24D-228 (4) 230 PROSPECT ST BP-2017-0258
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao-Block:24D-228 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0258
Project# JS-2017-000446
Est.Cost:$1100.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: Homeowner as Contractor
Lot Size(sq.ft.): 40859.28 Owner: Ricardo C. Lococo
Zoning:URB(100)/ Applicant: Ricardo C. Lococo
AT: 230 PROSPECT ST
Applicant Address: Phone: Insurance:
230 Prospect St (413) 586-0477 O
N O R T HA M PTO N M A 01060 ISSUED ON:8/30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: Strip and roof nine sq of shingles on barn
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 ft 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: FeeTvpe:
Date Paid: Amount:
Building 8/30/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
Departrven xse onlyf_
City Of hIortharnpion 5qa u.,of Fermis
Building Department, Ci.rb Cit/Dove rdp Perrn t
212 Main Street ova SEphc? ailaolil y _
Room 100 WateM1/ell sralWblllTy > P`
Northampto'rMA 01060 wdsSete ol'tFiio a 7Pih1,3
phone 413-587-1240 Fax 413-587-1272 lblotiSJte PI s
APPLICATION TO CONSTRUCT,4LTEF,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELL/NG
ECTION I SITE INFORMATION
I S
(/ 1.1 Proper vAdddrress: Tnls ervon Ela be completed by orf
'
e Hr 25O Crosse s1 P
:ITE
/�P,--{} a :gyn.' - O�4tajDl trmf .
N i� kc�3N((��. �1O4a L'7
Elm St G tr ct' 'CBp ,Hc:
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record. 23o Po6;a Qr c
'�tca.r.-rXa C. L.oct,�cc7 N�Y'�z a.... (*let 0)4 . orot>� I
J Name(Print) Cl:rrent Mating Addr s
KitCAV ri L . f..oc, o+= c Teleph4o4 4I y —0477 tf
Slgnalure .jOP
2 2 Auihodzed Auent: I
t! Name(P;nit Conan Mailing Address-
Signature _ �� Telephone _.
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to abe t(11 00 Offiolal Use Only
cnmv7leted bypermlt aoplrcent
I. Bufltng (a)Euiiding Permd fee n
2. Eeohc-ai - (b) Construction from (6)
3. Plumbing - Building Permit Fee y t
4. Mechanical(HVAC) /VI
5. Ere°refection /�
A. Total=(1 +2+3<4.5) ,Check Number (65
This Section For Official Use Only
DafE
Butidmg,°ertrii Number — issued: p �+ ,,('
Pl
5ignatur � .i ��. Pry / �-
idir
gutdin amml5aanatltnepecto.or BunAinys Oat'
o
r � a 2Vt< LCICWCl7 ClVfQ ( � 1�
Section 4. ZONING Alinformation Must Be Cereptesed.Permit Cal,Se Denied Due _omplet Conmatioo
((( frosting
I Proposed Required by Zoning
This Column to be filled in by
BuildingDeer:ent
Let Gra
Frontage — --
sebacks Front - ITR— __-
Side t Z' R -- L P' _ . ._ _
Rear __ ..
Bo:amp Height
Bldg. Square Footage
Open SpaceFootage
Latera minus bldg&paved I i ' ,.,,__
kit
#of Parking Spaces ._.._t
Fu, tt
( ince&Location/
--- -. - --
A. Has a Special Permit/Variance/Finding ever been issued for/on ihe site?
NO a DONT KNOW CD YES 0
IF YES, date isued:i
IF YES: Was the permit recorded at the�R^e'�gistry of Deeds?
ND 0 DON lJ
KNOW YES 0
IF YES: enter BookPagel ± and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES,has a permit been or need to he obtained from the Conservation Cornlnissioni
Needs to be obtained 0 Obtained " , Date Issued:
C. Do any sins exist on the property? YES 0 NO 0
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 0
IF YES, describe size, type and location
E. Will the construction activity disturb(cleating,grading, excavation, or filling)over 1 acre or is it pad of a common plan
that wig disturb over 1 acre% YES 0 NO 0
IF YES, then a Northampton Siorrn Water Management Permit from the DPW is required.
I
SECTION de DESCRIPTION OF PROPOSED WORD((check all applicable!
New House Audition LJ Replacement Windows Alteraticn(s) Li Potting
Or Doors +.7
Accessary Bidg_ I I Demolition U New Signs/IC] Decks [f-] Siding ICI) Other EJ
AWork lteration ption of Pp o !7 tf$� rk oeG el Ve tr'•'1 d..
of[Description rr ose ri.
of existing bedroom Yes (/ No Adding new bedroom Yes 'i' No
Attached Narrative Renovating unfinished basement Yee ✓No
Plans Attached Roll -Sheet
8a.if New house and or addition to existunq hoeesh*i..complete the following
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
• 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 Compdance. 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. Dept of basement or cellar floor below finished grade
k. Wi!{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 my behalf,in all matters relative to work authorized by this building permit application.
((yyS.y�nafure�ooyj'fOwner � 5� u��- J� Dov
egli
I,� `'k 'C,q,,I° C rA CaC :7 �...__ 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 plains and penalties of perjury
o .
T�tova l
C. LOCO c- CY _
Print Name
. --
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: kloptApolkable E
Name qi LiCM152 Holder
cense Number
Address Expiration Date —..
Signature Telephone
9.Rea' teied Pomo Improvement Contractor Not Applicable E
Company Name ...� Registration Number
Address Expiration Date
Telephone___
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(KG L.c.152,§25C(6))
II Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in thedenial oflhe issuance of the building permit
Signed Affidavit Attached Mem . E
1.1 e Koala Oltnea' iterantion
The current exemption for`homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 1083.5.1.
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
strictures.A person who constructs more than one home in a two-year period shall not he considered a homeowner.
Such'Tameuvmer"shall submit to the Building Official,on a form acceptable to the Building Oficial,that he/she shall be
responsible for all such work performed under the bufldine Dermic.
As acting Construction Supervisor your presence on thajob site will be required Gem time to time,dining and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chanter 152(Workers'Compensation) and Chapter pter 153 (Liability of Employers to
Employees for injuries notresulting in Death)of the Massachusetts General Laws Annotated,sou may he liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner certifies and aSSIMIC8 responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated,
CHomeowner Signature �-✓"� 1�
The Cm nmenweeIth f!?assaohMse is
vu�
a Department-of sfri T Adcfcdeeess
Department
q j ee of Shaeeshigadons
.1( •ee.= hi; 3x00 Washing-tele Steeei
45. P hsnstsat,MA 02111
hehthe iehetr„. wvvrov.reass.gev/die
Workers' Compensation. insurance Afl;Edatrin finniti7¢fesskinstraraahmtrs/EliectrIcini nc/1Pllu nbers
Applicant information Please 'Print !snottily
Name(flusiness/Organization:Individual):
Address:
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
1.E1 I am a employer with 4. H I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New con3hvchon
2._ Ian a sole proprietor or partner- listed on the attached sheet, 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. Demolition
woddni; for me in any capacity, employees and have workers' —
com t
insurance 9. Building addition
ow rkers' conn. insurance p
re ed.] 5. [] We are a corporation and its 10.11 Electrical repairs or additions
3, am a homeowner doing all work officers have exercised their 11._ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGI. 12. J Roof repairs
insurance required] t c, 152, §I(4), and we have no
employees. [No workers' la.(_., Other
comp. insurance required.]
*Any applicant that checks box#r must also fill out the section below showing theft 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.
tContractors that check this box must attached an additionalsheet showing the name of the sub-contractors and state.whether or not those entities have
employees. If the sub.contractus have employees,they mustprovide 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.Lie. #: _ 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 MGT 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 at'this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi/y under the pains and penalties ofperjury that the information providedyabove is true and correct.
imature: - t _ Date: V
Phone#
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
I.s,suing Authority(circle one):
1, Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other r
Contact Person: Phone#:
City of Northampton
k4Massachusetts gmb'� �
bbyrCuMksibil "ft ,1
'Qoit :51
2'_2 Main 8nnand 0 dinniniPil Building �l
Nonthamoton, MA 01060 4'1'YfJ
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXFnIPTION 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 exempton, 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 couch 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
V\ I, --.0n C
�—r 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 r9 ' 7S—(E
Address of work location Z 3 o kJ'Pj S
/1/0/4- 010W
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of JCL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: Z 3 v Cv-Ds ec i Sr
The debris will be transported by: Se( '
The debris will be received by: ,c rte- c t
Building permit number:
Name of Permit Applicant , C� cc S
Date Signature of Permit Applicant