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23D-157 tD HINCKLEY S'l : BP-2007-0582 GIS COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 157 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-2007-0582 Project# JS-2007-000857 Est. Cost: $1500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: C & T Construction Lot Size(sq. ft.): 26920.08 Owner: KELLOGG MICHAEL C Zoning: URB Applicant: C & T Construction AT: 60 HINCKLEY ST Applicant Address: Phone: Insurance: 15 Fairway Drive (413) 586-4965 FLORENCEMA01062 ISSUED ON:11/22/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:Replace windows and front door 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 11/22/2006 0:00:00 $25.003628 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2007-0582 APPLICANT/CONTACT PERSON C&T Construction ADDRESS/PHONE 15 Fairway Drive FLORENCE (413)586-4965 PROPERTY LOCATION 60 HINCKLEY ST MAP 23D PARCEL 157 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ✓l�uildi Permit Filled out !ACu U3� L.-Fee Paid `t Typeof Construction: Replace windows and front door New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFMATION PRESENTED: l!//Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission / Z2 /U Signature of Building Official Date ( l Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Lot Unit / /(C E 7 r Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /1i (Ae/ /Ldgf 61(9 hid i / $/ / , 2 1'►14: Name(Print) Current Maifing Address: ik_q_11)15( Telephone Signature 2.2 Authorized Agent: n _K-gegg9 l6 Faiv- . Or /-/dveice ad6( Na ri Current Mailing Address: i re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building , S/� (a)Building Permit Fee s 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ql<-7 S CO 5. Fire Protection It"3 6. Total = (1 +2+3 +4+5) S�, Check Number This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 i . i Frontage = ii Setbacks Front z • Side L:! t R:I i L:' R: • I Rear ` Building Height Bldg. Square Footage ' % i — �� I Open Space Footage %(Lot area minus bldg&paved • parking) #of Parking Spaces 1 Fill: ',, j (volume&Location) i `i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: . enter Book Page and/or Document# I B. Does the site contain a brook, body of water or wetlands? NO ( DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained Q Obtained Q Date Issued: ;' C. Do any signs exist on the property? YES Q 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 Q NO Ey- IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, ex ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Win s Alteration(s) n Roofing El Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[E] Brief Description of Proposedfdd11-s/t 754 ' /� �� r` wS Y ff�i' r.Work: Alteration of existing bedroom Yes 1- No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes .I— No Plans Attached Roll -Sheet ;, ..: r...'. ��zY.;. r.�.G{;...' . 'ss,-'�„ _'�'�" .kx�`«. .�T' "=�'.ati,�:- "°�';,i�.t xE:.a'�`a.�`..�'.; 6a.tF,ke-i,hoase g d t ad"tti8Tial llgf id}Wsln ompte #rMifaWnq: 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. 1. Septic Tank • City Sewer Private well City water Supply SECTION-7a--OWNER.AUTHORIZATION-TO BE COMPLETED-WHEN OWNERS AGENT:OR"CONTRACTORAPPLIES FOR>BUILDING PERMIT I, miff i ""7 k7+7as Owner of the subject property hereby authorize (y L,* s / •1 q to act on my behalf, in all matters relative to work auti ri ed by this building permit application. v ', c \''-Q l �./ -Q Signature of Owner Date 2.8 (? 1, Yl c' /4 ,as Owner/Authorized Agent here eclare that the statenpand information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under th ain and penalties of perjury. k S 67/ Print Name Date (720/6 Signature of Own r/A SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:s�/ / ��� Not Applicablep❑ Name of License Holder: f ,"�S l�y�'"w77 062r� 0 7 License Number 1S �ctI`tday �7r, ll/04/ /Ark )'Gr/2 ie01/d7 Address Expirat n Date Signature Telephone Ct elit tela ome lmpr6V.emen ratecto TM ,. m Not Applicable ❑ Company Name Re istration Number Adds / V may" /OK/4VX24 f /// ' 0/�'Z /7c/orj -��/jExpirafDate Telephone��o SECTION 10-'WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M.GL.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 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 ofland 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 • • • �1.7snrETnLrlls' _ DEPARTMEIJT OP BUILDING INSPECTION'S 411 212 Main Street Municipal Building \zit Northampton, Mass. 01060 WORKER'S COMrTENSATION -L\NSURANCh_ AITU)AVIT • Kerr ccn_s.:cipermitics) with a principal place of business/residence at: are 4 hone') ���(�—1‘7IS"--- (sit/ci t• sutLlap) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the following, worker's comoensabon coverage for my • employees wor±ng on this job: (lnsuncc Connacy) (Policy Number) ( :pinion Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors Listed below wbo have the following worker's coonensanon pebcies: ( Name of Co^.r::'.cior) (lr1Rlrance Company/Pobc, Nurni:c:) (t-xnirat:on Date) (Name of Contractor) (insuranc:. ComoaayPo!.ic Nuobcr) (EXviraion Date) (-Name of Contactor) (Insurl_nee. Company/Policy Number) (Expiration Date) (Name of Contractor) (I franca Company/Policy Numty.r) (Expiration Dale) . (.o oediticcail LScc,if occom.:p to-Inc-.& oc per.. to.11 o -r-or;) P. ( am 'a sole proprietor and bave no one work ng for me. ( ) I alma home owner performing all the work myself. NOTE:plcx be carat[tfi•1 wt k 6cmwwncri wbo roxploy pool to do r-•r - -,:cucc c'rcgaa work on r d..<11_E.of act loge theo 'tsv t=itais wbicia the bo 000v oc raido cc cc ciao rounco z.7purtccc s tbeax c.-c co(g -J1y ccor:d.--o1 to be enploy ,i'f t c s",:e4 t * Y *icc Ant(GL152sa I(5)).=pplintion by.bomwavc for:lie=_cc permit rz y e idmoe the logo!rts.'uc of en exployor under tiro Woricol.Compoca.iion Act [uadeniad th t a copy of thu mtemem ooiy be torte-o-do4 to t .o pe+p.irLmmt of Aeart`"*-e'+'OJLoo of(rz�.+(.om for the oovcasc vcif c1tioc Uz_t tiltac to acatrc tovcrnsc, idr--rxtioo 25A of MOL 152 an led to the i ioa of aimia.l pca ltio mn^f*i-t;y or a Goo of up to S 1„SWOP.ttdtor¢tt{rriaoottx-n of up to ono ycor e.od ciil pm.Yic.io dac form of.Stop Work Ord and fm of S I o0.00 c thy cp(iQA ex_ For rr.i.e- —�`�u,c only � �� Permit 1`i t1IDlX1 �� pc Lot e J . Si tuzr of Li ct'rxLi o1:i ttAM p2O t o ar $ Olify of Nora �ampto t . . 2 �i; %W may" " lleassacltusrtts 1.W10I1-11a1't111._ - ' "4"� DEPARTMENT OF BUILDING INSPECTIONS • `` INSPECTOR 212 Main Street • Municipal Building 7, — Northampton, MA 01060 e' 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;: •".nor. 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 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