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City of Northampton Status ofPerr7itt �
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Btuilding Department Cur6,b
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^('Q3 2-12 Main Street Sewer/Sept+cA a►Iabl
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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:____ — —.