Loading...
13-009 534 NORTH KING ST BP- 2012 -0150 GIS #: COMMONWEALTH OF MASSACHUSETTS Map.-Bloc 13 - 009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit # BP- 2012 -0150 Project # JS- 2012 - 000216 Est. Cost: $4388.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size (sc . ft.): 43995.60 Owner: WILES LYNN M Zoning: SR(100) / /RI/WP Applicant. HOME DEPOT AT HOME SERVICES AT. 534 NORTH KING ST Applicant Address: Phone: Insurance: 345 GREENWOOD ST (401) 935 -2633 () Workers Compensation WORCESTERMA01607 ISSUED ON. 815120110:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2 REPLACEMENT DOORS 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 8/5/20110:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner ,- City of Northampton 5 2fl�� Building Department 212 Main Street r r of euiwiNe w s=cws Room 100 g. Ho MN p 1060 Northampton, MA 01060 phone 413- 587 -1240 Fax 413- 587 -1272 I _ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTIQN '! �SITE�iNFQRMgTION -�� �� ���'" plet` 1.1 Property Address T hrs s�tran trite W 'd 6 offs 1 SFr SECTION 2- PROPERTY COWNERSHIP /AUTHOI2IED AGENT 2.1 Owner of Record 1 Name (Print) Current Mailing Address: C Telephone Signature 2.2 Authorized Adant 0 iawa Name (Prin Current ailing Address: Signature Telephone SECTION.3= �ESTI AXEDL1CONSTRUCT16 N COSTSr A Item Estimated Cost (Dollars) to be�� Qffic�at Use Oniy 77 mow, completed b permit applicant ���'�:�.'�:� 1. Building A l 2. Electrical y Esttma�ed Total'�Cas� Constrttcboh from 6 _ .. w . 3. Plumbing Erlding Permrt Fee pg 1 ` ''*' Y Pa - ,.�, s+'":.'4 ti s' f� '" s' ° ro t ,, ' . y ` r..�xk' P.z � 4. Mechanical (HVAC)- 5. Fire Protection 6. Total = (1 +2+3+4+5) ItIS eGtldn FOr.- OffICId1 Lase Q[CI tia w �. Building P @rmrtNumber �x .a v S� '§ µ k `2c. 7t 'a' ."§�,� mss'" -- d- v"... h•. A i x .,�-•- ,_ - �:�- x� . ", :� .,z ,. �� . r � -� ,..�� � � 'k.. �3� k� r � �' `F� s ,. { *i- '��i*� . �'. `- � Bwldmg_ GommissionerJlnspector of Builtlmgs "' � Section 4. ZONING Ali Information Must Be Completed. Permit Can Be Denied Due To Incomplete InformaV,41 , Existing Proposed Required byToning This column to be filled in by Building Depattment 1 Lot Size Fronts e �� C Setbacks Front Side L: R: 3 L: R: 0 Rear Building Height Bldg. Square Footage 011'0 l - - -- -- — _ _ -- _Open Space Footage --� %o C� (Lot area minus bldg & paved arldn ) # of Parking Spaces Fill: i (volume & Location) I i L E I A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued - - � IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Pag 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 be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location j - -- D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: 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 NO - IF YES, then a Northampton Storm Water Management Permit from the DPW is required. i x W SEGTfON 5= QESCRIPTIQN OF PROPOSED WORK (check allapphcatilel �} —�, ,. _¢fs C'"�,� ...�, 3 n.�a .rc?^ �r �a n", ^a ✓� s ,�`MmSr -k New House ❑ Addition ❑ Replacement Wi ows Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [O] Other [p] Brief Description of Proposed — r Work: G Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 'd jffin.n >G ,� . . s e 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 " V �` EGLION '?a�OWNERtAU'>�,i0�1�ATtO, I�,�Q,°B�GOM,>f:£E£�HE_ . �OWNER�AGENT OR CQIV�RA`GTO}�A`PPL�ESif "Bt�II`Dll�f rFE�IIAI 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 �r Signature of Owner Date 1 . 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 th and pe f perjury. Print Name Signature of er/ ent Date A J SECTION 8 `CQNSTRUCTIQN SE�21/ICES Y 8.1 Licensed Construction Sue Not Applicabbl Name of License Holder e License Number Addre Expiration Date ss w ' i 4 , )A Sign Telephone N0 62(0 is e . om m .r verve ,oritrac Not Applicable ❑ Company Name Registration Number QW Addres - Expiration Date elephone EC�ION�10- tWQR10El2S' COMPENSATION INSURANCE A�FIDA�IT�(M G L�� [52��355C(6j��,��� Workers Compensation Insurance affidavit m be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin ermit. Signed Affidavit Attached Yes....... No...... ❑ 3 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 tor 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 • The Commonwealth of Massachusetts J L Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): G� _ Address: (' Nu�� City /State /Zip: j Phone #: Are yo an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 67D 4. I am a general contractor and I 6. - 0 New construction employees (full and/or part- time).* have Lured the sub- contractors -- 2. ❑ 1 am a sole proprietor or partner - listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors. h ave 8. E] Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. $ required.] 5.0 We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Ro re insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. Dtther comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such #Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide 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. Lic. #: ((rj��j Expiration Date:. ka Job Site Address: City/State/Zip: QyL Attach a copy of the workers' compensation policy de ration page (showing the policy number and expi ation date). Failure to secure coverage as required under Section 25A of MGL 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 mst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of th IA r insurance overage verification. Zd hereby cer under t p ins d pe Ides ofperjury that the information provided above is true and correct Si a Date: Phone #: - - = Official use only. Do not write-in- this -area, to be completed by city or town-official City or Town: Permit/License # _ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plu...bir.g Inspector 6. Other Contact Person: Phone #: City of Northampton Massachusetts �e DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jy Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION 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 - Ne /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 1, _ __ 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 —^ — PIZASE BRAD THIS 5o1d. Ftanished and ItsstaDed by Boom Ikntm TFID At�iome Sa+vlas. Inc _ _ 1 d/Wa The }come Depot At.Hnene Seavias 345A C,raamwood Stoeet, Uetit 2, Worms MA 01.607 Toll Free (900) 657 Pax (SM 7S6- W Branch Number: 31 Fedual 1D # 75-2699460; UN lie # C 02439 RI Coat. Lh* 16427 Cr LAC k EIIC 22; Home Iespto MMA C�aa Reg- # 176893 City Zip tarebrer(► }: Werkftouc Hoerr l wee 01 IMF— House Addr"i (if different from lestallation address) City state Zap 9- man Address (to receive project communications and Home Depot updates): ❑ 1 DO NOT wish to receive any marireting emaihs from The home Depot M� ii ,ffee o n�. C]'aderaigned ( "Castoa)er'I, the owners of the property located at tba above i uaMation address, Agrees to buY, a�Iw Tilme services. ins. ("itht Home Depot") 'agrees to fianiah, deliver sad M=V the inspnlladM (I=tttliatlon') of au materials described on the below sad on the referenced Spec Sheet(s), all of which ate WMparuted Into this Contract by this reference, along with any sppUcable State Supplement and Payment Summary attached hereto and any Change Orders (collectively. "Coaftect "): Job ft mm.xset.d.a p ih PralftAummal r� W,uaows loaaation #7S t S G Ct []games i COMS 5 Daera Q Vitrudonm U 1"dation S 1� i cwre<s C7bhaay coax © 06A owing 13 Vlhmdows M Ie�rion S paattesa 7 0W ❑ 3 n W d— C ' t#rmowa Inaolatiea $ Qtktemx I Co+eas L - -%FMY Doers ❑ 1r6siowsaxselGDepw& cfCwAmdAmowtisgm omcadmdtbiramuars TOW Combed Amourt $ C'+ MmiaePaaeimsQa�rmtdrpaytmemmmnaethkdeftlset7taaraniAn immL Customer agrees that, immediately upon oomple ion of the W011t for each Product. Customer will execute a Compkuon Certificate (one for each Product as defined by an individual Spec Sheet) and pay any balance due As applicable, each Cmeomer under this Contract agrees to be joh* and severally obhgamd and liable bumurAw. The Hoare [depot rr aervea the rig* in iuge a Change Order a townpate this Contract or any individual Product(3) included henin, at its discretion. if The dome Depot or its authorized service provider determines that it cannot perform ins obligations due to a structural problem with the butane, envuU mental batcards Mich as mold. asbestos of lead palm, other Safety wooers& pricing arm a because work required to ocnrlae the job was not included in the Contract Pavmad Saonman: Tire Paymmt Summary # 42266 1 . included as parr of this Contract. sets fords the total Coeuae:t amount and paynirAn required for the deposits and final paytttants by Product (as applicable). 1Ql77�t�"i CUSTpkasElt Yog are eudiled to a tom �-In aop� of the Cegmad at the three you no not am a COMM et s C�e� (note* dune is one CompMsiso Ce for mete 1=1'r�tdaa .a Adiued by C= spec Sleds) belt re work a, that Product b tempw in the event of terminadon of tbis CAmect, Customer agrees to pry The Rome Depot the costs of mahwuAs, labor, expeasa and services prow" by The Rome Depot or Authorized St' Om PrevMtr Oromo the date of ter on, plus any other' smegats set form it this Agreement or albae0 asedes spoNcable lea. THE B0613 DEPOT MAY WIMMOLD AMOUNTS OWED To T]OZ »b1YlfE DEPOT' FROM THE OR MW PAYb> MT OR OTHER PAYMENTS MADE, WITHOUT LjMffING THE HOME DEPOVS OTHER REM MMS FOR RECOVMV OF SUCH AMOUI'f1'S. A ft' Customer agrees and gndasands that this Agreeenetlt is ekes satin agreement between Cu,%WW v f Ho. Depot w to the Products so Installation services mad ra4xmxdrs all prior discussions and agreements, either orate or mm um rekting to said Products and Installation. This Agreement caimot be amped or amended except by's writing signed by Cautimer and The Home Depot. Customer acknowledges and af¢aa true Customer has sad. ■stand• vohuaanly excepts the terms of and has received a copy of dds A ' a � X stostwe - DOWD Saks Co **hart's rgiiom Dais X Telephone Na Customer's signstum Date Sakes Cnruukaat 15eeatee No. tlfxE7 CUSIOId1FR WAY CAN(.'t?L 71Ii5 AC WITHOUT PENALTY OR OMJGATTON BY DELIVMF NG WRITTZN NOTICE TO THE HOME DEM BY hIlID UT ON THE TUMD N UMMS DAY AFTER SWzMG TIM AGREEMMTI. THE STATE SMINI MIENT ATTACUM HERETO COITIAMS A lP'OBM TO USE IF ONE 15 - SPSiCALL'Y PRRSCRWW BY LAW IN CLWrOb='s STATIL "W& AbOrtMAL'rMO dam OOtiDltri" AM 8'rATXD OdV IW *MM SW AMAM MART OW YM CON71ACT "I -10GSC MMte- ikgM&hR* Yeear- Crntamar