24B-080 (13) 56 BRADFORD ST BP-2005-0699
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B-080 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-2005-0699
Project# JS-2005-000955
Est. Cost: $10350.00
Fee: $135.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10149.48 Owner: LARGEY MEG&
Zoning: GI(100)/ Applicant: LARGEY MEG &
AT: 56 BRADFORD ST
Applicant Address: Phone: Insurance:
56 BRADFORD ST O 584-5849 ()
NORTHAMPTONMA01060 ISSUED ON:1/10/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:CREATE UPPER & LOWER
STORAGE/RECREATION CRAFTS IN 24 X 24 DET GARAGE,AMDENDED 3/17/09 - ADD
BATHROOM
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 1/10/2005 0:00:00 $135.00M0
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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File#BP-2005-0699
APPLICANT/CONTACT PERSON LARGEY MEG&
ADDRESS/PHONE 56 BRADFORD ST NORTHAMPTON ()584-5849()
PROPERTY LOCATION 56 BRADFORD ST
MAP 24B PARCEL 080 001 ZONE GI(100)/
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: CREATE UPPER&LOWER STORAGE/RECREATION CRAFTS IN 24 X 24 DET
GARAGE,AMDENDED 3/17/09-ADD BATHROOM
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 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
63(18I07
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.
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•Department use only
City of Northampton StatusufPernitt
Building Department Curb Cut/Dnveway Permit
212 Main Street Sewer/Septic Availability
Room 100 VI/ater/tA/etl Availability
Northampton, MA 01060 Two Sets of Structural Flans
`',15, >�ne 413-587-1240 Fax 413-587-1272 Plat/SttePlans
Other Specify
APPLICATION 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
56 Grad hivol 5t . Map Lot Unit
No(J'i1AviipfiM ( MA 0/060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ry Rr4•I f d 51-. iV b✓�L1 kh4'p taYr
Name(Print) .Jl Current Mailing Address:4, 3 6 s
Telephone
Signature
2.2 A
Name(Print) ent Mailing Ad�res5.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ( 410, 000 , 60 (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) C `pro / 4 f/0 d OC
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
. .
. `
Section4. ZONING All.Information Must Be Completed. Permit Can Be Denied Due mIncomplete Information
Existing ' Proposed Required byZoning
This column mbefilled in by
Building Department
'
Lot Size
Frontage _^ -------'--- � ------�--. -------/ '-- --------'—Setbacks Front
Iront
Side ���---� ��F---� L�/ B:| / r---� | �
Rear
Building Height
Bldg. Square Footage
Open Space Footage
---- | -- F----
(Lot area minus»uo&paved
parking) \
\
[---� \ �--- [---1
#of Parking Spaces
Fill:
(volume&Location)
A. Has_ _ Special Permit/Variance/F—dirig ever been issued for/on the site?
|F YES, date issued /
IF YES: Was the permit recordedat the Registry of Deeds?
NO 0
IF YES: enter Book Pagel and/or_ #|'
B. Does the site contain a bro k, body of water orwetlands? NO K } D�7K�W � ) YES K �
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained x—� Obtahned v�� Date |
�_� 4~� ' ' �
C. Do any signs exist on the property? x-�y� 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 0 NO C)
|F YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading vatio� or filling)over 1 acre orisit part ofa common plan
that will disturb over 1acre? YEGK��l NO K��)
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 I2 ElReplacement Windows Alteration(s) Roofing
✓ Or Doors El
Accessory Bldg. 1 Demolition El Replacement
Signs [I Decks [ElSiding[� Other[O]
Wioe Description of Proposed rk: dV ire, J11 i I►II I/ irisi14 Le w r � r,, 14+1ra0w (WAS, t yo ) /n [ a re)
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No 7f d/kl
Attached Narrative Renovating unfinished basement Yes No (ci,�_ ✓
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing,complete the following:
a. Use of bui ' g :One Family Two Family Other
b. Number of rooms in b family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new constructan,. Dimensions
e. Number of stories?
f. Method of heating? Fire• - or Woodstoves Number of each _
g. Energy Conservation Compliance. Masscheck En Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetland Yes No. Is construction within 100 yr. dplain Yes No
j. Depth of basement or cellar flo• .elow finished grade
k. Will building conform o 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
�,l`' 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
r 1, 11/1I , as Owner/Authorized
Agent hereby declare tha e staters nn&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.
Me- Lr i
Print Name
/ ((
Signature of 0 r/ to
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Re liste d.Rnm td"verneadirt Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE A III •VIT(M.G L.c. 152,§'25C(6))
Workers Compensation Insurance affidavit must be complete. -n, 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 r
.. 1 .. ';
11.. I3ome wner ®„. emption
The current exemption for",.meowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeo ' er to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 7:i, Sixth Edition Section 108.3.5.1.
Definition of Homeo ner: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 .-,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A pers. who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowne 'shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for .II 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 an Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
s,)
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The Commonwealth of Massachusetts
:
Department of Industrial Accidents
4,,, .., ,,:::7.,,
7, t- Office bf Investigations
i. s= 600 Washington Street
Boston, MA 02111
a,. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly•
Name (Business/Organization/Individual): _
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box:7
Type of project(required):
4. I am a gene contractor and I\
1.❑ I am a employer with 6. 0 New construction
employees(full and/or part-time). have hir the sub-contractors
1 2.❑ I am a sole proprietor or partner-
listed n the attached sheet. 1 7. ❑ Remodeling
) `
rf ship and have no employees These sub-contractors have 4 8. 0 Demolition
f working for me in any capacity. `,, Ffiployees and have workers' 9 Building addition
I [No workers' comp. insurance /comp. insurance.#
r,tquired.]
5. We,are a corporation and its 10.0 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. right of exemption per MGL / 12.E Roof repairs
insurance required.] t c. 152, §1(4),and we have no/
employees. [No workers' - 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also f• out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub,-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.polity 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/State/Zip:
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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day 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.
I do hereby ce under a pains and penalties of perjury that the information provided above is true and correct.
Sienature: . Date: 07101
Phone#: f13--se`I - SeHr1
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
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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 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 ne home in a two-year period shall not be considered a
home owner."
The building department for the City o ,Northampton wants •erson(s) who seek to use
the home owner exemption, to act as th=• own constructi.. supervisor, to be aware that
by doing so you become responsible for ompliance -rth state building codes and
regulations. The inspection process requ. -s that th• .uilding department be called to
inspect work at various stages, which inclu• - foundation/footings (before backfill),
sonotube holes (before pour), a rough bui . inspection (before work is
concealed). insulation inspection (if requir..) 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 o obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform ork (electrical, plumbing& gas)the
homeowner will be responsible to make sure that le trades hired secure their proper
permits in conjunction to the building permit issu:•, and that they get their required
inspections.Failure of the individual trades to sec e the permits and inspections as
required can DELAY the project until such time as,the proper permits and inspections are
made
I, l vl 1 i' understand the above.
(Home owner/r sident s signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date -1/7/6 9
Address of work �
location 56 l3 emu.
l'lldYfiLalf1 , O/Dhci