31A-074 (4) 4 WASHINGTON AVE BP-2007-1235
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-074 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-2007-1235
Project# JS-2007-001965
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JESSE MONTGOMERY 077410
Lot Size(sq. ft.): 10628.64 Owner: FOUR WASHINGTON LLC
Zoning: URB HD Applicant: Jesse Montgomery
AT: 4 WASHINGTON AVE
Applicant Address: Phone: Insurance:
P 0 BOX 329 (413) 585-8482 ()
LEEDSMA01053 ISSUED ON:6/22/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE DECKING & RAILS
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 6/22/2007 0:00:00 $50.001473
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
•
File#BP-2007-1235
APPLICANT/CONTACT PERSON Jesse Montgomery
ADDRESS/PHONE P 0 BOX 329 LEEDS (413)585-8482()
PROPERTY LOCATION 4 WASHINGTON AVE
MAP 31A PARCEL 074 001 ZONE URB HD
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out . z/ ,73
•
Fee Paid �J
Typeof Construction: REPLACE DECKING&RAILS
New Construction
Non Structural interior renovations
Addition to Existing.
Accessory Structure .
Building Plans Included:
Owner/Statement or License 077410
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INpMATION 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
Peri 't from Elm t Commission
2c:2:2
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.
File#BP-2007-1235
APPLICANT/CONTACT PERSON Jesse Montgomery
ADDRESS/PHONE P 0 BOX 329 LEEDS (413)585-8482()
PROPERTY LOCATION 4 WASHINGTON AVE
MAP 31A PARCEL 074 001 ZONE URB HD
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: REPLACE DECK G&RAILS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077410
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PI SENTED:
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
Per it from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Co ' ion
,/2//W°°2
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
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
L� � �1 �/�'. Map Lot Unit
fl/Ov t r `C .Y'')n , /•✓ 4+ Zone Overlay District
;J_ Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
CL.) .CCV--\&)0•1 7-0`z:0c
N me(Prin Curren aili, Address'
j,U4 jj Telephone
Signal•
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building YI' •3 coo. Do (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) 7.5 �����""
VLw. co
Check Number 1 7 41 5D
This Section For Official Use Only
Building Permit NumberDate
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 1 I ' •
,...._
Frontage
Setbacks Front • 7-7
, •
--.1
Side L:•,----zi R:-' 1. L:- :.: -R: 1 ; I .__ __
1 r----
Rear
Building Height .______
1 . r----:
:________I
Bldg.Square Footage , , , % r------ ! „
Open Space Footage % , 7------;
(Lot area minus bldg&paved • ' . i_;
:
. .
parking)
•
#of Parking Spaces
Fill: ----,,--
, I
, 1
(volume&Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
----NO— -----DONT—IENOW 0 YES 0
IF YES, date issued:1l
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page i i a d/or Document C
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 I
, Date Issued:
C. Do any signs exist on the property? YES 0 NO er---
: .
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
IF YES, describe size, type and location: I
E. Will the construction activity disturb(clearing,grading,ex "on,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition U Replacement Windows Alteration(s) Roofing [
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [El Siding [0] Otherf
Brief De iptiop of Proposed(� -I 1 �Q �
Work: C�\�lC� 1<`vT��`l �L�C lS GZI ��r I�✓x� J
Alteration of ezistirig bedroom Yes ✓ No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes v No
Plans Attached Roll -Sheet
6a. If New house and'or addition to existing housing,complete the following
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
Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction�nnthin—tOO yr. floc tptairr 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
II, i ��4"---re..41 , as Owner of the subject
pr
hereby authorize �.SS e l ' J Om C
to act on my. ehalf, in all matters relative to work authoriz by this building perm. applic0 ion.
So
Se of Owner Dat
I, ,as Owner/Authorized
Ag h reby declare that th at is and info ation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
°vise 3-6,--f/La_iQ-
Print Name
c/C'
Signa a Owner/Agent ate
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable 0
Name of License Holder: `t 6J[e /l� wfy v Ap/-7 LI ( 0
License Number
�( o C Sk• elo''c'1C e /114 !p i S o-7
Address ExpiraLon Date
re Telephone
flketisferedHomeImproveonlalteor M��' � ; 'A-: '76. wNot Applicable 0
e7c-s5e rl on6c5-wIcr j ,3 Li 3 -Li
Company Name Registration Numb
1 -10 00,K St- /a-�. d -7
Addre ,�A^ ��-y U .yry" ,ry Expiratio Date
1 10/CnGC �-1- 6 wp Q Telephone-! 3��5- ^^C
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 ❑ No 0
11._ Home 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 Officialithat 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
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
} Office of Investigations •
A 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
•
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet 7. ❑ Remodeling
2.I 'I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp. insurance comp.insurance.
t
required.] 5. ❑ 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.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no t✓
employees. [No workers' 13.0 Other
comp.insurance required.]
*Ally applicant thal checks box if must also tin 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 state whether or not those entities have
employees. lithe 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: _
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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
Investications of the DIA for insurance coverage verification.
I do hereby certify and air aides of perjury that the information provided above is true and correct.
Si afore: Date: b/is-/ô-7
Phon : i f v u SU U o2
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
( Northamptonitp QfNorthamptonL =_
•
$���� w •�6 jGla�ssacJtusctts n 'i' .s \J
.4ES.172,4; "CV
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building 'o
Northampton, MA 01060
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::: 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 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
•
•
Ar
sV t. -,,`-• -r:
.d.
'A.• rfr ['TT? /•••••J••• ,i
''......;-, bill _
..,
...._
___
,.._ .,_,,,_ is , s., '
?�My /.
' 'S _ _
.. yam .-I 111 Ill11LIUL °t2 ;=>.
or, y `ot, _ ,• • ,,,..„A.. •4.1. • 1 i i
A.
V' 1•
s
Anthony Patillo
From: Peg Keller
Sent: Thursday, June 21, 2007 11:13 AM
To: Tony Patillo(E-mail)
Subject: 4 Washington Ave.
Hi/ I just spoke with Louise.. she said wood will be replacing wood, no designs are altered, no impact to the
roof or columns...If the application states wood will be used, and only some floor boards and a couple feet of
railing will be replaced, it can be exempted. Peg
Housing and Community Development Planner
Office of Planning and Development
City of Northampton
210 Main Street Northampton MA 01060
telephone: 413-587-1288
fax: 413-587-1264
pkeller@northamptonma.gov