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29-466 (3) e dlo fb,b SUBJECT: Photographs of work completed at 15 Crestview Drive Florence, MA I, Lynn Reagan, owner of the above referenced address, hereby verify that holes were dug on July 3, 2004. 1 also hereby verify that the photographs viewed by the Building Inspector, of said holes, on September 15, 2004, are, in fact, located at 15 Crestview Drive, Florence, MA. Lynn R agan September 17, 2004 Subscribed and sworn to before me this 17th day of September, 2004. Madeline L. Broadhurst Notary Public MADELINE L.BROADHURST No"Public CWmaw"M of Me"Sou"IN My Cam*Won Eon Nov 3,ZQ06 4brt*, SUBJECT: Building Inspection Performed on 9/15/04 15 Crestview Drive Florence, MA I, Louis J. Montgomery, verify that holes were dug on July 3, 2004 at the above address. 2 holes are 56" 1 hole is 54" 2 feet in diameter 24" big foot footings installed in each hold 12" sonnet tube above grade installed on top of big foot footings filled with premixed gravel mix with 1/2" threaded rod 3 feet long as anchor bolts Louis J. M gomery License # CS 0134 September 17, 200 SUBJECT: 15 Crestview Drive, Florence, MA Inspection Performed on September 15, 2004 1 SEP 2 3 2,004 x -- �C �rVr ns fl1.It,D N.: I had the opportunity to have younger people to perform the work. I realize you do not conduct inspections on weekends or holidays. However, since you had been in this trade for many years you realize how much physical work is involved. I felt that as a responsible and conscientious licensed contractor for 31 years the photographs would suffice. For your additional information, we removed the deck, dug the holes, installed big foot footings, the sonnet tubes, mixed and filled the three holes in a matter of 7 + hours. We also layed plastic down and spread stone over the leveled area. As I am approaching 50 years of age, I am confident you can appreciate the fact that I took advantage of the opportunity to utilize these younger, able bodied men to help in this endeavor. Not wanting to bother you on a non-work day I took the liberty of performing the work. There was no intention on my part to mislead you or jeopardize the position you hold. I would also like to add that I value, respect and appreciate your position as inspector and hope that you can understand the manner in which this situation was handled. Thank you for your time. Loui.90 Mon m ry License 01 71 Septe , 2004 f + i � Y I I r i i i 1 -------- r DEPT`�r R 6 �C G v� r 1r i J TO � r ;, . ,ter 'r 6v r 32 joo 36 ik, t.. a 3 �u"04 i i i ...J VI - t � y$ y ii t � �, w �/.r�wa��.rra:�.a�rs:w�+..wnwe�>.,,m+:�-n�;va:�vA�+�ar�F'�'�-�ar4t�]IM�fir�il�iw"a�:!�'..Y�.�# � s' � ��� .. : . ,�:k t ,.. .,... . ,.,3. • 4 op 6 JR aasaCEl ITS etIs ,) - DEPARTMENT OF BUILDrN-G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 —' WORKER'S COiYIPENSATION !ISURANCE AFFIDAVIT L o uj S J. "L)r)tgam e+rc- (I►ccnseclpe�uu��ee) with a principal place of business/residence at: P. d Box 1013, 8a C-kjajrcl, mA 01333 -(oQ53 (phone:=} do hereby certi}-, under the pains and penall6es of penury, +-La?: { I am an employer providing the following workers compcns�,-tion coverage for my employees worldng on this job: (Insurancc Company) (Polio'Jumber) (Exairation Dat:; } I am a sole propr , contractor ietor, general con or homeovmer (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy NLmbCI) (Expiration Dave; (Name of Contractor) (Insurance Company/Polio;Niunt,--) !Expiraron Da (Name of Ca trlctor) (In_arranc-c Compaay/Pcli�vNumber) ^ (Ux%:ranon Da- T (Name of Contractor) (Insutanc--Compaay/Policy Nu mbes) (Expir,lion Date) (anach addition!sheet ifnocessuy to inc3ude mform ioa pwta_.g to all ooatrs o ) (0 1 am a sole proprietor and have no one working for me. ( ) 1 am a home owner performing all the work myself. NOTE:please be awaro that while homeowners who employ peroas to do maiutraanct,co.=Uc ioa or repair work on a dwelling of not more than throe units in which the hommwner resides of on the grm d,appurtenatfl thereto are not Ccn r-ally eo=dcred to be employ=under the worker's c=pc:sz4m Act(GL152,ss1(5)),application by a homeowner for a license a P=ait tray evideaee tike legs!st-, of an employer under the Workcea Compensation Act I understand that a copy of this suntan ccd may ba forwarded to the Department of lnd s d A=&m&Offioa of Inwraece for the oovmge vaif cstioo aad the failure to secure oovr mp under section 25A of MGL 152 can lead to the imposition of criminal pexalfies comisting of a fine of up to 11,500.00 and/or imprisonmera of up to one year and civil penalties in the form of a Stop Woex Order and a rum of 3100.00 a day agar 5mc, , Signed this_Oft —day of "" -1 For iPUtmeatal use only SECTION 8 - CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: k--OLI i 5 T, ly��.gpal" Not Applicable ❑ Name of License Holder : `l / 0134'11 License Number I ih� �0�-- Address p p , �OTC /O/3, /_3u k-10-Ad MJ9 Oi 3;38 Expiration Date 44a5-[Pg63 Signature Telephone 9. ReAliste H me I it ement Contractor: LO0-4_S S, MOht�90rnery Not Applicable ❑ Company Name P 8 o i U/3 8 uc k-f at rd, MQ 0/33 Registration Number / o/gloms Address Expiration Date immoodw Telephone 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 af`icav t will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 20 No...... ❑ 11. - Home Owner Exemption ['he 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 erson who constructs more than one home in a two-near 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 'ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ i Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ Brief Cescription of Proposed Work: 1 a X /to 3 -SeaSo� pov-C,�) Alteration of existing bedroom Yes X No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached =toll _ Sheet i sa. If New house and or addition to existing housing,, complete the following: a. Jse of building : One Family X _ Two Family Other b. Number of rcoms in each family unit: Number of Bathrooms 1 C. I s t^e r e a Iarage 3ttaC'cd7_A( perc.h d. Proposed Scuare footage of new construction.,a-XI& 3-SIMScn Dimensions e. Number of stcries? Method of ~eat:ng? GOL-S F1 P Fireplaces or Woodstoves Number of each g. Energy Cerserraton Compliance. Nlascheck Energy Compliance form attached? -ype cf cc-,7,s-.ruction WOOCL i. Is construct-3n within 100 ft. of wetlands? Yes _� No. Is construction within 100 yr. floodplain Yes i Cepth of basemen*, or cellar floor below finished grade N.11cl k. '^rill building conform to the Building and Zoning regulations? X__Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize C to act on my behalf. in all matters relative to work authorized by this building permit application. Signature of Miner Date Lou-iS 0. MOnt prr)e.-rq j 1. , as Owner/Authorized Agent j hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. i Signed under the pains and penalties of perjury. LOWS J M Of)4 —car►erc4 i Print Name I Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department 1 Lot Size I oo' X 1 ()0 �� (� �c cii; i Frontage Setbacks Front 34' ZL 3o Side L:35' R:oZ3 L R: �s Rear 30' 30 Building Height 1.dory,a,-,&h 15-Fary ra ndl Bldg. Square Footage I o d e % Open Space Footage % (Lot area minus bldg&paved parking) #of Parkin S aces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO — DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES — No IF YES, describe size, type and location: Department use only n U U I '. of Northampton Status of P$"`rrirtr II ing Department CurbCutlD►iveWay. ►t u Q04 Main Street Sewer/SepticAvarl- "I► r oom 100 WrlWellAvarfaih ha ton, MA 01060 Two Sets of r Stu alPjans � Y �F a� ' -a'. 240 Fax 413-587.1272 Plot/Site P' } p �(ON, Other Specify ~ a i APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: �This section to be completed by office Map--�-- Lot---- L Unit Zone Overlay District Elm St. District___ CB District j SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n n IQ e-O-G 0-r-) 15 CreS-LO'e-c0 be-,, r10(-e1-Ye� )4 A 010(0 ^Jam r nt) Cur. nt;� ailing.Address: 5S - o� Telephone Signature �- 2.2 Authorized Agent: U011140W 1013 , I&L�Yazd 01339 P-0. Box &8&294D Vfta8&W&, MA Name(Print) Current Mailing Address: Signatures„% Telephone SECTION 3 - E CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 4 5J G©o (a) Building Permit Fee Electrical 50 (b) Estimated Total Cost of Construction from 6 1 Plumbing A Building Permit Fee 4. Mechanical (HVAC) / A 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) 4 5, Soo Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date ROUTING AND TRANSMITTAL SUP TO: (Name, office symbol,room number, Initials Date building,Agency/Post) 1. 2. 4 IL I con File Note and Return roval For Clearance Per Conversation ues ted For Correction Prepare Reply ulate For Your Infownstion See Me ment Investigate Signature Coordination stify REMARKS DO NOT use this form as a RECORD of approvals, concurrences, disposals, clearances, and similar actions FROM:(Name, org. symbol, Agency/Post) Room No.—Bldg. Phone No. W41-100 *U.S.GPO:1995-"763/20072 OPTIONAL FORM 41 (Rev. 1-94) Proscribed by GSA (o /p cr house, , �� x37 nt o rs -7x � c4e C-L CP x 1 4� iax3o oco 7 TO (f op-en �iQQd !S i File#bP-2004-1288 APPLICANT/CONTACT PERSON LOUIS MONTGOMERY ADDRESS/PHONE P O BOX 1013 BUCKLAND (413)625-6953 PROPERTY LOCATION 15 CRESTVIEW PR MAP 29 PARCEL 466 001 ZONE URA (4J4 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 12 X 16 3-SEASON PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure - Building Plans Included: Owner/Statement or License 013471 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF90.MATION PRESENTED: 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 ssion Signature of Building Official Date 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. (Y) ©�� �� �� 5 CRESTVIEW DR BP-2004-1288 ;IS#: COMMONWEALTH OF MASSACHUSETTS jQ Block: 29-466 (CITE' OF NORTHAMPTON :ot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS 'ermit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PEWJIT, Permit# BP-2004-1288 Project# JS-2004-1941 Est. Cost:$5500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOUIS MONTGOMERY 013471 Lot Size(sq. ft.): 1001P.80 Owner: REAGAN LYNN E Zoning: ZltkNWSP Applicant: LOUIS MONTGOMERY AT. 1 l REST y'110 7 LA\ Applicant Address: Phone: Insurance: P 0 BOX 1013 (413) 625-6953 BUCKLANDMA01338-1013 ISSUED ON.6130104 0:00:00 TO PERFORM THE FOLLOWING WORT .CONSTRUCT 12 X 16 3-SEASON PORCH 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: f ;-T l Fi Driveway Final: cl Final: Final: � Rough Frame: Gas: Fire Department Fireplace/Chimney: __-- Rough: Oil: Insulation: Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL T ONS. Certificate of Occupancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 6/30/04 0:00:00 349 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 4161 l� SUBJECT: 15 Crestview Drive, Florence, MA Inspection Performed on September 15, 2004 2 3 204 -� ' �csn�r IN$PEGiICiiS 0110F0 I had the opportunity to have younger people to perform the work. I realize you do not conduct inspections on weekends or holidays. However, since you had been in this trade for many years you realize how much physical work is involved. I felt that as a responsible and conscientious licensed contractor for 31 years the photographs would :suffice. For your additional information, we removed the deck, dug the holes, installed big foot footings, the sonnet tubes, mixed and filled the three holes in a matter of 7 + hours. We also layed plastic down and spread stone over the leveled area. As I am approaching 50 years of age, I am confident you can appreciate the fact that I took advantage of the opportunity to utilize these younger, able bodied men to help in this endeavor. Not wanting to bother you on a non-work day I took the liberty of performing the work. There was no intention on my part to mislead you or jeopardize the position you hold. I would also like to add that I value, respect and appreciate your position as inspector and hope that you can understand the manner in which this situation was handled. Thank you for your time. Loui . Mon m ry License 01 71 Septe , 2004 �' :� i i � C5-) r+ n 7D, 7 � u � i 1 41- �+ 2 I s � CDT -� E 4k, - 1' a I� i a EE �r 4 ��a 10, OW, Q-N r7