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23D-022 (3) 498 ELM ST BP-2005-0607 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-022 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit# BP-2005-0607 Project# JS-2005-0803 Est. Cost: $11000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 4007.52 Owner: POWER-GREENE MELISSA Zoning: URB Applicant: POWER-GREENE MELISSA _4T .OQF! Mrr ---- Applicant Address: Phone: Insurance: 498 ELM ST (413) 586-9958 O NORTHAMPTONMA01060 ISSUED ON:11/22/04 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW BATHROOM ON EXISTING 2ND FLR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: G S rvice: Meter: i' Footings: Rough: � 1v2 � � Rou gh: / QJ (/. `1. House# Foundation: 4/ L. Driveway• Final: Final: r 414, -c i �tl�� ,(� Final: _ h 1; Rough Frame: g,/-7, 67il 4- s Gas: Fire Department Fireplace/Chimney: Rough: Oil Inslrlqtirn• Final: Smoke: o K 6 -a9-os- ---/,—,7 Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy/ ite____ Signature: - "` .4~� FeeType: Receipt No: Date Paid: Check No: Amount: Building 11/22/04 0:00:00 195 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo rr ofd rvl f�^,b/� ^� /' X ° cal,S'� �'y7 0 / • File#BP-2005-0607 APPLICANT/CONTACT PERSON POWER-GREENE MELISSA ADDRESS/PHONE 498 ELM ST NORTHAMPTON (413)586-9958 0 Ar1/,-)1422-4-"" PROPERTY LOCATION 498 ELM ST one) gov if MAP 23D PARCEL 022 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid j7J-- S0 Typeof Construction: CONSTRUCT NEW BATHROOM ON EXISTING 2ND FLR 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 INt2AMATION 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 ' sion / 2_0a 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 -----� -• , 'of Northampton Status of Permit: ilding Department Curb Cut/Driveway Permit n-1 12 Main Street Sewer/Septic Availability 2004 Room 100 Water/Well Availability NOV 17 N pton, MA 01060 Two Sets of Structural Plans phone 4113-58 -1240 Fax 413-587-1272 Plot/Site Plans L- -- INSPECTIONS Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Ad/dress: This section to be completed by office Li 11 5 mil t,-, 5+ Map Lot Unit AJokr-iA,,t,,,e,tevt. Ail o i'6 O Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Al 1 i s5 r O=��' �- C� tik, 18 I 1/4, Sf Name(Print) Current Mailing Address: 1 5 y *c) kk �/;3_,-- €A_ ' Telephone Signature 2.2 Authorized Agert: /Q [' / / f�J C' A fL14q. -C 1✓N0 J ell ` I., S 7' _. /746 dory-�Name(Pr' t) Current Mailing Address: // 6,,c .....,7".................-------------- Li1 240 Li ?OD Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 6 Cj)o 0 (a) Building Permit Fee 2. Electrical ( 0 (7 0 (b) Estimated Total Cost of Construction from (6) 3. Plumbing /J 0 DV Building Permit Fee 4. Mechanical (HVAC) ` 5. Fire Protection 6. Total = (1 + 2 + 3+4+ 5) /l 000 Check Number /96 &, ) 4-' -- This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner/Inspector 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 Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Varian inding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorde t the Registry of Deeds? NO DON'T KNO YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grOt gtexcavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ( 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 Addition Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other[ ] Brief Descripti9n,of Proposed I l- Work: r V f �Cl 1 "`�' t�D v� 1A (' Alteration of existing bedroom Yes ' No Adding new bedroom Yes v No Attached Narrative Renovating unfinished basement Yes /o Plans Attached Roll Sheet 6a. If New house and or additio to existing housing; complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms 1 c. Is there a garage attached? AP 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 I, lkit I S vV'e_if Cr( (' y lQ, , as Owner of the subject property /� I hereby authorize 1-0 Y1 f \{0 (\c7'[e to act ton mj�y,, behalf, in al tters relative to work authorized by this building permit application. -)( ( S2 A./J/j-P A -1� �1:� ] (I i D 0 t- Signature of Owner Date , 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number 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 0 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 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 _ and State of Massachusetts General Laws Annotated. Homeowner Signature ibtl�.l 1.�1�-t � j2A ./- \''r------ 1 $ 1 li i 1 t 1 ...... 1 417. ., . F i ,........... I i 1 i i i 1 r , t 0 i 1 I i . 4 1 , 4 „: _ ....- .......---.....--.--, _ 0 ro 0 l'i C 10 . , R r R 0 5 €_,, ( 0 k u otA i t D- I t ...t - - .- 1 $ 0 1 . u., ; . t4 i L'cooc li , ,\ ) 0 .1,,, '1 i . ' ' ' ' (‘ 4,,,'1•,,t:iks, • ( /.' • 0 • g , .. ; \i '` t'' t 1 1 i,q 4A- 7 ±)ket40, f 1 ., r t 1 ry 1„....\,. 1 i f i ! r.......:4.----. ' . I o ''0 Q k 0 0 .. .. . .,........ • ''. k....' .. ....,, • Proposed New bathroom at 498 Elm St, Northampton, MA Demolition and Construction 1. One non-load-bearing wall between existing room and main hallway to be removed and rebuilt one foot further into hallway, still leaving 36" plus in the hallway. 2. Two new walls to be built to enclose new bathroom space. 3. Wall below bathroom to have sheetrock removed and floor to be opened up to allow access for plumbing and electrical. 4. Bathroom to be sheetrocked, tiled, etc. Electrical: work to be completed and permit obtained by Esworth James, Amherst MA 1. One baseboard heater to be installed. 2. One vent fan in ceiling, vented to attic 3. One dedicated GFCI Circuit 4. Overhead lighting and switches Plumbing: to be completed and permits obtained by Gingras Plumbing, Springfield, MA 1. Install new waste pipes and supply lines to existing waste and supply. 2. Install bath shower unit, sink, and toilet. • boa-(tw-r p), r Urif12 ofNorthampton'.?A..7'rel4 p___,,.., 1 t• A �� • gt.s•krhntrlle v DEPARTMENT OP BUiWri G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Macs. 01 060 r` WORKER'S COMTENSATION 1Th1SITRA CE AFFI DAVIT. ff� i `� 5a �odef — 6v-0.4,4 . (I1 permlticc) wiitrh a principal)place of business/residence at: — -- `� l p IW , y {— IV°1'f- a /11 D(0' ,hone' SW ! se (su-=l/cirf/ atr rip) do hereby certify, under the pains and penalties of perjury, :hat . • ( ) Ian an employer providing the following worker's compensation cove age for my employees working on this job: ansuran=Company) (PoLic:Nur r) (r:-pirauon D2.1 1) I am a sole proprietor, general contractor or omeowoer (, rcie one) and have hired con actors listed below who have the followine --. ' s compensation policies: 0'_ a t12 (� S 0 1€ T a f 1 t r 1" d w°iketiLp42(Non c of C :?r::lcior) (IRRlranc:. Colnoan 'fP iiCi NuSIlc(r) �:pirduon l (Name of Coo O cior) ( incInsua Company,Pojicy Numc_r) (i:kpira ion Date) (Name of Cotm-aetor) (Lrisura.nc; Company/Policy Nanclx_r) (Expirrion Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Datc). (. :ckiaocc l c'teceif neo=3-c-y to c,c,.&iaforta•Eoo pervuiaian to.11 oosr"_e.o:a) - - O I am a sole proprietor and have no one wort ng for me. ( ) I am.a home owner performing all the work myself. NOTE:PI -se lx.9.zrc tl. ..trle bc.,, vm µbo eazploy pcwat to el.,r-•if,.--,r,-s =.�-.:c.Joo r gaff work oa.d..in_i;of oot ODOM tt.-..1.1'oc tth.r to u'aicb the bam000roct read=or oo the c ouod 7a7.u-um.:^_.theca -t Da(Ca:.11v oocr:dani b be eitptoyc-s untie the w-:0"---7.-_-ue°A t(GLit 52s I(5)),application by•bonooave for c tics...,:or pc.-mn rrcy evid ace t c 1cipl ct-acaz of en crployee under Ito War-kola C;oozpam.l;oo Act_ 1tuackrrtaccl dada copy of thia entemna m.y be forw rtf.4 to tbo Dop.truroo.2 of I nA,vriti AA+odoarl O15oo of Iri-uraoco for t6. covcr.zo vniGczioo and that Li1tac to soot=tovczase tmdc-r sxtion 25 A of MOL 152 cut Icd to the i•* ,;'ioa Of a imirMi PM'1i;C3 ooasisiag of a fine of up to S 1300.00.ndlor iag risoomcca of up to ooc year rod civil p.-o.ttio in 6c form of•Stop Work Order tad• filb o(S 100.00 s day q icst me For:.. rt.. t u.c only - PCSZIl]t NuIDtx7 �` I� 0� h.(np. Lot ,R Signature of Licscc./Pcrtniucc to -- . . ' (A4p2 O oo ='`_ �CrztL of Northampton • i_ - /g � �. . r N8338C1t1[3ttf5 =- `_ DEPARTMENT OF BUILDING INSPECTIONS , i /= __ . 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 his/her construction supc: . 's 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 fancily 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 tegulations. 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, r.1-et(S `k-e=.v- ,✓- ,ems 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 1,\ I `"l l Address of work C1 location L-,-1 ' C� 5 i No-✓ Ian-r 4 y Pc 0 l 0