Loading...
17A-053 R `E cif of �.�rtrfl�altl}�tolt _= - �:� E ��aoanchrrcrlta —° = i w o DEPARTMENT OP BUIL1)r>\G tNSPECTIot,'S 212 Main Strcct Municipal Building Nor(hampt.on, Mass. 01060 WO RICE I Z'S C O NM E N S A TI O N G'q S UTZAN CE A Frm (]i CMSSCjpermj t1CC) v.9th a prbi lcipal place of business residence at: 4&s+ (phone:') —1 - 1 (str�tici ty/state/zap)T do hereby certify, under the perms 4nd penalties of perjury:, hat ( ) I am an employer providing the followine %vorkcr's cotnocnsadon cove zee Ior Inv etuplovccs Wor.Ung on t}tis job: (L=stir'a Corer o)) (Pclic; ?�urabcr) --- ( :piraor Dztc) O I am a sole proprietor, general contractor or homeowner (ci cie one) and Dave hired the coouactors lined below who have the foBowup workers coopensa6on policies: (Nam-, of C o n,=CiO") ([i]R 111 CoIr1D17 '/PGUCi N1LLM,-- !- n❑ - (Name of C000mcior) -- (1ns�rznc C0M0a.7''/P0S'jM' NUfk-N) (EiPiFa ion Date) (Name of Cona-aclo;) (Insurance ComBanyfpobc�• Nulnbr) (ENpirtioo Daic) _ I (Name of Contractor) 9xIsuraacc Compzo-y/Po6cy Num).yer) (Expif-J;ioo Daft). (a .•ti;;:oca1 ilncccun•to¢�cjuc�iaforaa�oo pc�tainias to all r {• ) I am a sole proprietor and have no one wor4dLg for me. t ( ) I am,a home oN�rner performing all the work myself. NOTE:pI �be cw•-lrL t4_Mjj,ho.co�o,,,,��tvyo c¢xplof pcIom to iJ c �cib c rcpaa-oric oo.d.. tL,-- of ON mote the ttrr-L-a�r'j in u3icb the b=,Iocr r,=ida ow co the Qou.pr_,zpp,�tbeen ax C .1ty mcr d7ni to Nc citploy—uadc the .aS r -±oo A=(GL152--=1(5)�application by a bomcoaaa far oc permit cry c �(bc Icpl-t --of ea--z loyor under dw WorSc. 1,Co .p . n� [undrnxaad dui a Dopy of chi.mt.cmmt may bo Cor�.vrded w tba Depanmevr or i-a—z-ri al Arodcacy c t o0 or trsur•oca roc the - cova�.se"cif olioo°"-td th1 L-.i]ta�to scauc bovcra undcz weiiOa 2SA of MOL 152 cis I=d to the io�Gion of cirri pco%Wc: oo =B of a fwc of up to 51500.00 nNo,ta�y 0C,,p to Doc yczr e.od evil pc=Ll-o is 6c form Ora Stop Wort Order end a rim of S 100.00 t d_y a&XjVA try_ For permit Numb= Lot . Si ictur of LiQS1SCr-/pCCZtL,UCt, JF O¢'tHAMPTO $ « flldassHr hills ettIs DEPARTMENT OF BUILDDNG 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 his/her construction sups_: --alsor. 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 backfiIl), 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: C) Lic=ensee Number �h C> 9 Address Q Expiration Date Si nature mow\ C'� 1 (oG3 9 Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ (it 1 —) I Company Name Registration Number Address �— rr Expir ion Date 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...... ❑ 13. - 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-vear 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 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [Q Siding [0] Other[O] Brief Desc.ptiorl of roposed Work: + r r1 Alteration of existing edroom Yes No Adding new bedroom Yes Nom0. \ a 9 9 Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. if NeWU• Ouse and or addition#o exist]ng housing, complete the following: 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 to act on r9y behalf, in all ratters relative to work authorized by this building permit appli tion. Signature of Owner Date I, ak r\�� � , , 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 \@naltieess o perjury. Print ame \d, Signature of Owner/Agent Date ' Section 4. ZONING All Information 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 Setbacks Front Rear Building Heigbt Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (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 issuad:` � IF YES: Was the permit recorded ut the Registry orDeeds? NO 0 DON7KNOV (-) t-1%YS --'------ ` r--- -- _-------'-' -� IF YES: enter Book ` Page and/or Dunument# e",% /-% B. Does the site contain u brook, body of water urwetlands? NO U DON'T KNOW U, YES \~� IF YES, has u permit been or need to be obtained from the Conservation Commission? Needs tobeobtained /~� Obtained »\~�'-� Da�e �suumd' �-- ----�----� \^� ' � ---�------Cr- pnq�xft-y?'-YES-�- --�-� N0� f ) IF YES, describe type location: ' ' ' D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0 IF YES, describe size, type and location: ` E. Will the construction activity disturb(clearing,grading,excavation,nr filling)over 1 acre misd part oyo common plan that will disturb over 1acre? YES ( ) NO ( � �� �� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Depar mentusia only!' Ciit of Northampton Status f Permit auilirig Department Curbtte�niay Permit 2T'2 Main Street Sewer Sep 10-,rath bilrt ERoom 100 We#ereli�Availability S F �.CMorthana pton, MA 01060 Two Sats of S ructural,P arcs hone 413-5. 77-1240 Fax 413-587-1272 Plot✓Blte Btans �' -- ©therRSpecify APPLtttlA-ri; ViMUCT.AFTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to b . office e'completedby oce Map Lot .Unit < Zone Overlay District. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: { Name Print) Curren ailing Address: Telephone r ' � Signatu a �-( 2.2 Authorized Anent: It S Nacre(Print) �� Current Mailing Address: Signatu Telephone 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) Check Number 30-7 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2008-0320 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0320 Project# JS-2008-000460 Est. Cost: $1450.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BOB THIBODO ROOFING & SIDING 152172 Lot Size(sq. ft.): 10890.00 Owner: TONER JONATHAN D &TERESA M Zoning: URB Applicant: BOB THIBODO ROOFING & SIDING AT. 157 OAK ST Applicant Address: Phone: Insurance: P O BOX 201 (413) 527-7663 () NORTHAMPTONMA01061 ISSUED ON.912512007 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE 2 PORCHES OVER 1 LAYER 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 9/25/2007 0:00:00 $25.003074 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo