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13-039 (1)
s P - - ==fit= v s_ �� ..., DEPARTMENT OF INSPECTIONS ! __?_ �' �- - 212 Main Street • Municipal Haag =r*" INSPECTOR Northampton,MA 01060 ` 1 , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right and 78001083.4 to , act as-his/her cxinstruaion super ..isor.The state defines`Homeowner"as,"-Persoiu(s) who owns a tercel on which he/she resides or blends tobe;a ► - dwelling;attached orcietached structures any to such use and/or lath structures.A . person who constructs more than one home in a two-year period shall not be consumed a . home owner." - .—__The of to f _ Pets (s)-who-sec-to-_ - --. • _ ... ... • use the home owner won,to act as their As ooh supervisor,tribe aware that by doing so you become responsible for compJance with state b.I dhag codes and*5egulations.The inspection process-requires that the burifuig department be called. to inspect work at various stages,which includefoteadationifootines arertirehaddilll. - sonotub_a holes-(bdere hour),a rough 6�ding insneeiion tbefore Work is - co s ■ .- ., 11,-1.171 ■ ■,, •y�..ri ilt' if -,l.iit-ii rondo r3• . ,__L__,,, . •'`:�cr__—��, . _The builditig departmentrequires these inspectaoThos OtCtbe wodi 15 conceded;failure-to • secure these insocciious can result in failure to�a certificate of ixermancv _ mull the work can¢e wed: . - If the homeowner Itiies other trades to perform work(electrical,$w bing&gas)the • homeowner will be ale to make sure that the trades hired secure then proper • . permits in vonjunction to the building permit i and that they gat their required • ins.Failure oldie individual trades to securethe permits and mspertrons as required can DELAY the project until such tithe as the piper pe u'ts and inspections are made - I, • • _ i end the above. {Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the buildingpermit __.. .._. ..ist�edome. .. . _ . .-...... _ .v. ._ ..:.._. . Date Address of work location r s 5 . . • - . . . • • . • • . . - , . - - • . . a., - . - - • 01.51 i) ,r- - - 4. 5qeA,e. 4. -- - - . =-C-=---'--t.-- -..,--,---r - - Criii-R of Nortlia.mpfou ?tt 46 _:•■-11,4:.!: ' .1%.vkA65 . . - • 1.z..----:....._,;.,-....:1,.. . - • ...:- • • ------ - . DEPARTMENT OP BUILDING INSPECTIONS - .- 212 Alain Street ' Municipal. naiiaing •40.6.....7.-_,._-------...5 . . - • -Northampton, Mass_ 01060 . - '44410' - • .. • • ... . --.'• -- - -:•--W-G-RICEIZ'S CONITILNSATION 'GISURA.NCE A.141j1.0A..VIT... . .. . - . • • I, ' I /14-01) ;-.) L1/4...-C „, _ . -_-- , . • , - ., .(licensedperrn.it(ec) - • . with a principal place of businissfresidence at:- • . — 7 ----; --- . I 222_ 4i-i/t,/ ,-,L, i2d- ttee4) 414 ao,- (phone) t/7-3 5-" ( e-y(t ,. (str..1/city/statchip) .do hereby certify, under thc.pains and penalties of perjury, • . . . • . . - • ( ) I am an employer providing the following!worker's compensation coven:se for my employees wonting on-this job: - • . . . . . . -V • • .. • ,- . . , • • • • - • • - • (Iasuns=CoeicanY) *- - Wolic7 Number) _(ExPirj.ion Date) . . ' -: .• .. . .. . ( )-I am a sole proprietor,general concr-aaor or homeowner(circie one)and have hired • the coon-actors listed below who.have the following workt;es compensadon policies: . .. i . ... . .. . . ' • • - • - . • (Name of Con •vactor) (Insuran=Company/Poi:icy Numkr) . (F-kpirduon()etc) • - •-, •• . __. • . - (Name of Cana-actor) (insurance.Company/PoLicy Number) ,(Eipirmion Date) . . . - . • . - . . .. . .- • ,... . • - • (Name of Cona-ac-mk) ammo=Company/Policy Number) (Expiration Date) . • •- . . . . • . • (Name of Contractor) • •(Lastua1=corcipany/Policy Number) (Expiration paLo... ._....... („dia...6s€037.1,tso ,if acacia:4-y to ea choir inforscuS az pang to...11 oaccrocrro) • . • - - - • ,(t-7'I am a sole proprietor and bave no one working for me. ( ) I an-La home owner performing all the work myself. .• • . NOTE p l=..l e bc o w a r c t b a o i a s b a c o r s o s a a r a roam c a s p l o y p e a;o o s t o a t c o a t t m o o o k,c:-.•-•saao=m a i wont t o I d otift a aot wom b=*immix...ia allicitibe boaloannta-reaidas or co the gnaw&apportgootatbocto or oat c=aally oapiebod to be acillki)crs one=dor um:ter omapt=stixt Act(GLIIS2=1(S)).citprtattion by a boatcosser fm•.i,6c=ac or wail s=y evidotec the lega earattr ciao weployor nadir Oho Wodoteg Cooapeocolia•pa Agt- • • - I Witlimstsod*As.copy of thir ettototaat°soy Ito foroordod to tb.Depontloot arud.oid weeidcace Mk.et'ticunoto rat du. •coverogy vartatitio mitt IltriTatac to rostrct ocr*gc%iodcrIcazoet1A&MOL 152 coo 124 to*a iosposilloa arcriosiga P=1641 •co :as' aro rtor of op lo 31„.100.00 mortar isaprisoacorat°fop to ate?tor aod cha pcwaio atC,63nli as SI"Wart C/14=.85a a fit=0(S100.00 It ay epic:" a ram - V . .• " • .- - •- ..,..n.. i For deparalGoJ%pc orgy •• . -•-• D.....r.It Member ---- ----...-------- -.• °.....7.-'7"--'-‘' e SECTION.8-CONSTRUCTION SERVICES 1 8.1 Licensed Construction Supervisor: Not Appficable 0 Dame of License Holder: License Number Address Expiration Date Signature Telephone =.4 :, Not Applicable 0 L-L) /112,e 6 Company Name . Registration Number S-t� Address Dace /� l 71/v4'k`t• /'44F 444-Telephone C tlf 7) SECTION 10-WORKERS' COICAPENSATION'1NS c:tS2; .25C(6J) 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 Signed Affidavit Attached No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dweltinas 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.CMVIR 780. Sixth Edition Section 1083,5.1. - 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 resnonsibie for all such work performed under the baildipe 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 r • .a • . . •SECTION 5-DESCRIPTION-OF PROPOSED WoRK(check:411SeoliCable) New House ED Addition El,: Replacement Windows Alteration(s) El Roofing 121/ Or Doors 0 Accessory Bldg. 0 Demolition 0 New Signs DM Decks [CI Siding[CO Other[01 Brief Description of Proposed Work: • - . . Alteration of existing bedroom Yes No Adding new bedroom Yes No • Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ia.41•WW•tielaigWilannEKttaWFTIO. ticroa: _ a. Use of buittling:C.Ine Tim Fe;ay 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 IL 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 za-,.ovfraifskAtAiOttatfe*titWtO :-fa:':1-:':: aNNERtAtErtritiitto Thamos Tolith /410.-c2' as Owner of the subject property 4 hereby authorize rei9I t r%,%• 1"-k- Ne 3 - to act on my behalf,in all matters • to work authorized by this building permit application. • \-T t Mr , 0.00 Signature of Owner Date 7JM er 4../ as Omer/Authorized Agent hereby declare that sta 7 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- /11,4-4;ii4- Print 2-4C • atImd ■Own Date Section 4. ZONING All Infamsatifin Must Be Completed.Permit Can Be Denied Due To Incomplete In onnation • Existing Proposed Required by Zoning This column to be Billed in by Depanmeat Lot Size Frontage ! 1 I f 1 I Setbacks Front I j ` } i Side 1.:1-1 R--1 r,r -! R ----1 I ! : Rear . Building Height : = ' L T— _ _- Bldg.Square Footage 1-1 ) I % 1 ( j I .i 1 �s % � l ! I I I I I 1 I puking). #of Parking Spaces r-----1 1 Fill: , I I ii (volnmselt Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q Dot T KNOW © YES Q . IF YES, date issued:, i IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW © YES IF YES: enter Book I li. Page - I and/or Document#j 1 B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © `, Date Issued: I f C. Do any signs exist on the property? YES () NO 0 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: 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 r NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. . • , ......r....-....... Lq .'.--...,-,-..-4, 2--,,,--,4,-. -.,It, .u,,,,,,___„z...._,,x•,e_.., .--.A. ....,..c.....-2-,L.--evLp-,,.... ;,,e....t.o•-, *-0---,-3,,,-,7-.1-, , .,:. .__., ...-_-...,e,-. .4.,..--..., City of Nortprnotoo ..-,,,.,,.2.....1......„-7 ..., 4--,-,..,-,.-..:-.. ,_-....-f-.------- _. ,.... ‘,„t-.---:-..--_,-;;;...,,,-- -.÷F.::-.j ,:-.:1.- i....,:q.,,,:...14, -r.,, -.....-`'," ^-,_-■•-•.•.:1-'1..",4,"'' -------"r". -----‘--- ---- --::''.-2----' .7...,..; Building Department ;=--.....,...,...,— -----, .---,,,-------.- -------:•-=-,--.-,.. --, ,,,---,',..,..:: ,. ..., ,, '''"0'','''"' ; -.. {, --:-',:::,....---.. ..'..2.‘_.--''-_-..,-..-— '"...-.. -.-..•r''' . \ , 212 Main Street Y-ufil-,---Ly..d.-".. ...-----,•-v.-,, - ,-,....“,—. .L......,1,,,,:....: ,..‘", "V.Lti`.ailitaialt-ce. .....r.r.,,,o,„., ..........7.. j-4 ....„ -.:,..,.,.477:4',V......:.:...., Room 100 0:--.-i,-_',,--c-r.,--.._,1 ,11,-:-T,,,,F.:,7-1-,:c-.2...,......_a_n-F- ,y,..,.. ':::-..:...-v,..ts r-17.•,_r,..,..,A.,,,., ,..z .,,4, -71-1-7---;':k.-7.tf."-:..• =a, —., ...: - --v'' '...e"fil, -? Northampton;MA 01060 7 piione 413-587-1240 Fax 413-587-1272 3 :‘,,,,,---. .-...c,-Z-4-...,;e:.,- - ..;" -',.` --•-'" '""_::..":- ,: ,,,,'..-f ,.,',. '..!,..P-sts •g."•..t: i \ , APPLICATION TO CONSTRUCT;ALTER.REPAIR.RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEWNG .. ... . '. -.:,-.,-.7.-.....:- " _-.-:,-.:....--..2----,-.,:-,:-,ms-,:,:,..T.: •- --;*......,, .. - SECTION. -1...-tntRiForauktioti . 1.1 Property Address: - '..,-.^.4ft%<:ig.x.---.-40orat-V..c, ".'''.:,----r'-'':44•.••:4-_,-__•_.0- ---•..'":'--:.k.=•'='::'*,-i _ - - --,, -,, -..-4.--,----'''''''...-7-4,4A4/4: 77...,-....."'?"'..A.- -1; •-•'*- •`-=.-- ''' ' ..., -.., ,.:,-,---•.zz:s....,..;L...,;.;...._- - ,4-. . ."''''''' '-''--,- ; -•■• ., N.,---•■:r..'3'..,:., •%,..--z-- "...' .o.: ;t...-1r .: ,..I.Z.1.77.....,... ...`".,..,.; ,p...,. ,.... SECTION-2-PROPERTTOWNERSHIPMUMORIZEDAGBLIE.,t' - 2.1 Owner of Record: ihroli Xalip. Abdr‘ R 9, rb9c gq /149/-t-happrol tuilb- a(ob I Name(Print) Current Maing Addzrso 5.z.7, 6 i 06, Telephone . . . Signature 2.2 Authorized h.43ft t&r ,it .. L(.../..-(-....—.._...—....__ 2 )4_1(4 ti/ Name(Print) / s---- ji, Conant*dna Addis= • ----... 4/1 -'2 Y Signature Telephone AknotizmagamIstinamtrat. - ..„. - ---- - -. - . -ca - _ Item - Estimated Cost(Dogais)to be -- _ Official Use Only completed by pear*velment 4 . I. Building -1.... . .. ilanizt:Pei Pee V61°) g 9 2. Electrical 3.1.Eslihtated-Altal COst a - -..------, _reettathiCriori*alit(6) 3. Plumbing 'BiAildfingFermitFee - 4. Mechanical(HVAC) ,- 5.Fire Protection - e------ 6. Total=(1+2+3+4 4-5) - , ' , L'-'---- :Check Number 00 . - . ..... • _, s ... - . 4 . ,..-: Signature: r i Building CommissionerAnspedorof Bulking* Dah3 -- •-: • BP-2008-0545 GIS #: COMMONWEALTH OF MASSACHUSETTS 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-2008-0545 Proiect# JS-2008-000823 Est. Cost: $5700.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIMOTHY J LUCE 149288 Lot Size(sq. ft.): 22041.36 Owner: ANDROS THOMAS J Zoniw: SR Applicant: TIMOTHY J LUCE AT: 385 NORTH KING ST Applicant Address: Phone: Insurance: P 0 BOX 14 (413) 387-9800 LEEDSMA01053 ISSUED ON:11/28/2007 0:00:00 TO PERFORM THE FOLLOWING WORK: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 11/28/2007 0:00:00 $25.001007 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo