12C-030 242 SPRING GROVE AVE BP- 2012 -0018
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map :Bloc 12C - 030 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: HANDICAP RAMP BUILDING PERMIT
Permit # BP- 2012 -0018
Project # JS- 2012- 000032
Est. Cost: $2900.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sq. ft.): 13503.60 Owner: LAMICA PAUL & LAUREN
Zoning. URA(100 /) /IU/\VSP Applicant: STEPHEN CAMP
AT. 242 SPRING GROVE AVE
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527 -7124 () WC
EASTHAMPTONMA01027 ISSUED ON. 7/12/2011 0.00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT RAMP
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 7/12/20110:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
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File # BP- 2012 -0018
APPLICANT /CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413) 527 -7124 O
PROPERTY LOCATION 242 SPRING GROVE AVE
MAP 12C PARCEL 030 001 ZONE URA(100 )//RI/WSP
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: CONSTRUCT RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 082531
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFqRMATION PRESENTED:
_LX 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
,:;� 14 'J ,1 ld
Signature of Building Official Date It
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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City of Northampton f�
RECE1V Building Department
212 Main Street
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Room 100
orthampton, MA 01060
'3- 587 -1240 Fax 413 - 587 -1272
OF BUIU O 1
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APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION r1 -SITE INFORMATION
This section to be completed by office
1.1 Prooertv Address
��/ ��� ��� r✓L /��� Map Lot Unit
OverlarwIstrict
Elm St DlstrIct CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
i
Name (Print Current Mailing Address:
S`z 2 ev y
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building /+ UJ C (a) Building Permit Fee
2. Electrical 7 (b) Estimated Total' Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) Z 0 1 00 • c'r+ Check Number
This Section For Official' Use Onl
Building' Permit Number. Date
issued:
Signature:
Building Commissioner /Inspector of Buildings Date
w ,
`
Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete In rmation
Existing Proposed Required by jZog
This column to be 11i ed in by
Building Departme
Lot Size
'
Frontage
Setbacks Front
Rear
Bldg. Square Footage 010
Open Space Footage %
(Lot area minus bIdg & paved
# of Parking Spaces
(volume & Locat on)
A. Has aSpecial Permit/Variance/ Finding ever been issued for/on the site?
�� �� ��
NO v�� DONTKNOVY �_* YES v��
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
»_�
NO
�~� wwn/ m,vW 0 ,c,
IF YES: enter Book 1 Page and/or Document#
��
B. Does the site �� tecontain a brook, body NO �~� DONT KNOW »�� YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained »�� Obtained �~� Date ----
�_/ �_� ' '�____________]
C. Do any signs exist on the propert �� �� y7 YES v�� NO v��
|F YES, describe size, type and location: �
���������������������`��
D
»~� «,�
Are YES NO
D. �~� x_�
IF YES, describe size, type and location:
E. Will the construction ectivitydisturb (clearing, grading, excavation, n, filling) over 1 acre urioit part nfa common plan
that will disturb over 1 uoa7 YES K � NO K )
�� ��
IF YES, then a Northampton G0onn Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable
New House F Addition F Replacement Windows Alteration(s) KI ED
Or Doors 17 1
Accessory Bldg. Demolition New Signs [0] Decks [[Z) Siding (0] Other
Brief Description of fropos Ze_
Work: 4 ) 09 41 a/!�
;Gi" ) 0 zc-'C�
Alteration of existing bedroom Yes No Adding new bedroom Yes 'k No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
00
IN66 "Wire RMW
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. I s 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED -WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR: BUILDINGPERMIT
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
as Owner/AAWz"ized—
Agent hereby declgre that the statemenS and information on the foregoing application are true and accurate, to the best of my knowledge
and
Signed under the pains and penalties of perjury.
1-1 -n
Print Narn:,,,�
Signature of Owner/Agerit Y'—/ Date
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Smervisor Not Applicable ❑
Name of License Holder �9 J 2S
License Number
As Expiration Date
Telephone Ng
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
5'7 SY t Telephone / �f
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....... ' No...... ❑
�nenr>a
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
The Commonwealth of Massachusetts
Department of Industrial Accidents .
Office of Investigationg
600 Washington Street
Boston, MA 02111
www.mass gov/dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electric ans/PIumbers
Applicant Information p Please Print Legibly
Name ( Business /Organization /Individual):
V v
Address :
City/State/Zip: ,, lO Phone .#. e 2
Are you an employer?. Check the appropriate'box: -Type ofpiro - ect (required)•. /
1. I am a employer with 4.. El I am a general contractor and I
: have hired the sub contractors
6 . ❑ New construction
employees (fall and/or part-dine). -
2_Q I am a sole proprietor or partner- listed on- the.attached sheet 7. E].Remodeling
ship have no employees These sub - contractors have .8. Q Demolition
working or me in any capacity. ploy=s and. workers'
wOTlCCTS'' Ct9mp MSM IICe
9 . �a�dloll
: - C
required ] S. Q. We are a corpoiatron and its 10.0 Electrical repairs or additions
3. I am a homeowner doing aall offi
work cers havexercised their 1 I.� f Pitmnbmg repairs or additions
myself [No workers' comp. 6f exemption per MGL 12: Roof
4
insurance requaed.] t c. 15 §1( and we have no - `�/
employees. [No workers'. 13. Other
comp. ingM= requited.],
`Any applicant =checla -box #Alimust.also fin out the section belowshowing Alcirworkars' cotnpeasation policy information:
t Homeowners who submit this affidavit.iudicating they are doing an work and then. hire ==must trust submit a new affidavit indicating such.
:Contractors that chock this box must.atiaehed an additional shed showing the nacre of the sub = contractors add state wlhether-or not1hosetatities have
employees. 'If the sub- contractors bave employees, they must provide dwir workers' comp..poficynumber.
I am an employer that is'** viding workers' compensation insurance for my employees Below is the policy and job: site
information. .
hmmance Company Name: U ✓ cZf'tS... D .
Policy # or Self -ins: Lic. Expiration Date:
Job Site Address: �� S� /mast jeo v- City /Stafe/ZiP= '' I C'• /O 2�
—,
Attach a copy of the workers compesation policy declaration page (showing the 9h number, and exE irahon date .
P cY - - )
�o penalties of
Failure, to secure coverage as requued under Sectrrni5A '2 ofIGICrL c: T52 caii lead to fire smon of
fine up to S1,500.00 and/or a
one -year impiisonmen4� as well as civil .penalties iu the form of a STOP WORK -ORDER and • a fine
of up to S250.00 a day against the violator. Be advised 1* a copy of this statement maybe forwarded:to t ,O i 'ce. of
Tnvestrsatrons ofthe bIA. for insurance' covera>e veriticatron:
Ido hereby certify under th pains dpenalties ofperjury drat the cnformationprovuded�rbov ittrL _and current
Signature: ate•
Phone
Official use only. Do not write iii this area, to be completed by city or town official
.City or Town: PermitUcense # -_-
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 #•
r
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 one home in a two -year period shall not be considered a
homeowner."
The building. department for the City of Northampton wants person(s) who.. seek to use
the home owner exemption - to act as their ovvn 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 /footings (before back fill),
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
�ermits 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 torme.
Date
Address of work
location
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527 -7124
Submitted To : Paul and Lauren Lamica Phone- 527 -2638
Address : 34 Hillside Meadow Drive Date - 4/24/11
Southampton, MA 01073 242 spring grove ave. florence
We hereby submit this estimate for - Ramp
The ramp will be built with all pressure treated lumber.
I will build a landing at the doorway and the ramp will aim towards the garage.
There will be railings built where needed with handrails on all sides.
If bushes are removed, I will build the ramp in that location.
Otherwise, the ramp will be built in the driveway.
Building permit and trash removal are included in the price.
Price = $ 2900.00
Contractor Supervisors License number 082531
Home Improvement contractor Registration number 135204
1 propose to supply materials and labor -in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted within 30 days Authorized Signatur
Acceptance of proposal. Signature f�/
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