32A-122 (14) •
67 ICING ST BP-2004-0828
GIS#: COMMONWEALTH OF MASSACHUSETTS
32A- 122 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0828
Project# JS-2004-1230
Est. Cost: $12000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Young Roofing Co Inc 011878
Lot Size(sq. ft.): 28880.28 Owner: NORTHAMPTON CO-OPERATIVE BANK
Zoning: CB Applicant: Young Roofing Co Inc
AT: 67 KING ST
Applicant Address: Phone: Insurance:
P 0 Box 56 (413) 584-1367 Workers Compensation
FLORENCEMA01062 ISSUED ON:2/27/04 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW MEMBRANE ROOF & INSULATION
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: Receipt No: Date Paid: Check No: Amount:
Building 2/27/04 0:00:00 16270 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
w � � x
City of Northampton S'at ®. P ,i_" a
Building Department Grit e t: � § g= _ - L k°,
212 Main Street S `� °��..;ist If tr
Room 100 _ --zot.i,,,,,, r
Northampton, MA 01060 alp a +
phone 413.587-1240 Fax 413-587.1272 ot4Sit Pan ^ ' .-- '= ,, W ' y -
cVi ter, z „
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE`INFt RMATIQN
1.1 Property Address:
W 1 1 v l` I A V "- - - �::,y4 7,,,t n.: '.
'� ` � � y }c set 'xy.�i .^ 'S .
�� a � � �r
:''',A.�- � �� � �4 .£ate• - � .N �,,�f.. & i.:.
: EI.,1.F t'!,is,rict ' >''
SECTION r.2 PRO'.PERT(•*OWNE:RS�IIP/�AUTHO IZED.R ENT:
2.1 Owner of Record:
M01 (111 A Cea-hve .3� i I�. t�°1 ��x S for-�,a�n n, o o
Name(Print) Current Mailing Ad e s_ . ,„
3 � y- .
Telephone
Signature
2.2 Authorized Agent:
Young Roof i,ng Co., Inc. P.O. Box 60056 Florence, MA. 01062
Name 17 j L Current Mailing Address:
e-G�i t
R chard Yo r
e President 413-584-1367
Signature Telephone __
tb-fit a t-i I'NIAltb Cons 'RoC DN`CC 5T`
Item Estimated Cost (Dollars) to be Official Use4Orfly
completed by permit applicant _ .. -1 .: ..
1. Building (a') Building Permit Fee
�1\a�i
►-r 0 DUO.(,Y�
2. Electrical (b) .stimated Total Cbst of
Constructionh,from (6'.) ....... ..
3. Plumbing Building Permit fee
4. Mechanical (HVAC)
5. Fire Protection /,e-/.
6. Total = (1 + 2 + 3 + 4 + 5) 0100 ),W Check Number (Mo.-O.
T:his.:Section;For.Official Use.Only . : .. .
Building.Permit Number Date'Issued:
lignature::
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear '
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW , YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW '// YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 7-
YES
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 ✓ NO
IF YES, describe size, type and location:
D. Are ere any proposed changes to or additions of signs intended for the property?YES
No •
IF YES, describe size, type and location:
•
SEGTION S 'DESCRIPTION OF PROPOSED W( RIB cl,ec pPl catilej •
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing X
Or Doors 0
• Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 1ns-Lti ) () wlbvitv)e. I DGk 4 2'Sut il)10 ,
Alteration of existing bedroom Yes -"No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet 0
§� ArlItiti alid - "@,fi trn .D ; isgin: . a :l=n a `e of wtng:
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. Mascheck 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 Nc
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
•
T ON , OBE COMPLY ELX WHEN
r I T d t?� ES FOR` WM: PI=f M s
' .. x:.cn.u' - • n '. ._..-_.i?? -xx1:....:T::....t:kL:x.. x. _r+x.:+e.., .J....x4 r:9i*xx -
, as Owner of the subject property
hereby authorize to act or
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 Owner/Agent • Date
•
SECT3flN ct NST'IRIICTI;ON SERVICES
•
8.1 Licensed Construction Supervisor: Not Applicable ❑ •
Name of License Holder : Richard Young 011878
License Number
P.O. BOX 60056 Florence, MA . 01062 onlik-110
Address Expiration Date
t it 413-584-1367
Signature Telephone
e•ga c xo a n# .,on ra:Cto �. ` Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
EC lift fl YIIO R ERS° COMREN.SOlip. INSQRANCE AFFIDAVIT(M G L c 152, § 25C06)) •
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
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
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DEPARTMENT OP BUILDING INSPECTIONS
.
212 Main Street •' Municipal building
Northampton, Mass. 01060
•
WORKERS COMTENSATION INSURANCE : + AVIT
•
I, .— _-- - __------..--- — --_.--__._...__...- -------._------ .
(licens_clpertnittcc) ,tt
with a principal place of business/residence at:
- ------ — -- — —• (�ptlonc'=.__ _..—_._.�
(stneet/eity latey7ip)
do hereby certify, under the pains and pcnaltic s of perjury, that: -
( ) I am an employer providing the followinz worker's compensation coverage for my
employees working on this job:
America International Companies ' LCC,00744g3I lJ • • ill (Q,5-
- (Insurance Company) (Policy Nu::nbar) (Expirz t on Date)`
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the fob -.ing worker's compensation Policies:
•
•
(Name of Contra ctor) (Insurance Company/Policy Number) (1 xt?:rn tion Date)
,r
•
•
(Name of Contractor) (insurance Company Po!iey Number) (Expiration Date)
(Name of Contractor) — (Insurance ComFpanvrPo icy Number) (i_xt. r:tioa Date)
•
(Name of Contractor) . (Insurance Comc oyIPolicy Number) (Expiration Date)
(mach additional sheet ifntee:1. to:.c..ie i:::cr:^.:ion F-ratan ins'.:ell o:c:-an.‘,:-.1
( ) I am a :sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware the while Ixencown ra,rir3 e:^,plcy Pe.::,-t- to t.),^air'ems.nee,co:Ten:aim or repair v ti,e^a d.,elli-:g of
not mete than throe units in t,i:idt the Jenne r.,zr-re it=oc oa the n.-ii app.uter-trtt thcete a.c n:.Y cavrally Met:,;..t a:a be
caiployea under the workers card_aiicn Act(GLI5'_-31(5)).np;l:rtion by a homeowner for a lieetsc CS peeni:rate.'+.e.i:':nce the
legal steam of an ccoployer under the Worker.Coenperration Act. -
I undo.-eand that a copy of this!stater er1 may be fo.wnrde-d to ti Daliwtaxni otiz.4,,:trial AcciEat?'Office of 1:�.,ranx for the.
coverage vo eil ioo sad that failure to secure covorngo w-4 r somocann 25A of MOL 152 c lead to the imposition of r.oia l peralt:es
. oomisting of a Cur-of up to S I.500.00 andior Mmr, isrencm oCup to cn-}tar and civil /tics in the fixer of a Stop Wert.Ord.and a
frooCS100.00z day zc:in-tiris . •
F ,,Vnatal u.o only
gia6104
porerdmiio
/ Signature oil.i ;ccfPcrm . -.---1/4__ _.........._ .ittc• • • Ty:t:::: f.
:tiw.lam{;1'..• _..... ._.
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Qap of NorfironptoYt _ ==: (l I-$ v ; 1assacinsts
`z" _' DEPARTMENT OF BUILDING INSPECTIONS ', _ i /^
INSPECTOR 212 Main Street • Municipal Building ':>
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 sups:-,'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
SNI liy: NO1-1‘HAW'I ON CUD'; 41351342209; JAN-7-04 11 :27; PAGE 2!2
. .
' Contr. I.J.e.No. i01723
__
Si
I
Tel. 13-61$34-1367
IrODITG iiii00711110 CO. MCC. 13-0 6-9107
PD.Bok 600138FIMINCE MA 01002-0060 Fax 13-6,85-0226
I
1
Dat .: 1./5)04
Customer : : Northam. pton Cooperative Bank
I: I
Address: , 67 King St. Northampton, MA. 01060i
TobtocTia onr — — '—' — -- -- — — — — — — — —I — —
1 Section of roof above Friendly's Restaurant
SPECIFICAtONS:
. !
1. Power brooin all loose gravel off the complete roof.
2. Apply 2.7 irich polyisocyanurate insulation over the complete roof. (R Valu .- 20.0
3. Install Carlisle's reinforced mechanically attached roofing system.
4. Flash all walls,edges, and roof penetrations with an approved Carlisle detail'
5. Remove all1Terra Cotta Cap and install a pressure treated wood nailer. 1
6. Install .032;ga.uge bronze brown aluminum edge metal locked to a kicker str
7. Install a nelv Smith 10-10 roof drain and connect to the existing plumbing b : licensd.
plumber. 1
8. Remove al!our roofing 4ebris from the job site and dispose of in a legal Ian fill.
9. Upon completion of the work Carlisle will inspect the job an issue the owne: a Ten1(10)year
warranty. i 1
1
1
1
m n.timil inTL,..0 .......4.7 -,74—..7,.._; i..iic,....fi
ElpearCb44 an irwurnry OMNI! up 11.r 6
11V",air.= -b„.1„przlitz...0.,,eAll r";117,11 otnwiltertmerarynlotti
ii;leriurnzedic:leruire pod Velvlawymfe gicatt" liateoha:az%
/7
.A.uthorized i l'./J:EA‘T I •
Signature Richard iir ng , esident__
mt due int:Me uneerfirel mg b pay all comb,mmulled
ACOOPtanoe of Proposal- The above prices,specifications I
ecanial0A0\.. ....,
and conditions areisatisfactory and ale hereby stecepted. You ore authorized to Wit11088
do the work CM Mpgcified.Payment will he made as outlined above. Signatur . . 0
: .
Acoep , ._ • (.1. ...../ Date of Acceptance_0_104
) 1
i
i •