32A-183 (2) June 18, 2007
'-Fodd Boyiitori
83 Silver St.
Greenfield, MA 01301
775-2775, (413) 772-8829
MA HIC#126807, MA Construction Supervisor#CS 079221
H
Ind MHL"I "
Customer:
Kendrick Property Management (Rc-roof orc Lr with tirt*ifecittra"shingle..)
1185 North Pleasant St.
Amherst, Ma 01002
253-0285
Property (), Unit 23-28, Coolidge Village Condos, 73 Bridge St., Northampton
Work to be done:
Complete main roof and porches:
Re-roof over existing layer with Tamko Heritage 30-year designer architectural roofing
shingles, Weathered Wood.
Re-seal andJor re-flash around all protrusions and walls.
10-Ivill. :'tt111'a fill), lilt h1h1w, /lilt liffit 1111-er'N 11 arrallh 011 111WATidil.
George— This should be done bl,the middle-end ofJuly. Antis questions,feel free to
call. Todd
Total Cost $ 9,615
(Labor and material)
omeowner:
Deposit required of. $ 4,500 H
Balance upon Completion: $ 5,115 Contractor*
(Sign and return one copy with required deposit)
i141Aj, j-ht,( As It,,1'able to: Todd BoYntem
Top quality materials used — complete insurance coverage.
References available. All trash removed by contractor. All
permits secured by contractor.
OgTIiAMp�O �
Grib of Xarthailrptan
$ � �ssaxcf�usrtis
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DEPARTMENT OF BUILDDN1G INSPECTIONS
INSPECTOR
212 Main S Meet G v`1lIIiiCIP,U D iiiiiiiiL6
�
Norduanpton, MA 01060
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° :`Sor. 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
dtivelling, 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
d 600 Tflashington Street
Boston,MA 02111
=v° www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Q Please Print Legibly
Name(Business/Organization/Individual): �
Address: 3 S7 e
City/State/Zip: 41Wt 7e6 0f3GJ Phone#: 775
Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. [] I am a general contractor and I
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0�I 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 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption'per MGL 12. Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
xContractors 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 1s 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 tine
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 under the pains andpenalties ofperjury that the information provided above is true and correct
Signature: y- Date:
/ffPhone# ( _
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#:
AV
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
istere .Home=1`M orovement Coriractor �
Not Applicable ❑
kl
Company Name / Regis ration N mb r
Address Expiration ate
Telephone Tim
SECTION 10-WORKERS'COMPENSATION,INSURANCE""AFFIDAVIT(M:G.L.c.1"52,;§'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......
- � x
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 fob 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
f
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s)
❑ Roofing
Or Doors u
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding[O] Other[E j
Brief Description of Proposed e ,,./ /,± ' e 54.41
Work: 4W G� 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 Newhousean�oraddit�or�`ta-ex�s�n4""ttousrna:�comtite e=theollo±r�vrna:
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:AUTHORIZAT.ION-TO BE COMPLETED WHEN
OWNERS AGENT.OR'GONTR ACT 0R'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
/�� G ,as Own uthonzed
Agent ereby declare that the statements and information on the foregoing application are true and accurate,to the b;;;t of m kn
and belief.
Signed under the pains and penalties of perjury.
Print—Name
natur bwn ate
` . AO
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 Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
�
A. Has a Special Perm it/Varia nce/F ever been issued for/on the site?
NO \_��� DON7 KNOW YES x~��
�
|F YES. date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO K j DON7 KNOW vux
��
IF YES: enter Book Page; and/or Document#! �
�� ��
B. Does the site contain a brook, body of water orwetlands? NO DO07KN8VV �_� YES v��
IF YES, has permit been or need to bo obtained from the Conseh/odon Commission?
Needs tobeobtained �~� Qb�a�ned �~� Date
�~� �~� ' �
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 additi ons of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
'
E. Will the construction activity distoMb .grading nr filling)over 1 acre oris it part ofo common plan
that will disturb over 1acre? YEG � ) NO
�� R
IF YES,then a Northampton Storm Water M anagerne nt,Permit from the DPW is required.
'
Y �{//) C•-'/(f Department USe only
City of Northampton StaWsofPtt
Building DepartmentC �e
212 Main Street S w ,e atlabila �'
�n Room 100
i 31 Ne ,ampton, MA 01060
i phone4' 13-5k7-'1240 Fax 413-587-1272
APPLICATION T "~ONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
S9CTION,1-SITE INFORMATION
1.1 Property Address: Thas;secfion to be comp ted byofce
t
Map
� : ry
Zone Ouerlay DlistDCt
CIKI o-5-Ri7 Eim St District CB District
SECTION 2 PROPERTY OWNERSHIPIAUTHORIZED AGENT'
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Acie
NaXent) Current Mailing Address:
Signature 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 tb)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
This Section For Official Use Only
Date..
Building Permit Number. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
BP-2008-0044
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-2008-0044
Project# JS-2008-000066
Est. Cost: $9615.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: TODD BOYNTON 126807
Lot Size(sq.ft.): Owner: KENDRICK PROPERTY
Zoning: Applicant: TODD BOYNTON
AT. 73 BRIDGE ST - UNITS 23-28
Applicant Address: Phone: Insurance:
83 SILVER ST (413) 772-8829
GREEN FIELDMA01301 ISSUED ON.711712007 0:00:00
TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF 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 7/17/2007 0:00:00 $50.003260
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo