23D-039 (3) 64 RIVERSIDE DR BP-2006-0530
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D-039 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:
BUILDING PERMIT
Permit# BP-2006-0530
Project# JS-2006-0788
Est. Cost: $1140.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Tom Boyle 111700
Lot Size(sq.ft.): 6969.60 Owner: BRALEY ARTHUR J&LOTTIE M
Zoning:URB Applicant: Tom Boyle
AT: 64 I I ERS!Dc QR
Phone: Insurance:
Applicant Address: (413) 296-4544
43 DAMON POND RD
CHESTERFIELDMA01012 ISSUED ON:11/14/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE ENTRY DOOR & BATHDOORS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET BuildingInspector
Inspector of Plumbing Inspector of Wiring D.P.W. p
Underground: Service: Meter:
Footings:
g
Rough:
Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas:
Fire Department Fireplace/Chimney:
Rough: Oil:
Insulation:
Final: Doop,s o(: Z�3b(or
l,aUfs
Final: Smoke:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION
, ------ el - C/
Certificate of Occupancy f Signature:
FeeType: Date Paid: Amount:
Building 11/14/2005 0:00:00 $25.00
1 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 a 44
Building Commissioner-Anthony Patillo
BP-2006-0530
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0530
Project# JS-2006-0788
Est.Cost: $1140.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Tom Boyle 111700
Lot Size(sq. ft.): 6969.60 Owner: BRALEY ARTHUR J&LOTTIE M
Zoning:URB Applicant: Tom Boyle
AT: 64 RIVERSIDE DR
Applicant Address: Phone: Insurance:
43 DAMON POND RD (413) 296-4544
CHESTERFIELDMA01012 ISSUED ON:11/14/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE ENTRY DOOR & BATHDOORS
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 11/14/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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__ — _ _, [-pity of Northampton Status-'oaf P. r �: ` ^.,,,a..r.: t>i,: � •,` ,; �
C6 (� [_P Q V �' wilding Department curb Cut/ vew.P. I!� ;ram
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212 Main Street S ewerl,Sep �c A'::1,1ab I
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4 2005 Room 100 w riwelI.A$vai l � � S`'+= z` `� '
NOV Northampton, MA 01060 k..A.0 ''` _,,
p TwgSets of14`StniC Ural Pans F= , ' _ '4 .,�,a `,
phone 4131.587.1240 Fax 413.587.1272 Plot%Site Flans•``'4 , .g ,w 'Y
DEpi Dy r j er. pectfy4 -x- ,k ;, .y-, ..
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
•
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This sectton olbeciciip ete bY oide1.1 Property Address: s . , . ,�
/ I _�. .z : Map of fit ,
A/ h2 a Zon ,, Overt• Dist - ��,
;i•EIm,FStADistr`'ict ,, % . S�Dtstrct. �. .
SECTION 2 - PROPERTY,OWNERSHIP,/AUTHORIZED AGENT -
X 2.1 Owner of Record:
iltt&el.i By>_,Le r Name Print) Current Mailing Address:
Z5)111/L-C— k---V4) ._
CT.-C�'�" Telephone
Signature r b
2.2 Authorized Agent:
/Din j.9o�/4 E /--�Om e (?&fn, R lea & , y C/J 7/?/=i�'&. 0
Name(P int) Current Mailing Address: T "
//,3 -a9 - 4,,s--y v
S nature
Telephone
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SECTION 3 - ESTIMATED CONSTRUCTION COSTS
._..... . .-...._... ........
Item Estimated Cost (Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
4j// yo. v i
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 /10[ p7,5'""
This Section.For Official Use Only
Building Permit Number: Date'Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
,
Section 4.
- ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear •
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
.. . _.. ..... .._
SECtf01 45,.9ES R1BTION OF PROPOSED WORK (check all applicable) .
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 18(
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work•
//.e.w'
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet 0
6a "fa±7evl oust ndior addittron to ex:isling4 outing; co}� etelt eifo11Mi g:
a. Use of building : One Family X 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. Mascheck 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 Nc
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
X I, - , as Owner of the subject property
hereby authorize f d i i3 pv ). ��OJr e iq&PA') ' to act or
my behalf, in all matters relative to w6rk authorized by this building permit application.
Signature of Owner Date
X l Cji. 1/2 �— l , 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 penalties of perjury.
Print Name
•
•
Signature of Owner/Agent Date
SECTION.8'. CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :% O h'j A S 3- Boy I 0 4f o y 7 9
License Number
y3 D&m o/v &'M iD Rd. /,j'r !FEi m 6 O - a ?
Address Expiration Date
d a E 3 -115-4/1-/
S. nature Telephone
e ste mprovement •`ntracto Not Applicable 0
i?g'P/4-JJ ,
Company Name f Registration Number
,3 DA127a N Pa 1V 0 Rel. CJ J/eS — oZU — O 7
Address Expiration Date
Telephone //j
SECT10 1O 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 0
n kf, t '11 end .:!‘t4 aMOD'
:
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 acccptable 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 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
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..n ....... DEPARTMENT OP BUILDING INSPECTIONS
..T.....y,—,_s___,=--• :
212 Main Street ' Municipal Building --7-_-_--•—. ,:."
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Northampton, Mass. 01060 UP
WORKERS COMPENSATION INSURANCE Allill'il)XVII'
I ' - —-- _ •
(licchste/v.-rmittec)
with a principal place of business/residence. at: ..
•
._(plione).___ ______•.
— ----- — ,
(,strecticity/5tatt./7_ip)
do hereby certify, under the pains and penaltie.s of perjury, that:
_..
( ) I am an employer providing the following •.-•,.orls:cr-s compensation coverage for my
employees working on this job:
• (Lnsuran= Company) (PcLicy Number) (Ex-piration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the follory-ing, worker's cornpensaon ,,-ic..;licies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
„ .
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
—..—
___
(Name of Contractor) (Insurance CoropanyiPolicy Number) (Exr.iration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional thee(if nr...7eni:-..•to ir,-- ....,k.i: .t .;-.=:zininr,...: 1;
(e>cl I am a sole proprietor and have no one workino.-, for me.
( ) I am a home owner performing all the work inyst.:If.
NOTE:please be aware thus while hcnKowners v.bo employ 2.--1-7:-.1.1 to da r.r.intraaricc,oxrenin.ion at rapair v..,,ii:(al:dwelling of
not more than throe uniu in tehidi the li•nni,owcea-rtaid=or on the p-;:tir,:is appallenent tharto err pc(ccecrally cc<1:idiftd:n be
employ=u.-nant the workres entrc-a-n:atica iset(Cil..152.aal(5)).arPlization by..hoincowmf for a UCZ.Z4 CS prratit rney..7...'.:noe the:
legal status of an enaployer under the Workeet Co.-nporc.ation
1 understand that a copy of thin rtaternem tttay be forwarded to the D-.-.pettenerrt of lochs..trit.1 Accie.f.3'ofrioa of i,-,s'ur-"°'for the
coverage vcrinc:slicle and that failure to atc.tre coverage under section 25A of IAGL 151 can lead to the imposition of criminal penalties
. consisting of a fm.:of up to S 1,500.00 artdke tn.rtr, i..t.o.hrna of up to ono year end civil pcnaltics in dc form of a Sir;Work Ord.':end a
fur of 5100.00 t clay against
For
.. clopartineiral ll 1,C on y
._
• Permit Nurnbcr
Mapll_ L.ot g Signature of I.icciir,cc./Pcrmittcf:.
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '`>0,,4,=1,,.,'
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:,';:;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 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 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