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23D-018 (7) 1R. BP-2007-0575 tits#: COMMONWEALTH OF MASSACHUSETTS Nfap:Bkack 23D-018 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-2007-0575 Project# JS-2007-000843 Est. Cost: $1250.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Larry Yentsch Lot Size(sq. ft.): 7100.28 Owner: MCKEEVER CHRISTOPHER J Zoning: URB Applicant: Larry Yentsch AT: 540 ELM ST Applicant Address: Phone: Insurance: P 0 BOX 120 (413) 584-4750 LEEDSMA01053 ISSUED ON:11/21/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:Replace Porch (existing footprint) 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: Date Paid: Amount: Building 11/21/2006 0:00:00 $50.00673 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Pile#BP-2007-0575 APPLICANT/CONTACT PERSON Larry Yentsch ADDRESS/PHONE P 0 BOX 120 LEEDS (413)584-4750 PROPERTY LOCATION 540 ELM ST MAP 23D PARCEL 018 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Iilding Permit Filled out j.PEePaid t) 673 t SO, v) Typeof Construction: Replace Porch(existing footprint) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 f l/zr/d 6 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 Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify _ 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 Map Lot Unit U� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: c'N4l 5,rou'h /Neekfi-.ws 5 yO �/-M 5, 'T,r/U��7f�rr✓ �J :2iJ Current Mailing Address:Telephone2.2 Authorized Aqe Z /24Z.`"?' .. Y v7 j lam// C ,ay /2—p ./.. -=7,54)5 , zl/d S, Name(Print) Current Mailing Address: A,Y1-2V y si-2,1//7-0e./2 75-0 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of 4.'r ZSD. 11J Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) S-10' U 5. Fire Protection 6. Total=(1 +2+3 +4+5) Check Number it 6 73 so,c ) This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date S w 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 _ ______ __ re____ —_-- Frontage ------ Setbacks Front j -- Side L: I. R:1 L:__ R:_ _ Rear 1 --- Building Height f-1 _ Bldg.Square Footage 7 % 7 Open Space Footage (Lot area minus bldg&paved I I parking) #of Parking Spaces I Fill: — — ---- —— (volume&Location) -- — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES 0 IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW Q YES 0 IF YES: enter Book Page and/or Document#j B. Does the site contain a brook, body of water or wetlands? NO 0 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 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO ip IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 Q NO 0 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 7 Addition n Replacement Windows Alteration(s) Roofing l l r-� Or Doors El Accessory Bldg. I i Demolition 1 1 New Signs [El] Decks [C Siding(El] Other 1V] Brief Description of Proposed RE PLA c t pt ,ZC/- EX,gT iv /CVO T/', '/V Work: /Ci1,�f160 ©/-h .�'. P )� 1if(37) ,z 2/✓ io , � le,:0 7, '07 rGn xo7.__ 174 boce.4_. A.•/s/07lee #, ZZ S Alteration of existing bedroom Yes No Adding new bedrooms "Yes r."No / Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.ff New house and;"or adclltlon::to-existing.housmgT complete the follovul>zq: 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 Clf✓L1 , as Owner of the subject property hereby a hori b• /Lf,+ :/6't 2 to act t y�thalf, i .11 ma e s rel tiv t t k authorized by this building permit application. Si•• re : Owne Date I, Aizy , 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 perjury. /2-47--y r y�4/1"-Sc,t Print Name 4 - v - ///i/o06 Signature of Owner/Age t� (/ l�Y Da e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: f 1/24 y _7 ye_/29 ct::4/ License Number / 0 *-e' /?-6), /// 1(4 y t? Address Expiration Date ci ���,.. /j _� t y - /•7' 5//L/a Signature Telephone 9.Registered Ho"me`Improvement Contractor ; ' Not Applicable 0 '/ -/l' jf / '57 o ) 10 YC Company Name Registration Number /// Lr/.40-5A, S T�L /� L�._.�d�c, 4/7G)/vi5e 'Vie,/D Address Expiration ate Telephone spy-ys� 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 0 11 =Home Owner Exemption 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 hirc 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 • • 7„r.51‘..A)-1 (riff of Northampton • — = C ��: "rj�f $l.=.Rrhasrtle • DEPARTMENT OP BUILDING INSPECTIONS -o 212 Main Street Municipal Building Northampton, Mass. 01060 �r WORKER'S CO1ef'ENSATION •G`ISURA_NCF AFFIDAVIT • • (Ii ccnsx/permi ttcc) with a principal place of business/residence at: diof 3 PO f30) i ////// -3Zf_. 577 he019se 1 `3 phone#) 9/ `5_flf' (s t/city/staJ.cJap) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the following worker's comocnsadon coverage for my employees worng on this job: .. j (Insur-n Company) (Policy Nu:pocr) (Expiration Data) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers compensation policies: • (Name of Contractor) (Ins!ranc'. Coinpanly/PGUcy Nw:nixr) (Exptrauon Date) -- (Name of Contractor) (Ins-or-an ComoanyiPoiicy Number) (Eipiraon Dale) • (Name of Contractor) (Insuranc Company/Policy Number) (Expiration Date) (Name of Contractor) (Loslrance Compaay/Policy Number) (EXpirtion Date). (.such additional iniect.ifnocc.u..�•to inch&infor-ma.noo pe•uua;.as to.11 ooa7-_co:a) • e` I am a sole proprietor and have no one working for me. ( ) I am,a home owner performing all the work myself. NOTE:plcx be eonrc t*st tei:Je bcmeowocra ubo=ploy pcsooa to ^. +-,ram .tcJoo c rcaa'oork oo a dwell_a of not more than tt rcc tmita in tt-bieb the bomoowo raid.=or co the p-ouada app rtenrri tba-ao c c not co-:.11y ocerdaei to be employs:a unee the we-ker' ...,ion Act(GL152.331(5)).application by.homeowner fare Goa3c a palnh nay a ideo«the le®J craw of ea=plays under dro Worfcce.Coompocaation Ae- I uadertand that a copy of thi.mier000t o=.y be forword.d to tba Dop.,te of 1ociaa-tricl Aecidoot'OfLos of tro+noeo for th. coverage vcirnaion sad that filtne to securc bovcrase under section 2SA of l.(OL 152 eaa Iona to the insposaioa of.Irma=!penalties 000sining oft rant of up to S 1.300.00.rtdtor of up to one year sad ci ail pep:hies in ese focus of.Stop Wort;order sad rtin of S I00.o0 a thy spina For dcp.nm=-�u.c orgy Pcrmit Number ///,?t 1.�p"-- Lot" Signature of Li .ttcc re ¢(ti-AMPi\ . 4OG ., -_* e (it-g yf Xortl �mpt t t ep1 jtiassactiusetts a n_i DEPARTMENT OF BUILDING INSPECTIONS _ _ /:- INSPECTOR 212 Main Street • Municipal Building ,,.,�� Northampton, MA 01060 . e' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis/her construction sup::: . nor. 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 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