Loading...
29-436 �SENDER:COMPLETE THIS SECTIviv COMPLETE THIS SECTION ON DELIVERY • Complete jtems 1,2,and 3.Also complete A. Signature item`4 if Restricted Delivery is desired. _ El Agent • Print your name and address on the reverse X a C' ,, ,i Addressee so that we can return the card to you. 8. Received by(Printed Name) C. Date of Delivery • Attach this card to the back of them ilpie or on the front if space permits. .- C2 q D. Is delivery address different from item 17 �❑Yes y{ 1. Article Addressed to: If YES,enter delivery address below: �`�l No Jose Melo Maria Costa 51 Ellington Rd Florence- MA 01062 3. Service Type ❑Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7004 1160 0005 0270 9312 (Transfer from sere PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ri l 'Se 7777777 r-9 CER TIFUlD MAIL. RECEIPT M1 o- fDomesfic m�H Only;No Insurance Coverage Provided) BLDG INSP n Ln Postage $ O p Certified Fee Return Reciept Fee ' Postmark (Endorsement Required) S Here Restricted Delivery Fee r9 (Endorsement Required) 5 Total Postage&Fees I$ ti / p �. O Sent To Jose Melo £ Maria Costa'`" ----------------- -------------------- Street, -- ---------------- orPOeoxNo. 1 Ellington Rd City State,ZIP+4 Orence MA 01062 PS form 3800,June 2'J02 See'Reverse1orinstructions �t1AMp�, $ � �1'ilsssac}tusetts DEPARTMENT OF BUILDIIN,7G INSPECTIONS INSPECTOR '212 Main Street • Municilull Building ' Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT w� The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups::: :i,sor. Tlie state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be,a one or two fami�_ 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 depart ent for the City of Northampton wants.any person(s) who seek to use the home own 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 f egulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before bac!iML), sonotube holes (before hour), a rouzh 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 occuvarfily until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) t 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 r oQ'� of �a�fl�aill}iton - _~ o DEPARTMEI-T OP BUILDING INSPECTIONS - 212 Main Strcct • 11funicipal Building Northampton, A1ass. 01000 «'OlUCER'S C06u;,NSATZON LASURANCE AFFMAVIT (l;ccux/perm;tt�) Vvith a principal place of bu`si)nessfresidence at: - - �S1 2J�, " �UcS t TES A Y✓t✓� (phone--') �S`�6' ( city/statrJrip) do hereby certify, under die pains and penalties of perjury, -hat I am an employer providing the following worker's compcnsauon covemle for my eml)lovices wor.tong on dus job: 70,4 OyC,�'--�'/5�SU 17 (Irls�r� Conpr*�) (PoLic:Nut r) f-1 -,-pirdon D --) ( ) I am a sole proorietor, general cone ac-ror or homeow-Der(ci:cie one) and have hired the cooaaG Listed below who have the folloLVing worker's comoensadon pokles: (i+fl1D: Oi Cont^Ctor) (IIIRI]11t Comma i)-i'mUc NuIILC) �C>lr'd Q l D 1lC} - (N:mc of Colas ctor) (Insirancz Comoan`vFolic; Numi:cr) (E\Dirz6on Date) I I (Name of cc)=CIOr) (tnswa.nc:.Compan}'/Polk}• Nambcr) (Expiation Datc) (Name of Contractor) (Lasuranc-- Comrzay/Policy Numb,:--r) (Expiration Dau) . (sasca. s.:ocal r -IVnc---v to iafor¢ta.7oc pctainias to.0 Oct-cv:Y) O I am sole proprietor and -have no one worfdog for me. ( ) I am,a home owner performing all the work myself. NOTE:plese be ewn=tfii,, )c wbo ccnploy pcL,7m eo eta rcpair work on r d-,UI=-e:of ant a2cn-c th:� ` tmts in tech the bom..-,c r=do or oa the Qouz.6 th=a,ac ax C=c--Uy oce&--=d to be =:aplcr--un,---the-=k=m r�ti —.,'oa Aa(GUI 52-=1(5)�=ppUcL6c n by.homooav=far a lice=a permh m=y n-r6cn c tEe Icgs!R.^.,of ea es,�loyx under Qto Worlc,o(a Compcmat.ioa.Ad. [a;ade'uyad th,a a oo9Y of ttir mtemW may be for-xavded to tba Qopartmcad of Induuicl Acodcar OLGoa oC 4sau+noe for tb. oove-XLc vrriGc=ioa had tic L•ilt-M to tc=m tcoverase coder xa600 23 A of MQL 152 oa teal to the L-ap ca of cria i pcu+ltic of a f=of to s I-SOo.00 an vor' or up W - 6c form of a Stop Work ordc and �mJ.ssag up aa�zsoamer:(o p one yet end otiil pm.P.io>a fiao of S 100.00 a d_y tgxiaat tnc. i - For dcputa ux only - pC'fIII1I 1`ttlSlllJC1 - - V�l^ Siaaat n-c of LianscrJPcrmiucc e SECTION 8-CONSTRUCTION SERVICES a 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ►� L R'A`� / License Number Address V Expiration Date -To K) ©,-a-7 G 4,6 Signature V Telephone 9_:Riaisterefi Harne_1`inpris�zement~Contra�ar�� ,� ���'���• �_.� k, Not Applicable ❑ Al Company Name Registration-Num er —-- Addre / Expiration Date Telephone �� � ��j �-0Q-6 SECTION 10-WORKERS'COMPENSATION INSURANCE FIbAVtT(M.G:L.c.'152,§25C(S)) 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...... ❑ . � W f 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 r r.: SECTION 5-DESCRIPTION OF=PROPOSED W.ORK{check�alhapplicable} New House ❑ Addition ❑:, Replacement Windows Alteration(s) F-1 Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[ Other[ Brief Description of Proposed 1/r �- s�a�� t! �No Work: w Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.FfNe ,house a tl a ddiflow, t><nc fao s �lg comb tet ffi o Tau 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 tt1%Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNERAUT-HORIZATION=TO`BE COMPLETED WHEN OWNERS AGENT"OR CONTRACTOR aPPLIES'FOR BUILDING=PERMIT i l -gyp s '5 X04 1�174TU S 2` W /6 Z as Owner of the subject property r /I hereby authorize Z� T-3 to act on my behalf, in all matters relative to work authorized b this building permit application. Signature of Aner Date 1 e�F_' 40 a k) �Pe A-0 ,as Owner/Authorized Agent hereby declare that the statements and information o the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. r -0 Print Name Signature of /Agent Date � ^ ' -- Section 4. ZONING All Informatibil 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 IF Setbacks Front Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces ^ A. Has Special ever been hsuedfor/on the sha? ' � NO 0 DON7KNOW 0� YES 0 � IF YES, duteissued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DO07KNOW 0 'ES IF YES: enter Book Pagei and/or Ducument# ' �� �� B. Does the site contain a brook, body of water orwetlands? NO v��� VV «_�� DONT KNOW YES v�� IF YES, has a permit been or need to be obtained from the Conservation Commission? - Needs uoheobtoloed �~� Obtained �~v��� Date v�� ' � C. Dn any signs exist on the pvuperty �� ��� YES x�� �O v~_/ 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 0 IF YES, describe size, type and location: E. Will the construction activity disturb grading,excavation,or filling)over 1 acre oris it part ofu common plan that will disturb over 1acre? YES r NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Nortf;lampton Building Department 212 Main Street Room 100 er e t Northampton; MA 01060 lop 5 � phone 413-587-1240 Fax 413-587-1272 totS` Yap � APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTI6N.1 -SITE INFORMATION 1.1 Property Address: This section to tre"compfete&Oyu€k 3 l/i to i g n iro � � a � UEt /—X0.2 "N C' 'vf zone Overla�rD�strict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ° 2.1 Owner of Record: / �?'o ca h'1 �4 T ra 3� cep r 3 G�1lJ xt Name(Print) t Curr ailing address: - g Telephon Si nat < 2.2 Authorized Agent: Name(Print) Current Mailing Address: �! Signature Telephone SECTION-3-ESTIMATED"CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building G3� ✓ (a)Building)Permit Fee 2. Electrical _ (b)Estimated Total Cost of Construction from 6' 3. Plumbing Building.Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) // a Check Number This Section For Official'Use Only Building Permit m' r. Issued: Signature: r ��;, Building Commissioner/inspector of Buildings- Date w�• R '+'MIF+MM 43 ELLINGTONRD BP-2005-1189 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-436 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2005-1189 Project# JS-2005-1610 Est.Cost: $11024.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sq; ft.): 10018.80 Owner: MATUSEWICZ JOSEPH E Zoning.URA Applicant. B & R Siding AT: 43 ELLINGTON RD Applicant Address: Phone: Insurance: 781 Bridge Rd. (413) 586-4167 Workers Compensation NORTHAM PTONMA01 060 ISSUED ON.617105 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING & REPLACEMENT WINDOWS 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 6/7/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo