25C-001 (4) Job Details
Demolish room ceiling, etc
Demolish rotten flooring
Sister 15 joists
Redeck 2 @ 14'x 14'
Repair northwest post& west sill;temp. support&prep
Front, south, and west corner support posts:demo. &prep
Repair post, tie, &sill
Support,strip;& cut rot
First Floor Entrance: two front posts Repair posts
Support joists
Dig,prep, &support x 3
Replace front sill: Install sill x 4
Attach joists
Repair floor
Fix big doors
Repair windows x 3
Dig&pour footings x 3
Below Reinstall posts x 2
Install one new post
Ten braces
Repair roof decking
Up Repair three big joints
Sister/repair thirty rafters
Siding repair estimates:
North gable 20%
North wall 50%
East wall 30%
West wall 30%
Front wall 25%
Exterior Eave repair estimates:
Bed& crown 120'of each
Fascia&soffit 120'of each
Repair transom
Repair big doors
Repair human-sized doors
Install three fixed windows
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7 City of Northampton
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Massachusetts �wS
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� DEPARTIWNT OF BUILDING INSPECTIONS *t ;ter
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212 Main Street • Municipal Building
Northampton, MA 01060 sstrjy°yjil
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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, 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
M www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): j.Y' j �I �I-) L L1 `�"o 1'1
Address: �J -Q 1 4 z
City/State/Zip:,-_Q.f' A ,,Al c, r 9 r .3 Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction
2C4I am a sole proprietor or partner- listed on.the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are:a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 1525 §1(4), and we have no
employees. [No workers' 13.F-1 other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify nd the ains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: +n Not Applicable £
Name of License Holder: F---t Ir '001 1 Z+
License Number
Knoivis- AL% 4 J )
Address Expiration Date
�--�A 11.1 ._ 'L-11 (k. r) I 0 5
Signatur _ Telephone
9 Reaisfered Home Imairovement Contractor: ._ w' _.,.,, ;; Not Applicable E
i J 4 3
Company Name Registration Number
�( 7 14•
Address Expira ion Dat
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.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...... £
11. Home.Owner Exemption
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.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 1
Accessory Bldg. Demolition ❑ New Signs [O] Decks [[] Siding[j ] Other(1]
Brief Description ppf Propos d (,� , \
Work: �� w.4�i'at� A'C> "Ae- ("�T Y'fc' '� � l f aI �� � �a I'> �1��
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New°`hwse'and or.add'ition Yo`'ezisting.h'auslng;:complete the:followlna:
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 BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
as Owner of the subject
property
hereby authorize (r��•��5y ��
to act on m behalf,in all matters relative to work authorized by this building permit application.
Signature of Own r Date
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.
Yom ) S '__---{-"�., � ��•� �� G 1 -
Print Name � "�
Signature of Owne/Agent ate
.
~
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Building Department
This column to be filled in by
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage 010
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has a Special Permit/Vahnce/Fi riding ever been issued for/on the site?
�� ��
NO �� DONTKNOW YES
|FYES, dateis:ued: ` ��
IF YES: Was the permit recorded at the Registry ofDeeds?
NO K j DON O YE
�� -__0-
IF YES: enter Book L Page and/or Document#
��
B. Dues the site te contain a brook' body of water orwetlands? NO ��, DON7 KNOW v�� YES
IF YES, has a permit been or need tobe obtained from the Conservation Commission?
Needstobeobtained �-
� Obtained »�� Date |ssued.
'
�~� �_� '
C. Do any signs exist on the property? YES v NO
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 r�~�
_
IF YES, describe type /
' ' .
E. Will the construction activity disturb(clearing,grading excavation,orfi0ng)over 1 acre nrisit part ofa common plan
'
that will disturb over 1 acre? YES K ) NO
IF YES,then a Northampton Storm Water Management Perimit from the DPW is required.
�
^• City of Northampton
Y , f � ,r Pi "S4'k �e �5• A I�``hg,n s e k`s.:�
Evil ,re It I
f I F r An��f
Building Department �ur6JCtrt/DrfyewayPerrrttt '
CI I 212 Main Street i 9r L ceP ri j i'} ei�u}ai�V'dl5l7 a b 1 ty
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�,� orthampton, MA 01060 Two S+rts;¢t strrur1 PtansF , k, �" {i 2
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APPLICATION TO 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 office
6.
�' Map Lot ` Unit
Zone Overlay District
_....:
;Elm St District CB District
SECTION 2.7 PROPERTY OWNERSHIP/AUTHORIZED AGENT-
2.1 Owner of Record:
M1a�Otzc � C � ItK�N-�T'�
Na Pri ) Current Mailing Address:
1(t E e� f
�^ Telephone
Signature
2.2 Authori Agent:
Name(Print) — Current Mailing Address: t, t�
-��. - ( N� 7
u M Tele o
Signature h
r p
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (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) (" 1.)k j Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2014-1209
APPLICANT/CONTACT PERSON KRIS THOMSON
ADDRESS/PHONE 362 KENNEDY RD LEEDS (413)549-1027 Q
PROPERTY LOCATION 108 NORTH ST
MAP 25C PARCEL 001 001 ZONE URC000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building_Permit Filled out 0
Fee Paid
Typeof Construction: REPAIR BARN SILLS POSTS&SIDING
New Construction -
Non Structural interior renovations
Addition to Existing
Accessory Structure -
Building_Plans Included•
Owner/Statement or License 084152
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
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 Commission Permit DPW Storm Water Management
Demolition Delay
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.