36-102 APR-25-2005 10 :41 PM TARGET. RESTORATION 1 413 5696225 P. 01
rrx..,r•.
' c
Residential Commercial - Industrial Hj c,Mon.Reg,012AI68
C"N'cllcrnsup.'tcense mM75
TargetRESTORRTION
GENERAL CONTRACTORS
241 East Main Street#145,Westfield,MA olOW 1633
(413)588-4545• Fox(413)569.6225
DIRECTION AND AUTHORIZATION
s ' CIn h
You are hereby authorized and directed to pay TARGET RESTORATION from
the Insurance proceeds payable to me or for my benefit. as your Insured, by reason of
damage to my house, occuring on or about
•� �.S 5
Signed this day of Rog Ii at
5 5 SoM
Location
Insured owner(s)
Witness (es)
Additional Comments (if any)
TARGET REB MORMON
FM M LDA 04 889 03 06
, wa
¢ct+Mrpr
of Xazt4antptau z =
�l �1855HC}tli5ttt8 '
DEPARTMENT OF BUILDI ,1G INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building 44
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i:is/her construction sups:vs o.r. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fame
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 0gulations. 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 pouf, 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
I
IF� yti U
w o OEPARTNIE14T OP BUILDINIC 1NSPECTiot,,s - 1
212 Alain Strcet - Municipal Duiding
Northampton, Mass. 01060
i
«`O MC?I I S CO,1NU EN S A77O TAI MS UR .N CE A 17YU AAr1-j'
rr
%VILh a principal place of business residence at: -
y ` h
, C ` � J
—. hone
do hereby certify, under the.pain5 and penalties of pc9ul-y, ih:i
f I
an an employer providing the followine!wori:cr's comocns_:iop coverts for Ins
employees wor�3ng on utis job:
(Pclic: Nu--zb--r) -- F xpirmaorr D2L--) "
i
O I am a sole propreror, general contractor or homeow-Der(ci:c:e one) and have hired
the conuamors listed below wbo have the follo�vin2 worker's comoen_saaon policies:
\`+t1rI1C Oi Copt^c.o-1 (In2ranc: Coinoan -ili cUc; Ntum-h-- it\J1i-d�Qi<
(Name of CODU-,mor) (lns,uanc Compan}vpoijm, `ttmccr)
(Expir.6on D le)
i
(Name of Conn-acid;) Gmsurancz- Compan}"1Pol,•c?' Nt=b�r) (Expiation Datc)
I
I
(Nzme of Conaamor) (Lasuranc–c Company/Policy Numb`r) (E1pirUoa Date).
(nasc3•.u;�oc3.l c'�ca,irn-C+ -ti•to ircucE iaform-:ioa P-I-.inin&to.11
O I am a sole proprietor and have no one workiog for me.
( ) I am.a home owner performing all the work myself.
INOTE:plc=be nwzm tfi,•w U1 bcmeo..vera u bo ecaplay p�-zoai w� - � �-r�oo c rgaa Boric oa a d..edt �of
not axx-t th_a u oc=ru in%rbich the bomoo-we rtsda«oa the V ouz, z,Vpurum=tbeen i c we C=). Zy acrd mJ to be
eirpioyr�ttaY,c lbc..0-ld`s r�••k--.,'on Au(Gt152-za t CS))-:.{�Plir�oo try.bomeoava fcr a lies-a pcmit zy c�idmcac t>:e
Ic6a1 cta-'uc of m e=;)loyar under ds work ea Compom.t
I—d--z6d tha a oopy of thu mt.®em o y b,fo"mr i d to tbo Depertmmd of Inda+srid AecdeeLY office of l+r�for th.
oov�So`ci Boa and t2u L-ittac to to u='eovRnZC t33de soaiou 23 A of h(GL 151 na led to the;zt= oa of aimiG31 pea+hie
eoa==mg of a tine orup to S 1.300.00 andfnr impr,6�of up to ooc r=Lod civil peaaltio is tb<form-f-Stop Wor4 Ocde and a
S
o
rtan f 100-
00 '
Y t tnc
Far w ,- i u-only -
� Pcrmil Htunt� _
'l
Lot
-
Si arc o LIC=zCr-fPCCmiUCC e ��p" J ¢
SECTION 8-CONSTRUCTION SERVICES J I
.1 Licensed Construction Su erviso : ,ll Not Applicable ❑
Name of License Holder:
�— License Numbe
IJ
Address � � � � ��� � ��� Expiration Date
Signature a ho
r. *ax rsa.. *. _ _ ,': .. "' ;3
�Rb islere cfnelfm ranernontra _� Not Applicable ❑
ON
Company Name N Registration N ber - ---
Address t� Z ( u! Expiration Dat
Telephone 'I�J �'�
SECTION 1:0-WORKERS"COMPENSATION INSURANCE,AFFIDAVtT
Workers Compensation Insurance (davit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the uilding permit.
Signed Affidavit Attached Yes..\/ ❑ No...... ❑
IBM
tics,
" om � WNW
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 108.3.511.
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
resoonsible for all such work performed under the buildine 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
J.
SECTION'5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑:. Replacement Windows Alterations) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [O] Other[E7
O
IrD criptiorzo Pro
ook 1,
Alteration of existing bedroom Yes No Adding new bedroom Yes
d Narrative Renovating unfinished basement es
Attache Y No
�—
Plans Attached Roll -Sheet
s
6a_Lf NernLiose anoddtiaaltex>rs ��tcaacls�rtccon eefh . c�LouEg:
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-OWNERAUTHORIZATION TO-BE COMPLETED°WHEN;
OWNERS AGEN 1.OR C9NTRA'J, APPLIES;1=0R dWLbIN'G:PERMIT
1 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
1 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 pa sand penalties of perjury. '
P� " '�C• '+P'
Print Name
Signature of Owner/Agent
Date
I
Section 4. ZONING All Informatioh 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
fie, 4i I
Frontage
Setbacks Front-
Side L: R: L:' R:'
Rear
! I--
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
1 ,
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issue&
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Books Page; and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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 Q NO I
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
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 r NO 0
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_City,of Northampton
(E ildin 9 Department `
6
212 Main Street er tt
Room 100
Northampton; MA 01060
�� 2 ph( t 413-587-1240 Fax 413-587-1272 y n
APPLICATION TO,CONSTRUCT ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTI0N'.1-SITE`INFORMATION
1.1 Property Address:
This section.to be com toted'lb fffice
Z"or►e � °Ovec(a�Distract
Elett�S�D�stric! "y cB,Distncf s �
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED'AGENT,
2.1 Owner of Record: -
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized A erit: T-A py e•S't' Ut'�'i o
ly 5
Name(Print) Current Mailing Address:
cjt% 64
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
7.o Oc7 Construction.from 6
3. Plumbing ; Building;Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 31 5 p i�> Check Number t
This Section For Official'Use;,Onl
Date
Building Permit Number. Issued':
Signature: r
i
Building Commissioner/Inspector of Buildings- Date
File#BP-2005-1030
APPLICANT/CONTACT PERSON TARGET RESTORATION
ADDRESS/PHONE 241 EAST MAIN ST#145 WESTFIELD (413)568-4545
PROPERTY LOCATION 955 BURTS PIT RD
MAP 36 PARCEL 102 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Tyneof Construction: REPAIR FIRE DAMAGE
New Construction
Non Structural interior renovations
_ Addition to Existin¢
Accessory Structure
Building Plans Included• --
Owner/Statement or License 069275
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below) ��4u
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan C
Major Project: Site Plan AND/OR Special Permit With Site Plan
A Ac L
ZONING BOARD PERMIT REQUIRED UNDER: § Co'"'rra�
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
25�0r7,`Je 6sie-v'r�
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street ssion
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
955 BURTS PIT RD BP-2005-1030
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 102 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:FIRE BUILDING PERMIT
Permit# BP-2005-1030
Project# ]S-2005-1150
Est. Cost: $37500.00
Fee: $175.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TARGET RESTORATION 069275
Lot Size(sg. ft.): 17816.04 Owner: CLAYTON CHRISTINE J&WILLIAM E
Zoning:URA Applicant: TARGET RESTORATION
AT. 955 BURTS PIT RD
Applicant Address: Phone: Insurance:
241 EAST MAIN ST #145 (413) 568-4545 WC
WESTFIELDMA01086-1633 ISSUED ON:4126105 0:00:00
TO PERFORM THE FOLLOWING WORK.REPAIR FIRE DAMAGE
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 Shmature:
FeeType• Date Paid: Amount:
Building 4/26/05 0:00:00 $175.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
The Commonwealth of Massachusetts
Department of Fire Service
Post Office Box 1025
Stow, Massachusetts 01775
Northampton 20
(City) (Date)
Certificate of Compliance
M.G.L 148, Sections 26C Thru 26F
This certified that the property at 'R Sls Pl�
has been equipped with approved smoke detector and was found to be in compliance with
Chapter 148 Section 26C Thru 26F and Northampton City Ordinances 11-50 Thru 11-54.
Inspection/Testing Completed on i -R'c_; 20 By L _�
j Fee Paid: Gk �° �ia Brian Duggan
Head of Fire Department
This Certificate Expires Sixty Days After Date Of
j Issue, When Building is Sold or Transferred
(Owner's Copy) SU091802
i
I
3
C{ ���S� /,y/L��''��✓ � �T'/�NyO� -' `--� l�IJ�N� �o u� G � /UG�j p yD,�/Lvq�6� �/��.�i
Co D-
,/U
i
i
955 BURTS PIT RD BP-2005-1030
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36- 102 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:FIRE BUILDING PERMIT
Permit# BP-2005-1030
Project# 35-2005-1150
Est. Cost: $37500.00
Fee:$175.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TARGET RESTORATION 069275
Lot Size(sc.ft.): 17816.04 Owner: CLAYTON CHRISTINE J&WILLIAM E
Zoning: URA Applicant: TARGET RESTORATION
_ __v._...— AT. 955 BURTS PIT RD
Applicant Address: Phone: Insurance:
241 EAST MAIN ST 4145 (413) 568-4545 WC
WESTFIELDMA01086-1633 ISSUED ON:4126105 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR FIRE DAMAGE
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: `� Z� ✓,�/�
Rough Frame:
Gas: Fire Department i j! ,��`t. Fireplace/Chimney:
Rough: Oil: Insulation:Ck
f
Final: Smoke: Final: C)jC r1 1*;'c;' L:;
1 r
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONN/S.
,woe„ ',- `.
� t
Certificate of Occupancy i nature:
FeeType: Date Paid: Amount:
Building 4/26/05 0:00:00 $175.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo