23D-005 (4) 68 NONOTUCK ST
BP-2006-0379
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-005 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0379
Project# JS-2006-0550
Est. Cost: $800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 14069.88 Owner: OVERTREE CHRISTOPHER
Zoning:URB Applicant: OVERTREE CHRISTOPHER
AT: 68 NONOTUCK ST
Applicant Address: Phone: Insurance:
68 NONOTUCK ST
FLORENCEMA01062 ISSUED ON:10/11/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE GARAGE & BREEZEWAY
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 10/11/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
q a ,
-� ity of NortF��mpton e
:n ' ' u \\\''17 �Illi '`yBiuilding Department mi., � 9 fi i
212 Main Street e A
�; ! �• is rx� � � „°x ;,•-__ Room 100 � ` � ��� - 1,-;::!-.4,4„:,:;!,-� ��
ti Wit= e ® i � �
OCT — 7 2005 -` r ,
hampton; MA 01060 _• � � _
phone 413- 87-1240 Fax 413-587-1272 Ptot;EStf �� p � " �� `
Yi NCV�(1U1 NS CDtf e peetfy".xr x 3� Y
U O
"� APF�LIC CT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
S CTION 1 -SITE INFORMATION
1.1 Property Address:
This section"to be completed byofffce
4$ �� � 5i Map Lot Unit
(o/eetiE,, { l 4 004 "Zone Ovecfay Disf T
Elm St°Distrct CB D�stnct ` "
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of /o,rd:
R 1.4.y. (..)eir
4-e-A
VOid
Name(Print) 1 Current Mailing Address:
�' Telephone
Signature — 1 r
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Ite 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
Construction from(6)
3. Plumbing Building Permit Pee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number Pc......
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature: r
i
Building Commissioner/Inspector of Buildings Date
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 i
Setbacks Front i
Side L:', ' R: L' R.'___
I i
Rear ,
Building Height ;
Bldg.Square Footage I % _
Open Space Footage %
(Lot area minus bldg&paved i I j ! i i i l
parking)
#of Parking Spaces
Fill: , E !I
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book i Page; and/or Document#?
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
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 a NO 0
IF YES, describe size, type and location: f
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
IF YES, describe size, type and location: :
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 , NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1 ' •
0
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑: Replacement Windows Alteration(s) Roofing (l
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[C1] Other[0]
rief Description of Proposed pe r3-, -Work: (r00`I jdvdr y- brat etv
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa>i IYev+�="tause dif-dead#io to exist tic Cio stie i •f :ti eiC( r q:
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 7a-OWNER AUTHORIZATION-TO-BECOMPLETED WHEN
OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT-
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, SP ,as Owner/Authorized
Agent hereby declare hat the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under t • p.in and ii •-
4 , &Ili krc3 OM irte-
Print Name ' �;1
l �nature 4111r7/ ,b
Date a
• ' f
4
SECTION 8-CONSTRUCTION SERVICES i
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
tiRealsfere dThxi e m.a roveTifi Cana a a a si s. .: _ - . ,'.' Not Applicable ❑
Company Name Registration Number _____.__
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCEvAFFIDAVIT`(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 permit.
Signed Affidavit Attached Yes ❑ No ❑
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 , r . =- • .
The undersigned"homeowner"ce, ` es . d a u es re .os ibility for compliance with the State Building Code,City of
Northampton Ordinances,State .. • .•moo •,y t r! d State of Massachusetts General Laws Annotated.f fill
Homeowner Signature
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-o DEPART}4EAf7 OP BUILDING INSPECTIONS ,
212 Main Strcct ' Afunicipal Building •
Northampton, Mass. 01060
w.OIUG R'S COMTENSATION •C StJRANC.b. AF :DA: 1r
(li censxJpermi ttee)
with a principal place of businesslresidence at:
(phone")
(sur11.lci t•J/statcta p)
do hereby certify, under thc.patns and penalties of-perjury, that
( ) I am an employer providing the followine!worker's cornocnsa of coverage For my
employees wor ng on this job:
..
- Qnsurn=Coapacy) (Policy Nu_�bcr) — (=:-pir<uoc Dar_.)
•
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the consactgrs list below who have the following worker's comnen_sason policies:
(N anic or COntmczor) (Innrrar:cc Company/Policy Nural-- ) (r\pirduon D1tc)
—
(1\lamc of Cont,clor) (Lisa -ane;- Comas,y/Polici Ni)trrncr (Lk3irdion Due) .
(Name of Conrraao;) Qnsiu-ance Compy/polic7- N:rrnb_r) (E.xair aen Datc)
•
(Namc of Contractor) (Insur-an Comczay/Policy Nu.mb:.r) Ct∎�iration Da1L).
(aL'.a[31 t:.00.l rho, if nonc...,Lry to in i iofoc-moa pciaiai.ag to..11 ooa-._C-ors)
< ) I a.m a sole_proprietor and have no one wort og for me.
I am,a home owner performing all the work myself.
NOTE:p1=--..be=wise tr.••s•-1-.^....1c bcm owaera wbo czaaloy De".om to db r•- e,-r�,
^"L -,..mloo c ,ry
r as worX on•d••c!L•:,-,of
not toots t!~a t oo traits is,...-birth the bomoorwc maid=or on the crouacS wpr:rtct •o Li Doe cm-.r 1 t te .4...-ed to be
cniploycs urtC,�the,...7.4-km,':cc . c Ac (0L1152. 1(5)).r-pptic000 by a botncowoe fa,•b�• or pc-rah ray c.-:deooc the
Ic-p 1'tiyc of en ctioyc uadcr tho Wok.",Co w A ._
I icoricora.ryd th,s s Dopy of this mtcmcat m..y be for-,..v'd•d to the C cpo, of Io ' ricr ncodcatj Of5o•of io=or•000 for th.
cv -1 tf sotto and th=t.L-zlta-c to sontu-t:tavoracc trade session 25A of hr(L 151 nn Ian to the imposition of eimiasl peasitics
eocitias ofa floc of up to 51,00-is ortd/oe oCup to°cc yr_r Lod c.il pe sJtia in be form of.Stop Wok Ordc and•
I Vi'L/ • Permit Hurnbes
Srgartture of Lit;= Trrrnirrr•r_ Lace I ri
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'xi"=r DEPARTMENT OF BUILDING INSPECTIONS _=F_,_ /_
INSPECTOR 212 Main Street • Municipal Building o��
S
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 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 foi-flee 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 r=egulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings(before backfiil)t
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 roject until such time as the proper permits and inspections are
made
j L LAA / understand the above.
(Home owner/residents signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued-to me.
Date 10 Ns
Address of work /i�
location la/ .V) -0 L
(--- CO reA.-4_,
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