24C-046 (9) low BP-2008-0691
GIS#: COMMONWEALTH OF MASSACHUSETTS
.111111.001, 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-2008-0691
Project# JS-2008-001071
Est. Cost: $1000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10280.16 Owner: MAHONEY JAMES J III&
Zoning:URA HD Applicant: MAHONEY JAMES J III &
AT: 345 ELM ST
Applicant Address: Phone: Insurance:
KIMBERLY A MAHONEY (413) 586-9857 ()
NORTHAMPTONMA01060 ISSUED ON:2/8/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 110 SQ FT HOME OFFICE IN
BASEMENT
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 2/8/2008 0:00:00 $50.00798
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0691
APPLICANT/CONTACT PERSON MAHONEY JAMES J III&
ADDRESS/PHONE KIMBERLY A MAHONEY NORTHAMPTON (413)586-9857 0
PROPERTY LOCATION 345 ELM ST
MAP 24C PARCEL 046 001 ZONE URA HD
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,�,a�j � D
Fee Paid 79
Typeof Construction: CONSTRUCT 110 SQ FT HOME OFFICE IN BASEMENT
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
IN.FORMATION PRESENTED:
1/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
aziot/oy
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
v C ',Qf Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
` %� 212 M n Street Sewer/Septic Availability
�� 1 �SRoo 100 Water/Well Availability
�, -, C� �- ,, ;,� on, MA 01060 Two Sets of Structural Plans
phck08- -1240 Fax 413-587-1272 Plot/Site Plans
:, � � r`n
\/cw1p, •. / Other Specify
v
A PLICATI TO CONSTRUCT,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
i ' FL PI S•T Map Lot Unit
NO/a.P-,1 NIP-roil, MA ow o CEO
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
1 1
2.1 Owner of Record:
CAM e 5 7 M 4/ ot( 3L/ fLN Ho jaTH 4AVT-•,) 0/Oc,v
Name Print) i Current Mailing Address:
Telephone
Signs re
2.2 uthorized 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 i Qa (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Z C' n Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
{/ (�
6. Total= (1 +2+3+4+5) Check Number t b 0
This Section For Official Use Only
Date
Building Permit Number: — Issued:
Signature:
Building Commissioner/Inspector ofBwldings 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)
I i
#of Parking Spaces
Fil
l:
(volume&Location) —1 ,-- --•- ••-•-••--- ,A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO Q DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Reg' try of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ei DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q . NO er
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 constnIrtion antivity disturb(clearing, grading, exc vation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
H,qs 13uuLK -C-EtD
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition (❑ Replacement Windows Alteration(s) f7i, Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding [O] Other[O]
Brief Description of Proposed Work: CRe4-rtH6- 110 S0 w(`-1 EKCLoStb i2C)C`.P-, li-( F4SeMeltr7- Fog_ E-/4Me
9 F F(G.e
Alteration of existing bedroom Yes I7/ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement ✓ Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following: •
a. Use of building : One Family V Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms -
' c. Is there a garage attached? N 0
/
t d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? /`/0 N'r 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 ZNo
,fo i.
j. Depth of basement or cellar floor below finished grade 7
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
1
•
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
74 Mg-s � M 444C‘WeY 14—
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 uri:ier the pains and penalties of perjury.
_ _- 7/4 mg-;' 7.-. _111 fl-Ho NEY -
Print Nam p
Signatu of 0 r/Agent Da
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: 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 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 he
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
orthampton Ordinances, tate and LLo al-caning ws and State of Massachusetts General Laws Annotated.
Homeowner Signature / ��
The Commonwealth of Massachusetts
Department of Industrial Accidents
�A n Office of Investzgaions •
tol 600 Washington Street
S.
d,= Boston,M4 02111
www.massgov/din
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ADplicant Information Please Print Legibly
Name(Business/Orgaaizadon/lndividual):
Address:
City/State/Zip: Phone-#:
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a emplo Y er with 4. 0 I am a general contractor and I
6. ❑New constriction
employees(full and/or part-time).* have hired the sub-contractors
1 2.0 I am a sole proprietor or partner-
These on the attached sheet 7. 0 Remodeling
shro and have no a loyees These sub-contractors have 8. 0 Demolition
-working for me in anycapacity. curployees and have workers' 0 v
gy 9. Building addition
[No woricers'comp..ms..��ce comp.insurance.+
required] 5. We are a corporation and its 10.❑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. n of exemption per MGL 12. Roof repass
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.❑ Other
•
comp.insurance required.]
----+isatY apPticant that cam pox i1 roust ae;o nu out toe scnon MOW snowing then workers'campensanon.policy=form:Mon
t Hotneowneri who submit this affidavit ineir•Atino they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
:Contractors that check this box must.attached an additional sheet showing the name of the sub-contractors and sate whether or not those entities have
employees. If the sub-concactors have employes,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/StaielZip: , '
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$1500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a da'q against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Zo hereby rdfy der the penolrips of perjury that the information provided above is true and correct.
nature°— _ ._ ta' Date:
Phone#:
11 Official use o )1 Do at write in this area,to be completeddby y or town official
Ciy or Town: _ P-er-mit/License-#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector
6. Other
Contact Person: Phone#: if
oy _
r
a . Jna=saciTiisrt.5 I_f
g: �I
y— DEPARTMENT OF BUILDING INSPECTIONS ry c=_!=r
212 Main Street • Municipal Building
INSPECTOR
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMFNT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups:•- sor. 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 regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footines(before backfill).
sonotube holes (before pour). a rouQb bufdine inspection (before work is
_ concealed).insulation inspection (if required)and_a final bjuldine 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
•
V,A M E.) V. M A-I0 tat Y - 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 a _"2 _ _
Address of work
location 7 tic C.-r1 - T