31B-171 (4) 41 HENSHAW AVE BP-2009-0075
GIS#: COMMONWEALTH OF MASSACHUSETTS
May.Block: 31B- 171 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0075
Project# JS-2009-000097
Est. Cost: $13500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN YOSHEN 88490
Lot Size(sq. ft.): 7710.12 Owner: SAVAGE FRANCIS
Zoninw URC Applicant: STEPHEN YOSHEN
A A,: 4'i i-t r1 v E
Applicant Address: Phone: Insurance:
P O BOX 41 413 634-5431
CUMMINGTONMA011026 ISSUED ON.7/31/2008 0:00:00
TO PERFORM THE FOLLOWING WORIC.FINISH & INSULATE ATTIC & STRUCTURAL
MEMBERS-REQUIRES CURRENT CODE FOR SMOKE DET/CO DET
POST 'CHIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
L-4'A*t,v to__✓ Footings:
Rough: Rough:�_ ��g.aia:House# Foundation:
RP j'n QfIM Driveway Final:
Final: Final:
Rough FrameAA
Gas: Fire Department Fireplace/Chimney:
Rough: Insulation: 09ldl
Final: Smoke: Final: OK 0'105109 "11%
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc �^- Signature:
Feer e: Date Paid: Amount:
Building 7/31/2008 0:00:00 $81.0093
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner- Anthony Patillo
BP-2009-0075
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0075
Project# JS-2009-000097
Est. Cost: $13500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN YOSHEN 88490
Lot Size(sq. ft.): 7710.12 Owner: SAVAGE FRANCIS
Zoning:URC Applicant: STEPHEN YOSHEN
AT: 41 HENSHAW AVE
Applicant Address: Phone: Insurance:
P O BOX 41 (413) 634-5431
CUMMINGTONMA011026 ISSUED ON.7/31/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:FINISH & INSULATE ATTIC & STRUCTURAL
MEMBERS-REQUIRES CURRENT CODE FOR SMOKE DET/CO DET
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 7/31/2008 0:00:00 $81.0093
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2009-0075
APPLICANT/CONTACT PERSON STEPHEN YOSHEN
ADDRESS/PHONE P O BOX 41 CUMMINGTON (413)634-5431
PROPERTY LOCATION 41 HENSHAW AVE
MAP 31 B PARCEL 171 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: FINISH&INSULATE ATTIC&STRUCTURAL MEMBERS
New Construction
Non Structural interior renovations
Addition to Existiniz
Accessory Structure
Building Plans Included:
Owner/Statement or License 88490
3 sets of Plans/Plot Plan
THIN�FE
�FO�ATON PRESENTED:WING ACTION HAS BEEN TAI���OU�fT SAPPLICATION q��BASED D�TK7�2S T6 CuRn�N r Canf
t. 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
Lo
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.
S
Department use only
of Northampton Status of Permit:
SOS
\JiI Ing Department Curb Cut/Driveway Permit�ual
1 Main Street Sewer/Septic Availability
doom 100 Water/Well Availability
NOrt ampt n, MA 01060 Two Sets of Structural Plans
`^ phone 41 y -1249 Fax 413-587-1272 Plot/Site Plans
1�0 Other Specify
n
I APPL ATION TOICONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot Unit
Zone Overlay District
r j`r✓t 1
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Cu rre t ilin d s
Teleph ne
Signatur
2.2 Authorized A ent:
P "a tJ Y�►�\ \V��
Na e( rint) Current Mailing Address: 0 p
1 X31
Sig ature Telephone
SECTION 3-ES (MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 0400
(a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
TO Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) Check Number .�
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r
j
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
(1 LI) of Building Department
Lot Size
Frontage
Setbacks Front
r"---g
Side L IEC Rj- 3' L: R:=' h _
Rear Tff a
Building Height
Bldg.Square Footage o ON m
F
Open Space Footage _. %
(Lot area minus bldg&paved -77--
parking)
77—arkin
#of Parking Spaces
Fill:
(volume&Location) -•"-.• --- —m`�"""`� '"_`m"'
A. Has a Special Permit/Variance/Finding ever been issued for/ the site?
NO DONT KNOW YES
IF YES, date issued: VI-107
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES (tJ
IF YES: enter BookPage_ and/or Document#" !
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: . `A
C. Do any signs exist on the property? YES NO
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
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 W
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement W}fidows Alteration(s) Roofing F7
Or Doors EZ
Accessory Bldg. ❑ Demolition New Signs [0] Decks Siding [p] Other[0]
Brief Descri Qn of Pro osedy (0. (� + (—e--
Alteration
--gyS ��✓C l QTR ' Y'^ ��5
Work: -�'1 ��5� (✓� 5 l 1/L
Alteration of existing bedroom Yes V No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to eidsting housing, complete 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 stones?
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 on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, , 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.
Print Name
Signature of Owner/Agent Date
r
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 1 g 2S ( L O
L'�D7lmrb9 1
Addres Expiration Date
L 1363 3/
Sig ature f Telephone
9. Re istered Home`lm rov`ment C ntractoi- 3 Not Applicable 2❑
z19Yo7
Company ame Regis ratio Number
3J �o
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 building permit.
Signed Affidavit Attached Yes....... No...... ❑
I L - Home Owner Ex, ernptio n
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-vear 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 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.
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 Commonwealth of Massachusetts
Department of Industrial Accidents
E :
...� ��---r�° Office bf Investigations
� 600 Washington Street
-- Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): '0-1 yn5�e_^
Address: - w✓'^r, 'C
City/State/Zip: rn�� Q� D o Phone#:
Are you an employer?Check the 4ppr4riate box: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I
2.dmployees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
iam a sole proprietor or partner- listed on the attached sheet. 7. emodehna
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.insurance.$
required.] 5. We are a corporation and its 10.0 Electrical.repairs or additions
3.❑ I am a homeowner doing all work
officers have exercised their 11. 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.
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 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do herebyZ4Z;��
lties of perjury that the information provided a ve is •ue and correct.
Sianature: Date:
Phone#: 6�
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#:
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 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 sour) 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 occupancv
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
1, 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
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BARRET PLACE
S 71'08'48" E
77.98'
/ I
paved drive
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m o L------1
/ BOOK 8400, PAGE 258
h
8,760± SQ. FT.
/ �.� 0
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#41
41.2ft N
b1b 8.0ft \ 6.6ft
/
/ N 70'56'00" W 160.07' wood fence
__max x x x x
/ wire fence
/ 36" maple „ „
EXISTING CONDITIONS
PLAN OF LAND IN
NORTHAMPTON, MASSACHUSETTS
ASN Cf PREPARED FOR
LEGEND �� RANDALL °y` FRANCIS SAVAGE
E.
o FOUND IRON PIN IZERy SCALE: 1"=20' FEBRUARY 6, 2007
■ FOUND STONE BOUND X3550303 2
`,�s,1o�''oe HAROLD L. EATON AND ASSOCIATES, INC.
SURVfy REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
413-584-7599 413-585-5976 (fax)
email — hleatonOaol.com
Y:\ dvwmpton nve:awg — --
BARRET PLACE
S 71'08'48" E
77.98'
/ � I
paved drive
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// BOOK 8400, PAGE 258
8,760± SQ. FT.
/ �2 41.8ft ^ w
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/N1 41.2ft U)
-
668.0ft \ 6.6ft
N 70'56'00" W 160.07' woad fence +
--�x x x x x
/ wire fence
/ 36" maple „ „
EXISTING CONDITIONS
PLAN OF LAND IN
NORTHAMPTON, MASSACHUSETTS
LEGEND �,�`�� PREPARED FOR
RANDALL /FRANCIS SAVAGE
E.
o FOUND IRON PIN /3IZER
5032 SCALE: 1"=20' FEBRUARY 6, 2007
■ FOUND STONE BOUND `� sswv'o� HAROLD L. EATON AND ASSOCIATES, INC.
"O SURREGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
413-584-7599 413-585-5976 (fax)
email — hleaton@(3ol.com
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�. JUL 2 9 2008
41 HENSHAW AVE J
ATTIC RENOVATION PLAN LCT IONS
INSULATION: The roof will be insulated with 6"closed cell foam, R39 and h—e w—alts J
will be insulated with 4" closed cell foam, R26.
STRUCTURAL:
Replace old rotten 6"x 6"beam with three 1 %"x 8" LVLs, glued and timber locked
together for a total span of 11' that supports half of a 7'3"wide dormer.
Replace 2x4 collar ties with custom glue laminated curved collar ties.
Replace exterior windows.
Frame 2 closets in the larger, main space.
ELECTRICAL: Install 3 smoke and 1 CO detector. Smokes at top of stairs and one in
each room. CO in main room. Wall outlets per code tbd.