23D-132 (12) 73 HINCKLEY ST BP-2006-1031
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 132 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1031
Project# JS-2006-1532
Est. Cost: $8780.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Cyrus Newman 142807
Lot Size(sq. ft.): 24480.72 Owner: ROOSA DOUGLAS F&DIANE E FABI
Zoning: URB Applicant: Cyrus Newman
AT: 73 HINCKLEY ST
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:4/4/2006 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 4/4/2006 0:00:00 $25.005167
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
S -
• Department use only
City of Northampton._ _ Status of Permit:
Building Department f [} Curb Cut/Driveway Permit
212 Main Streetl )�F _ Sewer/Septic Availability
Roo\ii 100 1 nWater/Well Availability
Nortt mpton; MA 010 i0 A.pP " Two Sets of Stiuctural Plans
phone 41& 7240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVA+.la*DEi1}&SH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
4-3 Map Lot Unit
` Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Rt•t) Current Mailing Addr s:
(tile) 3y
Telephone
Signature
2.2 Authorized Agent:
C y t1 . t•I'ri.A_)rticce-) LP"1 7 ern racei?d. 11 `k7r--4
Namle(P' t) Current Mailing Addr s:
-
Signatur Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item w Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee W Z� 00
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 41 StbT oo A)
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
t
Section 4. ZONING All Informatibl 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 I i
Frontage ( I
Setbacks Front 1 i I
Side L:I i R:, 'L:1 R:1 I
Rear
Building Height rr--i . .__
Bldg.Square Footage % I I
Open Space Footage _ %
(Lot area minus bldg&paved . I
parking)
I I I
#of Parking Spaces
Fill: ' f-
1
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW ® YES 0
IF YES, date issued:: I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book I Page. and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
• Needs to be obtained ir, Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO I
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: ' 1
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 ,. NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
g
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) 7 Roofing Ilk
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[0] Other[O]
Brief Description of Proposed
Work: 1ti; ' ,lr>. 4-1 "- j(� ( � n►iL v
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa Ne h Usea Or aaditioir a ex strnc JioUsing' com ete the�(owing:
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 AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENTOR CONTRACTOR APPLIES FOR BUIL:DING=PERMIT
I, ,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
I,_C (!)S --j • ►`+etOrntAn , 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
l"•' 3 a�-�06
Signature � er/Agent o'• er/A ent Diite
SECTION 8-CONSTRUCTION SERVICES f.,
8.1 Licensed Construction Supervisor: Not Applicable 0
/ ' I ! ' qO
Name of License Holder: ` 4 ( � `C C-�,!l(L r I l_...2 l.K.ot'1L0
J License Number
l (( c CAW 12d.
4ittr.) °1 c I C_
Address / Expira on D to
.2( g
97)Signature Telephone
9..Registered Home Improvement_Contracto Not Applicable 0
Company Name ye ( r.,rk.w 0 n • Registrations u b(e
wq- 6-roy lai, w-itcy,
Address / Expi ion ate
Telephone��f/3), o-OZ1.3
SECTION 10-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 ,k. No D
11. - Home Owner Exemption
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 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
,-
•
• V •
b L rf�) of ;a f li nii�J ton
•
TROT—- E ��c�a�cr}ncrfla'
,
c� DEPARTMENT OP nuluo1)G INSPECTIONS
212 ?`lain Street Municipal Building
Northampton, Mass. 01060 rr'
WORICER'S COMPENSATION LNSURA.NCE AFFIDAVIT
C _ Nt
(liccvs Jpermittec)
w!h a principal place of business residence at:
i Li 1r-) Vta (F honci)(LI13)c •-6Z9.
(sur .-t c-it't/stair.' p) •
do hereby certify, under the pains and penalties of perjury, that
M, I am an employer providing the following'worker's comocnsadon coverage for Iny
employees worng on this job:
Crdti5 C . 5
(Lam/an=Company) (Policy Number) (Expi do Date)
•
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the conu actors listed below who have the following worker's compensation po iciest
•
(Name of Contractor) (In uranc: Cornea ,/Pont Nurnix;) (E\pIratc.,n Date)
(Name of Coo rrac or) (insurance Company/Policy Nu t-er) (kpiration Date)
•
(Name of Coun-acio;) (Insuranc: Company/Policy Nuibu) (Expiration Date)
(Name of Contractor) (Lasuranc Company/Policy Number) (Expiration Date) .
(anatt additioc.71 rSca in an,-,.^3,-to it c!u&inforto on pcv iains to.11 --r-n:-3)
( ) I am a sole proprietor and have no one worming for me.
( ) I an-i.a home owner performing all the work myself.
NOTE:plea be ew-xrc Lr wtrilc bccocowocr wbo cm:ploy pc-totu to ^. "- -L,uo r rc,uc work.as a dwri of
oat mote tb_n tt.r-o-_tank..is wbich the bomoow wr rciid<t or co the pouf zppurtean tbc-eo'- Dot eccr:d-ed to be
crtplcye-"t, c e the t v S e{z cr-,-1e--11w Act(GUI 52.a 1(5)),ppliatioo by•bomoowaer far:lie, _or permit tczy evideocc the
Icp l ct.o of a.a c-eployer wader tto Wark.:et Com pom..Lioa Aar.
I unden+ad dui a Dopy of thi.etatemem CPA be fo.-..vni.d to tbo Doportoo0ca of Ind+at,i i Accbash'Moo of tru+r.oee for Lb.
eovcr'Sc vcj[atioa+ctd th1 L"ilut to Locum lxveryga undo saaioo 25 A of MOL 152.a Ind to the i•,rn.,frio0 of ciminsl pe t,itio
comain of a floc of-up to S 1500.00 andfor ctt;aisotaxat of up to ooc ytor Lad civil p^*+•tia is t5c form of a Stop Work Order and a
flan of S I DODO a t_y tptia 1 tnc
For dcp• r u,c envy •
Permit Number
M2p.__ Lot
Sipes AfLio=tsctlPcrm.ittcc Date
4itiAMp7. .
�0 oy ,,.(rzf�r of Northampton • ►_ _*—_"
Af.. zn r'l Massachusetts g ___ i_
DEPARTMENT OF BUILDING INSPECTIONS 44 _1 "1 '
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060 5
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup,: •.i 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
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 fegulations. 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
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
r
Proposal Page No. of Pages
NEWMAN'S CONSTRUCTION 4 c
697 Bridge Road
NORTHAMPTON, MA 01060
(413) 586-0273
PROPOSAL SUBMITTED PHONE DATE
�c3u a s Pr .57' — ?3 5/ 3//7/0 8
STREET j J
/l 110._'� ` t (((
3 � 5-� ���ems: � n Sz��,ow
CITY,STATE and ZIP CODE JOB LOCATION
1`—lai4-ft/Ce Alt4 0(66Z 5avet c
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
TdQFS 9__ 1
tri s..e.ctor\s
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ii!i t PmOst hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
L1� 1,// �-5,L/ tf /I tJ ytel)n fcD 1, NT y v/G�— dollars($ 777/• ).
Paymen be d as tolj /
d/t' : �T >1`a�f Q P) 1.1 Cf 1)f�t. u? C,,i6 ems►
c oc t5 1-1,UHO.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
Al
manner according to standard practices.Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders,and will become an extra Signature
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control.Owner to carry tire,tornado and other necessary insurance. •This proposal
\Our workers are fully covered by Workman's Compensation Insurance. with awn by us of accep w i b days
'Acceptance of Proposal —The above prices,specifications
•
and conditions are satisfactory and are here. accepted. You are authorized Signature
to do the work as specid f . Pay will r:b �g�
ade outlined above.
(., q'
Date of Acceptance: v` Signature ,