38B-002 (6) 24 PAQUETTE AVE BP-2007-0302
GIS#: COMMONWEALTH OF MASSACHUSETTS
-MMI.Block: 38B-002 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0302
Project# JS-2007-000458
Est. Cost: $4600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BOB THIBODO ROOFING & SIDING 152172
Lot Size(sq. ft.): 106722.00 Owner: HABERSAAT BOB
Zoning URB Applicant: BOB THIBODO ROOFING & SIDING
AT. 24 PAQUETTE AVE
Applicant Address: Phone: Insurance:
P O BOX 201 (413) 527-7663 (�
NORTHAMPTONMA ISSUED ON:911812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE 2 LAYERS & 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:
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 9/18/2006 0:00:00 $25.003041
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo
ti.
City of Northampton
Building Department '
. d
'212 Main Street
Room 100
Northampton, MA 01060 e
hone 413-,387-1240 Fax 413-587-1272 t Site atis `� �p �
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1--SITE INFORMATION
1.1 Property Address: Th's section to°b completed byeoffice
A k
ap kat Unli
�y a e:the v�
ope OuefaDEstErct
�SE.Distrrct . .., C�District.
SECTION2 PROPERTYOWNERSHIP/AUTHORIZEDAGENT
2.1 Owner of Record: 11
°� �>o• a 'n1
Na rint)/ Current'Mailing`ed\&s I: M-A. Q 133 b
Telephone
Signatu a (�" 17- 9
2.2 Authorized Agent:
V 1V Or A v+,ld b�
Name(Print) Current Mailing Address: IM c^S5 mom► 0((A `
Signal a Telephone
SECTION3-ESTIMATED,CONSTRUCTION:COSTS:
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building,Permit Fee
2. Electrical :(b)`Estimated Totaf Costof
Construction from; 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+ 5) p Check Number 0 6�
This.Section For-Official,Use Only
D`aife -_
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:i._.�. R:' L: R
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
j
(Lot area minus bldg&paved f i
parking)
E
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T 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 Page 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
s
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 Q
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 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1 %
SECTION 5-DESCRIPTION OF-PROPOSED:WORK check all anotable.
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors p
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[CD] Other[O]
Brief Description_of Proposed
Work: o �. �r o� $S a + h a� 30 �r Sht�^ S
Alteration of existing bedroom Yes No Adding now bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
� 6:',^'T N"m.�.. rte. yam� �''x� `"" '� •:�'s .,u. "., ���,_ >#s «�".^�
6a4 flewioelse arrcalc>rttc> exsl�xctCe tte ara:
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 Yes No.
I. Septic Tank City Sewer Private well City water Supply
ED:WHEN ATlON-TO BE:COlVPL1a
OWNERS AGENT-OR CONTRA&oR .APPLIES FOF.�BC,ILD ING1 PEJ§MIT
I, O� lTG\��Qrf SQlC1 as Owner of the subject
property
hereby a onze
to ac n my ehalf,in all rpatter,s relative to work authorized by this building permit application.
Sig ture of Owner Date
as Owner/Authorized
AgenThereby 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.
'T \9)e 0 0 -
Print-lame
Signafure of wner/Agent Date
SECTION 8-CONSTRl1CTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable 0
f d
Name of License Nolder: — �1�„—�,�
License Number
. E in malt L A41 L,,,,,A6, A coo C, _ r )-_`. I
Address �— �i Expiration Date
Signatu a Telephone
:Reals ere €ori rit ec Cezrctet orificacta ".:`' ' %1 � ` '' Not Applicable .❑
Wim, t pP
nAL
1 : ILI
Company Name Registry on Number
1'C E .,
Address \ C A 5 k� � Expiration Date
`rAhT®'w^. Telephone �( a sroo
SECTION 10-WORKERS'COMPENSATION INSURANCE.AF1 IDAVIT(M G.L.c.t52,§Z5C(6))
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...... U
NiP
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 shalt 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
�' A "' E �aoanrSlntctte"
i
w ca DEPARTMENT OP DUILDf?-"c INSPECTIONS
212 Main Strcct Nfunicipal Buddint,
Nort.harnpton, Mass. 01064
j:
`4'O"I21Q IZ'S CON/EPENSA-110N CISUR NCE AIlI'1J7AVIT
-- - ----- -- (I,ccos_cclpermr(fcc)
v✓ith a principal place of business/residencc at:
l'
(sa-c t— City,'statclrip)
F do hereby cerdi ,-. under die palm and penalties of perj'w-y; hal
( ) I am an employer providing the follosvirat� tvorkcr's cotnocns.aon cove ale for my
etnployces xvorlang on Ljiis job:
(Us _ac—_Cott •) (Palscr? u-ai�er) {�:p1rat�oR Dom}
( } I arrt a sole propr:ecor, general contractor or homeowner(ci:de ogle) 20d have hirea
the concractors listed below who ltzve the `01.1otviog workees compensaiion pclicies,
([iaru-c Of Cont=cior) (IRSUr'1nt: Coinpaa"7)'li obc-, l~rllmh-_-) Ditc)
i
k`
I '
(tame of Contrclor) (bis-Wane Cotlpaativl'a1ic, \ttmcri) (—E:-.Ditation Dace)
(Name of Coanamor) (Lnsuranc:� Comp—icy/Palau- Number) (Uxpirarian Date)
(Name of Coatramor) (Lasuranc—c Cotaraay/Poticy Numbzs) �T_apiimdoa Dau,)-
(aa.A adrocsJ x5cct.ifncccza V to ina.'uw iaforIDsaoa Pczta!ajAjG to..0 oo=-_ccrs) -
{Vj I am a sole proprietor and bave no one worL-iog for me-
( } I am.a home o%voer performing all the work myself.
NOTE:Ptesc be ew-j=t}.*.vQc bc,,c, .m ui»cmploy p=.sQm b cto r.:.- �.,,,^} c ",:e�uo c rgav work a�a d�.<1- of
ooc acct tbna `t!.ra=?a is K�ic h the bomow+v reida oc oo th4 gvunks zip Ytean zbcstn i c eras�c-Ity oc�:d�vd to Lc
--Plorc ' the-- ceoea*=_: c.Ac:(G1.1 52_z 1(5)�zVpUctinoo by a homcow=f=:liccr---oc Permit rc.-y n'+dc (bc
tegsl c-L=u of eA==:loyer=der dao W ockzea GxmpamaLioa ea_
I uada.ad the x oopy of this a m y t�Ener-xardod to tbo� of indastsicl road oly fltrioe of tom fol Ib-
csr
c"crkgc vcs'ircciioa='d ttu Lzilta'c w sccurc'covcra zaoda's4c6oa 23A of MGL 151 can laid w the iai?ms ca of criminsl Pc-ltio
oom.i:.mg of a fine of tp to 11,$00.00 andf- y o f up to oat yvr cod civic PcnaPjo in 6c roan of a Stop Work order od a
rrm ac:5 100.00 a day aPirsa tat
For d�u.c only
PcrMjt Number
Sigp Wrc of Lim elPcM iUcc
Lzty of Xort4aii ptor
" DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street i Municipal Building
Northunpton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to
act as 1-11s/her construction supe: , isor. 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