CITY OF NEWBURYPORT BUILDING DEPARTMENT 60 Pleasant Street Newburyport, Ma Main: Fax:

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1 Peter Binette Building Commissioner/Codes Administrator CITY OF NEWBURYPORT BUILDING DEPARTMENT 60 Pleasant Street Newburyport, Ma Main: Fax: CHECK LIST FOR BUILDING PERMIT APPLICATIONS Zoning / Historical: Questions, plan review and or denials see Building Inspector. Plum Island: All work requires Conservation Agent and Health Department sign-offs on application. All work no exceptions. Flood Zone / Wetlands: Requires Conservation approval for any work within 100 of wetlands, waterbody or in the flood zone. Flood Zone: Plum Island and River front properties require a FEMA/NFIP Flood Elevation Certificate with a site plan showing (BFE) base flood elevation and FEMA zone marked on the site plan, prepared by a Registered Engineer or Land Surveyor. Site plan: Required for all new buildings, accessory buildings, additions, decks, tents, pools and demolition. All site plans shall include: proposed and existing buildings with distances to lot lines, adjacent buildings, wet lands, drainage, driveways, parking and septic as applicable. Building Permit Application: Note: Sheet Metal, Signs, Swimming Pools and Wood Stoves have separate permits applications. (2) sets of building plans drawn to scale (1/4 = 1 min) In sufficient detail to show work area and required code compliance. Floor plans of existing and proposed work Foundation Framing and structural details Door and window schedule Interior and exterior finish details Elevations Section details Fire Prevention: Required for all new buildings, major renovations, alterations and additions of sleeping areas. Other conditions may require upgrades of alarms and/or sprinklers. Include existing system and proposed changes on permit application. Stretch Energy Code Compliance: 2015 IECC with 8th Edition Mass Amendments (780 CMR AA115) New Residential Homes must use a HERS Rater and submit a Projected Rating from plans with a projected HERS Rating Index of 55 or less. HERS The Home Energy Rating System. Additions and whole house renovations use RESCheck energy compliance report. Note: Whole house renovations will have (R403.6) mechanical air and a (R402.4) blower door test requirement. Alterations, renovations and repairs follow prescriptive code, include insulation details on plans/specifications. Windows and doors include energy efficiency U-value from manufacture (U= 0.30 min or less). Commercial use COMcheck energy compliance report. New Commercial Large Area and High Energy Use Buildings must use Performance Rating method. Owner Authorization: permit signed by Owner or include copy of signed Contract. Copy of signed Contract in compliance with the HIC program for all residential work. Condo Owners: Exterior work requires a letter of authorization from your Condo Association. Home Owner Permits: Owner occupied one and two family dwellings only. (2) additional forms required Homeowner Construction Supervisor License Exemption form. Home Improvement Contractor Registration Exemption form. Mass Construction Supervisor License and Home Improvement Contractor Registration. Photo copy of CSL and HIC licenses. State required with all permits: Workman Compensation Insurance Affidavit Debris Disposal Affidavit Board and Commission Decisions: Full copy of all decisions with bar code stamp indicating recording at the Registry of Deeds following the 21 day appeals period. Sheds and Detached Garages: Full front setback for your zone with 6 minimum side and rear setbacks to lot lines and 10 from other buildings for all accessory structures up to 22 x 24, max. height 15. Larger structures require full dimensional setback for your zone. Sheds under 100 square feet do not require a Building Permit but must meet zoning requirements as described above.

2 Page 1 of 4 CITY OF NEWBURYPORT BUILDING DEPARTMENT P.O. BOX 550 NEWBURYPORT, MA Permit No: Zoning District: Fee: Peter Binette Building Commissioner/Codes Administrator BUILDING PERMIT APPLICATION PROPERTY ADDRESS: MAP LOT APPLICANT: PHONE: MASS STATE BUILDING CODE: 8 TH EDITION AMENDMENTS to the 2009 ICC CODES and 2015 IECC ENERGY CODE BUILDING PLANS (2 COPIES) ATTACHED ROLLED PLANS OWNERSHIP PRIVATE PUBLIC CONDO RESIDENTIAL COMMERCIAL MIXED HISTORIC BUILDING YES N / A NO MUNICIPAL WATER MUNICIPAL SEWER FLOOD ZONE NO WETLANDS NO FOR OFFICIAL USE ONLY ZONING DISTRICT: USE: CODE: PLAN REVIEW: BUILDING OFFICIAL USE ONLY PERMIT DESCRIPTION: STAMP RECEIVED STAMP APPROVED

3 CITY OF NEWBURYPORT: BUILDING DEPARTMENT Page 2 of 4 PROPERTY ADDRESS: TYPE OF IMPROVEMENT USE AND OCCUPANCY ALTERATION / REPAIR RESIDENTIAL ASSEMBLY A - SITE PLAN REQUIRED SINGLE FAMILY (R-3) BUSINESS NEW BUILDING TWO FAMILY (R-3) EDUCATION ACCESSORY BUILDING THREE FAMILY (R-2) FACTORY F - ADDITION TOWNHOUSES # of units HIGH HAZARD H - FOUNDATION ONLY APARTMENTS # of units (R-2) INSTITUTIONAL I - MOVE BUILDING HOTEL, MOTEL (R-1) MERCANTILE TENTS (TEMORARY STRUCTURES) ASSISTED LIVING (R-4) STORAGE S - DEMOLITION OTHER UTILITY / MISC TYPE OF CONSTRUCTION MIXED USE SPECIALTY USE ( I - V ) A B DESCRIPTION OF WORK: DEEP HOLE TEST ( NEW CONSTRUCTION ONLY ) TOTAL FLOOR AREA, ALL FLOORS S.F. FIRE PROTECTION: EXISTING / PROPOSED : LOT AREA FAR STORIES TOTAL ROOMS SMOKES/ CO S SPRINKLERS FIRE ALARM MEDIAN HEIGHT BATHROOMS ENERGY CODE: PROJECTED HERS RATING - NEW RESIDENTIAL PORCH BEDROOMS ResCHECK REPORT - RESIDENTIAL ADDITIONS & RENOVATIONS DECK(S) BEDROOMS ADDED MECHANICAL AIR BLOWER DOOR TEST REQUIRED ATTACHED GARAGE DETACHED GARAGE ComCHECK REPORT - COMMERCIAL BUILDINGS PARKING SPACES: INDOORS OUTDOORS COST OF IMPROVEMENT FOR OFFICE USE ONLY BUILDING $ PERMIT FEE ELECTRICAL $ BASED ON TOTAL COST (ROUND UP TO NEAREST THOUSAND) PLUMBING / GAS $ BASE FEE $50.00 (INCLUDES 1 ST $1000) $50.00 MECHANICAL / HVAC $ $10 / THOUSAND 10 X = FIRE SUPPRESSION $ OTHER $ TOTAL PERMIT FEE $ TOTAL COST $

4 CITY OF NEWBURYPORT: BUILDING DEPARTMENT Page 3 of 4 PROPERTY ADDRESS: PROPERTY OWNER: STREET: CITY STATE ZIP PHONE OWNER AUTORIZATION: I authorize to apply for and act on all matters relative to the work authorized by this building permit application. Note: Contract will be accepted as Owners authorization. Owners signature Date ATTACH ALL APPLICABLE DOCUMENTS: (1) A SIGNED CONTRACT- in compliance with the HIC Program. Required for all residential work. (2) CONDO OWNERS: Exterior work requires a letter of authorization from The Condo Association. (3) HOME OWNER PERMITS: Complete CSL and HIC exemption supplement forms. (Owner occupied 1 & 2 family only) ARCHITECT/ ENGINEER: MA LICENSE STREET: CITY STATE ZIP PHONE CONSTRUCTION CONTROL: RDP responsible for document submittals and affidavits. CONTRACTOR/ COMPANY NAME: STREET CITY STATE ZIP PHONE HOME IMPROVEMENT CONTRACTOR REGISTRATION: # Expires PERSON IN CHARGE OF PROJECT: PHONE MASSACHUSETTS CONSTRUCTION SUPERVISOR LICENSEE: NAME: STREET: CITY STATE: ZIP PHONE: CSL# - Expires PHOTO COPIES OF CSL AND HIC LICENSES ATTACHED STATE REQUIRED BY ALL APPLICANTS: WORKMANS COMP AFFIDAVIT CS - UNRESTRICTED (BLDGS 35K CU.FT) CSFA - 1 & 2 FAMILY ONLY CSSL - SPECIALTY LICENSE 1 - DM - DEMOLITION 2 - IC - INSULATION 3 - MA - MASONRY 4 - RF ROOFING 5 - SF - SOLID FUEL 6 - WS - WINDOWS & SIDING DEBRIS DISPOSAL AFFIDAVIT APPLICANTS SIGNATURE: By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. APPLICANT: SIGNATURE DATE PRINT

5 Page 4 of 4 CITY OF NEWBURYPORT: BUILDING DEPARTMENT FOR INTERDEPARTMENT USE ONLY PROPERTY ADDRESS: MAP LOT DESCRIPTION OF WORK: MUNICIPAL PAYMENTS ARE IN GOOD STANDING. PROPERTY TAXES SEWER DEPARTMENT WATER DEPARTMENT Sign-offs at Treasurer Collectors Office Main Level City Hall DATE DATE DATE BOARD APPROVALS Attach Recorded Decisions APPROVED DATE Comments CITY COUNCIL CONSERVATION COMMISSION HISTORICAL COMMISSION PLANNING BOARD ZBA SPECIAL PERMIT ZBA VARIANCE DEPARTMENT APPROVALS: As Directed by Building Inspector DEPARTMENT APPROVED DATE COMMENTS Fire Prevention at 0 Greenleaf St FIRE HEALTH Lower Level City Hall Planning Department Main Level City Hall CONSERVATION PLANNING ZONING DEPARTMENT OF PUBLIC SERVICES DPS Building at 16A Perry Way CURB CUTS ENGINEERING SIDEWALK/ TREES SEWER WATER I / I I / I Demo Electric National Grid Letter Demo Gas National Grid Letter

6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partnership and have no employees These sub-contractors have 8. Demolition listed on the attached sheet. 7. Remodeling working for me in any capacity. employees and have workers 9. Building addition [No workers comp. insurance comp. insurance. 10. Electrical repairs or additions required.] 5. We are a corporation and its 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12. Roof repairs insurance required.] c. 152, 1(4), and we have no employees. [No workers 13. Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers compensation policy information. Homeowners 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: Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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, and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $ 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 certify under the pains and penalties of perjury that the information provided above is true and correct. _ Signature: Date: Phone #: 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 #:

7 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers compensation for their employees. Pursuant to this statute, an employee is defined as...every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152, 25C(6) also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, MGL chapter 152, 25C(7) states Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under Job Site Address the applicant should write all locations in (city or town). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department s address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA Revised Tel. # ext 406 or MASSAFE Fax #

8 Peter Binette Building Commissioner/Codes Administrator CITY OF NEWBURYPORT BUILDING DEPARTMENT 60 Pleasant Street Newburyport, Ma Main: Fax: DEBRIS DISPOSAL CONSTRUCTION SITE ADDRESS M.G.L. c. 40, 54 Every city or town shall require, as a condition of issuing a building permit or license for the demolition, renovation, rehabilitation or other alteration of a building or structure, that the debris resulting from such demolition, renovation, rehabilitation or alteration be disposed of in a properly licensed solid waste disposal facility, as defined by M.G.L. c. 111, 150A. Any such permit or license shall indicate the location of the facility at which the debris is to be disposed. If for any reason, the debris will not be disposed of as indicated, the permittee or licensee shall notify the issuing authority as to the location where the debris will be disposed. The issuing authority shall amend the permit or license to so indicate. LOCATION OF DISPOSAL FACILITY Signature of Applicant Date For Office Use Only: Permit No.. Date