23A-015 (2) 18 PARK ST BP-2006-0452
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-015 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0452
Project# JS-2006-0673
Est.Cost:$500.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ruili Ma 070307
Lot size(sq. ft.): 34717.32 Owner: FITZGERALD HAROLD R
Zoning: URB Applicant: Ruili Ma
AT: 18 PARK ST
Applicant Address: Phone: Insurance:
37 MARY JANE LANE (413) 586-2529
F L O R E N C E M A 010 6 2 ISSUED ON:10/31/2 005 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOF REPAIR
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 10/31/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
-
City of NortPempton
Building Department
212 Main Street ,
Room 100 -r (?'Act -+11,'S. 9 . ice
Northampton, MA 01060 .7i t:fxt r.'- � `
phone 413-587-1240 Fax 413-587-1272 hr -�^ !: : -
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE EIR TWOFAMILY DWELLING,
SECTION 1 -SITE INFORMATION
1A Property'Adpdress' / Thissection to be completed bypffice - -
I Ll/7-kuru6 -
Zone ' 'Overlay Dishfct -
�� , tk--i o r o b a
rEhitsMDa[nci CB Obtrtct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Nam!H " /Q 'e- i-.crP,.O 37 hal 5.,..a 2-- e
PMt) �• V Current Mailing Address:
, • & nr
6a-
a , - /•-- / Telephone
Signa. re Z } ) ca-t6 m-?--C4
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone r-
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be _ Official Use Only
completed by permit applicant r J
1. Building �.� (a)BuiFdin0 PefititTee
Svv -
2. Electrical (b}Estimated T'oteb,Gost of if,
Construction from(6) -
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection �r
6. Total=(1 +2+3+4+5) Check Number PYA'y rp pZ�'
This Section For Official Use Only
.:..Date
Building Permit Number. - Issued:
Signature:
Building Commissioner/Inspector of Bufldings Date
r.
Section 4. ZONING All Informati6n Must Be Completed.Permit Can Be Denied Due Ta Incomplete information
Required by Zoning
This��® Required to be filled in by
Building Department
lggOMIIIIIMIMIMMUnn
Setbacks front
ide11111111
Rear
Bldg.SgBldg Sq®uare Footage ® m--H1 111=11.11
Open Space Footage ®el®®®
(Lot area minas bldg&paved
----
Fill: I
volume&Urcmion)
A. Has a Special Permit/Variance/Finding ever been issued forton 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 Q YES Q
IF YES: enter Book '. Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , bate Issued: ,
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 4 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading excavation,or filling)over I acre or is It excpart of a common plan
that Mit disturb overt acre? YES Q . NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTIONOF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑., Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg, n Demolition ❑ New Signs (p] Decks [q Siding[C]] Other[o]
Brief Devcap tion of Proposed !/ Y
Work: t!/O l 10Jh ar 7s-P�fJ(A.St l-L4rian`-- ria! j✓yr'�P.e ,.
Alteration of existing bedroom Yes UU No Adding new bedroom VV Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ss i£Neto- creta D Zi4dififio'ic.T snii3Qris ifs eoi ofiifttl f (t"a r :
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 j Yes_No
j. Depth of basement or cellar floor below finished grade
It Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well ,,, City water Supply
SECTION Ta-OWNER AUTHORIZATION;TO:BECOMPLETED WHEN.
OWNERS AGENT OR CONTRACTOR APPLIES.FOR BUILDINGPERMIT
as Owner of the subject
property .—...—..
hereby authorize
to act on 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 OrmerIAgent Date
SECTION 8-CONSTRUCTION SERVICES -r-
8.1 Licensed Construction Supervisor. Not Applicable ❑
1 t
Name of License Holder �C�IiI I
I
License Number
37 (qA-ry-- iClrrena s /7a . OfC/ GS x7'0307
Address Expiration Date
Sire ( 7 Telephone i� �/
L- c--z VY-3).-qY asc}qq
efforri m.lovemft.Go'ntffiZ CSrafs5 ' -es?aul 'tc:'& L'srk '. ' Not Applicable ❑
Company Name Registrationumum e�>�—_-_--
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT'(M.G.L.c.152,§25C(8))
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 0 }No.o._... ❑
riti
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 hire who does not possess a license,provided that the owner acts
- as supervisor.CMR 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
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
-, ;-
rORS1tAFl PT
a• (tt e (TILT. of Tarfl)ampt0li - *�
rare. •
•
DEPARTMENT OF 3u'wrNG INSPECTIONS = f- =
' 212 Main Strcct ' Tfuaicipal Dui!dln0 �-.f,
Nror(hampton, Mats. 01060r'
\'/ORICER'S COMTENSATION INSURANCE AF',IJ)Avn-
1 _
Q, . �A'. .tilt) /
with a prncipal place of-business/residence zr: 37 lam'/Ar 1 --I-ett_�
iit5-7•e , . c , tt\--(n( . 0 /06, - (phooei0(qv 31SiPf-as,
(sacLIcityfswt/tip) 7.
do hereby certify. under diepains and penalties of perjury, Dial
( ) I am an employer providing the followine'workCe5 compensation, covet;e for my
employees working on this job.
•
(fns nnc Comcan) - (?Nit:Ninth r) (_piruon Dnc) '
• () I am a sole proorieror, general contractor or homeowner(ci;de one) and have hired
the co0macto(s listeeci below who have the following workers co_pensadon policies:
• (Nam:: of Co.n cwr) (IrsL:rl:vr Coln?urff?tile; !dun.c) (F.xptrauon Dom)
(Name of Couuraor) Ms.uznc Cnmpan-nPo!ic N'umEcr) (Lipindon Dace)
Male of Com-actor) (Insurdnc Company/Policy NumF:,) (Expindoo Due)
Mame et Concanor) (Insur'anc Compwy/Policy Numb^_r) (Ewilzdoo Dale). - _.
(.cat Sari GN.roar,.:;to-au&iclon.ao pmucins in.n e roan)
() I am a sole proprietor and have no one wor',dng for me.
() I am.a home owner performing all the work myself
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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 super-.1 sur. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a oiie or twofanuly -._
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 buildrng depaftment for the City of Northampton wants-any person(s)-who seek-to
use the home owner exemption, to act as their ovm 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