24C-100 Porch permit 2015h�
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Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To : Lu Knox
Phone- 584-1752
Address : 89 Massasoit Street
Northampton, Ma 01060
Date 10-19-2015
We hereby submit this Estimate for- Roof
This price is for the job of building a roof system over existing deck.
I will install 4x4 posts to support a carrying beam for the roof rafters.
The roof will be framed with 2x10 rafters with 5/8 " plywood.
I will frame and install 3 skylights supplied by the customer.
I will use 30 year architectural shingles color to match existing roof.
The fascia and soffitt will be trimmed to match existing house.
I will install storm door panels the length of the walls and have 1 operating to enter and
exit.
The door panels will have glass and screens in each removable.
( The ceiling will be unfinished / open rafters )
Price for materials = $ 3850.00
Price for labor = $ 5100.00 Total = $ 8950.00
Contractor Supervisors License 082531
Home Improvement contractor Registration number 135204
I propose to supply materials and labor -in accordance with above
This proposal may be withdrawn
By us if not accepted within 30 Authorized Signature
Acceptance of proposal Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: !V7 A�4'U'ecf 0
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant Phi-en.V
Date Signature of Permit Applicant
INSPECTOR
Louis Hasbrouck
Building Commissioner
City of Northampton
Massachusetts
DEPARTMENT OF BUrZDZNG INSPECTIONS
212 Main Street *,Municipal Building
Northampton, MA 01060
Chuck Miller
Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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 ai 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
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 locatio
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
` xis www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Inform
Name (Business/Organization/Individual):_
Address: qt; Z"4) �;e—
City/State/Zi
Ple
MEN
02-7 Phone #: SrZ 7 ;/
Are you an employer? Check the appropriate box:
l.11 I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.$
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7.4 Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:�i N�-•�� , „�L� S. �. �. —
Policy # or Self -ins. Lic. #: Of Expiration Date:
Job Site Address: �l MA.f�Aj 0,1"r � �T City/State/Zip: d✓ � /��✓ /�?'t ���'�t'
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Simature: Date:
Phnne #-
Official use only. Do not write in this area, to be completed by city or town of
ciaL
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Su
Name of License Holder:
ervisor:/%?
l�—
NootjApplicable £
(/ Y2_ ) -J7
License Number
7
Address i
Expiration Date
Signature Telephone
9. iReciistered Home Improvemen��fl1Contractor
Not Applicable £
Company Name
elk �`�-
s'�'�
Registration Number
,
Address
Telephone
-ffxpir6tron Date
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 affidavit will result
in the denial of the issuance of thebuilding permit.
I Signed Affidavit Attached Yes.,%'l,. £ No...... £ I
11 .Homme Owner Exemption
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 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 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑
Addition
Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑
Demolition ❑
New Signs [fes] Decks [[] Siding [O] Other VIX
Brief Des riptionRf Proposed
Work: LS
Alteration of existing bedroom Yes _ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes J_No
Plans Attached Roll - Sheet
6a,If fVew house an or addifiort to existing housing, complete tY a folloWin :
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 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
i, 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
Y-4�ekv')
I, as Owner/Authorize
=A=t hereby declare that the statements and information on the foregoing application are true and accurate, to the bes o my nowledge
and belief.
Signed under the pains and of perjury.
`penalties
s'h.�.�J
Print Name
Signatur o Owner/Agent Date
Section 4. ZONING
All Information Must Be Completeo.
Permit Can Be Denied Due To Incomplet Information
Existing
Proposed
Required by Zoning
This column to bf filled in by f
Building Departifent
Lot Size
Frontage
Setbacks Front
Side
Rear
L:= R:. !
!---- 1
L: R:F
) �q
Building Height
Bldg. Square Footage
�%
1
Open Space Footage
(Lot area minus bldg & pavedparking)
%
�--^
# of Parking Spaces---
1
Fill:
(volume & Location)
i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW O YES
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q 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 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtainedQ Obtained Q , Date Issued:
_.—.._.
C. Do any signs exist on the property? YES a 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 Q NO 0
IF YES, describe size, type and location: j
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.
I�t,�CEy =v City of Northampton
Building Department
212 Main Street
Room 100
LOFBUILD6NCa1N5PECnONB Northampton, MA 01060
aoaTHAMPTON,MA01 13-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1,61
Name (Print) Current Mailing���� Z. � �Z
Telephone
2.2 Authorized Agent:
Name (Print) v Current Mailing Address:
A2 r2_7—�/2�e
Signatur Telephone
SECTION 3 - 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 Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2+3+4+5) i Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/In..spector'of Buildings Date
File # BP -2016-0529 d"
APPLICANT/CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST ST EASTHAMPTON01027 (413) 527-7124 Q
PROPERTY LOCATION 89 MASSASOIT ST
MAP 24C PARCEL 100 001 ZONE URB(100)
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:_ CONVERT DECK TO 3 SEASON PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 082531
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR�ION PRESENTED:
I
approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR
Major Project: Site Plan AND/OR
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit
Special Permit With Site Plan
Special Permit With Site Plan
Variance*
Received & Recorded at Registry of Deeds Proof Enclosed.
Other Permits Required:
Curb Cut from DPW
Septic Approval Board of Health
Water Availability Sewer Availability
Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
elay
n Z—d
Signa re of Bui ding O ic' 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.
89 MASSASOIT ST
GIs #:
Map:Block: 24C - 100
Lot: -001
Permit: Building
BP -2016-0529
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation
Permit # BP -2016-0529
Project # JS -2016-000885
Est. Cost: $8950.00
Fee: $65.00
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sq. ft.): 16073.64 Owner: KNOX JEFFREY R
Zoning: URB(100)/ Applicant: STEPHEN CAMP
AT: 89 MASSASOIT ST
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527-7124 O WC
EASTHAM PTON MA01027 ISSUED ON:10/26/201 S 0:00:00
TO PERFORM THE FOLLOWING WORK. CONVERT DECK TO 3 SEASON PORCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service:
Rough: Rough:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:
Meter:
House #
Driveway Final:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeTvne: Date Paid: Amount:
Building 10/26/2015 0:00:00 $65.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck — Building Commissioner