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32C-271 (2) - f rtf?e °a ' entp City of Northampton Status ofPerr7itt � ' Btuilding Department Cur6,b rfv way ^('Q3 2-12 Main Street Sewer/Sept+cA a►Iabl ,� L' Room 100 !Vater/Well Ava ,_ 4 Northam ton, MA 01060 TwoSets�ofS ctu aI�Par�s t'� �— hharie 413587.1240 Fax 413-587-1272 PbtlSite Plans� '� Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office i 1.1 Property Address: Map ,_ Lot Unit 1 — Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print, C.rrent fs it Ac�� �s�: sign pure 2.2 Authorized-Agent: 'tint) r��_,_. SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be �r Official Use Only _completed by permit applicant L Building (a) Building Permit Fee _ ! !her timateca Total Cost of construction from (6) _ 3 Plumbing !I Building Permit Fee 4 M,echamca! (H r;+C) 5. Fire Protection j 6_ Total = (1 + 2 + ? + 4 t)) f— -- - — — Check f'umbe _ This Section For Official Use Onl _ Building Permit Number: Date Issued: god Signature: _ _ --- -- ----------- Building Commissioner/inspector, f- Buildings Date BP-2003-1118 GIs#: COMMONWEALTH OF MASSACHUSETTS . - CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2003-1118 Project# JS-1999-1680 Est.Cost: $13980.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: R4 CDT CONSTRUCTION Lot Size(sq. ft.): 10410.84 Owner: SHEAN MICHAEL T&JUDITH E Zoning:URC Applicant: SHEAN MICHAEL T &JUDITH E AT: 46 WILLIAMS ST Applicant Address: Phone: Insurance: 46 WILLIAMS ST NORTHAMPTONMA01060 ISSUED ON.616103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE EXISTING SLATE ,RESHEATH WITH 1/2"PLYWOOD, INSTALL 30 YEAR SHINGLES 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 6/6/03 0:00:00 5274 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo PROPOSAL CDT Construction 158 North Maple Street Florence, MA 01062 (413) 585-8677 Date; March 22, 2003 NAME Mike& Judith Shean RE: Fire restoration/phase#1 ADDRESS 46 Williams Street CITY Northampton,Ma. 01060 (413) 584-5539 We hereby propose to: Repair damaged roof board sheathing, remove existing slate roofing and cover entire roof area with 1/2 inch plywood and finally to cover entire roof area with 30 year asphalt architectural shingle color of choice. Price includes all necessary flashings and flats For the sum of Thirteen thousand nine hundred eight Dollars ($13,980.00) With payment made as follows: 87,000.00 to start balance upon completion. Respectfully submitted Note-this proposal may be withdrawn by us if not acc ted withi _7 days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature �1 1�. ,�,,,� Signature Date, - `r-�� Date �CYAM A Li fty of Nar#(lailipfait z z � � e �itiasSa�l���S�tcs DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street * Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as 111's/her construction super,,;sor. The stale defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or trvo family rl►velling, 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 0 a a GAP Of �V>7ztfj�illt�tnli a6 �i�sRChnsrtta' — m DEPARTMENT OF DUILDIT(C INSPECTIONS 212 Main Street ' Municipal Building ra Northampton, Afass. 01060 WORKER'S COMTRNSATION INSURANCE ArFIIJAN']T (Ii ccnserJpcuni flee) %with a principal place of businesslresidence at: ----------- - -- ----- - (phone (str�.tici ty/sta Lori p) CIO hereby certify, uric+er th,-- and penalties of perjury, that_ O I alu an employcl providing the following "V011r cis colnpensanon covci,,— or my cmployccs working on Leis ;obi (InsuranG Cornpan}') (PoLC;Number) O I ml a sole pmuilctor, general contractor or homeowner (circle one) am; lave— 1L ed the contractors listed beiow,vho have the following workers colnpensa"ion po!icies: (Name of Contnctor) (Insumnc°, Company,'Potic f Nwnbcr) (l xp,rinon Datc) (Name of Contractor) (Zns-lrancc CoMT,—=v/Policy Numb--r) (E>: irr:lion Date) (Name of Contractor) icy (Name of Contractor) (Insurance Coml�ary/Policy Num�z) (E�:ni::aior; Date) (attadt id!itimil zt::ct if t:c�cn.r:!n�r�:_f::%Sc i::f:<tnz:i a:pu taininr�;.•all c_<:'satin:�) i ( <U11 it sole proprietor ,-ld have no one "Ork;inc; for Ilse. O C am a hol�le owlle pCtiorliling akl the wo[:r Illysclf. NMI::Plc,se be awa c t1:3!'.51_`Ic t:- o :r a r+ J c,-,,Play iY T to c:: _m cr t air •x not imrc ihyn thrt o uniti in t{::mot tx k ,krouz ct rcz:(:c a oct L`e(r rs zPpartcr-i Lhcdo c:r cxt ccrr-rallV ca ployc�un ct t}r.tvotl ct' c x - :a!irn At (GI.152 a 1(S)),:-IPI: _!icn by a homco%N-Kr fora Lcnu ct Icgil ztntuz of an omployx untie ho WNkc*jz Compern.tion Ad I undcrsumd thz1 a copy of Oir zt>t.cn:cci may be foawnrd«I to tha D?ctbrtarrii of lnCurtrin1 ADii&n &Offi—of l:::cu mo=o for tlw covaige vrrificsIio(3 and that f_iium to a!atre coverago under.cc-tioa 25A of MGM,152 can I"to a.intPosiLion of c:irnin_1 P",111;a coaatatma of a rtnc of up to S 1-5 00.00 a:t-'.'or i--r`PTi-runcnl of uP to on.)u a.).A civil penalties in ti,form of a Stcp%Vcrk ork"--an;I a r,rm aCS100.00 a day Igaimt nr_ - Foc dcputnr1C11 ui Doty Permit Ntunber Map" r; n� Sig]MturcofLiccn;cc/Pcm Low SECTION 8 -'.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Q�' License Number Address Expiration Date Signature Telephone 9 Registered Nom`s Im�rovementContractor „,w„�y•,,,,,,„ , ,,,;h _, 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...... ❑ a,l omem®wher Exemption The current exemption for"homeowners” was extended to include Owner-occupied Dwellings of one(1) or two(2) farlil ies 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 buildiny-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 fcr 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 SECTION 5='DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: t Alteration of existing bedroom Yes�� No Adding new bedroom Yes vim" No Attached Narrative❑ Renovating unfinished basement Yes _'�_No Plans Attached Roll ❑ - Sheet ❑ 5a.',If News h"Ouse,"and or°addition'to existing housin comlflete,,Ahe followin'° a. Use of building : One Family_ Two Family -4 - 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 reg.jlations2 —_Yes No . I. Septic Tank City Sewer Private well _ _ City water Supply SECTION 7a -OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize __—__-__- to ac; or my behalf, in all matters relative to work authorized by thy, '�;ullding permit application. Signature of Owner Date cm�l _ 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 and penalties of perjury. Ci�nt -re Signature of er/Agent _Date 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 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 �° ` UON'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 ere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location:____ — —.