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17A-286 (3) i < \ , N. . : v ...--------- - - - '(- 344# 1 9 °"' • z• o f el , : xr` . A . « • f `,P g ,r M1 gyp..., • `S ..b A a +� '^�� ,,‘.,,,,,, . ,. ' i .....„, : , ".1. :: i tt'1 7-:".. --1 7 _ c .. 4&444 '.,. - • • may t A t t1 t { � � Sz t = ti , a .i r � �'. � } b•. A ' S. x !. ,, ;..., t t ! t Yx } , 1 �1 " � , i as v � � � e . n ',;'-',-'17-',41;',`'. < _ .� . s ,yi" .- t* ro ! k� ift: 4 gyp , ! ■ w. 1 t t T. s f S Y 3 . T�Q• - • r 1 d a r " y fi s ® ` . s s., — —N27'53'24" E 232.42' 4 " 232.42' — 203 61' 7 28.81' 06 •L 2 , ; C-06 N art ST f '`P _ '. •q- BOOK 3230, PAGE 25 SEE: PLAN BOOK 42, PAGE 13 ' 52,501 S.F. ± 1.205 ACRES I (TOTAL) 1 � J . TRACT 1 ! 1 '` s � ' 1 G r s i ,.� t� E. E a f a CL f (f ; e / W CY 1 o � i DWELLING i W g f'' °j o , /"4 170.91' LAI1 44.90' 44 CHESTNUT STREET Ito . 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 home owner." The building department for the City of Northampton wants 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 /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 - - - - - -- perrnit&_in_conjunction to_the_buildingpermitissued, _ 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 to me. Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents g isirl E Office of Investigations _ r r _ 600 Washington Street e , • E: =_ Boston, MA 02111 www.mass.gov/dia • -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Orgarnzation/Individual): N/ 4Vfl /TS / �1f1"GJ 'aiC Address: 6 5 41 au. w Pr IA) S 7 - City /State/Zip: f tt F4) thc-a /i44 d / 0 3 f Phone. #: I I/ 3 - 2 G 45 - 7 a 9 Are you an employer? Check the appropriate box: Type of project (required): /' 1. ®I am a employer with / . 4.. [J I am a general contractor and I 6- [aNew construction employees (full and/or part time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner - listed on the attached sheet 7. 0 Remodeling These sub-contractors have. r- - ship and have no employees b $. [�Henio,ition for me in any capacity. employees and have workers' working Y P ty 9- D Building addition [No workers' comp. insurance comp- insurance.$ required.] 5. p We are a corporation and its 10 Electrical repairs or additions 3. I am-a- homeowner -duin - G °r Zexcised ir-- --1-1.0 Plumbing repairs or additions myself [No workers' comp- right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Oilier comp. insurance required.} 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affida 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. lithe sub-contractors have employees, 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: / SS /9- /611 Z - e....0 VAI S4 /fit --•J ce e,,, Policy # or Self -ins- Lic #: tADC- -e- 0 D 3 n 1 o / 2 a / d Expiration Date: . ' // d Job Site Address: GLVF€ $' % P vs, City /State/Zip: * 4- te -4-) log 'VIA di «c Z 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: Tie 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 certify u ' th " , , nd penalties of perjury that the information pr.ovided_above istrue _and correct _ __ Signature: • Date: V I- / 0 Phone #: 4//3 —" Z 6" — 7 Official use only. Do not write in this area, to be comfkted by city or town official City or Town: Permit/License # Issuing Authority (circle one): i Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _ 6. Other - J Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : v 4 S �—' � 64 • v J / 2- License Number />7ecc , Jr+„J S %. hc ypsA J «, X1%14 Dot 7- Z3/2e1,1 Address Expiration Date / Z ea — ?v 5 !` gnatur Telephone 9..Recristeretf +lome4.ltni rovertet tOoritractol a iii i �4_a. 4 z Not Applicable ❑ iss ere/ Company Name Registration Number 5// cr/ Z a t ( 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 No ❑ The_current_exemption for "homeowners "_ extended to include Owner 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 o ampton eYetnances; a -.: • " • _. , - •:_ • . . sfreneral Laws Annotated. Homeowner Signature J SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) [J Roofing Or Doors ❑ Accessory Bldg. Er Demolition ❑ New Signs [M] Decks [E] Siding DM] Other [C] Brief Description of Proposed 2�{ )42-6: G c, Work: 12 &o E1H 5% G , 2EPLAcC (,PH NeL.J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes c_ No Plans Attached Roll - Sheet a'`like Use lid ddn i ct t gditrii4liaus ti iiinfilct .t e f no g: a. Use of building : One Family 1 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 AG N OR 0 TRACTOR APPLIES FOR BUILDING PERMIT 1, 141 aft r " -- i ' 4 I A I A , as Owner of the subject property herebyauth•rize -.14w ' yrL.J(Z&U to act on • / • - half, n - 1 • atters relative to work authorized by this building permit application. . Signat re o 1 ne Date 1 J 444 /-14-L-J , 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 thy•ains enalties of perjury. Print Na e / / Signature of Owner /Agent Date e Section 4. ZONING AU 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 2 - 4-14£ S J I Frontage L. __.__.. _ _._.___ _.._ ` Setbacks Front q s ' 9 a 1 f 1 Side L U1t R:7 5 = L:IT� -6-1 _1 R ��,'' __ Rear - Building Height t 2- ma Bldg. Square Footage 13 ab j E ?% Lo t 1 r: i Open Space Footage % (Lot area minus bldg & paved i i s i parking) # of Parking Spaces E 3 Fill: I ........._�.._�. w..,.�w.,._..�� /4/ �n��rc►�gUc - (volume & Location) a — r . -- ------ --- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 i Page; and /or Document # ry B. Does the site contain a brook, body of water or wetlands? NO - DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued C. Do any signs exist on the property? YES 0 NO e IF YES, describe size, type and location: _- -- — mD: Qre tt a e'any proposed c angel o'�or a loo or signs intenZEd roi die property ? YES 0 NO --- IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO er IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • -e ji a t 2 City of Northampton 1; , , , Building Department C 14 4 m - 4 ,. * k " 212 Main Street 1, Room 100 r q r)::.) Northampton, MA 01060 `' phone 413 -587 -1240 Fax 413 - 587 -1272 m - itlit 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 2 Z - FS+ Nom' s i Map Lot Unit f'C 6 i'F 9 (-- ' Zone Overlay District , EIm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Prin / Current Mailing Address: �i . ... 'A. „ Telephone Signature ' ' 2.2 Authorized Agent: / • James A. ate.) ,..,,t) 4 o i 7, etAi y y4 ,c) fr. / . c Name (Print) Current Mailing Address: �,-�. 4/4 - 2-4 5 76 71 Signature Telephone SECTION 3 - !MATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building , T (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of z D srD Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total= (1 +2 +3 +4 +5) 4I v Check Number 4 /OC9 J6 Y This Section For O Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 1 - r - Massachusetts - Department of Public Safct■ Board of Building Regulations and Standards • 'Construction Supervisor License License: CS 10092, Restricted to: 00 JAMES C LAWRENCE 85 MOUNTAIN ST HAYDENVILLE, MA 01039 --4-- - � , *Expiration: 12/23/2011 (,nin inner Tr 10999 4 a File # BP- 2010 -0838 APPLICANT /CONTACT PERSON JAMES LAWRENCE ADDRESS/PHONE 85 MOUNTAIN ST HAYDENVILLE (413) 268 -7099 PROPERTY LOCATION 226 CHESTNUT ST MAP 17A PARCEL 286 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 6 s 3 'Paq+ q-v Fee Paid �`U(p `C Typeof Construction: DEMO EXISTING GARAGE & CONSTRUCT 24 X 26 DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 010092 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON LVF0p.MATION PRESENTED: oved 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 Lif C7 47 -1/4.( j Signature of Building Officia 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 4 y 226 CHESTNUT ST BP- 2010 -0838 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 286 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- 2010 -0838 Project # JS- 2010 - 001239 Est. Cost: $42000.00 Fee: $124.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES LAWRENCE 010092 Lot Size(sg. ft.): 43560.00 Owner: CHESTNUT ST LAND TRUST CIO ROBERT ABUZA Zoning: URA(100)/ Applicant: JAMES LAWRENCE AT: 226 CHESTNUT ST Applicant Address: Phone: Insurance: 85 MOUNTAIN ST (413) 268 -7099 WC HAYDENVILLEMA01039 ISSUED ON:4/9/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO EXISTING GARAGE & CONSTRUCT 24 X 26 DET GARAGE 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 St. nature: FeeType: Date Paid: Amount: Building 4/9/2010 0:00:00 $124.80 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo