23D-009 4.
26 NONOTUCK ST BP-2007-0421
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0421
Project# JS-2007-000629
Est. Cost: $1000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 20081.16 Owner: DUFFY WILLIAM G&SALLY A
Zoning: URB Applicant: DUFFY WILLIAM G & SALLY A
AT: 26 NONOTUCK ST
Applicant Address: Phone: Insurance:
26 NONOTUCK ST
FLORENCEMA01062 ISSUED ON:10/13/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL METAL ROOF ON CARPORT
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 10/13/2006 0:00:00 $25.003549
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
..
ir �",�"x..e.`'` aa Depa NSe tt6 . ^ �• "„ w..
City of Northampton Status 4i ; r
Building Department x °l
W
212 Main Street : Sep'' a ' ' ''
�� Room 100 atef/We yaira�ill a
Nortf ampton, MA 01060 w ei o 5 � � '
�� -Phone'.113-5a.\7, Fax 413-587-1272 Plo Site a � k
Otbe Specs ' �.
•APPLICATION-TC5 CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-SITE`INFORMATION
1.1 Property Address: This section to be.completed by Offfce
M'ap Cot Up�t€ .
G,�� Zorse Overlay District 1,2.; :s4,,r..-,:,v,:t'-
d f! Y)p' C�` �� i�24 �:E1m4SE Distrrc G iistrtct
SECTION 2-PROPERTY'OWNERSHIP/AUTH.ORIZEDAGENT
•
2.1 Owner of Record:
V ) 1 m,1,' �
c.l.4 1 \)u 1[`_' g
Name Print 11-4:1--11"* �j Current Mailing Address:
A z d Age ' e., S Telephone
Signature v � - \
2.2 Authorized Age
Current Mailing Address:
Name(Print)
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building U U �(a)BuildingPermit'Fee
1
2. Electrical (b}Estimated Tota'Cost�of
Construction,from(6)
3. Plumbing Building Permit Fee
zs
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number 3�� /
This.Section.For-Official.Use Only
Date
Building;Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
J
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 L _�._ ' ._.__
Frontage —
Setbacks Front
Side L:!___. = R: L:_. R:L___
Rear
Building Height
Bldg.Square Footage I i %
Open Space Footage %
(Lot area minus bldg&paved
parking) •
#of Parking Spaces
Fill:
(volume&Location) t I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW q 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 j 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 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
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 Q NO cD
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing
Or Doors D •
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[D] Other[D]
Work:Description of Proposed �c `-� /� )
Work: An i7 �5? Y pG J- 1
Alteration of existing bedroom Yes t../No Adding new bedroom Yes 1...VNo
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
s,,,, � e*,.�^r,,:scr�'ti, `aC-�czn �.,r��K.x �':w.�-"` = ai.-'��a-^;w�'-..; 6 �.ws�_�
di'i ,New-t dit4g4r>eariadEiror�wtaIeilst► q laiastnc a p niti8 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 BECOMELETED-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
C t tQ p _� Own- Authorized
Agent hereby dec are ha state e t a d information on the foregoing application are true and accurate,to the •est of my knowledge
and belief.
Signed under the pains and penalties of perjury.
IL) ( 1- ki A /I-) qJ i^c� � Y
Print Name
f -P .IQs'Olt,— � -fC S� /0 - ( 3. 65
Signature of Owner/Agent Date
.t
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone .
9_Reasteied"F[om e=t" pafiiemeatiC�atiracoitil =a' " f- 'q a Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M:GL.: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-owna-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 La and State of Massachusetts General Laws Annotated.
•"----..>'- Homeowner Signature U)i 9. ,l i....____
i
„f `a )r��•'ti (ii- of �artIJalltpton • 1 )°—:
1.% � E eZ.J an(h RLCIIa t_
Q DEPARTMENT OP BUILDriG INSPECTIONS • --
, filikt: —-....
212 Main Street • Municipal Building
Northampton, Mass. 01060 r•
VT O RICE R.S CONITENSA liON L-NSURA?Cii AFFIDAVIT
I X
(1i ccusxl permi ttec)
with a principal place of businesslresidence at:
(phone:')
(s> t/city/s ta.tcia p)
do hereby certify, under the.pains and penalties of-perjury, :hat •
( ) I am an employer providing We followinc worker's compensation coverage for my
employees worng on this job:
(Ie_suraec Comm) (Policy Nu_ cr) ('':-pir,:tion Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the conuac-tors listed below who have the following worker's cocperl_cadon policies:
(Name of Con'_7,1c,or) (Insuranc;, Cotnoaiyi?otici Nu h-c-.) (r?:pindnoa Date)
(Name of Coatraezot-) (Instraucc ComianyiPoiic-v Numc• r) E -pir.:tion Date)
(Name of Connaetor) (Ltasura.nec Company/Policy N:11rbc.r) (Expilrtiou Date)
(Name of Contractor) (I.csurance Comp-airy/Policy Numb-.-.r) (E pinion Date).
(aa�th adli�oc0J tca4—...,z=rr•to asc?v&*tnfocro Son pc�.iains to..11 o - ) i
i
i.i
( ) I am a sole proprietor and have no one wori,3ng for me.
I am.a home owner performing all the work myself.
NOTE:PI -44 be Acme the..4 1e 6emeoveccrs vbo auplay pesooa to do c-.;,- ,.,,x o;-.•rtero c rc u•.orz on.d.•c.1L•:s of
ant toner tb_o t.t o:tmtr La with the bomnowvc raider or oa tb.c p-ouor,3 the-ao ere nu(c-=.. oec r:d-rri to be
eatploy o s u,+Gc the.,ccicats cct..,,_ _t•ca Aa(GLi52�l(5)),=ppliatioo by It bo arlowca far r.lice:or permit cozy e.idc-oce the
Ic-gil n_,,,or na exp Ieyar under dao Worlrel.00colp.eCsaliCra Arc
I undcranad da,a a copy of thir mtcmc o ovy ba for-xc,-d.4 to tba Qcpc rr
of Jam= ri.l ArcIdcaLY Offioo of(sa r�aoa for Lb.
cova->,Sc vci 1c tioa cod thsl Ciltze to tocurc tov,--ry,so trader s.oetioa 25A of MGL 152 ma Icd to the iaposaioo of cimin_3!pct lti'
ooasi a of a fiat of up to S I}00.00.ndJor iaprisoctzoc=mt of up to ooc ycar rid dvil pca.hic in cc Corm o(.Stop Wort;Order-cod.
II=o(S 100.013 r my.fin me
For dcp.,un�s1 u.c only
---3 1 f $ , /
421,•,_,.3 ) / (�C7IIlJf Number
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DEPARTMENT OF BUILDING INSPECTIONS - j—_ 1_
INSPECTOR
212 Main Street • Municipal Building —5,,
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:: ,' 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, whichincludef undationl_fo ttings (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, Lo _Le,,, h-�' �u understand the above.
(Home owner/resident�`''s'"'signat_Iur r questin emption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date ( 3 _ 0/ n - e,
Address of work
location 24 NoN41(4 c-K 5Y
fIO1t!nl C-6 /A.A