Loading...
23D-116 202 FEDERAL ST BP-2004-0936 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:230- 116 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-2004-0936 Project# JS-2004-1387 Est. Cost: $4000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 30056.40 Owner: CARRASQUILLO ANGEL& Zoning:URB Applicant: CARRASQUILLO ANGEL & AT: 202 FEDERAL ST Applicant Address: Phone: Insurance: 202 FEDERAL ST () 586-9430 () FLORENCEMA01062 ISSUED ON:3/31/04 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL 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 Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 3/31/04 0:00:00 4668 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Department use only City of Northampton Status of Permit: L� a ,Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/ Well Availability MAR 3 1 Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALT.tR, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office a():1- rL J Map Lot Unit ���'� � �� „ ' ►� � r) ;l � O � •� Zone Overlay District Elm St.District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 Owner of Record: Lj0 � -1-e - 1/4140-Al � e(Print) 1 Current Mailing Address: ,C/' - � ` ,( \ • ( 0 Telephone ! Signature !!" 1//3 511e, 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant Building , j D D (a) Building Permit Fee 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 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date i . 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 4, 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 ermit/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 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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: SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding{,Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll❑• Sheet a 6�a' .,-.`l'ew Mousetand brit ad.ltion#tralgtfng Housing complete tie folaowing: 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. 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 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 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. Signature of Owner Date , 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. P ' t Name - .ter ti�.C'� 3/k 3 atur- .f Owner gent (719e- Date SECTIONS-:CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : License Number Address Expiration Date Signature Telephone TTI ►e a ere fom iitl5FOvemen` 'Contractor- ;ro` ` � ,_g „�,,, � � �� � Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone SECTION 10,WORKERS' COMPENSATIONI 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 0 No 0 co0 l:eO>wneY' en ea1a 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 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 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 aws and State of Massachusetts Generalenne� Laws Annotated. omeowner Signature' _/mil ,C-t%�..w"1 LIX- T tAH J.r , = ) .%. eit O . 41 . rifr of t�ilJ� t} tiit _ q114g fitasaachnattle' >4�i�, DEPARTMENT OF BUILDING INSPECTIONS • m 212 Main Street ' Municipal building Northampton, Mass. O1060 r''s_, • t WORKER'S COMPENSATION INSURANCE : < < AVIT I, — -- -- - -------—— ---_.�.---- ___-----_....._..____------- . (licensc:Jlcrnlittee) with a principal place of business/residence at: .- (hone ) -- _ ------ (SiTlalC7ty!aiiiCizip) dO hereby cerd y, under the pains and penalties of perjury, that: ( ) I am an employer providing the followint worker's compensation coverage for my employees working on this job: - ('Insurance Company) _._.— (Policy Number) (E)piration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expire Lion Date) (Name of Contractor) (Insurance Company/Policy Number) (Exj,traboa Date) (Name of Contractor) (Insurance Company/PolicyNumber) — (Expir:aticin Date) (r.ftach.,.daitioctal sh,Int if hogs.:-:n irate-.; imccm.aor. ,:_._..:it:,-,:..11 o:c;--du:•) ( ) I am a :;Ole proprietor and have nO one '.,'orkin`ty for me. >d I am a home owner performing all the work myself. NOTE:pie:ac t o aware that w bile txrrcowuccs%%no employ;doer:to e.t t.ain1caancS errs=+-ic...i l c r::par..•or,ea-,,Nctli.g of not more tun throe oohs in"-brat the l:o:»a:vo -rrnit�a or at d.o g^:r.ei3 appurtcn-r1 thavto ere not Generally ccr.:Eti_rut:o be catployc-a"ruler the ,:_ration;•s:(r't,t fa_ea t(5)),a I o tion by a hot:-ow r,c fora ticct c cc i°-' - --...'•:ncc tin legal ctatun of an employer under tiro Worker'.Co:npoonntion Art 1 uncle_-itaad that a copy of thia data t tnay bo forwarded to tnt Dcsinrtn cni of I ,+tri:1 Actiidortts'Oiroo of::-sur""'-o for the °overage verif r..tioo and that failure to titre cove-raga under ecetioa 25A of MOL 152 can lead to the imposition of e ir_:1 per.altics . ea:sisting of a floc of up to S 1.500 00 tr icr i^prisxsne:11 of up to one y cw aril civil perultie in the forth of a Stop Wert Ord.:Ind a Lie of S 100.O0 a day again.-.1 ay._ Foruumta!uao only permit Ntttntx r -___ _ _,& ?`Saps— ---Lot c` aturt of -•:/ i (• �,. i 7;cJPcrnttttrt, i.,:'r l _ w 0tiAMp7 �0 O (rztp- of yortE & upton • t= ' c _ � $ Ij 41fliassacliusetts - =_`'i_---�= 'r"°" DEPARTMENT OF BUILDING INSPECTIONS , �' / INSPECTOR 212 Main Street • Municipal Building _ Northampton, MA 01060 ^4 s �y' 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)t 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 K-I, ,,"-- ,� . 1 understand the above. (Home owne4`/ esident's signatur requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location