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23D-024 (4) t � BP-2006-0009 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0009 Project# JS-2006-0013 Est.Cost: $25000.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SHAWN FOREST 080296 Lot Size(sq. ft.): 4007.52 Owner: GRENAT CARMEN Zoning:URB Applicant: SHAWN FOREST AT: 492 ELM ST Applicant Address: Phone: Insurance: 17 EAST ST (413) 527-7258 SOUTHAMPTONMA01073 ISSUED ON:7/13/05 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 10 X 20 DET GARAGE & KITCHEN REMODEL 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 7/13/05 0:00:00 $80.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-0009 APPLICANT/CONTACT PERSON SHAWN FOREST ADDRESS/PHONE 17 EAST ST SOUTHAMPTON (413)527-7258 PROPERTY LOCATION 492 ELM ST MAP 23D PARCEL 024 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 607 si P Fee Paid Typeof Construction: CONSTRUCT 10 X 20 DET GARAGE&KITCHEN REMODEL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 080296 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 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 atfl. Aoingbe‘rtment f Flp ampton Status of Permit: , JUL — 6 Curb Cut/Driveway Permit 212 Mpin Street Sewer/SepticAvailability DES— T�r Ai,,, ,.,p ir1�r,! Room 10 Water/Well Availability y,s NbttlH hipton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION g# 1.1 Property Address: �` This section to be completed'by office T /t�, 1 £/t--t J� Map 01 0 Lot Unit ^i " �'i�'t Zone Overlay District ?J'A:rti.+ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .AY->vwrt.1 C/92 M Sl-yt, Name(Print) Current Mailing Addres Telephone Signature 2.2 Authorized Agent: if /oky-iim2- Leu ` I7 6.6 — Si a'1rrawu aUjv4 Name(Pri ) Current Mailing Address: 7 /13 2---CrY Signatur Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 171. Building 2 Cl OC')is (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing D'1.�l��J� Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection I /U 0 0.. 6. Total=(1 +2+3+4+5) Check Number /n� This Section For Official Use Only �+ Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date e fp Section 4. ZONING All Informatibfl 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 i 1 �� } Frontage '7'D i i Setbacks Front i ( I 1 �1 Side L:1— i R: I 'L:HI R:iOV Rear Building Height r I f 1....___�__ 4 Bldg.Square Footage if „ . i % %� 1 r Open Space Footage % r— (Lot area minus bldg&paved I l 1 1 i —� parking) r-- #of Parking Spaces I 1 :, I Fill: r I E- i i I (volume'&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:; 1 IF YES: Was the permit recorded at the Re istry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Page, 1 and/or Document#I B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES O 19S(, 4 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained iQ Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO ') IF YES, describe size, type and location: j I 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 ca, 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 E Addition n Replacement Wi s Alteration(s) I W I Roofing [3.2 �{ Or Doors Lld Accessory Bldg.j Demolition El New Signs [El] Decks [E Siding[D] Other[0] Brief Description of Proposed y, Work: 1C20 �i�L �;cl C -C / r�., i r 121 •�. id 1 `fILi�.(. e I �// Alteration of existing bedroom Yes 1 No Adding new bedroom Yes W •No . Attached Narrative Renovating unfinished basement Yes ieS,2___No Plans Attached Roll -Sheet s'.;�'-0y •u' S�'..«< ' `tar' 'v�"ri ii+�` _., xcw; �xtt+LL,.:'�..,a `;�^�.,,^ =:�gn., sa''IfNewahouseano 8i.tio to x1stinq ioustna cori"ptete4h #o fowtng: - 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 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--ay BE-COMPLETED`WHEN- . OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize i" to act on my behalf,in all matters relative to work author' s building permit application. ✓ / Signature ofOwn 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. r Print Name Signature of Owner/Agent J Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: ` 1 ©r)2 / 6 License umber ( 7 � `�i i* 7 7 Address 0/07 3 Expir ion Da Signature Telephone Z7 72,3 9.:Re.i er d`Home fm.rovement Contractors :s,.;: - _.sj Not Applicable 4/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 buildi permit. Signed Affidavit Attached Yes 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 Laws and State of Massachusetts General Laws Annotated. Homeowner Signature I 1 }4�ttA.XfP)..o. f . ' _ R+ L���,e ���1 (rii- of artliampioii 1 —)= p Y � E �l sncfir:tatta• _ - DEPARTMENT OP BUILDING INSPECTIONS j 1 212 Main Street ' Municipal Building Northampton, Mass- 01060 r' WOPJG R'S COMTENSATION ENSURANCk. AFFI ), V1T (oiLcL- - -.. .--- —- 1 (liccus. Jpernittec) v.-it.h a principal place of businessfresidence at: t7 ea _ — oIv , (phone-') Lo S 2s- . (str ..t/city/staterip) do hereby certify, under the.pains and penalties of perjury, that . am an employer providing the following'tvori:ef's compensation coverage for my . .rui oyees woring on this job. (— fl,,,c r4 cn',ck_5 02,0 {fib o - --- :„ - (iasu. c Conran~) (Policy Nu-mbcr) (r_- irai on Dal) ( ) I am a sole proprietor, general contractor or homeowner (c cie one) and have hired the conuactors listed below who have the following worker's coopensadon policies: (NArne of Contractor) (Inurancc ColDoany/Poiic NuII± ) -- (.E: rt ion DDltc) (Name of Contraor) (inssrznca CompanyiPo!icy Nuncer) (Ex-pir,:tion Date) , (Name of Coturactd;) (L su.rancz C.ompan}"/Polio)• Numbs) (Expiratio❑Date) - (Na.me of Contractor) (Lasuraacc Comoany/Poticy Numb-:r) (Expiration Date)_ (card:d i oc=i th .if ncccr.ry to inc?u4 tnform-6oc pctia'o to.11(=dr--c.on) I ( ) I am a sole proprietor and bave no one world.ng for me. ( ) I aut.a home owner performing all the work myself. NOTE:plesc be ntrartt's.t..•ta.lc bcmaowocr3 wbo cucplay pccani to do c-s&-,--..m o~s:e.,00 c rcpau work an a dwc.dl_,.of ant tncc a the ttnr-tars is"'aloha the botnoowoc maiden or co the crouaCt zpputun:rl thcc'.n e 0 oo(c - 1p copridertai In be cctployc-,„rY' the wui:dz o --.lira Act(GUI 52S 1(5)).=optrnaon try n bomooQaa far a Gczrz.:a permit tr_y c.idcooc the 1 IkQJ ct-v•of ¢ploy.<coder the Woricoet Ccc ,c atioa AoL 1 - -•thy. copy of this. mrrscm racy bo foc,..vd.d„to tbo pry.rtaama of lDA.rri.l nc�aCca ti OiSoo of trc.+r.000 for tb. 00 - . t... • cad that Lilt=to Swart:tAvcrase - seetioo 23A of MOL 152 eta ird to the i ",+*dioe of m 11O.11 PC'"Gies f to to S I S00.o0 attdlor• _.....�. of up to coe yt_r nod a.il pro. is in:be forest of.Stop Wott Oader and a f=of , •• as a. y ttttinsotnc EEET _ p: Lotii Stt. a • o 1 i�i5crlPcrtniucc e . Oscoli J f p20 t \ 4 ti �,, . $ , Q xtEr of Northampton • t- _ I �"- fir - _ c=1`�; Y r' ilassac}insetts si; rail .y�y` (_.a .. _ v ' .'7 DEPARTMENT OF BUILDING INSPECTIONS 4 r INSPECTOR 212 Main Street • Municipal Building _ Northampton, MA 01060 s e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups: ziscr. 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 feguiations. 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 conceaIed), 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, 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 Iocation r .k...t... • —1— r .... .. cz‘.c.•:IL—_s, a Na 1 i N) V 'IQ C . ... '•P . 11 ....0 • -&) . ' '.. • 1::. .....__, SI W 1 CPb . `• I' I e`' -----r)I 1 e $ $ sires 1 - - • 1 . } . . . !. • 7 1 p -3\k12-iC) /G-• ORS/r4S 2® . M-lad i-O/rceY44 17) 2 Lip s -- 05, c an 5 2 Cow j d 1f U. 5 i c I n 121%L / 24" ir 94 Z " / �-,f- . 't''''."'"..--:wg .,e ,, °.2• 48 >' , 00 a� iii ;: I—' �YJ/ al ?' icer i.. _ 7.:!!!! init-r:::':, , ,r "sue --, f=SA1a I : BD24 SB3O ' .• U18 (-:-:,,,,m,a:i:k-,ii,..x,....:::::::, .1""1:!..2"7::7: e unnuesvene se ueeae � yy��Sg . �'.L.. 98 N ¢7� c � sOL 6 tt / -t r 6G r z r 7 All dimensions size designations given are "f"•g°-" '-' This is an original design and must not be Designed:7/3/05 subject to verification on job site and a, released or copied unless applicable fee has Printed:7/3/O5 adjustment to fit job conditions. ; .: been paid or job order placed. 703094b1.kit Fp I Drawing#: I