16B-061 3?, BP- 2010 -1022
GIs #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1022
Project # JS- 2010- 001509
Est. Cost: $57000.00
Fee: $342.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK LANDY 077431
Lot Size(sq. ft.): 45302.40 Owner: REGISH JOHN P
Zoning. URA(100)//RI Applicant: MARK LANDY
AT: 325 NORTH MAIN ST
Applicant Address: Phone: Insurance:
P O BOX 61 (413) 625-6992
ASHFIELDMA01330 -0061 ISSUED ON. 512112010 0:00 :00
TO PERFORM THE FOLLOWING WORK.- RETURN TO 2 FAMILY,DEMO BASEMENT,
REMODEL 2 BATHROOMS & ROOF STRUCTURE
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 5/21/2010 0:00:00 $342.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -1022
APPLICANT /CONTACT PERSON MARK LANDY
ADDRESS/PHONE P O BOX 61 ASHFIELD (413) 625 -6999 Q
PROPERTY LOCATION 325 NORTH MAIN ST
MAP 16B PARCEL 061 001 ZONE URA(100)//RI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RETURN TO 2 FAMILY,DEMO BASEMENT, REMODEL 2 BATHROOMS & ROOF
STRUCTURE
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/ Statement or License 077431
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION 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 Permit DPW Storm Water Management
Demolition Delay
c --. e�-- � A 4 - � 's
Signature of Buil ing 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.
City of Nort �
f
Building Department
212 Main Street
Room 100
1 Northampton; MA 01060 T` a ; t '�
phone 413�8� 0 Fax 413- 587 -1272 P us
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMtLYDWELLING
SECTION 17- SITE INFORMATION
1.1 Property Address Thils section to he camptetecf bYofEice
31 �p Map Lot Unit
Zone ' k OverCayDtsfrict
t
EIm SD�strrcf ,`. nn
_. CB DwtFtc
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Addres I
Telephone 2 �A`
Signature C r!
2.2 Auth rize A ent:
_cs•IK L;R , �° ^ �� AsH fib W + 61330
Current Mailing Address:
Signature Telephone
SECTION:3 ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building '5 C (a) Building; Permit Fee
2. Electrical (bl) Total Cost of
Construction from 6
3. Plumbing Z�7O Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) - Check Number g LO ��
This Section For Official Use , Onl y
Building Permit Number Date
tssued:
Signature:
Building Commissioner /inspector of Buildings Date
! 1
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
1
Setbacks Front
Side L: R: • L R
1
Rear
Building Height
Bldg. Square Footage !, —I, %
Open Space Footage % �—
(Lot area minus bldg & paved I
parking)
# of Parking Spaces
Fill:
(volume,& Location)
A. Has a Special Perm it /Variance /Finding.fever been issued for /on the site?
N0 Q DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Recustry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book '- Page and /or Document #
_ _
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issu d:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
r`
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO
IF YES, describe size, type and location: i a
E. Will the construction activity disturb (clearing, grading, ex lion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0- NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
10 It a a.e'd'terj 4 tj; ' ��
SECTION 5 DESCRIPTION OF PROPOSED WORK (check all. applicabiet
New House ❑ Addition �:, Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition New Signs [0] Decks [p Siding ] Other [O]
Brief D � { ril�ti o of Propo J v{ r"os'-- dV
Work: t
Alteration of existing bedroom Yes �o Adding new bedroom ✓ Yes f No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa €Newriosei�ncddicatfi e� arisinoretf [an
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? NC
d. Proposed Square footage of new construction. Dimensions N `
e. Number of stories?
f. Method of heating? CX V6 ��(�� 'r"�' �i� Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction 4►�� 4t`'
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
b
k. Will building conform to the Building and Zoning regulations? _ Yes No.
I. Septic Tank City Sewer t. `' Private well City water Supply _V__ -
SECTION Ta - OWNER AUTHORIZATION - Tf1 BE COMPLETED WHEN
OWNERS AGENT'OR CONTRACTOR APPLIES` FOR BUICDING:PEI2MIT
as Owner of the subject
property
hereby authorize 1'
to ac my behalf, i rs elative to work &uthorized by this building permit application.
Signat4 of Owner Date
- - - - -- - - --
M
I, `t aster /Authorized
Agent hereby declare that the stat ments 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.
P
Signature o �Agent Date
SECTION1 _- CONSTRUCTION SERVICES
8.1 Licensed Construction N
S a llot Applicable ❑
Name of License Holder V tak L `^'�1 ,. - +� 31
License x o Numb ( ,1. r
�,0,�d i
Addr Expiration datd
Signature j Telephone
S.e'i§feEettirtim rae[tteiCoEifi I `' Not Applicable ❑
pax .4t � i�; \� S�� ►��� ti31 ��'�
Comoiny Name I Registration um er - __ - --
Address Expira iot n Date
�n t t'1Q Telephone
SECTION 10-WORKERS' COMPENSATIO4I INSURANCE AFFIDAVIT (M.GsL. c. 152,, S.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 buildi permit.
Signed Affidavit Attached Yes....... No...... ❑
«QY
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'fassachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under 7oning
The undersigned "homeowner" certifies es responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and LocLaws and State of Massachusetts General Laws Annotated.
Homeowner Signature
f
E (rif Jqf �\Trrrfl1alitI) toll
R _ E 61 iRClt lis(tt0
i —
DEPARTMEIJT OP DUILIDrNC INSPECTIONS
212 Main Strect Municipal Building
j Northampton, Dfass. OIOGO
WORKER'S COMPENSATION O tSITR- AI'I
Mak
wILL a principal placc of businessfresidence at: - - -
IA; Ge+ Ai ��PA V4,, � 3e� (phone'> � �'� C9 'q
do hereby certify, under the.paitis and penalties ofper3ury, hai
I
( ) I am an employer providing the following'workcr's COInocnsado, cove ale for Illy
em�lovet s «or'�ng on this job:
1 tLr Cocipsr (Pclic: N - -- .
(? ) _ t:.�. -r) (T' :•pirtior, DzL)
i
ef a sole propmr -tor, general contractor or homeow - oer (ci: cie one) zod have hired
auactgrs listed below wbo have the `oUo - ,vino worker's compep_sadon pcLcies:
i
i
j ("N=c o= Conc c:o:1 (InRranc;; Cotnoan }'ii'ciic} (Y :pi< - aeon Date)
(Nzmc of Concaaor) (lnssranc: Comma y /lobe• Numcrr) (E\-t trZ600 Date)
i
(Name of Coaaactor) (Lnsuraacr- Company[PoUcy Nwnbcj) (Expilz6on Dalc)
1
i
(Dame of Coatra(nor) (Irsuian Compauy/PoLicy Number) ( Dale)
(nL:.u. :r.>,•!i�cxst tiea,itn -�. to a,c'vt iizforta,_ioc pecaiaia6 tC .11
I am a sole proprietor and have no one woridng for me.
() I am -a home owner perforrniflg all the work myself:
NOTE: pl be avn.tt rt,,. - 6emeri.tix:a wt�o c=ploy Pe-.Arm to ciz c'--= a rcp a -ork on a d- - ^c of
tt�c bomoolwe rnida or oa the pvsas zq?arLc== tbec'.a wt o c Cz._ .11y cc-v--.d -Cd to be
eirployes u c the jai ms's � u- --+' AG (GL`15Zs 1(S))� zppii=6= try . bomcoa fc c bc==v « pcmit ==y a idmce the
teIPi R, .. of dLo Workola Co�oa. Act
I uadertyod tha a Copy of tbir cyt ®cm o y b. foev.nrded aC the L}op.nmcoa ClIo�sriJ Aaadeatj office of lrz++r� rw Lb.
oovcz.sc rc C=tioo ,ud ths L-iltac to S'==rc) o.—&Cc unrSc ==ioa 23 A of MGL 1 m Leal to tbo ;= =;? oa of cimiaa! p=" (=
ooazt xag of a fiat ortp to S I }00.00 n &cc ¢=pr6Oaxtl of up to ooc y= Lod ci vii pcaal'um in 6c form of a Stop Work Ordc and .
fi= o1 S 100.00 a dsy I Px n me
"".."° .. For d4v ta.� 1 u,c only .
Qcrmit littmtxs bot
Si�-1
7 of Wort hamptan Z x
'� � �i assachirsetfa _
DEPARTMENT OF BUILDI]`G INSPECTIONS
INSPECTOR 212 Main. Street • MuuiciFa Building '
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as hds /her construction supia:isor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he /she resides or intends to be, a one or twoJami y
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 mg "" department for the City of Northampton wants - any person{s) - seek to
use the home owner exemption, to act as their oven 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 bacis l),
sonotube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if required) and a final building inspection.
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 requesti .g'exemption)
I will call to schedule all required building ins ctions necessary for the building permit
__...._ issued -tom me.
Date-
Address of work
location
r
f'