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17A-062 (5)
0 6 C -D 6, . s File#BP-2016-1249 APPLICANT/CONTACT PERSON DAVID FORTIER ADDRESS/PHONE 32 Laurel St NORTHAMPTON01060(413) 586-8965 PROPERTY LOCATION 243 BRIDGE RD MAP 17A PARCEL 062 001 ZONE URB(100)/ 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: DEMOLISH GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 008026 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved__,Xdditional 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: § i AEL-6 Sib-6 A4 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 Pen-nit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signa re 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. File#BP-2016-1249 APPLICANT/CONTACT PERSON DAVID FORTIER (3-O 6 0 ADDRESS/PHONE 32 Laurel St NORTHAMPTON01060(413)586-8965 PROPERTY LOCATION 243 BRIDGE RD IA — MAP 17A PARCEL 062 001 ZONE URB(100) S THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST HDU, ENCLOSED REQUIRED DATE $ ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid INP-W pU FC�J AIL-- Typeof Construction: DEMOLISH GARAGE New Construction hr�gyj �j�w;�►EU Non Structural interior renovations Addition to Existing Mkl L, Accesso Structure Building Plans Included: Owner/Statement or License 008026 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 Commission Permit DPW Storm Water Management Demolition Delay 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. Department use only -__-- ---__ City of Northampton 5tafus otPermlt . .' ul Ing Department Curb Cut/Dnvewa Permit. Y 212 Main Street Sewer/SeptieAvailabdity P.00m 100 WaferM/ell?vailabilty Northampton, fV1A 01060 TwoiSets of5tiuctural Plans p - -------- hone 413-587-1240 Fax 413-587-1272 Plot/s�te Plans Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ECTION 1 -SITE INFORMATION .1 Pronertr Address T.hfs section to,;be conipfeted b:y office `I leo Map Lot Unit. Zone Overlay Disfrict Elm St'Distnct CB;District -:: =CTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I Owner of Reccrrd: c'a�►�_ �-►9d '�%�'fir' ��'3 Fi��I�� t�� r r;" �� avr4 me(Pri Current ailing Address: /7-��y—Lf6sc ff" �_ Telephone ffafure Authorized Aaent: �aau +��i iC�� $ lir-�,'� �� /�c7 i1 4ri�'►U,� ��q C%rUc 11 ne int) ^� Current Mailing Address: iature Telephone TION 3-ESTIMATED CONSTRUCTION COSTS Estimated Cost(Dollars)to be Official Use Only completed by permit appiicant 3uilding 1 (a) Building Permit Fee lectrical (b) Estimated Total Cost of Construction from 6 'lumbing Building Permit Fee lechanical (HVAC) re Protection otal=(1 +2+3+4+5) ' �;GJ.(� ,Check Number This Section For Official Use Only ing Permit Number: Date Issued: 3ture: Building Commissioner/Inspector of Buildings Date 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 Frontage _..__....._._.__- ... __.._._ __. -.___ _ ...___..___._. _.---_._ -_.... ........... Setbacks Front Side L:=---__M R. p w..,.,— L ,_...:. .. R::'- Rear •..Rear Building Height Bldg. Square Footage _._ __...__ % Open Space Footage _.,.,___... °lo (Lot area minus bldg&paved -••- parking) #of Parking Spaces .... .--. _ _ _.. . Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:` 1F YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES a 1F YES: enter Book Page. and/or Document#% B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date issued ry ' C. Do any signs exist on the property? YES 0 NO 1F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 1F 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 n NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 6-DESCRIFTIOM OF PROPOSED WORK(check all a p olicable) 7 New House ❑ Addition ❑ Replacement Windows Alteraiiora(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Deimolition New Signs [O] Decks [CJ Siding [O] Other[ED] Brief Description of Proposed,,— --I Work: I'VX 1904-JEU C>14J�T(/N(� 1�1t 13 r �h Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet .... 6a. 9f New hoiuse acid or�addi-io¢ to exesfa a�_Eaa�Isuu . c©erol�9e e`fiG�e G©FfOr as�e�: 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. 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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, A- l� �" 'rf� as Owner of the subject property hereby authoF(ze� i 'C"L Fed` to act.oii 4behaFf, in all matters relative to work authorized by this building permit application. f Si Pure of Owner Date i tes-CSOL-r/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 perjury. Print Nam .` Signature of ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licansad Construction Supervisor: Not Applicable £ Name of License Holder: °}e!'9�t '� E((% C-5— 01 0111(l, License Number Addr e Expiratio Date +VtA 0—33 SignatuYe Telephone 9. Registered Home Improvement Contractor __ ,._ Not Applicable £ n Companv Name Registration Number 7/l0 //fv Address Expiratio Da e �a� GA�ut2L Ste. � '11��1'1l✓,/ 0MlTelephone 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.X. £ No...... £ 11. - Hom" wnelt fleffii�o 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 helshe 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 i The (C'®mm oxwealth ©f Mas a ChY,sefs Dm1r�,en o �lv��wns97 a,I Accld'.rY 9S gfjxe of Investigations 11 600 Waskington Street F Boston ISA 021111 Wo>rkelrs' Compemsztnom Insuirs-mee A11;1�1� tate I alnIl e>rs/�om'����tc®>r�/ Ileetrrn�fl�m�/I��un>ilmhe>r� AirnllDurmnt Info>rmllaltno>m rLegRbRy Name (Business/Organization/Indivi dual): Oft cl i 0 �vtrn 5 v :e h(<' 'S c Address: 3 L City/State/Zip: , ,`'�' n-� (310U-0 Phone #: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. F-1Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, EX Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 7 We are a Corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 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.[:1 Other comp. insurance 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: M� i 6 9tF t/Eei / Y �rI/S• ce) . — i Policy#or Self-ins. Lic. #: �SS-'7 s Expiration Date: dq3 13p..ioct"on � Job Site Address: – City/State/Zip: , c( A� �t 7 ofob 0 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 gertify under the pains and penalties ofperjury that the information provided alcove is true and correct. Signature: / Date: �4 Phone#• Ll 13 Of use only. Do not write in this area, to be completedby 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 cf Ncrthamptcn 9- 2 r f•' , � 212 vain Street o Municipal Building :: 1 Northampton, Num 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEA/IPTION 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/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 occupancv 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 1 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: aq3 &,2(6 C"& L), The debris will be transported by: �Qiu"Dl6)z f t2F'Z The debris will be received by: L,'F(2YL11L.1&- Building permit number: Name of Permit Applicant l(0 t [Q Date Signature of Permit Applicant ACCOROP CERTIFICATE OF LIABILITY INSURANCE DATE{MM/DDIYYYY) `,../ 4/25/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT House Ring & Cushman Inc. FAX -9322Oxt: A'C' P.O. Box 447 EMAIL ADDRESS: 176 King Street INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURERA:Ohio Security Insurance Co. 24082 INSURED INSUPERB:SafetY Indemnity Insurance Company 33618 David Fortier Builders INSURER C: 32 Laurel St INSURER D; INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER CL1642501438 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR _ ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MM/DD MM/DDIYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE a "FS OCCUR DAMAGE (Ea REN D nrrence $ 300,000 PREMo BXS55722835 12/2/2015 12/2/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE g 2,000,000 X POLICY❑PRO JECT ❑ LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: Expense Mod Factor 1 $ AUTOMOBILE LIABILITY EadacademSINGLE LIMB $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED AUTOS AUTOS /6225303 10 8/2015 10/8/2016 BODILY INJURY(Per accident) $ X HIRED AUTOS X AVTOSWNED PPReOPEERR.Zt AMAGE $ Uninsured motorist BI spirt limit $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ —TIEDT1 RETENTION$ $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS'UABILfTY YIN TATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 100,000 OFF(CER/MEMBER EXCLUDED? E NIA A (Mandatory in NH) XWS55722835 9/4/2015 9/4/2016 E.L DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMrr $ 500,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE - ,r. © 1988-2 C CORPORATION All rights rese d. ACORD 25(2014/01) The ACORD name and logo are registered marks of A INS025(201401) 5/6/2010 City ofNorthampton Mail 243Bridge Fd �J���� � --= = � Louis Hasbrouck <Ihasbrouck@northammptqnrna.gmn> __-__W_- � 243 Bridge Rd 1moeoage Louis Hasbrouck <|has bnouok@nmfhannptonnna.gov> Fri, May 8. 2018ed1:47PM To: Carolyn Misch <omisnh@nmthomptonrna.gov> Cenn|yn. We reviewed a zoning application for an addition at 243 Bridge Rd. | denied it for rear setback (URB. only 18). Turns out it's a corner lot. If they chose the lot line w/16' setback as the nide. /t meets the 15' requirement. That leaves the other lot line as the rear but there's 50' setback on that side. The existing building and addition meet front setbacks. See attached. OKwith you? Louis Hasbrouck Building Commissioner City ofNorthampton Town of Williamsburg ' (413) 587-124Ooffice /413> 587-1272fax 17A- 62.pdf 31P{ mtpo://nai|.gooOn.num/nai|/oa/uxO/rui=2&ik~ex5fl9aoro&vimw=pt&oearnn=nent&m~1540r2e7fcO359ef&vim|~1ow;72orfcO359ef 1/1 - N7051'11" w 109-260 o " 1 � I2 28.0' 26.5' (n c o ,10 eo re ove , 0 oLu � Qt rn 50.1' remove r^ 17.9' Lel + Cn #243 0 rn Z Q X BOOK 7897, PAGE 92 1015,35± SQ. FT. S 80'44'09" E 90.09' BRIDGE ROAD LEGEND O FOUND IRON PIN ■ FOUND STONE BOUND "PROPOSED IMPROVEMENT LOCATION" PLAN OF LAND IN NORTHAMPTON, MASSACHUSETTS PREPARED FOR JOSEPH ANTHONY LAMANNA & ERICA L. LAMANNA SCALE: 1"=20" MARCH 28, 2016 of s, HAROLD L. EATON AND ASSOCIATES, INC. RANDALL ��, REGISTERED PROFESSIONAL LAND SURVEYORS E. 235 RUSSELL STREET -- HADLEY — MASSACHUSETTS IZER X3550303 2 y 413-584-7599 413-585-5976 (fax) email — hleatonOaol.com ° SURVEY 0' 20' 40' 60'