23D-001 (8) 511 NON•. ,.,. }, T. BP-2004-0256
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-001 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0256
Project# JS-2004-0378
Est. Cost: $3200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BAYSTATE WINDOW & DOOR 125626
Lot Size(sq. ft.): 12501.72 Owner: BOUCHARD MARY J&M MORIARTY&
Zoning: URB Applicant: BAYSTATE WINDOW & DOOR
AT: 51 NONOTUCK ST
Applicant Address: Phone: Insurance:
87 SHATTUCK RD (413) 549-6824
HADLEYMA01035 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:STRIP OFF 2 LAYERS OF EXISTING SHINGLES
AND RE-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: Receipt No: Date Paid: Check No: Amount:
Building 9/9/03 0:00:00 3431 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
,
•
City of Northampton
Building Department m� �� �il� ��-s , ? � '' ''.
212 Main Street i,tk 9 -;7:m ,
Room 100
Northampton, MA 01060 -01i'o' r°ii .)_ -
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This seetio totbe cpm retell by offic ;' ,
e, : `
i �.- Map ; � "- - -a:
1 i 1 Y 4*Zo*nk 3; � Y :Overly ® strl4 f �i. c.,x 7 c:
EIm,St Di trict . a j CB DAs rict.;.
SECTION 2 - PROPERTY::OWNERSHIP/AUTHORIZED'AGENT
2.1 Owner of Record: /
Aka i Li
i3c iu!;t_.g. ( Aid' } , --'X_"c/cei i ii c/646,1_
Name(Print)) Current Mailing Address:
" 7 r, Telephone 2�/r d/6 t
Signature ,
2.2 Authorized Agent
Name-(Print) r� r...— Current Mailing Address: �'3r'c i'N\ , , 2 ---D
Signa ure Telephone
SECTION43 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use'Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) . timated Total Cost of
Construction.from (6)
3. Plumbing Building Permit Fee
•
4. Mechanical (HVAC) -/c—
I5. Fire Protection
—
6. Total = (1 + 2 + 3 + 4 + 5) d!r/32) U"J _Check Number 't-.3</,_ 3
This Section For Official Use Only
Building ermit Number: 2 q�� j
g ��- cav`f -b�,S� Date Issued: d�
/
Signature: /�
Building Commissioner/Inspector of Buildings Date
- I
4
Section 4.
- ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW V YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO \i/ 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 _
No
IF YES, describe size, type and location:
. %, -
SECTION 5 ID •S R I 01410F�PROPOSED WORK checktall a••l le , :
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing %,--:-.
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: S f+- ' o g G.J; s Q i I -. ,
Alteration of existing bedroom Yes iC No Adding new bedroom Yes ? No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet❑
Alf'.. ;ewml :. :d of a:ddi:tion t eo isti'Y uo ing corriple. a °`e fol d rng:
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. Mascheck 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
N EYCTON 7�6WIk#1 OR...fZATtON T,O BFE C0:. 0 .._ D EW H EN
O-WP ,C�NO NTR�ACOR A PPLIS' OR BUIML DING PMT
!,
I' owl, (30,(4,5,..04--) , as Owner of the subject property
hereby authorize 1;.. k5- ) 0,,r<;�s to ac;. on
my be alf, in all matters relative to wor uthorized by this building permit application.
Signature Owner Date q 6
J,,,,....tit.6(-7,-,C7:_)-
, 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 . d penalties of perjury.
.,, ., L 4 V 0-,;
Print I.
fl
:m. ,�
q At//Id T
Signa ure of Owner/Agent . Date
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SECTJON$ CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
.Rec�" a e• gbme irn•`E•vemen i.Contractor 1E Not Applicable ❑
MS 110,;- z Q- •CY6 (Df t t3
Company Name Registration Number
27-7 S > u.ck ! //0/6V
Address ,/ Expiration Date
01035 S-7&- --47'
7, , . _;parr Telephone
SECTlON`10 WORKERS' COMPENSATI®N',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 per it.
Signed Affidavit Attached Yes 0 No //'
/
tuysmo 0,11
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 Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature _
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,, 41111... DEPARTMENT OP BUILDING INSPECTIONS
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212 Main Street ' Municipal Building
Northampton, Mass. 01060 1109'
WORICER'S CONITENSA'110N rNSLTIZANCE ASFDDANra
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( con with a principal place of business/residence at:
(phoned)_
- • - - ----
(strc•cticitylsiat!ship)
do hereby certify, under the pains and penalties of perjiiry, that
---
( ) I am an employer providing the following •••ork.cr's compensation covera:i.e for my
employees working on this joty.
- (lasu_ranc.-.:. Company) (Policy Number) (F__y:pimtion Date)
( ) I am a sole prOPrietOr, general COLICT-01- or homeowner (circle one) and have hired
the contractors listed below who have the followin2, workers corripensatlon policies:
(Pame of Contractor) (lnsurancc Corr.11-..,37rylPo(icy Nuinbcr) (Exp:rat-ion Date)
(Name of Contractor) (1..a_surance Co.LT_Inar-iv/Po!ic-,, Nurn'ocr) (1-1):Dirzlion Date)
— -•
_ .......
(Name of Contractor) (1 ,,n-anc:_. C o 1:37,-;:m:,i1)o I i cy NIIII3b..2r) ,:f:ix.,-;:ratior) Date)
(2\ine of Contractor) nsuane Colary/POLCy Number)
(Expi,..T.tio5 Date)
(,.u...,c.ii a.d:..4.itiala..)s.)....7ct:5•...., .-....,-,:od......-.):. ::, -.-:7-:: 1".!II,...:<:"..r.,:l.,,,')
. I aim a sole proprietor and have no ono v;orh.ua for me.
(, ,) I am a home owner DC:IQ-1'11r all he ''''—'` -----'-'''IS
NOTE:picric bc asvarc that v.':...,..10 r. or s.,:::-3 C:7:2 I Cr;P.:7=7:-=:-.LO■'.):17 V.:',-:--,-,--','C-.C',...'7"rs'CL.C'n or'7"Pa u.''''''''r".")'`i"til'n?'c:
not more th.tn throe its ir,tvi:::di'..he 1...:...•-tr. -.Avo.-.7.-r.):::.2.-7.1 c.n.-a;•..1-,.-e.,--:-.1,.2.:-.-).3 z..--,;•artcr_,....r..t thc.c;f::a:-t rr:.<cc-K.1-2.11y c<.•:-...::;.).7.:.z..j:.:.,b..:
oznployc-3 un.c.r tht‘vori,:r-r:mrs.....-:---..ttion Act(G)....!Si-a i(5)),nr,-..)..-..-a:Jor.by 1 hotticowncr for t Lc.-='-:%c oc i>,7-rmc,--)-,.:. ''."''''r^:c"::='''
I egal rtatua of g.n acaployer under s Wocicce'a Co.^op.cr-......ation?xi
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t .-ztJuad that a copy of this Etttcr-cr-1 may bo fon.s.lu-si.....)to ti:rt 1.? t..-noni of lodustri al Ad....11Y c.,,ir..e..of for U
coverage vcrifi=i0.3 and th.tt fli.lurc to t.:c..:.:::covtrago urAz.....r r.ccticn 2 S A of M01.152 cut lc.,.1to the irnpositical of cr...,tnir-t1pccall.its
co-mt.:sting c(.a finc of up toSI...M.00 arr.:Yoe irttprit--yr--nct7.1 of tip to co...ycz,-2...r.-1 civil pcnaitica in t'...c ICK111 of a Ste?',...),:rri'..Orik:-. tr,:i,..
fir 0(S100.00 a.day againtt tn.:.
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Fa-(..Cr43artria-st al tisc only
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DEPARTMENT OF BUILDING INSPECTIONS =t5._i= /,
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INSPECTOR 212 Main Street • Municipal Building 7`o,„-,•
Northampton, MA 01060
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 •' sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
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 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/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