23D-022 (3) 498 ELM ST
BP-2005-0607
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-022 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit# BP-2005-0607
Project# JS-2005-0803
Est. Cost: $11000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 4007.52 Owner: POWER-GREENE MELISSA
Zoning: URB Applicant: POWER-GREENE MELISSA
_4T .OQF! Mrr ----
Applicant Address: Phone: Insurance:
498 ELM ST (413) 586-9958 O
NORTHAMPTONMA01060 ISSUED ON:11/22/04 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW BATHROOM ON EXISTING 2ND
FLR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: G S rvice: Meter:
i' Footings:
Rough: �
1v2 � � Rou gh:
/ QJ (/. `1. House# Foundation:
4/ L. Driveway• Final:
Final: r 414, -c i
�tl��
,(� Final: _
h 1; Rough Frame: g,/-7,
67il 4-
s
Gas: Fire Department Fireplace/Chimney:
Rough: Oil
Inslrlqtirn•
Final: Smoke: o K 6 -a9-os- ---/,—,7
Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy/ ite____
Signature: - "` .4~�
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 11/22/04 0:00:00 195 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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File#BP-2005-0607
APPLICANT/CONTACT PERSON POWER-GREENE MELISSA
ADDRESS/PHONE 498 ELM ST NORTHAMPTON (413)586-9958 0 Ar1/,-)1422-4-""
PROPERTY LOCATION 498 ELM ST
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MAP 23D PARCEL 022 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid j7J-- S0
Typeof Construction: CONSTRUCT NEW BATHROOM ON EXISTING 2ND FLR
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
INt2AMATION PRESENTED:
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 Co ' sion
/ 2_0a
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
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-• , 'of Northampton Status of Permit:
ilding Department Curb Cut/Driveway Permit
n-1
12 Main Street Sewer/Septic Availability
2004 Room 100 Water/Well Availability
NOV 17 N pton, MA 01060 Two Sets of Structural Plans
phone 4113-58 -1240 Fax 413-587-1272 Plot/Site Plans
L- -- INSPECTIONS Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Ad/dress: This section to be completed by office
Li 11 5 mil t,-, 5+ Map Lot Unit
AJokr-iA,,t,,,e,tevt. Ail o i'6 O Zone Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Al 1 i s5 r O=��' �- C� tik, 18 I 1/4, Sf
Name(Print) Current Mailing Address: 1 5 y
*c)
kk �/;3_,-- €A_ ' Telephone
Signature
2.2 Authorized Agert: /Q [' / / f�J C' A fL14q. -C 1✓N0 J ell ` I., S 7' _. /746 dory-�Name(Pr' t) Current Mailing Address: //
6,,c .....,7".................--------------
Li1 240 Li ?OD
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 6 Cj)o 0 (a) Building Permit Fee
2. Electrical ( 0 (7 0 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing /J 0 DV Building Permit Fee
4. Mechanical (HVAC) `
5. Fire Protection
6. Total = (1 + 2 + 3+4+ 5) /l 000 Check Number /96 &, ) 4-'
--
This Section For Official Use Only
Building Permit Number: I sssuu
ed:
Signature:
Building Commissioner/Inspector of Buildings Date
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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Varian inding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorde t the Registry of Deeds?
NO DON'T KNO YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grOt gtexcavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ( NO' )
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 Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other[ ]
Brief Descripti9n,of Proposed I l-
Work: r V f �Cl 1 "`�' t�D v� 1A ('
Alteration of existing bedroom Yes ' No Adding new bedroom Yes v No
Attached Narrative Renovating unfinished basement Yes /o
Plans Attached Roll Sheet
6a. If New house and or additio to existing housing; complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms 1
c. Is there a garage attached? AP
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, lkit I S vV'e_if Cr( (' y lQ, , as Owner of the subject
property /� I
hereby authorize 1-0 Y1 f \{0 (\c7'[e
to act ton mj�y,, behalf, in al tters relative to work authorized by this building permit application.
-)( ( S2 A./J/j-P A -1� �1:� ] (I i D 0 t-
Signature of Owner Date
, 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
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
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 0 No 0
11. — Home Owner Exemption
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-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
,Local Zoning _ and State of Massachusetts General Laws Annotated.
Homeowner Signature ibtl�.l 1.�1�-t � j2A
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Proposed New bathroom at 498 Elm St, Northampton, MA
Demolition and Construction
1. One non-load-bearing wall between existing room and main hallway to be
removed and rebuilt one foot further into hallway, still leaving 36" plus in the
hallway.
2. Two new walls to be built to enclose new bathroom space.
3. Wall below bathroom to have sheetrock removed and floor to be opened up to
allow access for plumbing and electrical.
4. Bathroom to be sheetrocked, tiled, etc.
Electrical: work to be completed and permit obtained by Esworth James, Amherst MA
1. One baseboard heater to be installed.
2. One vent fan in ceiling, vented to attic
3. One dedicated GFCI Circuit
4. Overhead lighting and switches
Plumbing: to be completed and permits obtained by Gingras Plumbing, Springfield, MA
1. Install new waste pipes and supply lines to existing waste and supply.
2. Install bath shower unit, sink, and toilet.
•
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Urif12 ofNorthampton'.?A..7'rel4 p___,,.., 1 t•
A �� • gt.s•krhntrlle
v DEPARTMENT OP BUiWri G INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Macs. 01 060 r`
WORKER'S COMTENSATION 1Th1SITRA CE AFFI
DAVIT.
ff� i `� 5a �odef — 6v-0.4,4 .
(I1 permlticc)
wiitrh a principal)place of business/residence at: — --
`� l p IW , y {— IV°1'f- a /11 D(0' ,hone' SW ! se
(su-=l/cirf/ atr rip)
do hereby certify, under the pains and penalties of perjury, :hat .
•
( ) Ian an employer providing the following worker's compensation cove age for my
employees working on this job:
ansuran=Company) (PoLic:Nur r) (r:-pirauon D2.1 1)
I am a sole proprietor, general contractor or omeowoer (, rcie one) and have hired
con actors listed below who have the followine --. ' s compensation policies:
0'_ a t12 (� S 0 1€ T a f 1 t r 1" d w°iketiLp42(Non c of C :?r::lcior) (IRRlranc:. Colnoan 'fP iiCi NuSIlc(r) �:pirduon l
(Name of Coo O cior) ( incInsua Company,Pojicy Numc_r) (i:kpira ion Date)
(Name of Cotm-aetor) (Lrisura.nc; Company/Policy Nanclx_r) (Expirrion Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Datc).
(. :ckiaocc l c'teceif neo=3-c-y to c,c,.&iaforta•Eoo pervuiaian to.11 oosr"_e.o:a)
-
- O I am a sole proprietor and have no one wort ng for me.
( ) I am.a home owner performing all the work myself.
NOTE:PI -se lx.9.zrc tl. ..trle bc.,, vm µbo eazploy pcwat to el.,r-•if,.--,r,-s =.�-.:c.Joo r gaff work oa.d..in_i;of
oot ODOM tt.-..1.1'oc tth.r to u'aicb the bam000roct read=or oo the c ouod 7a7.u-um.:^_.theca -t Da(Ca:.11v oocr:dani b be
eitptoyc-s untie the w-:0"---7.-_-ue°A t(GLit 52s I(5)),application by•bonooave for c tics...,:or pc.-mn rrcy evid ace t c
1cipl ct-acaz of en crployee under Ito War-kola C;oozpam.l;oo Act_
1tuackrrtaccl dada copy of thia entemna m.y be forw rtf.4 to tbo Dop.truroo.2 of I nA,vriti AA+odoarl O15oo of Iri-uraoco for t6.
covcr.zo vniGczioo and that Li1tac to soot=tovczase tmdc-r sxtion 25 A of MOL 152 cut Icd to the i•* ,;'ioa Of a imirMi PM'1i;C3
ooasisiag of a fine of up to S 1300.00.ndlor iag risoomcca of up to ooc year rod civil p.-o.ttio in 6c form of•Stop Work Order tad•
filb o(S 100.00 s day q icst me
For:.. rt.. t u.c only -
PCSZIl]t NuIDtx7
�` I� 0� h.(np. Lot
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Signature of Licscc./Pcrtniucc to -- .
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�CrztL of Northampton • i_ - /g �
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DEPARTMENT OF BUILDING INSPECTIONS , i /=
__ .
INSPECTOR 212 Main Street • Municipal Building •
,,
Northampton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supc: . 's nor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fancily
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 tegulations. 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 the proper permits and inspections are
made
I, r.1-et(S `k-e=.v- ,✓- ,ems 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 1,\ I `"l l
Address of work C1
location L-,-1 ' C� 5
i
No-✓ Ian-r 4 y Pc 0 l 0