12C-052 BP- 2010 -1050
GIS #: 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- 2010 -1050
Project # JS- 2010- 001547
Est. Cost: $3000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH GEORGE 99372
Lot Size(sq. ft.): 11499.84 Owner: ANNETTE E GRIFFIN & SUSAN D REARDON
Zoning: URA (100)//RI/WSP Applicant. JOSEPH GEORGE
AT. 20 CLOVERDALE ST
Applicant Address: Phone: Insurance:
64 HAYWOOD ST (413) 774 -3604 WC
GREENFIELDMA01301 ISSUED ON 512112 010 0:00.00
TO PERFORM THE FOLLOWING WORK: I N S U LAT E ATTIC SPACE
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 5/21/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -1050
APPLICANT /CONTACT PERSON JOSEPH GEORGE
ADDRESS/PHONE 64 HAYWOOD ST GREENFIELD (413) 774 -3604
PROPERTY LOCATION 20 CLOVERDALE ST
MAP 12C PARCEL 052 001 ZONE URA(100) //RI/WSP
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: INSULATE ATTIC SPACE
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Buildine Plans Included:
Owner/ Statement or License 99372
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INOGIATION 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 IF
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.
of Northampton
Bail irig Department
211 Main Street
IRoom 100
M AY 2 2010 Northampton, MA 01060
phone 413 -587 -1240 Fax 413- 587 -1272
3
APPLICATION TO'CONSTR=-ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Proaertv Address
This section to be completed by office
Unit
Zone Overlay,D�stnc
A- t
=
�Nt1, 5C� Dlattict � , CB.Distrrct
SECTION '2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
- v SOaA b. '��Aon t ca�«
Name (Print) y, Current Mailing Address: k3) 3 4 13 u
� ✓✓ y,[,t� Telephone t
Signature
2.2 Authorized Agent:
Name rint) Current Mailing Address:
(4 IFS 77 31 (D4
Signatu Telephone
SECTIO - ESTIMATED CONSTRUCTION COSTS
Item �,���, �� �� Estimated Cost (Dollars) to be Official Use Only
completed by ermit 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) Check Number `—
This Section For Official Use Onl
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 i
Side L: I R• _ ' L: R: f
F-1 ---
Rear L----j
Building Height F
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg & paved
par
F
# of Parking Spaces ---
Fill:
volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO ® DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DO KNO 0 YES 0
IF YES: enter Book Pag and /or Document #'
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued: ��..
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
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: 3 m
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 NO Q
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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing El
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [r-3] Decks [C7 Siding [I]J Other [p)
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
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 ra - OWNER AUTHORIZATION'- TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT'
t, ' 5V Ve"Am as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authoriYed by this building permit application.
Signature of Owner Date
�bs� —(��1 e'jC°�'��e— as Owner /Authorized
Agent hereby declare tha the statements an nformation on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of pedury.
Print Name
` ��AND' - -
Signature er /A nt Date
SECTION 8 -CONSTRUCT
ION SERVICES
8.1 Licensed Construction Supervisor ( Not Applicable ❑
Name of License Holder : �J�'� _V� � C 51_ O t o l , 3�
License Number
Address Expiration Date
Signature le phone
0
kioverna t#t is cl ..� ,. �.P emu¢' Not Applicable ❑
Company Name Registration Number
Address ( ,� Expiration Date
Telephone ( q ( 774360`f
SECTION 10- WORKERS' COMPENSATION INSURANCE APfIDAVIT (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...... ❑...
.. •����`�4i'lIt1�l�tl�II
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 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
• T
The Commonwealth of 1lfassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass gov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractor s /Electricians/Plumbers
Applicant Information Please Print Le�j'bly
Name ( Business /orgmiiation/Individual): J �Q� lT� 9�
Address: \j.` colb S - T'
City/State/Zip:
m k 1 Phone. #:
Are you an employer? Check the appropriate•box. -Type of pioject (required)•.
1. [A I am a employer with 4, E] I ara a general contractor and I 6. ❑New construction
employees (f 1,1.1 and/or part- time).* have hired the sub - contractors
2- El I am a sole proprietor or partner- listed on the atxached sheet �• Remodeling
• ship cud. have no e—pip ioyees
These sub - contractors have. .8. ❑ Demolition
working for me m an � oy-and have workers'
king y t3'. emplees
•� - - 9 Btiildsng addition .
R�o workers' comp' msivance - 10. Electrical repairs or additions
required:] 5. We are a corporation and its ❑ ep
3.0 I am a homeowner doing all work officers havexercist:d their 11.❑ Plumbing repairs or additions
emption per
myself- [No workers right of ex MGL
comp. 12:0 :Roof repairs - •
insurance required] t c. 152, § 1(.4); and we have no -
1 ees. o workers' 13.[] Other
comp. insurance requited j
'Any app&c=t that checks box #1 must.also fin out the section below showing tleirwork=' cotnpeasat cn policy information
t Homeowners who submit this affidavit.indicatmg they are doing all work and then biro outside contractors must submit a new affidavit indicating such:
?Contractors that check this box must.avached an additional shed showing the name of the sub - contractors and state whether or notthose-eutides bave
employees. ' the sub•contraators have employees, they must provide their workers' coarp..pol;cy number
I am an employer that is provWng workers' compensation insurance for any employees Below is the po&cy and job site
information.
Insurance Company Name
Policy # or Self -ins. Lic: #: Expiration Date:
Job Site Address: 0% � -1� � City /Statm(Zip ' O (e 0 t_U a-
Attach a copy of the workers' compensation policy declarafion page - (showing the policy number and e>riratton date).
- - -
Failure. to secure coverage. as require d Seahon 25A bf MOL c. 15Z can lead to & m3poddbfi of crimz pe,' _ es of a
fine up to $1,500.00 and/or one -year imp risonment; as well as civil penalties in the form of a STOP WORK 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
Tnvestisations of the DIA for'ir'isurance coveraze verificition -_
I do he , _;i rtffy under the ins andpenalties ofperjray thafthe cnformadonprovideilnbavE slrlrr_aadcnrrect —_
Si
Phone
Offu:'url use only. Do not write in this area, to be completed by ctt or town offtciaL
City or Town: N.rmlt/Llcense #
Issuing Authority (circle one):
J. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone #:
a
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
Date
Address of work
location
J. P. George & Son, Inc.
64 Haywood Street
Greenfield, MA 01301
(413) 774 -3604
vt (ti5 L�o
BILLING DATE YOUR ORDER NO.
QUANTITY ITEM AMOUNT TOTAL
0 ��C
—Ti ('�M ce—
Net due upon completion of job.
Northampton, MA Property Detail Page 1 of 2
City of Northampton, MA: Residential Property Record Card
New Search Property Type Classification Code Reference Card 1 of 1
Parcel - Location - Zoning - Assessment
Map -Block -Lot: 12C- 052 -001 Zoning: Assessment:
Location: 20 CLOVERDALE ST Neigborhood: 15 Land: 115,500
#Living Units: 1 Deed Book: 8837 Building: 102,100
Class: R -101 Deed Page: 209 Total: 217,600
Dwelling Information Building Sketch
Style: Cape
Year Built: 1947
Story Height: 1
Attic: Full Finish
Basement: Full Descriptor /Area
Total Rooms: 6 14 A: FAA Fr /B
Wood Deck 720 sgft
1
Bedrooms: 3 6B B:1 Fr
Full Baths: 1 210 sgft
Half Baths: 0
14 C:Wo gDeck
Exterior Walls: Alum/Vinyl Wr O. s g ft
Unfinished Area: 0 15 zto
Ground Floor Area: 720
Total Living Area: 1218 30
Finished Basement Living 0 X 0 D
Area:
Basement Recreation Area: 0 X 288 24 FAIL FrlB 24 7zo
Woodburning Fireplace 0/0
Stacks /Openings:
Metal Fireplace 30
Stacks /Openings: 0/0
Heat/Central A/C: Basic
Heating System: Hot Water
Fuel Type: Oil
Quality Grade: C
Physical Condition: Average Addition Information:
Interior/Exterior: Same
Condition/Desirability/Utility: GD
Vacant/Dwell/Oby Status: Dwelling Lower 1st Story 2nd Story 3rd Story Area
Additional Features: Basement One Story Frame Finished Attic 720
Brick Trim: 0 X 0 10ne Story Frame li0
Stone Trim: 0 X 0 lWood Deck 168
Remodeling Data: lopen Frame Porch 10
Year Remodeled: 0
Kitchen Remodeled (Y/N):
Bath Remodeled (Y/N):
Land Data Outbuilding Info
http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =12C- 052 -001 &pagec... 3/5/2010