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17A-140 (8) WN4 f 10ME IMPROVEME NT Estimate P,O. Box 329 Leeds, MA 0 1053 Date Estimate 4 Late "281,2005 16 Fame Address— al Description Qty Rate Total RFPLACF ROOF,INSTALL NEW WINDOW AND'TUB SURROUND.DF'I AILS LIST BELOW, 1*F'M0VF'FXIS-��G ROOFTN'G(MIJLTI LAYER) 21RE'PLACE ALL FIASHINGS T10 SIDE WALL.S,ROOF EDGT-S,CHIM`NT,'YS AND PLUMBING STACKS. 3:fNSTAI.L ICE AND WATER BARRIER TO At 1,EVE"S ANT) VALLEY"S 4: DiSTALL I Sib.FELT PAPER TO FNTIRE R(W, )F AREA. 5'A 30yr-ASPHALT SHINGLF TO BE r,\TSf A1.1-ED WITH CONTTNIJOUS ROOF VENT AT RIDGE. 6-1 VINYL IfOPPER.WINDOW TO BE INSTALLED fN 2nd FLOOk BATI-I ABOVE NEW"R.IB SURROUNfiD. TSIDEWALI..SHJNGLESTo BE REPLACED AS NECESSARY AROUND DORMER AND BELOW NEW WINDOW. 8-TERMITFIT'S AND DUMP FT-ES'INCLUDED. TOTALPROIECT COST INCLUDING AN ALLOWANCE OF ($.;,000.(X))FOR T`UB SURROUND. A DEPOSIT OF S2000,00 DUE UPON SIGNING S6000.00 DUE AT START$7000.00 DUE CT ONI JOB COMPFTION CUSTOM E R ly'()N'. DATT, Total 4'itSAMP�. � � �lassacltnsetfs ^ ' VIZ ` DEPARTMENT OF BUILDDIZG INSPECTIONS /= INSPECTOR 2212 Main Street • Municipal Building 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 has/her construction supf:,'s or. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be,a one or two famuly - 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 hour), a rou-zh 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. Daze Address of work location r i R `f. �I(�I L7� �\Tarf L41 I 1 10 11 - _- � A ' f 31a�ahrhntrtta• _ -° o DEPART}tE 14 OP 13UILDr>\)G INSPECTION'S 212 Main Strcct Asunicipnl Building jNorthampton, MASS. 01060 I - !, «'OMCC;R'S CO\III'ENSATTON MSURA3rCE A II 1 A..VIT z, S e -- i ccnsxlperm�ttcc) %%,ILh a priflcipal place of bUSIDesSfresldeIICZ at: C'l�rs ee f-� jl G d� nC-c -414, 63'CQ6: (.phone?) ,-�40Q—Wlt4 j I (SUCt/C1 t}istat.crD p) do hereby ccnif under die paLM and penalties of pcguty, :-hai ( ) I am an employer providing the followinp,workces cotnoc:ls-Zion cove 2gc Ior Illy eluplovccs workang on tills job: r (Insure Comp) (Policy Numbcr) (r:-pirztior,Dzir) I • ( ) I am a sole proprietor, general contractor or homeowner(c cie one) and h2ve hired the coouaCors listed below wbo have the following worker's cocoen_-adon policies: (N+amc Of Co:?rMao') (1n urzncz Cornpaji),iPOUci NIL1IIlt-Cr) -- (-EtiJlruuon Datc) (Name of Contractor) (Lasurancc Comoa-ativPoUm, Numcrr) Date) (N.me of Con=do,-) Glasurane; Company-[PoUq- Nambe-r) (Expimaoa Datc) I - (Name of Contsactar) (insutan Comp aay/Poticy Numbs) (Expiration Dais). (ntlxb: i�ocsl�cct.ilnca=sa_�•w ascrut�iafortaaEoc Pctainiac to art cacm-cLn:2) { am a sole proprietor and have no one working for me. ( ) I am-a home owner performing aU the work myself. NOTE:pl=y be we Ifi••aizDe bomco .D,�..•bo CCaplay pcioaa to do •:,-j,•••-• c,,rjoa Cr rgau •orz an c d-JI-i-Z of i not moct th-- tbroe>mrj in we cb Utx bomoownc r=d=o<oa the Qvua z,�purteo_r1 the cn tc nx aca:dft�m k czgrltjycs utc d the-=k-Cm cc=:p •*,oa Art(GUI 5L=1(5))� pptccatioa try a bomcoava far a 1 cTV or pc-m rr_y -i6—the of as<-tPloyx under dto WoAr, -Co�a Act I uodcn.od tba a oapy or tbi.mtcncm may be foc.-,t d tv ttw DcQartmco¢ roc tb. eoverasc v+cr c=ioo and ttit L•Um to Leone'M%'c�tinder scciioo 25A of 1.101-151 tea Ind to the iarxuaioa cda minal Pc-bi° ooasi isxg of a floc orup to 51-�OO.00 and/or es�Ciyo�of up to ooc yt3r end eiva pcoaltia a tk form ora Stop Work 0-i,--aid fim of S 1 n0.t?0 a d y Lpi=t>x For dp-na,='-�j u.c oily I parrIItt NuIDbcr ll f (!�J �5-- fit : i crcniucc e I SECTION 8-CONSTRUCTION SERVICES, f,: 8.1 Licensed Construction Supervisor: Not&7-74410 Applicable El Name of License Holder: � i/�,w" N"en License Numb r t. C k �f rC�'+� cola / /916 Address Expiration Date re Telephone 9t s om �mpiemea c14r Not Applicable ❑ j Company Name Registration aum er ` --- - �I cicz k �S m lc --iic . r1rt��.� /V//g Xps Address Expirat' n Dat Telephone `e' 7 --�4(41 SECTION 1'0-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...... ❑ 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 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 r I �^ Y SECTION DDEESCRIPTION OF-PROPOSED WORK(check all applicable) New House [] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding W Other[0] Brief D cri ion of Pro _ed_ n � 7 y e- w ✓t,1d�+w, 14cr '"C"sid' Work: � �F)E�T L✓� O �1t�fg�E'. f4C+i; Alteration of existing bedroom Yes K No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll -Sheet sa { 1Vev ogse n r �di ' o xlstlnc fiou`SlffW omaleteu#h o gnu: _ 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 fl 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 AGENT.OR CONTRAC7gR APPLIES`FOR BUILDING:PERMIT~ 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 C55c'r►?��'�l ,as Owner/Authorized Agent hereby declare that the st ement 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. ' _ Print Name _ r4 Si of Own - Date f � Section 4. ZONING All Informatibh 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 Side L: R:' E L:' R.i Rear Building Height Bldg.Square Footage F-7 % 7----1 —; Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces r----� i t Fill: (volume&Location) ' A. Has a Special Perm it/Variance/Findin ver been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page; nd/or Document B. Does the site contain a brook, body of water or wetlands? NO 8, �/ODON-r KNOW 0 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 0 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradinge ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. h t-1City of Northampton t building Department 212 Main Street 1 l Room 100 MG 1 5 2005 �'JS o hampton;'MA 01060 phon 413 87-1240 Fax 413-587-1272 IS _ 'APPLIEt N&aG9142114UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE°INFORMATION 1.1 Property Address: Thrssection to be completed byoffice F� h (>✓"c-'lc e Ilk d r b `zone Overlay Olstnct 9 �Elnt S�Dlstnct' xt,u�,'�4- Y ":«n CB T115ytnCt._'" SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: c%esFnlfi S}. Name(Print) Current M ' ng Ad Telephone 3igriature 2.2 Authorized Acierit: CS t ate �-wr�_ PO. P(K 9:5Lcl I_ef-t5 A4, U05-1 Name(Prin Current Mailing Address: 5 e Telephone E'CTI 3 IMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building QUd {a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Constriction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use-Only Building Permit Number: -Date _ . ' Issued: Signature: Building Commissioner/Inspector of Buildings Date 215 CHESTNUT ST BP-2006-0167 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 140 CITY OF NORTHAMPTON Lot: -001 Permit: BUiidim Category: BUILDING PERMIT Permit# BP-2006-0167 Project# JS-2006-0256 Est. Cost: $15000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sq. ft.): 23870.88 Owner: CARRELL JUDITH B Zoning.URA Applicant. Jesse Montgomery AT: 215 CHESTNUT ST Applicant Address: Phone: Insurance: P O BOX 329 (413) 585-8482 () LEEDSMA01053 ISSUED ON:8116105 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF, REPLACE WINDOWS & SOME SIDING 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 Sienature: FeeType: Date Paid: Amount: Building 8/16/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo