32A-255 (22) U!/I LP/LUV4 111V IU.lO !'ns !lU V V V vrav 44-- a,v.•+a..w.+,+., .....+..
Coatr. Lie.No. 101723
rya Tel. 413-584-1367
YOUNG R �r 004 (04 413-586-9167
RQ BOX 60OB13FLOPMEMMA0106MM Fax 413-585-0226
Customer : Hotel Northampton Date: 7/8/04
Address: Tang 9t. Northampton, MA. 01060
Job Location Low.roof next to Ballroom -
SPECIFICAMNS;
1. .
dub►� IRx'f-Ivy .
2. Install
3. , -with au
4. Install .032 gauge white aluminum edge metal.
5. Cut in a new copper reglett over the brick wall termination bar.
wma aaao WW fl*a7 M 19ff r open wrinen ordOm OM 41 �.
bwome en eava oharpe over and oLwe dre edJmae.oM apraemarsa COn1nQ4nl Loon /
slrlkta,andderus or tlekys fond Cur epn • ownw to Cony We atd olhw neot r
Ineurenee.INi eetpums not pad Ohm SD d us AlAwt b a lal!&A"U i 1P7'�r
pw month�yhn+, pplIpald b�anaa. In It I evefit Itset repN adNn h h aiWiMd Io mllmdt Authorized
any soma d�utltlM CHse�9aalrnl,0,raSQCPlIgn.0'a,"b pay ai m"hound
>,+dltlMlssaenableanoratYar.ee Signature_Richard Young resident_
Acceptance of Proposal- The above priccs,spccirications
and conditions are satisfactory and u re hereby accepted. You are authorized to Witness
do the work as specified.Payment WM be made as outlined above. Signatrure-
Aoceptmoe Dats of Acceptance_— r—/r--*- —
11N!1p
$ 6 �assacl� sctts -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060
r
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:visor. 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),
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
SttnN•r'r
�? $ (-►,ifyr I.�f �1tYt-tfj�urt}.rtnri
P 6 ,fsic�aRChustt(s' —
0
m DUARTMEITT OP nUIL)P�G INSPECTIONS
1
212 Main Street ' Municipal Building '
Northampton, MrLcs. 01060
WOMCER'S COi1rT ENSATION INSURANCE A FF AVLT
— (IIC�PC::JrCrII11tIC^) *e
Nvitll a principal place of businesslre-sidenc?. 11:
------- -------------------- (strceticit}•J,;t tcr7!p)
do hereby ccr'l1S}', under the p iris find 1)C:naltics of Pcf'111-Y, .01al.
( ) I am an employer providing the fallovi,im: v;orkcrts compcnsa-tson coverage for my
employees worlang on this job:
America International Companies WC00725331900 1/1/
(Insu anm Company) (Folic;Number) (E pirnon Date)
( ) r am a sole proprietor, general contrcor or. homeotiiner (circle one) and have hired
the contractors listed below-;ho have. tht foUo-.Va-ig workers compenssnorl policies-
(Name of Contractor) Rnswancc Comp::r Tolicr NtunlYr) (✓?:):=anon Date)^
(Name of Contactor) ( �,Lwrance Compazv/Pohc-; Num.t_0 (Ezvimtion Date)
(Flame of Contractor) (Ins'Iratiec Com;`,antiifolicy Nusnhtr) - ( xi.ir'eca Date)
(Name of Contractor) (Insurance Coniva lyr't olicy Numb-_r) (ExrJ: hips Date)
(atL�dt adai imil rlxd ilr.c_crT.^ :n i-rn'�.._.._=5:::.:ia:r- ._...a:>, •
ell o:r..:_,...,.•.)
( 1 81I1 it sole plUpr1CtUi' i'i1d have 111:5 one ...oriing for nic-
( ) I :ain i.? home olvncr perfb'mIn all tho V:Grr: iiivs:df
NO•I•E:please tr a:.r_r-,:C!:m cr I- au •''•Ii- ,,,call. cf
not aloce t1La throe units in%vt-;Ch:he r=iu u(XI ziT.Ixizr_m thcao--:e nN fir'a Iy Cry 3::.:±a he
e=IploYCc3 urldci the,vcci:cr s ec T-.=;_-tiro i•.c (EiL152---n-I(5)),'r-'l:=.ian by n hotncot,-nu for a 6, C c a p:'o:t.; - -._,-n_e 0
legal etahu Oran aenployec and r[he W"kcrt co.-upors I;On f.cf_
I undc-^Itand that i cOpy of tiv ctat=,cri cv.y ba fmyarded to tl» Qiriae or l!"-for tux
covtxabc vcrifictioa and that Edure to raztrc coNtr_Sc'umk :rctim 25A of?,(01.152 can Ind to the imposition Oftr,:nia_-I Pa:aL:ce
oomcvding Ora fur_Of up to S 1.300.00 ari_"or ir..Priso In::+1 of up to or.-)-,_r r.:.I civil perultico in de f-171 of a StO,' --rd a
Lm ofS100,00 It day tcrvn:l tn:. .
FOe dgs ruxr e-J u.e only.
Sicnnturc of I.ic JI r ulttc::
l ti l t alO S RVa fi �N.N
E N4,j t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Richard Young 011878
License Number
P.O. BOX 60056 Florence, MA. 01062 �l1�IQ5
Addres ;! Expiration Date
413-584-1367
Sig ature Telephone
r� n Not Applicable b
Company Name Registration Number
Address Expiration Date
Telephone
P-:r s r F,wt E ... .R
0 ff MFl}N$i4 �ONANAFFFI�DAIIT_{ML.Ec
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....... ❑ No...... ❑.
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 hive 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 them
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 acccptable 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
-
��
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding[ ] Other[ )
Brief Description of Proposed Work: S k+4c"ed C�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet 0
d t n e i�tiit� in
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. - Mascheck Energy Compliance form attached?
h. Type of construction
L Is construction within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes Nc
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
as Owner of the subject property
hereby authorize to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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 the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
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
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ev r been issued for/on the site?
0
N DON'T KNOW °y 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 #
i
B. Does the site contain a brook, body o f 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:
�I Cty Northampton
n Department
! 21 in Street
AN 2 5 /" 4 100
North ympt n, MA 01060
j H rte, A �-12 0 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
ST10N - SITE INFCRMAION ,.
h's
1.1 Proaerty Address:
3 � a,
PT
Elm fit �strct ,�
SECTION 2- PROPERTY OWNERSHIP#AUTHOkRIZED AGENT
_.
2.1 Owner of Record:
Name(Print) Current Mailing Addre
/.� `5D
Telephone
Signature
2.2 Authorized Agent:
Young R ofin Co., Inc. P.O. Box 60056 Florence, MA. 01062
Name(P " Current Mailing Address:
I and Yo President 413-584-1367
Signature Telephone
§, w'
SAC T 01� 3:--..ES I A7BD i.CO.N'STR 1C7IONg6b:'
..
Item Estimated Cost(Dollars) to be Official UseCrfily
completed by errrmit a licant
1. Building ��� ,� (a) Building Permit Fee
ICS C
2. ElecLrical (b) estimated Total.Cost of
3. Plumbing Building Permit Fete
F4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) j,QheckNuLrnber
Th §.Section For.Offici:a.1 Use O,nl
Build�ng.Permit:IQM r:'. Date issued;
Signature:
Building Commissioner/Inspector.of Buildings;; Date:
File#BP-2005-0245
APPLICANT/CONTACT PERSON Young Roofing Co Inc
ADDRESS/PHONE P O Box 56 FLORENCE (413)584-1367
PROPERTY LOCATION 36 KING ST
MAP 32A PARCEL 255 001 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid A4 27
Typeof Construction: INSTALL 155UALE COVERAGE ROOF SYS W/WHITE ALUM EDGE METAL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 011878
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQ ATION PRESENTED:
1 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 Co on
_ 2 2oo
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.
36 KING ST BP-2005-0245
GIS#: COMMONWEALTH OF MASSACHUSETTS
:Block:32A-255 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: BUlldiinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category BUILDING PERMIT
Permit# BP-2005-0245
Project# 35-2005-0303
Est.Cost: $1560.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Young Roofing Co Inc 011878
Lot Size(sa.ft.): 72614.52 Owner: STAR NORTHAMPTON INC
Zoning: CB Applicant: Young Roofing Co Inc
AT. 36 KING ST
Applicant Address: Phone: Insurance:
P O Box 56 (413) 584-1367 Workers Compensation
FLORENCEMA01062 ISSUED ON:8131104 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL DOUBLE COVERAGE ROOF SYS
W/WHITE ALUM EDGE METAL
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 SiLynature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 8/31/04 0:00:00 16991 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo