17C-180 o�•riw•rapo ff•• - - `
F e C�iii� of Nclrf[janip!on
DEPARTMENT OP BUJLDItC', INSPECTIONS
212 Main Street ' Municipal Building '4
Nrorthampton. Mass. 01060
_..:.. 'YV-O-RTQ-- COEWENSATTO.1at •LNS•URANC A' �S.trlT"
� • • -(liccnscelpermitfoc) -
xxtith a pri;icipal place of businearesidence ac
'PO -60K (phonex) Y13- 399 1-7xbd
(Sac/City/Slatc/zi p)
do hereby cerrifjr, under the.pzins and penaties of perjury., :her
( ) I am an-employer providing the folio .Up,korker's compensation cove mge for Inv ;
employees worijag on ttus job:
(Lnsur- Con may) (Pelic•Number) (Expirdoa Wit)
( ) I am a sole proprt:tor,general contractor or homeoiAmer(c c-e one) zoo bzve hired
the contractors listed below wbo,have the follo�vin worker's raea°.eszaon.policies:
(Natac o:Coneaco,) Onvturancc Company/Mic;?�aaiba (rEira;ron ogle)
(Name of Conemaor) (Is=ran=-COmpaatirpoliev NUML-_r) (t#irmidn Date)
(Name of Coaaaao:). ansu==Cowpwy/PoLicy Numbe-j) (E-epir-aaoe Dare)
(Name of Coaaamor) (Rmyance ComcaayRolicy Number) (E.�iradon Datc) __..._.
(adadt s3ds.�•.tz ar�Arnoaos_-g to:ncwudc arorsa..doa pa•ta;n a6 u qtr oo¢saco:s)
( I Taleweprietor and ba-ve no one woridng for me.
( ) I agt:a home owner performing al! the work myself:
MOM jd==W CW.WC O='.hi s Lomaow.=who amplap PC=-am to do iii—C=n=ea�sWo clgai-+aric m a dwei�of
got aansc tJa_n t:soe tmGa is�the botoeoaoC ataida a oo the Qoopds�p�stfm:C tber�z-c pot C-xs@�r o�od m ba
'��-� "' n Act{6I 52 1(3 :pPfiosos ttr a hamosaat fca x I; Cr Puma cr tsidmoc the
JCVj of v cs7lryrr cadet alas Wodrda Compams;ion Ant
I qod -J ftd a spy of thur mb"m _ a_fon%wd.d b th.
-ea"'One"e�x�ioo at:ud tltas'ti-re=t:m soouc 7 Dep.rtmo*otlod,eto;d noedamy O?rw erlmv+oat for tb.
l+avera�c coder section 23A orMOL 132 tap W to the mom«+aFein;C P=%WC%
000si.ztg of a fine orup to Y I VO.r1Q.edfor ofuP to Coe ytar tad c;Q pcaxWc id,6,Corm of a Stop Wok Ordc and e v
G=0(5100-00 a dad �►+---
For
1�.-r.n.t Nr1TIX'f
u "A 4DEPARTMENT OF BUILDD(G D&PEGTIONS
INSPECTOR Zit Main Sueet • MwicW BW-Vmg
NcxT wnjw o,MA 02060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massactwsetts allows the homeowner the right under 780C1VIR 1tY83A to
act as his/her construction super t isor_The state defines"Homeowner" as,"-Person(s)
who owns a varcel on which he/she resides or intends tote;a&ff r
d► S;aRtacibed or.deabdwd structures accessory to such use and/or fnrrm structures.A
person who constructs more than one home in a two-year period shall not be considered a
home owner."
--- The g r e Gay ofaaaoaptan any Pff
use the home owner ate mptionE,to act as their o,6 construction supowisor,to be aware
that by doing so you become responsible for compffance with state:buitdiog codes
and 4egulatious.The inspection prove ss-requirm that the building department be called
to inspect work at various stages,which include fouadationlfootiaES(be cord bacirrdrh
sonotube holes-(before oour l.a rouih beading isspeieiioir(before woirk is
conaeandl. n ftawctiowfif reasiredl aid it final h9VEZ msnction.:The
building departure nuregdm these inspections before the wodC is cmcea ;-failure to
secure Meese hwoections can result ut iWon to obtain it of eccnuancv
u=M the work can be i nsiiected. =
If the homeowner fires der trades to perform work(electrical,plumbing St gas)the
homeowner will.be responsible to make sure:that the traders hired secure-their proper
permits in cxinjuncdm to the building permit issued.°awd that they get their required
inspections.Failure of the individual trades to semen the permits and inspewons as
r equine d ran DW AY the project until such time as the proper permits and inspections are
made
L understand the above.
-(Home owner(resident's signature requesting eumption)
I will call to schedule all required building inspections necessary for the building.permit
Date
Address of work
location
:rte
r
SECTION Or CONS�ON SEMFICE$
3.1 Licensed Constructlah Supervisor. Not ApOicable ❑.
Name of Lime Holder:
License Number
Address tie
Signature Telephone
Not Applicable ❑
Cmam r Re9�tra6on -
Address �—' _ epinatiorh Date AAA- o io
SECTION 10-WORKERS' ._
COlAPE.fIS7F"LIOl�1N5
Workers Comps Insurance affidavit must be completed and submitted with this application-Fadune to provide this affidavit will result
in the denial of the issuance of the bulldog epmk
Signed Affidavit Al adhed Yes.-_—. No—. ❑
The current exemption for"homeowners''was extended to include Owner-occupied Dwd fpgs 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 flat the owner acts
- as supervisor.CM R 78. Shdh FAU—tb n Sedan 10&353.
Defhpitiou 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 dwellin&attached or detached structures accessory W such use and/or farm
struchires.A Person who coastraets more thaw one borne in a twe-year period d all not be oamidered a hemear►ner
Such"homeowner"shall submit to the Building Off vial,an a farm acceptable to the Building OffwnkjW bdsbe shaH be
responsible for aH such work performed under the WNW 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 Cdr 15.3(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Aunotated,ym may be Hable for person(s)
you hire to perform work fvr you auto this permit
The undersigned"homeowner"certifies and assrmnes responsibility for compliance with the State Budding Code,City of
Northampton Ordinances,State and Local Zoning Laws and State oftUssacliusetts General Laws Annotated.
Homeowner Signature
i
SECTION 5-DESCRIPTION-OF PROPOSED'11Md tclM&--ltv_MXI l
New House [] Additlim []:; Replacement Windows Alteration(s) [] Roofing
Or Doors D
Accessory Bldg. Demolition New Signs [i3] Decks [p Siding[01 Other[CA
Brief Description of Proposed
Work: a `i
Alteration of existing bedroom Yes No Adding new bedroom Yes No -
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
a. via v bs ffai.g: FWenft, Twin F?molly Other -
b. Number of moms in each family unit: Number of Badvooms
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 It.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 cordons to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private wag City water Supply
SECTION 7a OIMNF.fAiFlO.lE Y
as Owner of the subject
propertIf
hereby authorize
to act on my behalf,in all matters to work authorized by this building permit application.
Signature of Owner Date
--- L--IJ cr - as Owner/Authorized
Agent hereby declare that Ifte statements and Information on the foregoing application are true and accurat%io fhe best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
4 AF L U G e-
Print -
S' re 0 f Owner/
Section 4. ZONING All kgorMU6+Um Be completed.Permit Can Be Derded Due To kroornplete information
• mfg Proposed Required byZoning .
TWs cokww to be rtBctt in by
Buddins Dep uunm
:r
Lot SIZC
Frontage
Setbacks Front
Side. L:= F- i ; R-=
Rear
Building Height ' {
Bldg.Square Footage %
Open Space Footage % # ,
(Lot area minus bldg&pared i---
#of Parking Spaces�--�
Fill: l !
(volume*Location) ! -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES
IF YES, date issued 1 i
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
�— and/or Document#I I
IF YES: enter Book Pte; i
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
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 Q
IF YES, describe size, type and location: {
D. A_ re there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location: j 1
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that vAll disturb over 1 acre? YES r NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department
212 Main Street
Room I-00
Northampton;MA 01060 _
phone 413-587-1240 Fax 413-587-1272 i
rte• �"- ,� � �'� � ��
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SEGTtON t SITE 1NfRM�1'l1ION
1.1 Prone n Address: t` � s on Ca hie coQ>tl�
0 .:.. � '�<"""�^��+..i..,+"5.aa'."�" �-7F''°''."..-c`♦'. '�5.-r^�`..�°a�F'L{x".rr '-� fi
SECTION 2�PR6PER'FYOWNERSHIPFA
GTFiQRIZED AGENT:,
21 Owner of Record:
V, WC,J w 1c�� Flo
Name(Print) Current Mang
4 L`�• �� E��'3 3D
TrJepfrone
Signature
Z2 Authorized A'be >r _
Name(P' Curred Mailing Addres=s
10^0
Signal". telephone
iSECT10N 3�-E .. - CONSTREItON�: _:. -
Item - - Estimated Cost(Dollars)to be Official Use Only
comple-ted by applicant
1. Building *111n#.Pe1p*Fbe
2. Electrical >`S miatedTatal Gost_of
C'riiishiit�iomi fora .
3. Plumbing -,Bt 11ftsii-P.enuitFee
4, Mechanical(NVAC)
5.Fire Protection
6. Total=(1+2+3+4+5) () Gf>eck Number �5--
'[hig'St�t:6ti� ?Qi�Ose :
Building Permit Number`
Signature: r
Building Cominbsionedinspeckwof Btnldk s Dare
18 PLYMOUTH AVE BP-2007-0523
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 180 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-2007-0523
Project# JS-2007-000760
Est. Cost: $14150.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIMOTHY J LUCE 149288
Lot Size(sq. ft.): 8450.64 Owner: MARTIN JOHN&KATHLEEN
Zoning URB Applicant: TIMOTHY J LUCE
AT. 18 PLYMOUTH AVE
Applicant Address: Phone: Insurance:
P O BOX 14 (413) 387-9800
LEEDSMA01053 ISSUED ON.111312006 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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 11/3/2006 0:00:00 $25.00440
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo