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69 Day Ave Demo 2015-04-01.pdfFile # BP-2015-0874 APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION ADDRESSIPHONE 83 SOUTH MAIN ST SUNDERLAND0l375 (4l3) 665-99950 PROPERTY LOCATION 69 DAY AVE MAP 25A PARCEL 129 001 ZONE URBOOO)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Pennit Filled out /f);) b· t#Jfi: Fee Paid TypeofConstruction: DEMO SFH & GARAGE New Construction Non Structural interior renovations Addition to Existing AccessorY Structure Building Plans Included: Owner/ Statement or License 040714 3 sets ofPlans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: __Approved i/Additional pennits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ __________ Intennediate Project: ___Site Plan AND/OR ____Special Pennit With Site Plan Major Project: Site Plan AND/OR Special Pennit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § _________ Finding~____ Special Pennit'--______ Variance*____ ___.Received & Recorded at Registry ofDeeds ProofEnclosed_____ __Other Pennits Required: ___Curb Cut from DPW ___Water Availability ___Sewer Availability ___Septic Approval Board of Health ____Well Water Potability Board of Health ___,Pennit from Conservation Commission ___.Pennit from CB Architecture Committee Pennit from Elm Street Commission ____,Pennit DPW Stonn Water Management ---' £/~emolition Delay R..lA..~vV "yJ I / i 11~",. ~'-'.-/ Signature ofBuilding Official Date f I 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 ofHealth, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards ofMGL 40A. Contact Office of Pla1ll1ing & Development for more infonnation. City of Northampton Building Department .212 Main Street· Room 100 Northampton, MA 01060 '-r~~~~~~:J 13-587-1240 Fax413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTI9N 1 ~ SITE.lNFORMATION ... : .. 1.1 Property Address: l/1 l)A,j AvtL ~-Ulrl\-·~-ct4, V\A A 0 lOG, I 2.1 Owner of Record: W\\ Kit. M-Y kU-7i. G-D i':rvt ~5 Name (Print) Telephone to S ~ W1~ sr, Su;...4)f'culth--uO Current Mailing Address: . . Official Use· Only 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2+3 ,. ;. Current Mailing Address: . . YI ;, -s' 5" -j i'""t.t, pat~ ..Building PermitNumber: ____----::--__;...·-:-···-...,.___ Jss.u·ed.:_·_-..,..______________ Signature: _----"-_____---:-~-'--:------'"'-_..:.,.----...,... 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 Y,::. ;Building Department Lot Size I 11 :: : II I . Frontage I! Il II! Setbacks Front CJ CJ -c:J Side ~~ L:I , R:! I L1 j R:l : :1 CJ CJ Rear c:J I CJ CJ I j Building Height .c=J [ ! I Bldg. Square Footage CJ CJ% CJ CJ CJ Open Space Footage LI % c=J CJ(Lot area minus bldg & paved parking) .. # ofParking Spaces r=J ,1 r-~.., '"---' Fill: I .. I(yolume & Location) A. Has ~~ial permit/Variance/Findi~g ever been issued for/on the site? NO (j) DONT KNOW 0 YES 0 IF YES, date issued:! L-......-___---' IF YES; Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES 0 0 0 IF YES: enter Book [-~--l pager--,--l and/or Document #r1 _____-'..... B. Does the site contain a brook, body of water or wetlands? NO 0" DONT KNOW 0 YES ,0 IF YES, has a permit been or need to be obtained from the Conservation Commission? r------, Needs to be obtained Obtained , Date Issued: I Io C. Do any signs exist on the property? YES NOo EJ IF YES, describe size, 'type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 IF YES, describe size, type and location: L-._______ __ ____ . __.___•.,____________._______~ ~ ~ E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan / that wiU disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. L SECTION 5-DESCRIPTION OFPROPOSEDWORK(c~heck alnipplicabre) NewHouse D Accessory Bldg. 0 Addition Demolition Replacement Windows Alteration(s) Or Doors 0 New Signs [0] Decks [C] D Roofing D Siding [0] Other [OJ Alteration of existing bedroom ___Yes ___ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement __-_-::.Y7'e-s-____No Plans Attached Roll -Sheet 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? ____ ____-;-____ Dimensions ______________d. Propos·edSquare.foofage of new construction. e. Numberof stories? f. ,Method ofheating? _____________ 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 _______-'-___ ___ Yes ___ No . k. Will building conform to the Building and Zoning regulations? SepticTank__ City.8ewer ___ Private well_----,_, City water Supply ___ SECTION7a -OWNER AUTlioRIZATION~tO BEC'OMPlETEDWHEN ,OWNERSAGENTORcON:r~croRApPLlESFOR.f;3UILtiiNG PERMIT" . ,I, '----:-__-'--____~____~__________'_.,.__---------.;.., as Owner of the subject property hereby authorize :-:-:'-::--__::_---:'-:-:---:----:--~--:-~~~-:-~----:'7-'"'7."'"__::_--------------to act on my behalf, in all matters relative to work authorized by this building permit application. Date I," t; , as Owner/Authorized Agent hereby declare that the statements and informaf n on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Jo Print Name SECTION B -CQNSTRUCTIONSERVU';ES ... / S Not Applicable £8.1 Licensed Construction Supervisor: t S,., Or C{ ?> 'iJ tName of License Holder: -'lo.Y.-14 ,*. A-c....~pt 1 License Number 'Io/,'f/'y:,?J::.. ~S.JHA)/~~ \ Address Expiratioiloate I so",w~~h1 Telephone Not Applicable £r9~fR'&gigtefiiltfiomEmmpr.o~ITiijri1iTc6m~t'ton~g~ff~iWJ;f~~i'~~1f~fJJt~JZl~f6r{'i~~l~TI(0?~§Sl~t~£~~ \,,-zttu4.. SA-~~9 ~~. Co. t\.tl~')';l. I . Q ______~____________Telephone ./" tuf.-, ., f I SECTION 10-WORKERS! COMPENSATIOf,i I~SURANCE AFfiDAVIT (M.G:L. c.152, §25C(G)) / 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 ofthe building permii, . Signed Affidavit Attached Yes, ..\/.£ No...... £ The current exemption for ''homeowners'' was extended to include Owner-occupied Dwellings ofone (I) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a lic.ense, 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 ofland 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" shalI 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 ofthe work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofEmployers to Employees for injuries not resulting in Death) ofthe 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. HomeownerSignamre..__________~___________________________________ .1. ne f,.;,ommOnWealth0J Massachusetts Department ofIndustrial Accidents Office ofInvestigations . 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractor.s/ElectricianslPlumbers Applicant Information Please Print Legibly Name (BUSiness/organizatiOnlIndividUal):__S~...!~~;;;;....:..-C~,,,,--,-,__________~--'!.."..;;.L.:,-+,--...:G=-"-n...L~--"S,,-r~I__ Address: ~?:> S, \M..A ~ t-fS"(. City/State/Zip: S~~L~ ~ Phone#: ~~ou an employer? Check the appropriate box: 1. EJ I am a employer with) 4. 0 I am a general contractor and I employees (:full andlor part-time). *. have hired the sub-contractors 2. D I ain a sole proprietor or partner-listed on the attached sheet. ship and have no employees These sub-contractors have workipg for me in any capacity. employees and have workers' [No workers' compo insurance compo insurance.t required.]. 5. 0 We are a corporation and its 3. 0 "I am a homeowner doing all work officers have exercised their myself. [No workers' compo right of exemption per MGL insurance required.] t C. 152, §1(4), and we have no employees. [No workers' compo insurance required.] Type of proJect (required): 6. 0 New construCtion 7. o Remodeling 8. 0 Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrepairs 13.0 Other --~---------- *Any applicant that checks box #1 must also fill out the section below showip.g 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. :l:Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors have employees, they must provide their workers' compo policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: ~. Po .-r ,1-1 I" Policy # or Self-ins. Lic. #: W~"6t7AA-.,f G-tt, f.f ~fkL Expiration Date:_'z.._"1-1_'1-'-1-Z,-1-'t..=--__ r 7 Job Site Address:~b_"t{..::..'----=~'-'-~-r-----L~---.;..{..:..fZ-._.~H..L.::~~"'___ __·~--'----¥_'1,-,,-;,.Y,~. City/State/Zip:_6---'-J_D_""---'('--'--__ Attach a copy ofthe workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL C. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the .office of Investigations ofthe DIA for insurance coverage verification. d penalties ofperjury that the information provided above is true and correct. Date: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlLicense # _____________"....".__ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.~her ________________________ Contact Person: Phone #: Phone#: INSPECTOR \.,..:~ l:.y 01: l'lU;r;'l.,;..1lCU.J.L1:J L.V.L.L Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner ..HOME OVVNEREXEMPTION ACKNOWLEDGEMENT i The State of Massachusetts allows the homeowner the right under 7BOCMR 1OB.3.4 to act as his/her construction supervisor. The state defines "Homeowner'as, "Person(s) who owns a parcel on which I he/she resides or intends to be, a one or two family dwelling, attached or detached structures . I~ accesso~ to such use and/o~ farm structures. A person who constructs more than one home in a two- year penod shall not be conSidered a homeowner." .. . 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 constnJction 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 /residenfssignature requesting exemption) I will call to schedule al( required building inspections necessary for the building permit issued to me. Date._______________________________________ Address of work location ______________________________--c-____________________ '. r' City ofNorthampton 212 Main Street, Northampton, MA 01060 . Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 854, 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: _----'-'~_.t1--'-.l_...-<.D...!....!er,c--·t----,-:-IhJ--'!· .::....___'-"..IL..:=· The debris will be transported by: W I ~ktr~~5 --rRuG/,(.~V ThedE?bris will be received by: _____________ Building permit number: ____--,--________ Name of Permit Applicant SA-~~'1 ~-(, .&, 6J~UjL) ~kl . Date Signature of Permit Applicant