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SECTION 8 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Expiration Date
Telephone
9. Regisfe'red`Nome'ImiirovernentrContra'ctor1 .i�av: . t,M�r ; - Not Applicable ❑
-,-,mpany_N<ame Registration Number
L
- :,press Expiration Date
Telephones 25'y' &5 7,/
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
-ers Coinpensat on Insurance affidavit must be completed and submitted with this application. Failure to provide this af' r-.
esa't in the denial of the issuance of the building permit.
affidavit At±ached Yes....... CU No...... ❑
11"i.. Home,OwneriExemptiot'
The current exemption for"homeowners" was extended to include Owner-occupied Dwellings of one (1) or two(2) Tamil]:
ind to allow such homeowner to enoaoc an individual for hire who does not possess a license, provided that the owner ;Ict�
as supervrsor. 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 then_
is. or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or faun
trnrctures. A_Eerson 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 heishe shall be
responsible for all such work perforrned under the buildinL, permit.
As acting Construction Supervisor your presence on thejob 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
i:mployces for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for personfs
%ou hire to perform work for you under this permit.
I lie undersigned"homeowner" certifies and assumes responsibility for coniphance with the State Building Code, Citv o1
11omhampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Ilomcowner Signature _ ,_
DESCRIPTION OF PROPOSED WORK(check all applicable
Addition O Replacement Windows Alteration(s) ❑ Roofing
Or Doors 17
-.. DernolitioriL New Signs L J Decks [ Siding j Other
Nosed Work. 5]r-f 3/ ,�(�i�5 �r.✓yL
I
r�roor - Yes _ No Adding new bedroom _ Yes No
Renovating unfinished basement —_ Yes No
sheet
New house.and "or?addition5to ezist[HR:lfdtising; COM0101611he following:
ne Family Two Family_ Other
each 'an-dy un,t Nu! ber cf Bathrooms_- _ _--
�ned?
_.-. .ge of new construction. Dimensions
rip! � :ce Mascheck Fner gy o npiiance form attached'
100 ft of wetlands? Yes No. Is construction within 100 yr. fioodplain Yes
:ellar floor below finished grade
.,n to the Bcilding and Zoning regulations? _Yes _ No .
-,!fy Sewer Private well City water Supply
/ i O`r'r'NER AUTHORIZATION TO BE COMPLETED WHEN
AGEN OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of ub;e^'
wi�rk a,;ttCr ed D, .;iis L--)t j er
Da'e
Owner/AuthonzecJ Ag
'aterner and information on the foregoing appiication are true and accurate, to the best of rn;
nd penait es of perjury
Date
EC
Q Vit f hampton
u ldi partment
12 i Street f
ss,:0 2 5 2001 R 00 .
Northam ton, MA 01062
DEPT of 50 DI ► S N$240 Fax 413-5871272
yt RTKAMPTON,MA 01060
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
CTION 1 - SITE INFORMATION
Property Address This sectlonito be completed,by office,
q
CresAliet-1 d� Map` ' :, Lot �`., ar e ,• Unit`
Zone Overlay District
Elm St. District CB District
CTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
'`•,finer of Record:
Current Mailing Address:
- ----- Telephone
Authorized Agent: s1
Awl -r)— A�
�ft) Current Mailing Address:
Telephone
ECTION 3 - ESTIMATED CONSTRUCTION COSTS
Estimated Cost (Dollars) to he Official Use Only
completed by erm t a of cant
(a) Building Permit Fee
al (b) Estimated Total Cost of
Construction from 6 _
�5ing Building Permit Fee
-,-r,�,nical (HVP.Cj
^ �r-±ection
._11 + 2 + 3 + 4 + 5) �vC��— Check Number
This Section For Official Use Only
g Permit Number: Date Issued:
BI,ilding Commissioner/Inspector of Buildings Date
47 CRESTVIEW DR BP-2002-0354
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-462 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2002-0354
Proiect# JS-2002-0533
Est. Cost: $5200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sg.ft.): 1001 8.80 Owner: SLOAT REXFORD K JR&NANCY R
7 .ry
Lori;.b. Vi\t2- YiLrLfi.dLi: EL 'vVrul'L} i'
AT: 47 CRESTVIEW DR
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMA01060 ISSUED ON.91271010:00:00
1,
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:
AO—
b"
Final: Smoke: Final: e k.)
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/27/010:00:00 1378 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo