32A-202 (9) 1.111111111 BP-2008-0995
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-2008-0995
Project# JS-2008-001491
Est. Cost: $6995.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Jeffrey Cranston 079531
Lot Size(sq. ft.): 15420.24 Owner: LULA ARLINE L&NATALIE E LULA
Zoning: URC Applicant: Jeffrey Cranston
AT: 59 PHILLIPS PL
Applicant Address: Phone: Insurance:
P 0 Box 307 (413) 268-3504
WILLIAMSBURGMA01096 ISSUED ON:5/13/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR PORCH DECKING
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 5/13/2008 0:00:00 $50.001598
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0995
APPLICANT/CONTACT PERSON Jeffrey Cranston
ADDRESS/PHONE P 0 Box 307 WILLIAMSBURG (413)268-3504
PROPERTY LOCATION 59 PHILLIPS PL
MAP 32A PARCEL 202 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out 454
Fee Paid
Typeof Construction:_REPAIR PORCH DECKING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 079531
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 Commission Permit DPW Storm Water Management
Demolition Delay
_
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.
Department use only
t City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
[ 1 2 Main Street Sewer/Septic Availability
�oOm 100 Water/Well Availability
"—~ Northarpton, MA 01060 Two Sets of Structural Plans
phon4,4g 3-587-1240 Fax 413-587-1272 Plot/Site Plans
8
MAY '`' Other Spedfy
APPLICATION TO CON$-' 0CT,A..TER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION-1=5ITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
s
�i se
Zone Overlay District
r � k Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
I
2.1 Owner of Record:
pat 1.4 ,LA- 3 ?k,LLp L_
Na rin Current Mailing Address:
�p Telephone
Signature
2.2 Authorized Agent:
`SC e i s 4?( "VW a 54" hcaJv�t,(.,z- HP„ k--QL035
Name(Prig Current Mailing Address:
4)0
Signatu r Telephone
SECT •N 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit aoolicant
1. Building q9_d - (a)Building Permit Fee
2. Electrical b (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
•
4. Mechanical(HVAC)
5. Fire Protection x-�
6. Total= (1 +2+3+4+5) Check Number /,9 F I 574J '�
This Section For Official Use Only
Date
Building Permit Number Issued:
Signature:
Budding,Commissioner/Ins ector of builoin s Date
_ -
4
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 i
Side L: ' R: L:__,•._._ R: __..____ i J 1 i '
i
Rear _
Building Height -— __...
Bldg.Square Footage . % .___._._,
Open Space Footage ,_,.,, % _.�.. _ I
(Lot area minus bldg&paved __ ___
narking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds? •
NO (3 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 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO G
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: •
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 1'�►.
r
IF YES, then a Northampton Storm Water -anagemenf Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition r f Replacement Windows Alteration(s) I I Roofing 1 ,
0r Doors 0
Accessory Bldg. ❑ Demolition n New Signs [ ] Decks Sidinc `r Other:hl
Brief Descriion of Propo ed
Work: ete, L s 1),,ckt
Alteration of existing bedroom Yes " No Adding new bedroo Yes No
Attached Narrative Renovating unfinished b�sement Yes No
Plans Attached Roll -Sheet
sa. if New house and or addition to existing housina.complete the foiiowina.
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 Wo dstoves Number of each
g. Energy Conservation Compliance. Masscheck Ener y Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is constru n 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,e1.,N Lt,L,/,1 . as Owner of the subject
property � �r�
hereby authorize 34C �►iV-SJ
to act my behalf,ln all ma rs Feiati Ito work authorized by this building permit apaiication.
Signature of Owner Date
I. J CW 1 L 1 , as Owner/Authorized
Agent hereby decla a at the statements and information on the foregoing application are true and accurate, to the best of my knowledge
. and belief.
Signed u h r tlE) .ns d alties of perjury.
Print N- -
-.,�.. C s-&-e2(
Signature of ner/agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: .4Ar'(� , `� � b 141 53
1 License Number
46`f 'bob 104.1.:h \Vlei it t oe
nacres Expiration Date
;ignat re Telephone
Rensterred Home Improvement Contractor: Not Applicableb/0
:Nfte/1-( to )17
:omoanv Nam/
Registration Number
e-3/ /11, fel 5-\-- tf-A-#'3 U'`C— CN 015 43.—ZS-0
.ddres Expiration Date
111
, 4;41 Telephone
ECTION 1:0-WORKERS'COMPENSATION PISURAN.CE AFFIDAVIT(M.G.L c.152s::§.25C(S))
'orkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
the denial of the issuance of the building permit.
gned Affidavit Attached Yes 2 No 0
11. Rome Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or rwo(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 10335.1.
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
_ Y The Commonwealth o� Massachusetts
. .
..._. Department of Industrial Accidents
� '-. Office of Investigations
600 Washington Street
Boston,ltiLA 02111
www.mass.g ov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual). 3 s� .w 1,,,J�i
.k \
1
Address: g/ 1v ,,4 S
City/State/Zip: 0 ILL V 6`6. i Phone#: 9 —3 'c/
Are you an employer?Check the appropriate box: Type of project(required):
1. am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling •
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9 0 Building addition
[No workers'comp.insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Pbrrnbing repairs or additions
! o workers
myself. ' comp. right of exemption per MG
y t C. 152, §1(4),and we have o 1— I—,
Roof repairs
insurance required.] 13.0 Other
employees.[No workers'
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners 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 stare whether or not those entities have
employees. If the sub-contractors have employes,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 sire
information.
/ ...--
Insurance Company Name: j" - H— i b`---"1 rl,.'CC.- CAA _
Policy#or Self-ins.Lic.#: (N y L— xpiration Date:
Job Site Address: • 4tyistateizip:
Attach a copy of the workers' compensation policy declaration page(sho ' the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lea to the imposition of criminal penalties of a
fine up to S 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 S250.00 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 coverace verification.
I do hereby ce - r e pains and penalties of perjury that the informarion;provided above is true and correct
Sisnature: Date: g5/y ab
Phone `: Vrsir ISai
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
i Contact Person: Phone#:_
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 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