEL EL (Y/N) HEATING SYSTEM: STEAM FUEL TYPE: OIL QUALITY GRADE: L PHYSICAL CONDITION AVERAGE COND/D COND/DESIRABILITY/UTILITY FR INTERIOR/EXTERIOR SAME OUTBUILDINGS & YARD ITEMS PERMIT DATA 29 A/eex/e TYPE OTY YR SIZE) SIZE2 GRD COND DATE PURPOSE PRICE NOTES: 11/99 -VACANT, IT IS 146A R VERBANK 0. NOv e 11/06/14 11:23:19 AM RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998 PARCEL ID: 25 -007-001 142 RIVERBANK RD PLOT: LIVING UNITS: 1 CLASS: R - 109 CARD p: 2 OF 2 CURRENT OWNER/ADDRESS NEIGHBORHOOD ID: 20.00 FINAL VALUE FLAG: COST HAYWARD HELEN A LAND DATA - ASSESSMENT INFORMATION - 71 FORT MEADOW DR TYPE 512E INFLUENCE FACTORS LAND VALUE PRIOR COST CURRENT HUDSON MA 01749 LAND 97,400 91,40091 400 BLDG 157,500 117,200 117,'200 TOTAL 254,900 208,600 208,600 DEED BOOK: 5677 DEED PAGE: 280 SALES INFORMATION DEED DATE: TOTAL ACREAGE: 0.551 TOTAL LAND VALUE: 91,400 LAST UPDATE/COST: 20141106 DATE TYPE PRICE VALIDITY 19990401 LAND + BLD 50,000 A LAST UPDATE/COST: 20141106 ADDITION DATA X GATE: Louer Level First Floor Second Floor Third Floor Area DATA COLLECTION INFORMATION A Bsnnf 11 260 ENTRANCE CODE: UNOCCUPIED B Bsnnt EFP 272 INFORMATION SOURCE: C DATA COLLECTOR: MC D DATE: 19991204 E F DWELLING INFORMATION G H STYLE: CONVENTIONAL YEAR BUILT: 1930 STORY HEIGHT: 1.50 ATTIC: NONE Basement FULL TOTAL ROOMS: 6 TOTAL BEDROOMS: 3 FULL BATHS: 2 ADDITIONAL DWELLING INFORMATION Halt Baths: 26 e BASEMENT GARAGE(#CARS) ADDITIONAL FIXTURES: EXTERIOR WALLS: FRAME BRICK TRIM: X UNFINISHED AREA: STONE TRIM: X GROUND FLUOR AREA: 651 10 ,Er/B 10 TOTAL LIVING AREA: 1399 REMODELING DATA FINISHED BASEMENT LIVING AREA: X BASEMENT RECREATION AREA: X YEAR REMODELED: MASONARY FIREPLACE STACKS/OPENINGS: / METAL FIREPLACES: KITCHEN REMOD(Y/N) NEAT/CENTRAL A/C: BASIC BATH REMODEL (Y/N) HEATING SYSTEM: WARM AIR FUEL TYPE: OIL QUALITY GRADE: 0+ PHYSICAL CDNDITION AVERAGE COND/DESIRABILITY/UTILITY VP INTERIOR/EXTERIOR SAME EEe/B OUTBUILDINGS 8 YARD ITEMS PERMIT DATA TYPE OTY YR BIZE1 SIZE2 GRD CORD DATE PURPOSE PRICE NOTES: 11/99 -VACANT, IT IS 146A RIVERBANK RD.