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23D-077 (10) allatWOMLft BP-2006-0461 GIS#: COMMONWEALTH OF MASSACHUSETTS esiNagraltir CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2006-0461 Project# JS-2006-0656 Est.Cost: $7800.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 35501.40 Owner: ECK JUSTIN Zoning:URB Applicant: ECK JUSTIN AT: 117 WARNER ST Applicant Address: Phone: Insurance: 117 WARNER ST (602) 820-3240 () FLORENCEMA01062 ISSUED ON:11/1/2005 0:00:00 TO PERFORM THE FOLLOWING WORK:SHEETROCK 2ND FLR 3 ROOMS & UPDATE WIRING 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 11/1/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-0461 APPLICANT/CONTACT PERSON ECK JUSTIN ADDRESS/PHONE 117 WARNER ST FLORENCE (602)820-3240 Q PROPERTY LOCATION 117 WARNER ST MAP 23D PARCEL 077 001 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 Typeof Construction: SHEETROCK 2ND FLR 3 ROOMS&UPDATE WIRING 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 IpAMATION 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 Stree ommission ////. ow 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. ! _ �n Department use only Q1 City of Northampton Status of Permit: BuildingDepartment Curb Cut/Driveway Permit 0 212 Main Street Sewer/Septic Availability ' ` 2� :Room 100 Water/Well Availability P prthiarnpton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify OEP. APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 7 iNC e S T Map Lot Unit Q 0 Q-T 14 0 1 Fro 'v\N Zone Overlay District �J Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JusT J - Lic- 117 d cyr S-1 Name Print) Current Mailing Address: r, 3 a—LI ` Z Telephone Sign ure 2.2 Authorized Agent: . Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building g ()° (a)Building Permit Fee 2. Electrical oo (b)Estimated Total Cost of 0 DD. 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 Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Informatibrt 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 '6/o sit— Frontage fi(Pr Setbacks Front I I Side L: ' R:` L: ( R: • Rear I i • Building Height Bldg.Square Footage i Open Space Footage % i_ i ET;�-- (Lot area minus bldg&paved ! J parking) • r- #of Parking Spaces Fill: ,, 1 (volume*Location) A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO 0 DON'T KNOW YES 0 " IF YES, date issued:; IF YES: Was th permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES 0 IF YES: enter Book Page, i and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Ce DON'T KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? ' • Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO ef 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,ex ion,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. f SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ . Replacement Windows Alteration(s) Roofing Ei Or Doors El Accessory Bldg. n Demolition ❑ New Signs [El] Decks [I] Siding[0] Other[0] (JR_ uJ�\\ rceiRc�, la51-e- 0.)ail, C.w5-10,f5 (3 rho:�-,5 w�'1'ei p(✓ W2I I. Brief Description of Proposed _ Y Work: We a.�;1( be �r.e1/acrrtr, '1eIi vt) rtevJ dry0,211- Kn66 f,TU.ie f lec&es ly 1iJ,i/✓e replaced W rb a.✓he . Alteration of existing bedroom ✓Yes No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet sa_If NeW h useand-oc ddition. a exisf� c hous�n�t:co tp efr�th fo tav�rnq: 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-TO BE COMPLETED WHEN OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT ,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 (tN ,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. usT(r� Print Nam ..).2 70 45 5 Sig re of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9:Re its re fF ome=Tmproveiiienln.Go itracto Not Applicable 0 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 ❑ ,:P3-077'77rC,V1. ---1.1.4.7.., 111t., M4 11:11-.;MomezOwnewnteitiotion 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 — }_' -- r r / �o4�lw-r ahoy r.. • k "` -��'� cf Northampton 1 ; rZ c7+wr{�ntrlte' DEPARTMENT OP DUILDr)\C INSPECTIONS 212 Main Street Municipal Building • Northampton, Mass. 01060 r` WORKER'S COMPENSATION ON C`ISURANC>✓ AFFDD:i\'SIT ksfi EC � _ ...--- __. (Ii ccn.s&permli ttcc) with 2 principal place of business residence at: ' 1 (7 wI i NC ST. (phone) 6oz.-$Z13-321O (sit/ci ry/s-Latcra p) do hereby certify, under the pains and penalties of perjury, hal • ( ) I am an employer providing the following'workcr's corocnsanon cove,Igc for my employees worl6ng on this job: • • (Lsurmc Coney) lPclic: Nurnbcr) (E:-pi.ra on Dai^) ( ) I am a sole proprietor, general contractor or homeowner (ci cie one) and have hired the coil actgrs listed below who have the following worker's comoen_saaon policies: -- (Namc of CO„reior) (Insurance Coino1.nyl?olic"i Numhc) (F_xpiiuuon Date) (Name of Conn-actor) (Las rand. Compaq iPoli cy Nuncsr) (Ex-pinion Date) (Name of Conuactd:) (L1Lsuranc-- C.ompaoy/Folic}• Numbct) (Expiraen Date) (Name of Contractor) (Lesuranc Company/Policy Numbs) DatL). (ac th ad1,:«d1 srSccilnrocu.-}to fnclock inforto oc pcvfg to.11«aa-tors) --- ( ) I - a sole pFoprietor and have no one worli3.ng for me. (vKI am.a home owner performing all the work myself. NOTE:P1,-44 be c.ratC tt.` c botnco ax:a wbo a=ploy pc-or-1 to .raoc c rrar work oc of aot more t!_a t _t=r1 to t-bich the bomoowoc maidc,or cc ttac c oua6 z.pp;tt.coa:= oat. to be c>ploy�a woe-=the -.ioa P=(Gill52 I(3))...ppliaioo by.bomoomve fc a «pe-ait toy c.-idmoc tlr ley^tl crams of on¢?loy.-wader rho Workoer Compematioe Ara•_ t uoeic-c+ad[bat a Dopy of thu mt®cca may b.foa-a. '.J to the Dop rtmrsy of 1eAsr,icl Acodcard OfGio.of Loconooa for th. covc-acc vciretioa sad au[_tltae to Locum'cavernlb^o t,0etc-aoaion 23 A of MOL 152 cam 14 to the i n=rioa of ciminal p T•i+ia oR i�^g or..floc or up to s 1 SOO.00 artdlor i=p-boc rz1 o(up to ooc yr .r rod dvil pccatio is 6c roan of Stop Work Ord and. ftl o(S I OO.00 a day t7i¢4 me / For dGs.nc���u,c ocly lb/�(�j�[ Pcrraic Number C f 7 n.0 pz 1 i tgna.tire of rmiu,- U3ce Og1 .AMpiO a : ,`� Crzty of Nnrtltantixtnn z —'`_„ — /. $ aJ, � /�0 - jeassachusetts =_ DEPARTMENT OF BUILDING INSPECTIONS 4 =-- , INSPECTOR 212 Main Street • Municipal Building 'e Northampton, MA 01060 5 �'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 sup,: .•ispr. 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 seekto 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 fegulations. 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,__�ws 7 7 A) g - t- C- _ 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 /0A5/0 5 Address of work location ► f 7 (�t/1421V ER S-T. - J J011YD11'L1 0 10 Co