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43-052 (2) 516 WESTHAMPTON RD BP-2005-0466 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43-052 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-2005-0466 Project# JS-2005-0615 Est. Cost: $1000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MICHAEL MATRISHON 074136 Lot Size(sg. ft.): 40772.16 Owner: BURKE MATTHEW M Zoning: SR Applicant: MICHAEL MATRISHON AT. 516 WESTHAMPTON RD Applicant Address: Phone: Insurance: 10 STRONG ST (413) 527-3959 EASTHAMPTONMA01027 ISSUED ON:10/22/04 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 11 X 11 SLAB FOR HOT TUB 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• Receipt No: Date Paid: Check No: Amount: Building 10/22/04 0:00:00 1105 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0466 APPLICANT/CONTACT PERSON MICHAEL MATRISHON ADDRESS/PHONE 10 STRONG ST EASTHAMPTON (413)527-3959 PROPERTY LOCATION 516 WESTHAMPTON RD MAP 43 PARCEL 052 001 ZONE SR 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 11 X 11 SLAB FOR HOT TUB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 074136 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 Co ssion 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. ®etaL x ortOmpton Stat Peri° ' u I h-, Department 0- Main Street Servet` e � ira�,trl ��� ; e C jj om 100 e `��tlort ton, MA 01060 T" Se oftrerlral{PTans� phone 413- 87-1 40 Fax 413-587-1272 :n h " "APPLIC LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed byi Section 4. ZONING All Informati6h Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by ZYO 77z- j Building Department Lot Size Frontage j 7Y- Iota Setbacks Front Side R1 L:�R:=-U Rear Building Height Bldg. Square Footage OR Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume2&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW J& YES 0 IF YES: enter Book Page and/or Document B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: 0 0 C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding(0] Other } Brief Description of Proposed ,i ri Work: iDr�� (� 1)_� k j — Cf PC fWoke-e4D wOze- c:_cr,NCQt`"lf' �� �� Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement �l Yes X No Plans Attached Roll -Sheet sa.lf-New-hoose' -n Or ddition tohexrstiric hvas�nct:.: orxiplete �efoifOur ri : a. Use of building:One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? N 0 / d. Proposed Square footage of new construction. I Dimensions til -Cd fC f 1C ,� e. Number of stories? V 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 A No. Is construction within 100 yr. floodplain Yes__A_'1_No j. Depth of basement or cellar floor below finished grade ND/1/ 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 I, Ini RL4 Yf�� as Owner of the subject property hereby authorize to act on behalf, 'n II matters relative to w uthorized by t is building permit application. Signature f 6wner Date M(A H ems- fit( �' � '� 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 the pains and penalties of erjury. Print Nam V/ lc, Signatul of Owner/Agent Date r t SECTION 8-CONSTRUCTION SERVICES t 8.1 Licensed Construction Sq�u/p�ervisor: Not Applicable ❑ Name of License Holder: N l c4� t���✓t � ry 1 /� .r, License Numbe L ID 5+ap V,i� A ✓ L, Address Expiration Dat i/-49, Signature Telephone 5:.>ti2eistoniirr'tl+r "menticiltca #or � 0rt ,,. x Not Applicable ❑ Company Name Registration Number Address 1 ,t Expiration Telephone SECTION 10-WOR£(ERS'"COMPENSATION INSURANCE-AFFIDAI/IT(M.G.L..c.T62,§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....... ❑ Nov..... ❑ 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 Y 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 r i I -r of �nrfl�a�l�� olt Ilk 4 DEPARTMENT OP BUIL00\1C INSPEC'Tt01.'S 212 Alain Strcet ' ?Municipal Building I Northampton, Vass. 010G0 i ; W0 rUG:-R'S C O\SII'EN S A'n0 N MS URA.N Cly Al, II7 A.Vj-j- 1 (1i ccns:-r�'perzn�ttcc) BVI h a prirlcinal place of businessfresidence at: —.._ . b ` �-Pi6wt/ (Pnoner) (,-nr-tlri ty/aaictzz p) i do hereby certify, under Lhc.pand penalties of perjury:, h:r ( ) I aim an employer providing the following'it,.'orkcr's cotnocnsa aan cove Lgc for lily etuplovees woraig on uus job: (Iasura Con ) (po€ic, ?-,*u--zb--r} (r:girtion i7 } { ) I am al�ro.,,ot-Icto > geatral contractor or homeow70er(ciicie orae) and have hired the conuactprs listed below wbo have the followjog workef's c000er?4adon policies: (t`+a c of Cony;aor) (lnsurzncr. Coinp3n}'!Pobci }'itIIIib--:) (!:)Inj.:on Date) -- (Namc of Coot;aaor) _ Ons- cc Comoaz,,-iPoUc%, N;uimcrr) (f ioif bon Date) (Name of conn-a &) (Iz sUracc: Company[PoUCy Numb-r) (Expimdo!i Datc) (Name of Cona-ac-Lor) �uuur3t1C4 Comr aay/PoUcy Numb,:,) (Ezpisatioo Datc). {ntt,a.cs1:.d'!i acs!x'..cG.cfnc�u�y-ca a-ic�taf`oces.ioa pertaiti,ns to.11 ooc�-�.'..u:s) I arm a sole proprietor and have no one worliog for mhe. { } I arn.a home owner perfonn'ma all the work thyself NOTE:prcae b<ncrlrc Lfia wi 1e bcmcxx+ncn wt,,c=p1oy p--'.O=to docr rcpu..wk oa.d.•el1:y of twt matt than 4`sv this in t='aich trx bomoowacr rxaada ac ea the vvuod)zgVj�tbeeo L-r we C-=-n!eXa:d..vd w be eizpror--z ux d-the�. �+a o ,= �aa Aa(GL'1 S2.n 1(5)),:y i--600 by a bomco%-=far-6o:=V-cc permit t>_y c�i&m=the Iega1 ctamc of cn==Prayec under df Woet,c a coar{yomaiioo Act.. t +.nd tha a on or(hi.mt m„y be forty-1-4 to the Depe.ctmr�of 1a4,. ..r Ac�d.:LY 01G.of Gaur aoe Jr—th< covcagc i'+a'irctioo acrd the L-iItae to scoarc txavcrnse ta�drz zoCSioo 23A of htoL 1 S2�lc.d m tba i�pasEiaa orc-+mf...l pcwltia - -,i ng ora rrne orup to S x.304.00.rwoc orup to ooe yr-r nod a%i1 pca ruo m dx form or.Scop Work Ordc nod r rua or S 104.00 z d.y Lpjaa roc For dq.^ t v.c only / /J�,/j�� -� l?lTII371 HLLIDt7C7 Lot - Slgnahtrc Of crnuucc ' �Kt1AMP�. a"' � ,�Iassachixsetfs - DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street i Municipal Building Nordiwnptoii, MA 01060 , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as leis/her construction supr. . sor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two fa»u'ly 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/footings (before backfill), sonotube holes (before pour), a rou¢h buildine 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 t 171, 1 3� C, �L;is C,n�z0 Lo f � � r f c� reasonable timeframes, etc.). Finally, RAMP recommends that coverage criteria for mobility assistance-related equipment should be based on patient functionality, safety issues (i.e. risk of falls), and patient environment. It is critical that the Medicare program recognize that the range of conditions and situations that make it necessary for Medicare patients to receive items of DMEPOS for mobility assistance are broad. We understand the challenges facing your agency as you strive to ensure that all Medicare beneficiaries are provided timely access to the medical equipment they need while at the same time protecting the Medicare program from fraud related to proliferation of use of products by patients who fail to meet necessary coverage requirements. We are hopeful that CMS will take all steps possible to ensure that coverage guidelines have the flexibility that is necessary to meet the unique health care needs of patients who require mobility assistance. RAMP appreciates the opportunity to submit these comments on the Proposed Rule. If you have any questions about these comments,please contact_at Sincerely, NAME TITLE ::ODMA\PCDOCS\WSH\331875\1 -6- W e- (\.j C)w N-eQ_ 3 v t �T 4-eh P7V IV /XA J 1 5 77o,T , 1 _ f � 1 s rs°T//v r b y �CE'C�/L•C 'S�2�1c� v Shoff T© Qou,v p re� � (q