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Wiz_ DEPARTMEI�T OP a11LDI�G INSPECTIONS t 4 --„I__all-__„-:etk ........._.
212 Hain Street ' Municipal Building
Northampton, Hass. 01 060 ea`_,
. WORICEIZ'S COMII'ENSATION ONSURA.NCE Ay
•
•
I-, Ea LaLed....I ( tie,A677" _ _
• (tic en.. pernittec)
with a principal place of business/residence at:
, I/ R62- Se_ Nd -",2(„_ di i 40 e , / • (phone) ,5'SW- 6 7)
s, city/5taidzi n)
do hereby certify, under the pains and penalties of perjury, that
I "
( ) I a.ro an employer providing the following:worker's compensation coverage for my
eluployees working on this job:
•
.
(Insure Com c nv) • Pole N:nrr r: iaon Dal:) •
( ) I am a sole proprietor, general contractor or homeowner(cc:e one) and have hired
•
the contractors listed below wbo have the following worker's compensation policies:
•
Mann of Cont ctor) (Inslrant.; Co t panyi?oUc, Nurnir:) fl:):pirduon bite)
- .
(Name of Cootraor) (lrls ranc:. Comga.a}•fpoticy Nuraccr) (E»ication Date) ,
•
•
(Name of Conz-actc;) ails-uranc Company/Policy Number) (Expirtion Date)
(Name of Contractor) (Insuranc Company/Policy Number) (Expiration Date)
(amid:ad i oced r_'tea rd.noccai:y to',bells&inform.6'oo pay.iains to.11 000:7--eoa)
XI-am a sole proprietor and have no one worho.ng for me.
( ) I a.m.a home owner performing all the work myself
NOTE:ple_se be.astir chi wi:.le bomo7w'ocn who caploy pa-urns to do • �—.:clap a-repair wore eo.dw.Uii:F,of
tux more dao throe=its is wb;cla the bomoowvcr roido or oo the croonda wpurtcn:,a thceo e.-c Do(cocr-.ty oe-dad i to be
cszploye-:use the ucck.crs cocrp=r4co Act(GUI 52.a 1(5)). -pptintioo by a bomeoa-ca for:L cam.a pert try e.,d000c th:e
legal eta Oren stay«under dao Woyster,Coo ,u;0Q Awe.
I tadaetaae dui a copy of thi.c atrmom ca.),b.forwarded to th.Ocgartaxoa or locia.s'sicl'eodosn'Moe of Innum000 roc tb.
{ cotreragn wirestioa and tlt_t L-ilmr to•ecurc bo nso under soorJoo 25A of>,(QL 152 a lad to the inrsaairica araim;osl r"'ttio
oomisarg or.fiat of tW to S t oo.,00 utdtor or up to ooe yrnr rod c V11 pow-hit=in&Se rotas of a Stop Wort Order and•
fun of S l 00.00 i day'ping tae
—
For dcp.r .:a1 u.c only —
ta
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Permit Number
- 1.(2p: tot a
Signature of Licrnscc/Pc .. - —41144g- -_ .J
S�Mp2,.._..., ,,,,,;1 • I.. ______-_-„,%_ I
k.0.;07200 03
ity:f....:.11
4"", DEPARTMENT OF BUILDING INSPECTIONS , _=_r1^
r _
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 sups:•,•isor. The state defines"Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a oiie-o—r 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 oven construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and fegulations. 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
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SECTION=5-.DESCRIPTIONfOFPROPbSED WORK(check atkapplicable)
New House [] Addition ❑:;. Replacement Windows Alteration(s) [J Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[0] Other[0]
Brief Description of Proposed�;� /
Work: J1� )/� Roo az`,5 4.. -� 724 Adbe
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
g. !ve`tl � es '�, ;Lc%fie elt{3,xr, m;, 71]e;c7iii.S1Gl.lr?`;T4iC =QG[a�iil ,.&t3: --
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 N1O]N, [ERI THji T[O ,tTE�BE,COM t ETE4 YVF(EN''
OWNERS AGENTAReCONTRACTO PL1 TOR'B`F]tAING:PERN[IT- :
I, ,as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I Cdititgied 7-- C '6.8 d ,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 nder the pains and penalties of perjury. '
Print Name
• Ai /G 6
Signature of Owner/Agent /- Date
Section 4. ZONING All Informatibh 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
r
Lot Size I 1 1 i
Frontage 11
Setbacks Front
Side L: R: ! L:7 R:! 1 1
Rear
Building Height
Bldg.Square Footage % r 1 1
Open Space Footage
(Lot area minus bldg&paved I
parking). -
#of Parking Spaces I
Fill:
(volume'&Location)
A. Has a Special Permit/Variance/Fi ding ever been issued for/on the site?
NO 0 DONT KNOW cr. YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book i I Pagel and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ( YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission? •
Needs to be obtained Q Obtained Date Issued: 1
i
C. Do any signs exist on the property? YES Q NO )3(
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading ex ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 r NO
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton
Building Department
212 Main Street �.� k-��� dr
two 1 7 2006 Room 100
Northampton, MA 01060
phone.413-5$7-1240 Fax 413-587-1272 s o,aK,; � ,�x a m:
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION,I. SITE.INFORMATION
1.1 Property Address: ` � ectan to4ie c•fn•Cet •ab"offices+
5'9 CA-go►�'►� �-t-- ,=lo - t, t 4}
T im:S. lStTICt.Y a. k 2. + cfw Sr r
2'.rara� iTnh6ztv,.. .. tlf,{)ap�,� ..,... •
SECTION'2i--PROPERTY OWNEI2SHIP/AUTHORIZED AGENT
2.1 Owner of Record:
( nfN► c et-(2 L ss S
Name(Print) Current Mailing Address:
• Telephone c5-494,-�1>
Signature
2.2 Authorized Agent:
Fcd raPG) T QoRepe:T-- II Reed sf
Name(Print) Current Mailing Address:
..� �.-.r <5 /— Co 5 71
Signature Telephone
•SECTION.3.' ESTIMATEDCOMS7RUCTION`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
Constructiori.from(6)
3. Plumbing Building Permit.Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number arj
This Sectioii F'or?Official'Use'Only
Building;Pernif Nu►nber Uate.,
Signature:
Building,Commissioner/Inspector of-Buitdings Date
- 64 r :; BP-2007-0189
GIS#: COMMONWEALTH OF MASSACHUSETTS
2117pm' CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0189
Proiect# JS-2007-000288
Est. Cost: $6000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq. ft.): 8668.44 Owner: DECAROLIS RICHARD H&
Zoning: URA Applicant: Ed Corbett Jr
AT: 59 CAROLYN ST
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMAO1060 ISSUED ON:8/18/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 8/18/2006 0:00:00 $25.003180
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
i/l:e t A°6Y.2‘)
2"
/" 9" ro,("osai Vinyl Siding \`
I . #_ t Corbett Home Improvement Windows
�.., Northampton, MA 01060 Awnings
`` � t' I,/IL 1' (413) 584-6571 Canopies
/ // Gutters
/ ( ! 4 d 1__ ! C i d(o .5°6- Shutters
PROPOSAL SIIBM!TIED To CO.NI•C C-/G11 S/ PHONE$ $ ' 7 DATE 7V�j g „,?JG
STREET 5 � 1* ,c1' V` JOB NAME /
CRY,STATE,and ZIP CODE .( JOB LOCATION
DATE OF PLANS JOB PHONE��-..
We hereby submit specifications and estimates for:
23 �4J7A-Gt 7-Ca.- 4 La4-4e‘c tier e_A-r i VtoAlk.11� Artai (°rat/e s� lghJ oiv�.yr-s-.6:v∎
.,a( &JCL
3) T Atpx oi' iloof.Dec%.
lOcit,4Avi►iovu.■• 14, £err e 4/k4 Inc 4r ,s x
.5) NeZit/ _Flisbi,J1 duAd eLi-it y
-- 7'c. -4-U,4 r,< Atica.e4.
I 2Xd 4/ Et-k 3e y r s si..�Itys.
7 Areili t/e.,.'i /r7J 4/4fCS i/t LIS-r - j' our-' tJC 1l� fi✓
g) 112%(C. ,3�C)s keipi i r ,-p r f X19 s0/ Di S fff g-Z,
Te Troposc hereby to furnish material and labor-complete in accordance with the above specifications,for the suns of:
Aiwa. ` / , / Dollars($ O�� )
Payments to be made as follows:�/3 peas./r I/36
fr agyrie,J�^'
/
All material is guaranteed to he as specified. All work to he completed in a work-like manner according Authorized
to standard practices. Any altercations or deviation from above specifications involving extra costs will he Signature _
executed only upon written orders,and will become an extra charge over and above the estimate. All
agreements contingent upon strikes,accidents or delays beyond our a,ntn,l. Owner to carry fire,tornado Note: This proposal may be
and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days.
Acceptance of Wroposa[-The above prices,specifications —
are conditions are satisfactory and are hereby accepted.You are authorized to Signah e _. — _ _ —__; _. _.e.71. • �-
do the work as specified. Payment will be trade as outl ined above.
Date of Acceptance: 5/--/i -, c 6 Signature J
59 CAROLYN ST BP-2007-0189
GIS#: LUiV1MONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 112 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0189
Project# JS-2007-000288
Est.Cost: $6000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq.ft.): 8668,44 Owner: DECAROLIS RICHARD H&
?t;ninq:U:RA Apreiieota: Ed Ccrbett Jr
AT: 59 CAROLYN ST
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMA01060 ISSUED ON:8/18/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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: Oily Insulation:
Final: Smoke: Final: d� ' 04.
THIS PERMIT MAY BE REVOKED BY T CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIO .
Ave
Certificate of Occupancy / , Signature:
FeeType: D:t• Paid: Amount:
Building 8/18/2006 0:00:00 $25.003180
212 Main Street,Phone(413)587-1240, Fax: (413) 587-1272
Building Commissioner-Anthony Po