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45-042 (5) 1 348 OLD SPRIN 3EI.ELD_RD i 1 BP-2003-0716 GIS#: COMMONWEALTH OFMASSACHUSETTS ` ap:Block:45-042 CITY OF NORTHAMPTON ' Lot: -001 Permit: Building Category:FIRE DAMAGE BUILDING PERMIT Permit# BP-2003-0716 Project# JS-2003-1161 Est.Cost: $13000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: ' License: Use Group: Homeowner as Contractor. Lot Size(sq.ft.): 27834.84 Owner: FOURNIER FRANK N III Zoning: SC Applicant: FOURNIER FRANK N III AT: 348 OLD SPRINGFIELD RD Applicant Address: Phone: Insurance: 17 HARLOW AVE (413) 586-2831 () NORTHAMPTONMA01060 ISSUED ON:3/6/03 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR FIRE DAMAGE & REMODEL TO CODE 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: 1 i 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: Receipt No: Date Paid: Check No: Amount: Building 3/6/03 0:00:00 1498 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo I • File#BP-2003-0716 � I APPLICANT/CONTACT PERSON FOURNIER FRANK N III ADDRESS/PHONE 17 HARLOW AVE (413)586-2831 () PROPERTY LOCATION 348 OLD SPRINGFIELD RD MAP 45 PARCEL 042 001 ZONE SC 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: REPAIR FIRE DAMAGE.&REMODEL TO CODE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: • Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: /Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate AND /OR R Sp ecial,Plan A / Permit With Site Plan Project: Site 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 Sewei Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm S et Commission d�S' Signature of Build' O icial ate 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. ,. its t. , • t,,: , , _ 1 '. ; �=©. -,' 17711. �` :44 e. 0ity,of Northampton 'at "� o�Per�, m ,_, ,s. B 6 2003 `1�ui'Iding•Department • 'CurbkG 0/4)ore a,° emo tA"_, << 2 21�2 Main Street f. 5 r/Sep �c AOai ab fi:, z. �� t �0.t .Room 100 W°a:.er/WelllAva Pmt�+ ** �� :. , ,,,. Alt„Nortf<ia.r.�pton, MA 01060 � ;T�worttSets ofi�Struelui-�I �as� .�. .,�. y Y`,2JU hone 413-587-1240 Fax 413-587.1272 PC.ot%.011'e PJai == � `-!- Other Sp ct • M. ' 'APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING . Deed) I- P5Y SiECTION l kSITEiINFO,RsMATIOEN 1_U�e�'ce • �p 0W� Lt (�j� This seetig to be com leted by ofi rce � '. • 1.1 Property Address: s ,_ -. {Y ,iz,, ����� e �j ��t 4t19��`e.\ pc, sM4,..„.„,,•.,„.„‘„,,.. a�.. .,„ „� .. ,Q�t , .. . • a �t ' �1 4-�,a vY) �`Zokn•e -� • �.a�0ue.•4 bt,�lct . �: !� � �c s . a so- 8 = E,,„et5 District ,h, . at CB�D str,cf ,i rh } u . .. .. --� .._._�.._._ _.2 SECTIONt2 PROPERTYO1VNERSHIP%ATHORIZ }DAGENT I '2.1.Owner of Record: ! • • Far!k•— d ► 01 0 v c .1'7 I—ICQcY C-d J ,4 U . Name(Pri Current Mailg 6Id�ess: J / OK -- s6 — Telephone Signature . <s< • • ' 2.2 Authorized Agent: • . Name(Print) Current Mailing Address: Signature •Telephone SECTION 3_. ESTIMATED,a.CONSTRUCTIONC�OSTS Item Estimated Cost(Dollars)to be Official Use 0niy ompleted by permit applicant 1. Building ' �7 ga60 41 t� (a) Building Permit Fe`e 2. Electrical4 i O co . (b)'Estimated Total Cost;of • Constructionlfrom,.(6) , z . ...:. 3. Plumbing W Building`Permit/4 • I 4. Mechanical (HVAC) . . .,. .. .., .,. . .... .._ .. A) /A, . . ., „.„ ..,..„...., ,.,..„. ..., „.. • • .. ••,..:•. . ... .• .. . .. ..• . .• ..,....,... .. ....,..• .„ . . , .....".:..:-:-.,,„:„•...,,.. . . „ . , . . . ... . , .,.....,.,.. _ ,,.,., , ..,......., ,..... ,. ..., „.„ ., ...... - --,... -"- •••.•••,.. • . „.... ........... _,,,•... . 5. Fire Protection . , .., . . ..„... 6. Total = (1 + 2 + 3 + 4 + 5 Check Number . i Th s`t'ection,3For•Offici:a':Use Only • • Pe 'Nb t Date issued I I$ul4!r�g miturner . .,y„ ,gym 3 r ter x 3 :v a 5 3 �, i r k ;- 3 S .; 5 y fk. I L 'x �b'�r. Signature E Bu I i Commits o er/ins ector•, Bu id ngs, ;, D ... .. . w. , w .�, ..._w-.# =:1 r Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO.LACK OF INFORMATION Existing Propo e1\1d- Required by Zoning This column t'o be filled in by - I Building Department Lot Size / A ,23, I i ffll Frontage i A ID Setbacks Front 1 6W' Q/ d Side L: ► R: L: R: Rear g V Building Height 1 ` Bldg. Square Footage <156,v/ % I Open Space Footage d % - - (Lotarea minus bldg&paved —60 s parking) #of Parking Spaces 11//4 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW ✓ YES IF YES, date issued: • IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO L DON'T KNOW YES 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 NO 1/ IF YES, describe size, type and location: D. Are there any proposed changes to or adlditions of signs intended for the property ?YES No IF YES, describe size, type and location: �� ..� ....�..:.c..�w.r.,e.a.-x..� sac...-. .. ; ,_._.__ .fn`• t . ` . . • . 1111�qP3���'y" � t �a �.,�� � �f�k�'� ��� 3 T�5�'�k ��`'��,,"W'" 3 9 ru �I r� y '�'�'�' ��3�'�t�, ., =KSECTION5�D"ESC•RPTIONS'O'FPxROPOSE '{NORKfcte�kall ppulcabl1)' � ' i M _ 113 u'+J 3-..3a W C .y §16n35.A,z,M e$-° NY.23 t6 N32W36- z',igg i] J 4»3 1_. ti;13 t . s n » AR',s 5..., .;V.1133•.3 .,WP•3;3i ttiM:ral .Y - _ME New House 0 Addition • ❑ Replacement Windows Alterations) Roofing Or Doors 0 I I . Accessory Bldg. ❑ Demolition* New Signs [ ] • . Decks [ '] Siding [ ] Other [ ] , - Brief Description of Proposed Work: Re.?Ct I r . Pie'e. mCAae + 'Qe. 6Nti t_\ 46 CoC . .. Alteration of existing bedroom t7Yes No Adding new bedroom Yes 'No r', Attached Narrative Renovating unfinished basement Yes No -. • Plans Attached Roll o- Sheet F . sra lfi who' se nd ®. add.titrob t eRrS &in ho;=s.i.n 'e_e. h" fdEt:Ow>t a. Use of building: One Family 17... Two Family . Other • b. Number of rooms in each family unit: _ Number of Bathrooms 1 � I c. Is there a garage attached? Nt1 0 d. Proposed Square footage of new construction. 1 Dimensions e. . Number of stories? I f. Method of heating? E lec4 ' C_ Fireplaces Woodstoves! % Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction (Jac eQ Fret en t / „,ii i. Is construction within 100 ft. of wetlands?_ Yes L No. Is construction within 100 yr. floodplain Yes j. Depth of basement or cellar floor below finished grade NI 1 '4 k. Will building conform to the Building and Zoning regulations? t/ Yes No , I. Septic Tank V City Sewer Private well V City water Supply l 3 - kf r- P S x`ECTION 7ta 'OWNERAUTI1ORIZA;TfONq `fOzBE•OMPPLEETigR WFIEN 3®WNER"P:01.T OR CONIRACTO SPPLIESf L g10 DING PE1100 I , as Owner of the subject properf , hereby authorize to act my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner ' Date F 04 1\1 Fcuc �,` r �- 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. 1 Print Na 1 / . ..-- - 1 gV'., L nature of Owner/Agert i D e - • f I �.. . 'C .10N ERVICES a� S;ECTI�N 8 ICONS tRU T t • • 8.1 Licensed Construction Supervisor: • Not Applicable 0 Name of License Holder - • I . License Number • Address Expiration Date Signature Telephone • 'Mare mi®r®V ite n ;0on. 7 : '' € . � z ik; Not Applicable 0 Company Name _ . ' 0 Registration Number • Address Expiration Date Telephone SECTI0N10 iWORKERS' COMPENS`ATIONINSURQNCE3 AFFIDAVIT(MG.L c 152, § 25C(6;)) a, Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida' will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 • 1.41K4Aa 6m O lit aten 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 hike who does not possess a license,provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5 J1. Definition of Homeowner:Person(s)who own a parcel ofiland 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 homelin a two-year 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 al Zo g Laws State of Massachusetts General Laws Annotated. Homeowner Signature ii . • B,.R� )fir$ CLx� xxf Nnx#Eptiitpfart' ==1"� a ;��t? �6 xsaacfinscffs' -:v = r.,,W+! DEPARTMENT OF BUILDING INSPECTIONS • , • 212 Main Street 1 Municipal Building -, ' Northampton; Mass. 01060 . �," r' WORKER'S -COMPENSATION INSURANCE AFFIDAVIT • I, ' • (i1ttee) 4'. . with a principal place of business/residence at: r(phone#) (stt et t/city/statehip) do hereby certify, under the pains and penalties'of perjury, that:, • I am an employer providing the following worker's compensation coverage for my employees working on this job: aS pe I C • � �C P i� '3Z�? • ce Company) t7 (Poflicy Number) � 1 (Expiratfo Date) f • ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Conipany/Policy Number) (Expiration Date) . tf. (Name of Contractor) (Insurance Company/Policy Number)I (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number), (Expiration Date) (Name of Contractor) (Insurance Comp ny/Policy Number), (Expiration Date) (attach additio of rhect ifnc -n.ry to include information pertaining to all ooatractors) • ( ) I a a sole proprietor and have no one working l rking for me. ' ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ person:to do nraintrnc.nrr,construction.or repair work on a dwelling of not niece than throe units in which the homeowner resides oc oa the grounds appurtenant thereto i are not generally considered to be • employers under the worker's compensation Act(GL152,ss 1(5)),application by a homcowois far a license'or permit may evidence the legal at't,,c of an employer under the Workkoe'a Compooaaiion Act. I understand that a copy of thir.ctaiemeat may be forwarded to the,avert-mast of Industrial AociEcnta'Oflioo of Insurance for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties • consisting of a fine'env to S1,500.00 and/or inapt-600 of up to omc year and civil pc allies in the form of a Stop Work Ord -and a fins 0(5100.00 a day against me. • • For depart x a a1 use oat), . i Permit Number p�} Lot#oic ,-:r:;.i&I,,,,. Signature of Licrosee/Permittee Date • • • 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." I 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 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 tie proper permits and inspections are I, :. , ,Co-v / 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 00� d Address of work location L Qev c. 014 Pco-V% v> shim 1,5 laS 11 e V.� 1 Re,,n\ove_ 0I c Re`(`(`b ue_ 0 1,2 ceiA c, 1 1 v; q_, 64-an mut) ce 1 kr19 oY. ce vAe-t- /1,1 I n401 1 Pa44ec , Qo'1 ce r4e 43- i 1 ne,(4) Ror-V lyee4-W (Ag_ 40/7 Plywc.cp 5Iq I! e,,,„ keercl 61 ;try ley wig In5iral I n 5 h - k q4c x or\ & i I �. ' - iitsiair4orAme' ,• orow-.1 , v Oidirdwommu . : , a It (6.• ., 4 .4' t 0 ' ! r?crPtecv . Pre511 room, Mill J , r over‘eval PI y 1.4 00 C.a•- ' .510r1P. r 11111.11111.111 D i ogirie , r , Adz 1 , Cevi; er- fae. b , . , vly. , . R a(7-TP fTh iN 1_ LI Z / . ;L. E ,I a / r2 ,Y i'Q X i ES • L....1 VI 11‘8 . a , I (1 tjt R.00‘r(\ _. 1 , IL 0 IA lore* R 1: I Ce IA+err"' X) tjr)I M eZil) C ' _ -ri 3 1 , 7 , 942 3 Tab • � I ci ra 1�1 • ts GOP '. a CC • • r� sx X W Q6 41,) • 1 � • • • Ct •ROA D � I I N. f I I v- tuxCr 'kap o f � • • • • •