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32A-205 (4) 1111111.4w. BP-2007-0144 Is#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0144 Project# JS-2007-000216 Est. Cost: $30000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BRETT DODGE 053533 Lot Size(sq. ft.): 6011.28 Owner: GREGORY PATRICK BOLTON& Zoning: URC Applicant: BRETT DODGE AT: 36 BUTLER PL Applicant Address: Phone: Insurance: 42 EAST HAWLEY RD (413) 337-4013 HAWLEYMA01339 ISSUED ON:9/28/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL KITCHEN CABINETS & INSTALL 2 REPLACEMENT WINDOWS 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 VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/28/2006 0:00:00 $150.001259 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2007-0144 APPLICANT/CONTACT PERSON BRETT DODGE ADDRESS/PHONE 42 EAST HAWLEY RD HAWLEY (413)337-4013 PROPERTY LOCATION 36 BUTLER PL MAP 32A PARCEL 205 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ,y '�g, Fee Paid f� L25�V v''''' Typeof Construction: INSTALL KITCHEN CABINETS&INSTALL 2 REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053533 3 sets of Plans/Plot Plan ✓HELLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION 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 Co ' ion 4,7 ------"e— ..o. •-c, . --e4" ____92k/P_L 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,Depar ent 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 o Planning&Development for more information. Department use only City of Northampton Status of Permit: . v l-t 1 \6 _`=-'Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability AUG ' 2(. Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Cr`'r' — Other Other Specify APPLICATION-TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: a C� This section to be completed by office 3� �3�t-� t1.. (00 r-Ackl , M/� 0I060 Map Lot Unit J Zone Overlay District t Elm St.District CB DistrictF SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: &72► C K ( E�'-0(a�l 3 abi�) p1G 02-/ Nor"i o�,.+1 r7, lA Name Pri_nitt)) I' Current Mailing Address: l `�� ck. ' k c.-f e30 f Telepho e _ Signature J (y/3) 6-C—(/c -j 2.2 Authorized Aqe :G� 0� Z / �/i yt1 ///// 4/ .cry/ � .�/� P )( Name(Print) !/ Current MailingAddress: C 71 / l W/�Signature /.. --"4- Tele hone P SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building gal/ ©'6.0 (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=(1 +2+3 +4+ 5) Check Number /6 _ ` j This Section For Official Use Only Date 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 , • i Frontage Setbacks Front . . • _______ Side L: R: L: R: I 1 _ , Rear 7—I T-1, Building Height , . . ______i' • Bldg. Square Footage _______, . % Open Space Footage % ____ __ __ _, i . i (Lot area minus bldg&paved parking) • , • , #of Parking Spaces Fill: --i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 014 YES 0 IF YES: enter Book Page: ' and/or Document# . B. Does the site contain a brook, body of water or wetlands? NO . DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 3 IF YES, describe size, type and location: , 1 D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 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 Q, IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) n Roofing ,n Or Doors LK Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [E Siding[O] Other ] • Brief Description of Proposed ,-6, A r, Work: L. W1 WAOtA)ri KITCROQ CA6(MOT( Alteration of existing bedroom Yes X No Adding new bedroom Yes -k No Attached Narrative Renovating unfinished basement Yes ie No Plans Attached Roll -Sheet .y f x�� ��''li rnr�,c,�.5aahrtrx' '-^C."SL�3""'i�.:'s" ... ' -"�7r:� �'c�y.. ,' s.�- '"" g Sri: =�` sa:11'f`NeiVti asriirdG _ tivrr iW ttii fio ging ViBTRAfiTtoit iii t: 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? )I-'- , 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, (-4, C,,� ar or-4 , as Owner of the subject property hereby authorize 13 re-if &lq Q.-- to act on my behalf, in all matters relative'tb work authorized by this building permit application. .. ea- 'ic.,E Crr�Ricr� Signature of Owner V Date wf' irGZi �/ _ , as Owner/ thorize ( en ereby declare that the st e C.—nts d information on the foregoing application are true and accurate,to the best of m w edge and belief. Signed under the pains en an palti of per'/ l L may. 0 &__ Print Name .--- ) 41/7 r r Signature of Owner/Ag g Date a • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supe isor: Not Applicable 0 Name of License Holder: /cL7! �OSr35-33 (/ License Number / /17:7 4aii.-y-j At, g/3 2-V7 Address E tion ate Expiration yip 77—*/3 Si Telephone 9 Re mere _,o m rauemen° onttactol5 � � ' Not Applicable .❑ Company Name Registration Nu ber //7/1" • / 56/P Address 1 Expiration Date y, 1 41_ biet, ..4.Telephone , 137 yr/ 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 the building permit. Signed Affidavit Attached Yes 0 No 0 oxne one - pupa 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 f. .'ly dwellin , •ttached or detached structures accessory to such use and/or farm structures.A person who constructs mo • tha i m ne home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Buil. • Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed un s •r the building permit. As acting Construction Supervisor your presenc• on the job site will be required from time to time,during and upon completion of the work for which this permit is issues Also be advised that with reference to Chapter 152(Wo -rs'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massac setts 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 • g , Vt. �7 i�7 o f a1 ±!lamp a l l l J f oil l �� — ter, _ �- A e :� .n a �1as.wcfinsctla' '• 1. _- = ���?• DEPARTMEIJT OP nu1LDr-NG INSPECTIONS 212 T1nin Street Municipal Building Northampton, Mass. 010G0 IMP WORKER'S COfrCPENSATION E NSURACE AITTAVflT II --_�/'�L4 --- ._.... _ — (lit sxJpcsmittec) \1.1th a principal place of businessiresidence at: yL,tSfl� X • �•�,d 4, • 4/�3 (j)hone ) y3 3-3.2, Ve/3 �G !� citylsu clap) do hereby certify, under the pains and penalties of perjury; :i.h.i( ) I am an employer providing the ioliowinct worker's compensation coverage For my employees worng on this job: ..,. - (Laura= Corm::=•) (Policy Nurnbcr) :piration Dale.) I " ( I am sole proprieto general contzactor or homeowner (circle one) and have hired the contractors I - .- ow wbo have the following worker's compensation policies: • (Name of Co-''cior) (luauant74: Coinoan)/hotel-i 1,!u.m - ) (F. tiuti Date) • (Name of Cootraor) (1n -w-ant~ Company/Policy Ntunccr) (Tikpi.r,:tion Dale) • (Name of Conraarto;) (l-asuranc: Compan)./Potq' Nusbc.r) (Expiration Date) (Name of Contractor) (Insurant~ Company/Policy NtLmbcr) (Espintion D . . (.a.Ch_d.ibotszl t'x,a.ifacoa.ry to etdudc iaform.-ioo pet.iciac to..11 cc --.e.o ) ( I am a sole proprietor and have no one worldng for me. ( ) I am.a home owner performing all the work myself. NOTE:plesc Ix"'"arc tti,,.,•'ta.lo bcozowvm w'bo employ pes.oco to d0 r-•fr.-„•,-• oaaa-,1a.loo c rrnc work oo a d,.cll_z of aat luocc the tbroo t=rs to te-htch the bomoo+wa-Hard=or oo the rrounda zppurtea_rs thc-c'.o z-c cot r.-�,:.IIY oecz:dacd to bc oaoploye-z uae'.e the" It ycc Ace(GL1 S7s 1(5)).r pptinaoo bye bom000-oa fat a 6cr^v or pam'ri m i c dmoc tl_e Icgs1 nz_uc of ea a-lIoyac uoder d o Woc4 x'.Coospace..tioo.Act- . I yadca�ad tbrt a copy of chi.rage=m.y b.fot..ord..d to tbo Doo.rm000t of I,,.t.,eri.!Aoodmi''olsoo er t+a'c`M'"for th. • coves C vcif eslioa nod thu Cittac to so3uc'oovcres-a trader s,oaioa 25 A of Mal_152 ca lad to the t.�v-Rica of=Dias! c3 eoosi.v.2 of.fax of top to S I}00.00.adfor Cacprisoomaat of up to ooc year end a vil past is to tx form of.Slop Work Order fills of S100.00 t d:y.Faust me f Or u.c enly / P rmil Ntuntxr _ I4.--____--- fi )tfaP^ t'Ot itn iaLurc f Li .= e -- • *511M p2. aO e. t (City f Xrrf anptrn , 00•it, tiyn el?4 it lassachusetts _! f� III _ '1 SET -- DEPARTMENT OF BUILDING INSPECTIONS , si 1 /, 14161, 212 Main Street • Municipal Building '%, -' INSPECTOR , Northampton, MA 01060 . e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup,:: •• sor. 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 Gee: ment for the City of Northa ,pton wants any person(s) who seek to use the home owner - emption, to act as their awn construction supervisor, to be aware that by doing so you bees ,e a responsible fo compliance with state building codes and regulations. The inspec-•an process r-•uires that the building department be called to inspect work at various stages, • hich i'dude foundation/footings (before backfill)t sonotube holes (before pour), a rou e e uilding inspection (before work is concealed), insulation inspection (if es ired) and a final building inspection. The building department requires these • spectio before the work is concealed, failure to secure these inspections can re It in failure to .btain a certificate of occupancy until the work can be ins s ec •d. If the homeowner hires oth- trades to perform work (ele 'cal, plumbing& gas) the homeowner will be resp. sible to make sure that the trades a •d secure their proper permits in conjunction to the building permit issued, and that the 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 — — 1 1 �2e -a o .a BOARD OF BUILDING REGULATION- i License: CONSTRUCTION SUPERVISOR Number: CS 053533 Birthdate: 10/22/1962 Expires: 10/22/2007 Tr. no: 13409 Restricted: 00 BRETT A DODGE 42 E HAWLEY RD RD G� HAWLEY, MA 01339 /9/ Commissioner i • • • r