Loading...
17D-023 (7) 95 STRAW AVE BP-2017-0061 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-023 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2017-0061 Project# JS-2017-000113 Est.Cost: $5600.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRUCE DUBRULE JR 069157 Lot Size(sa. ft.): 9583.20 Owner: BOUGHAN PATRICK Zoning:URB(I00)/ Applicant: BRUCE DUBRULE JR AT: 95 STRAW AVE Applicant Address: Phone: Insurance: 21 EAST BUCKLAND RD (413) 834-3331 WC SHELBURNE FALLSMA01370ISSUED ON:7/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 10 X 20 DECK 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: FeeTvpe: Date Paid: Amount: Building 7/29/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File BP-2017-0061 ±',y APPLICANT/CONTACT PERSON BRUCE DUBRULE JR /� h+,y}'ft�" ADDRESS/PHONE 21 EAST BUCKLAND RD SHELBURNE FALLS01370(413)834-3331 PROPERTY LOCATION 95 STRAW AVE MAP 171)PARCEL 023 001 ZONE URB(100)/ THIS SECTIONFOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FI1,1ED OUT Fee Paid /MMO , Building Permit Filled out Fee Paid Tyoeof Construction: CONSTRUCT 10 X 20 DECK New Construction No Structural interior renovations Addition to Existing Accessory Stnme Building Plans Included: Owner/Statement or License 069157 3 sets of Plans I Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INyORMATION PRESENTED: J 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 Pemrits 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 -molition Delay Sim ature of Building 1Ticial 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. �--- OM/./ 74/1-5 714) /ter t ' Department use only City of Northampton Status of Permit. . `(' Building Department Curb Cut/Drveway Permit c 212 Main Street Sewer/SepticAvailebility cast �'/ +r e Room 100 WaterNNe(lAvailability Northampton, MA 01060 Two Sets of Structural Plans ` 7a:ne 413-587-1240 Fax 413-587-1272 Piot/Site Plans yRe 9'a1)' Other Specify Vc ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEC ON t -SITE INFORMATION 1.t Property Addresg; This section to be completed by office 9S` Ste-tier R- -c- Map Lot Unit Zone Overby District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: p G] PA1rrt'( &frk YN $— ST/hw Z Name(Print) Current Mailing Address: lea) ihD7 Telephone Signature 2.2 Authorized Agent: 14no,...c 4,It' 1+- C a) f ,6,,ctr‘r..,0 ✓LD ,1:42,5r/6 Fes-// Name(Pdnt) Current Mailing Address: 1376 G.� .. . . .. . iii/ .. Signal a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Hem Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical CM Estimated Total Cost of Construction from 1, 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+B+4+5) f(zce, cc Check Number /t) �© This Section For Official Use Onl Building Permit Number: Isatsu Ded: Signature: Building Commissioner/lnspector of Buildings Dale Section 4. ZONING Att Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be titled in by Building Department Lot Size Frontage Setbacks Front Side L 10 R,_.! S" Lao, R'. GJ Rear Rbe B-401-) Building Height - '- Bldg. Square Footage % Open Spare Footage (Lot area minus bldg&paved parking) #of Parking Spaces - —'- (volume&lauation) _._. _... _ __.. _._. _.. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW a YES Q.. IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 0. TF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO -0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingavation,or filling)over 1 acre;oris It pad of a common plan that wat disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition Q Replacement Windows Alteration(s) 13mx7R1i Or Doors ❑ Accessory Bldg. I Demolition [1 New Signs ([7j Decks .4 Siding ICI Other[17] Brief Description of P chosen Work: ICI ej ,.. /N.f1Y� 11G'•fYl �'� f +`�l Alteration of existing bedroom Yes No Adding new bedroom Yes A, No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a, Use of building: One Family Two Family Other I>. Number of rooms in each family unit. of Bathrooms c. Is there a garage attached? /t/e7 d. Proposed Square footage of new construction. )--00 Dimensions I e- e. Number of stones? I f. Method of heating? T Fireplaces or Woodstoves G Number of each g. Energy Conservation Compliance. "1 Masscheck Energy Compliance form attached? h. Type of construction if Lei' Is construction within 100 ft.of wetlands?_ Yes , X No. is construction within 100 yr. floodplain YesNo 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, r 1( 1-4P `ri ltai , as Owner of the subject property \ �� II hereby authorize O 8 CO✓.1 tr'L,Xltr.-t.. ( ' ". 0_ I to act on mAL-half, in al afters relative to work authorized by this building permit application. I soca Siena of s mr Date I, e uze ! . Lei< Cr 3 />' Cor-Jfk.-hias Own:. •u torized .e •ereby declare that the statements and information on the foregoing application are true and accurate,to the best o -.ge chef Signed under the pains and penalties of perjury. Bitve_ Q✓YJn 4 Print Name Signature ofwn f gen,.— Date SECTION 8-CONSTRUCTION SERVICES 6.1 Licensed Construction Supervisor::: Not Applicable £ Nameof License Holder'._ p"Iufj - .... License Number -) E. hKr4 11 rry� sk�CK.0 /4 /to%S7c ,'/ac/i� Address Expiration Cate Signaur( e Telephone 9.Registered Home Improvement Contractor: Not Applicable E. l!R eCoo,SY- f G `f 7 7 Company Name Registration Number a-I f 8U�4Ch." shcbredk l=am/g of CCSB Address �1 1 fI Expiration Date IJ Telephone IJy11 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit.will result in the denial or the issuance of the building permit. Signed Affidavit Attached Yes tl. -Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 titan 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 ail 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 ofMassachusetts General Laws Annotated, Homeowner Signature __ N The Commonwealth of Massae/ntsetts 1=74 44 Department of Industrial Accidents -Ik Office of investigations irk j` 600 Washington Street , Boston, MA 02111 ..,. .7..---.r'.z o'W m'ww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name('Business/Organization/Individual); LC/A C6r$ne4.4 Address: 34 5 tek(4,41 IZG' City/State/Zip: h4tcis-,- F'/4 API/. el32hane #: Are you an employer?Check the appropriate box: Type of project(required): l$-I am a employer with t� 4. J I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ( New construction 2.[1 I am a sole proprietor or partner- listed on the attached sheet. 7. LJ Remodeling ship and have no employees These sub-contractors have 8. 'D Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.$ S required.] 5. Q We are a corporation and its lO.L] Electrical repairs or additions 3.0 I ata a homeowner doing all work officers have exercised their It.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI, 12.0 Roof repairs insurance required.]I c- 152,§t(4),and we have no employees. [No workers' 13.JANOt her 4.Go.%- comp_insurance required.] i 1 *Arty 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 tConhactors 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. Lie.#: Expiration Date: Job Site Address: 1,— S1,'-'- lie, - ...✓ Oily/State/Zip:S/y _+' a+-..4"1Ql. 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 cerdfy under the pains and penalties of perjury that the information provided above is true and correct. 7 Siypmture:.._ �/2-.,^i" c_- Date: 7/1/9/7( Phone V13 $`J Y33— / Official 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 . c. N. Massachusetts Crill:f 7 R DEPARTMENT OF WILDING INSPECTIONS t' 212 Main Street • Municipal BuildingY ' Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Budding 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 he, 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 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 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: q. jti?w i1 The debris will be transported by: L'5 The debris will be received by: V 9j�i y iZ ,yc L Building permit number: Name of Permit Applicant tf1r4 few ntf L . 7//v// Date Signature of Permit Applicant 9 5% sr/ , k A-v c. 0cc( - j /at,CLre•--- • '�f fro u 5� . r -‘31 c NCS.. fit' • 1. irwa, 47, / City of Northamptoi i �G�////` Building Department 7%/ XJGPlan Review 5 .57 et - i¢ru c 212 Main Street Northampton, MA 01060 Dtcy De±4 & 'sirallll- ( ii . n11 --tt.bil- )-s. le Alfi Xi S1mx) —.- --.1111WFtIn ,7 pilt ` 7 y r;itir %� V 17,� II STc� i-?s ,5v mar --es — ‘ o ' -__-----1 ).1- o n Pd J'C JP /Z-1)`) imuggPsngsgo 7 31 1of 4-,Ax p t 1 tri+-t;..-t ).-./. le j)vvbct 64rM a 1 11- I -61_ -6,1 - l -G' _ t 1 — 95 5T, #-u- 4-Cl'-e-. I Q-4-64 - seer-1)71 .fir r _ P^t of-srcoA-c t. J' po in .&oQst I. parr em-to /214-t4,,, —i Pr Lr (701-• K r7 'sr/1,t,-- j-,,,%-✓1'3rP t14* tit ?Jr ? tl '