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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 r 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. re { t C 0 City of Northampton f� RECE1V Building Department 212 Main Street Z Room 100 orthampton, MA 01060 '3- 587 -1240 Fax 413 - 587 -1272 OF BUIU O 1 R7H ; O 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 r 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�/ ZZ Ll fe 07 All http://www.northamptonassessor.us/tabs.htini 3 � E dtJ- h t J w, �i pro perfi e s 1 of 1 4/l/2011 9:07 AM