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12C-027 (2) 54 BURNCOLT RD BP-2016-1030 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-027 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-1030 Project# JS-2016-001740 Est. Cost: $32875.00 Fee: $213.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AAREN HAWLEY 98625 Lot Size(sq. ft.): 11630.52 Owner: CAMERON JQAN Zoning: RI(100)/URA(100)/WSP(loo)/ Applicant: AAREN OAWLEY AT. 54 BURNCOLT RD Applicant Address: Phone: Insurance: P O BOX 5 (413);667-5684 HUNTINGTONMA01050 ISSUED ON:2/22/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-FRAME IN BASEMENT, ADD BATHROOM/LAUNDRY & STORAGE ROOM POST THIS CARD SO IT IS VISIBLE FROM THE §TREET 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 2/22/2016 0:00:00 $213.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1030 APPLICANT/CONTACT PERSON AAREN HAWLEY ADDRESS/PHONE P O BOX 5 HUNTINGTON01050(413)667-5684 PROPERTY LOCATION 54 BURNCOLT RD MAP 12C PARCEL 027 001 ZONE RI(100)/URA(100)/W5P000) THIS SECTION FOR OFFIPIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid zff2 C;PIP Building Permit Filled out Fee Paid Typeof Construction: FRAME IN BASEMENT,ADD BATHKOOM/LAUNDRY&STORAGE ROOM New Construction Non Structural interior renovations Addition to Existing` Accessory Structure Building Plans Included: Owner/Statement or License 98625 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON TI'IIS APPLICATION BASED ON INFO ATION PRESENTED: pproved Additional permits required(see below) c 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 c� s 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 e /f Buil g f icial 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. City of Northampton StatusofPerrntt27 7 Buil in Department Gtrrb Cur/Drf+�eway Permi# `,!��� t 21 Main Street islt ' FEB t t Sewer/SepCeAualfa61lr(` bt oom 100 UVater/V eCC:Ava# bility 'F k � �4 ,1�` y �,.y.,; gill DEPT OF F r UN.tca..F-<<• stha pton, MA 01060 Twa�Setsa€Structural Plaps i�� I ��-4 F „y {I �' t+ ' - NOfl rnn9 ° - -1240 Fax 413-587-1272 PIof/Slte Ptans , ::Other=S.:ecl: ,,:,_:::..':,_>,.,.... _�_::_,.__-_.,•. .. _ Fm APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE',OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION; _ This sectionifoibe_com'°lefedeb. _office.—..*.:,,' 1.1 _ _;_—_ Property Address: v_°,__:__ __.__.., ,a'_.-:::x—-— T__—_ .v T=—!,i?:iey;y_T_:,.___:FI2'i "'Sv'u=_i��^*:fJ::,F_r : ,. �_,: ,Unit r .�:, ..._. ..,<;=a., a:v,.,,::awn.,. ::..°•r_'___._'�.r.'�,_=.:;_r,..'.=.J,__�"= =' 7i t 2 Elm'r t.Dlstnct r _v. GB Dstrict - SECTION 2.7 PROPERTY OWNERSHIP/AUTHORIZED.AGENT 2.1 Owner of Record: TlDew1 c[;Y1nC�r�c�/1 � / / il1`✓1 Lv I cf Name(Print) Current Mailing Address: /3 _ 4'�23--e9A? Telephone Signature 2.2 Authorized Agent: t^— Name(Print) Curren Mailing Address: 4?0i 3 (c '7 J" Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �d` 75- (a)I Building Permit Fee 2. Electrical (b)','Estimated Total Cost bf Construction`from' 6 '' 3. Plumbing © Budding Permit Fee i 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) v7� '7]' Check Number ThisSectio For Official Ilse Only Date Building Permit Number: Issued: Signature: Building Commissioner/ln..spector.`of Buildings: 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 Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&payed #of Parking Spaces (volume&Location) A. Has aSpecial,Pennit/Vahance/Rndingever been issued for/on the site? .�� �~� NO �~�~�� DON7KNOY{ �~� ^YES \�y IF YES, date issued: IF YES: Was the permit recorded at the Registry ofDeeds? / NO "~�C 3 DONT KNOW 0 /ES IF YES: enter Book Pageand/or Document#F B. Does the site contain abrook, body ofwater orwetiands? NO 0 DONT KNOW 0 YES IF YES, has permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Doany signs exist nnthe prnpert �� ��y� YES �,� NO �^� IF YES, describe size, type and \ocation: D. Are there any proposed changes tooradditions ofsigns intended for the property/ YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, gradingexcavation,orfilling)over 1acre orioKpart nfacommon plan that will YEGy � NO �~+~� ' ~�/ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. | ^ ~^ � ' | X , SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable _7 New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs (❑] Decks [[] Siding[❑] Other[❑] Brief Description of PropoQsed j Work: F �� .hbe,sz.��f, ,+��c� ��/�V �-=+� =-� �r ��vc�.---,, S'h�' S'e- 't'=t� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement >< Yes No Plans Attached Roll -Sheet sa: If New.houre.antl-or.adtllt>lon to exi5tlng:h"ouslng compete Elie foFlowlnc a. Use of building : One Family X_ Two Family Other'. b. Number of rooms in each family unit: 2 Number of Bathrooms c. Is there a garage attached? __1 d. Proposed Square footage of new construction. Ted s: JGf 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 /d 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 Iy P, C A 0, as Owner of the subject property ,, ! hereby authorize l r-«l-e.✓�'s AIC fit' to act on ehalf, in all matters relative to work aut orized by this building permit application. t7l' //(A Z � Signature of Ow er Date as Owner/Authorized Agent hereby declare that the state ents 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. Prime Sign o Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holde �f S —C / License Number ll i Address Expiration Date s ' L Signature Telephone ;9`Regisfered_Home.IT"..__ Not Applicab�Np£ Company Name Registration Number X'011- <�_ 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...... £ 'l l r Home owner Egem`phon 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, i The Commonwealth of Massachusetts Department of Industrial Accidents T. Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: )B-uilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: )>X s City/State/Zip: b!�--1 /a,, e, .� Phone#: ;7 r�Y Are you an employer? Check t appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general,contractor and I employees (full and/or part-time).* have hired the',sub-contractors 6. New construction 2.�/'I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. F� 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. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [Nd workers' comp. insurancl,required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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.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/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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Of 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#: City of Northampton Massachusetts i. _V11t r DEPARTMENT OF BUILDING INSPECTIONS ✓t -x, ' r 212 Main Street • Municipal Building Northampton, MA 01060 ss� •,�115 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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/footinqs (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 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 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. Date Address of work location I' i I � City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 3c,,^,� � The debris will be transported by: 9,, A� �• e �✓ The debris will be received by: '��� Building permit number: Name of Permit Applicant fes , CQ ° f Date Sign-azure of Permit Applicant I New Wall — Remove Wall Water tank&Boiler j + Gas Line 3 `y1 i)TI Window � � y Water Line Washer/Drye. Sewer Drain 40 Existing Bathroom finished room Small Room Here is a general idea of the design we talked about. I accept terms and conditions of the estimate and have hired Aaren's Home Improvement to do the work outlined above. I agree to make prompt payments upon completion of each project. I agree to pay 10%of the total job cost,if for any reason homeowner decides to cancel project after signing of contract. A deposit of 1/3 the cost of the job is requited after signing contract for work with additional cost to place special order products(if necessary). Signature(s) Accepted By: Date: Deposit Amount$ CK# Date: Remainder Upon Completion: Contractor Signature: (Aaren Hawley) Aaren's Home Improvement Aaren's Home Improvement Page 2 of 2 8' New wan 4' 23' Closet Remove Wall Water tank&Boiler Gas Line Beam O o Window(14"x 33") 10' IMMM Emergency Window D UI) Water 16 Line 3' 6,. 40' � � � $, Sewer Drain 8' - Bathroom 7' 20' 11, 9„ Existing Existing Storage Room Finished Room 10' 3" 11' 23' 9 Legend ` New Wall ®-� Remove Wall Beam 0 Window(14"x 33") Emergency Window New Walls- will be constructed from 2x4 wood, with a larger stud every 10' to the concrete and fire caulked on both sides. There will be a continuous % fire block above the top plate. *As shown and stated in attached drawing. Remove Wall- will take down existing waifs, we will remove approximately 38" of wall between existing finished room and existing storage room. No door will be added this room will be an extension of basement. Windows- all existing windows are 14" x 33", there are 7 windows total. Emergency Window- will be added for a second emergency escape. Window will be at least 5.7 square feet. Metal window well will be added to the out side, gravel will line the bottom. SOL ct F� n,�-L, ep-cc)- R. Rtze I b,taw �go i .--� / n ����� �a� �LS..F'•'v'-�i2 �. n�l