16B-046 211 NPRTH' , BP- 2010 -0442
GIS 4. COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category_ BUILDING PERMIT
Permit # BP- 2010 -0442
Project # JS- 2010 - 000598
Fst. Cost: $13000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Conn. Class: Contractor: License:
l'sc Group: JOSEPH E SMITH 88805
Lot Size(sq. ft.): 14026.32 Owner: FROST HOWARD E
Zoning: URB(100)/ Applicant: JOSEPH E SMITH
AT. 231 NORTH MAIN ST
Applicant Address: Phone: Insurance:
31 PRICE ST (413) 530 -0399 WC
SPRINGFIELDMA01104 ISSUED ON. 1012312009 0:00:00
TO PERFORM THE FOLLOWING WORK :SHEETROCK & REPLACE KITCHEN CABINETS
& FLOOR
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 10/23/2009 0:00:00 $78.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -0442
APPLICANT /CONTACT PERSON JOSEPH E SMITH
ADDRESS /PHONE 31 PRICE ST SPRINGFIELD (413) 530 -0399
PROPERTY LOCATION 231 NORTH MAIN ST
MAP 16B PARCEL 046 001 ZONE URB(100)/
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: SHEETROCK & REPLACE KITCHEN CABINETS & FLOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 88805
3 sets of Plans / Plot Plan
I'HE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
� Z
Y 009
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.
ity of Northamptonatc�sPtit X
z / Bu' ing Department��tti%evayf tt
a 21 Main Street ser�fcuatabt 5
oom 100 W�rr
, ampton, MA 01060s��o€�c�is
J
port 3- 587 -1240 Fax 413 -587 -1272 PlSrtIas � x
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Provertv Prove Address: This section to be completed by office
M A '" S Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name ( Print) Current MailingAddr �^
tI
Telephone
Signature
2.2 Authorized Agent:
N e 'nt) Curren t Maili g Address:
4- P - 3 - 5 3 0 - C>
Sig Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit appli cant
1. Building G (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost or
Construction from 6
3. Plumbing / G G Building Permit; Fee
4. Mechanical (HVAC)
5. Fire Protection Ar
6. Total = (1 + 2 + 3 + 4 + 5) ,�• off' Check Number
- - - - - - --
This S�ectinn Fr.vr:OfFir ial USP
Building Permit Number: IIsssued:
Signature:
Building CommissionerAnspectorof 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
Frontage
Setbacks Front
Side L: _.,. ~_.__ R L :'--- ..__
Rear _
Building Height
Bldg. Square Footage % --
Open Space Footage % __..._..._.
(Lot area minus bldg & paved ,
p arkin g )
# of Parking Spaces —•- - ~
Fill:
(vol & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW . YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES
IF YES: enter Book Page and /or Document #',
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 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:
. ..
- C):re here any proposed changes to or actions of signs into ed for - tie property ? YES 0 NO
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 NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
b.
a
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows ration(s) ❑ Roofing ❑
Or Doors 171
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [p] Other [14
Brief Description Of roposed / ,—J /
Work: C�oa�/ �'� Lt�'i, C 7;c�a�.f !'l`M� : n�� �'�'� So•� Sh
Alteration of existing bedroom Yes _ __L, : : �o Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes _LLZN
Plans Attached Roll - Sheet
6a. f New f 6u"S'i and or id 16h o ez sfrnrt housiricl complete the,fo11"inA:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: 3 Number of Bathrooms ,
c. Is there a garage attached? d'l
d. Proposed Square footage of new construction. Dimensions
e. Number of st ories?
f. Method of heating? �u�d 94ell �, �Kc 4t' Fireplaces or Woodstoves Number of each
i
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction g Came, A , /
i. Is construction within 100 ft. of wetlands? Yes _2�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? �0 .. 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
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
�� d yl 1� �U '✓-+` r7z / i 1 -7 as Owner /Authorized
Agent reby declifre that the statements and information on t e f egoing application are true and ccurate, to the best of my knowledge
and belief.
Signed urjqer the pains and penalties of perjury.
Print Nam
Signs a of Own Agent Date
SECTION 8 - CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder
License Number
/,) f i c -� ,5 Sj,! ►''; �►, oi�,` p elf ✓yt d /�4� ��s"t � //
Addr s Expiration Date
� U� _JS 30 -0_j
nature Telephone
9.. Rea sterexl ttotrte'lriigFOvemnt Cortrai� tor° Not Applicabie ❑
ComDanv Nam
e Registration Number
Address -
f ^'� 2 �/3— Expiration ate
i u-�_5 fit► t i M 1 � e
eld �ry /(4- �1` elephone .S � d 6 57
„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...... ❑
��.5 nip ner,xltaho
-
The-current-exemption for.`liomewners' ° was ex tended to include, 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.
Alco be adviced that „pith rPfPrrnrP'tn Chapter 157 (Wnrkcm5' Compcns;A69n) 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 fat - you - mderthis permit. - - - - --
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
North ssachusetts-Genera- Laws - Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department oflndustrial Accidents
Office of In vestigations
600 Washington Street
Boston, MA 02111
`�M�•'� www.massgov /din
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print L 'blv
Name ( Business /Organization/Iadividual): 0"', e "'
Address: C' 1
C
City /State /Zip: : ; e ( C1 k" VPhone.,li-:
Are you an employer? Check the appropriate box: Type of project (required):
1.94 am a employer with j % 4.. [] I am a general contractor and I
employees (full and/or part-time).
* have hired the sub- contractors 6. ❑New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no s loyees These sub - contractors have. 8. F7 Demolition
working for me in any capacity. employees and have workers' 9. Q Building addition
[No workers' comp. insurance comp...insurance. _
required.] 5. We are a corporation and its 10.[ lecirical repairs or additions
3.0 I am- a -homeo-wne -- - - - -__ .__ cerslaa veIxercised their 1-I i�lumbing repairs or additions
myself. [No workers' comp_ right bf exemption per MGL 12.0. Roof repairs
insurance required_] t c. 152, § 1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required j.
"Any applicant that checks box #I. must also fin 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 notthose entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing worked' compensation insurance for my employees. Below is the policy and joh site
in ormatwn �' rt � - oL
Insurance Company Name:_
Policy # or Self -ins. Lic. #: a c� .3 i Expiration Date: c' Q
J ob Site Add 3 t^�l H S� City /Stafe /Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as reduired under Section 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. 13e advised that a copy of this statement may be forwarded to the Office 'of
Investigations of the DIA for insurance I coverage verification
I do hereby certify under the pat'ns and f"' s ofper'ury that the information provided above cstrue_ardcorrec4 -_
Si tore:
Date:
r —
Phone #:
Offc&l use only. Do not write nth s area, — to be comp ted by city iW town offu'iaL
City or Town: Permit/License #
Issuing Authority (circle one):
L Other Health 2. Building Department 3. City/Town Clerk 4. Electrical, Inspector 5. Plumbing_Ins
rson: 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 ins. tion n q .res that the building department be call 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 insuections -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
_ -- _ -- its- in- conj- unction_to- the._ buildin".ermitsssued,_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
'rom: Betty Ramey At: LebeIA.avigne & FaxID: 413- 534 -8982 To: City of Northampton Date: 10/2012009 01:27 PM Page: 1 of
. CERTIFICATE OF LIABILITY INSURANCE
OP ID BR DATE
ACQRD {MM /DD/YYYY)
SMITH 10/20/09
PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
L ®Bel /Lavigne & Deady ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
637 Grattan Street / PO BOX 59 I . I -" i' - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1. Chicopee MA 01021 -0059{ I
Phone:413 - 532 - 3291 Fax:413 -534 r INSURERS AFFORDING COVERAGE NAIC#
INSURED ` OCT 2 0 SURER A: Nautilus Insurance c ompan y
u I INSURER B'.
Josaph Smith dba L INSURER C.
Joe' s Remodeling _
31 Price Street `'� "" t INSURER D
Springfield MA 01104
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1NDICArtD. NO1Wi iNSTAND!NG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMIT' SHOWN MAY HAVE BEEN REDUCED B'r PAID CLAIMS.
LTR TYPE Of I!lSURAFJCE -tCTNE I POLICY NUMBER I DATE OV-fi! DD YY} Cfi ;L !! CCNY; I — — LIMITS
GENERAL LIABILITY ( I EACH OCCURRENCE $ 1000000
A I X COMMERCIAL GENERAL LIABILITY j MC896544 I 04/28/09 04/28/10 ( PREMISES (Ea occurence) $ 50000
CLAIMS MADE I X OCCUR I MED FRCP (Any one person) $ 50
H i (
PERSONAL &ADV IN JURY I $ 1000000
f GENEP.Al AGGREG � $ 2000000
I I I GEN'L AGGREGATE LIMIT APPLIES PER I! PRODUCTS - COMP /OPAGG I$ 1000000
POLICY ACT LOC
AUTOMOBILE LIABILI'1'1' COMBINED SI^.IGLE LkM!T
$
ANY AUTO
(Ea acrident) (
l ` I
ALL OKTJED AUP - f BODILY INJURY $ - --
I crHEDULED AUTO -5 I ( f I (Per person) .
I I E- ----- - - - - --
I HIRED AUTOS I i i BODILY INJURY I
(Per weident) `$
NON OWNED A.fTOS I
PROPERTY DAMAGE I $
I {Per accidart} I
I GARAGE LIABILITY I I AUTO ONLY - EA ACCIDENT $
I I ANY AUTO I I OTHER THAN EA.AC $
I AUTO ONLY AGG $
EXCESSIUMBRELLA LIABILITY I EACH OCCURRENCE ( $
OCCUR U CLAIMS MADE i r AGGREGATE $
I $
DEDL;CPBLE $
RETENTION $ I I I $
WORKERS COMPENSATION AND i I ?O°Y LlMI ?S ER
EMPLOYERS' LIABILITY I I F L EACH ACCIDENT $
ANY PROPRIETORIPARTNEPJEXECUT IVE
GFFICER1 EXCI -Uf CD^ { I E.L. DIGEAAGE - EP, EMPLOYE $
It yes, describe under
SPECAAI- PROVISIONS below EL DISEASE- POLICY LIMIT $
OTHER
I
DESCRIPTION OF OPERATIONS I LOCATIONS J UffiCL ! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
CITYNOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
City of Northampton, MA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
Dept Of Bldg Inspections IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Inspector of wires
212 Main Street REPRESENTATIVES.
Northampton MA 01060 AUTHORIZEDREPRESENTATtVE
John Eagan
ACORD 25 (2001/08) a ACORD CORPORATION 1980
2409- 10.242tl5 . 4139866172» 4135971272 P212
JOE'S REMODELING HOWARD FROST
LIC#88805 REG. # 1 53931 231 N MAIN ST
SPRINGFIELD MA 01 104 FLORENCE MA 01062
413 - 530-0399 CELL H- 413 -584 -6280 C- 413- 530 -3810
KITCHEN REMODEL
MYSELF, THE PLUMBER, AND ELECTRICTION WILL PULL ALL NECES.SARRY PERMITS
I WILL REMOVE. ALL THE CABINETS AND APPLIANCES AND GET RID OF THEM
THE FLOORING WILL BE PUT INAND INSTALLED BYA CO. THE CUSTOMER HAS HIRED
THE PLUMBER AND ELECTRICT ION WILL ROUGH OUT THERE. WORK
I WILL SKIM COAT THE WALLS TO COVER SEAMS FROM WALLPAPER
I WILL PAINT THE WALLS, TRIM DIFFERENT COLORS, I WILL GET THE PAINT, HENJIMEN
MORRE PAINT
THE DINNING ROOM, ONL Y THE WAINSCOA TING AND TRIM TO BE PA INTED
I WILL INSTALL NEW CABINETS, COUNTERTOP, TILE, FIXTURES, AND APPLIANCES, SUPPLIED
BY CUSTOMER
THE PLUMBER AND F_LECTICTION WILL COME BACK FOR THE FINSH WORK ALL TRASH WILL
BE TAKEN OUT AND DISCARDED PROPERL Y
TOTAL MATERIAL AND LABOR INCLUDING
PLUMBER AND ELECTRICTION $ - o,, o aa
RETAINER r
$ 500.00
$6,350.00` t
DEPOSIT TO START
53,000.00__
53,350.00
DUE UPON COMPLETION $3,350,00
ANY UNFORESEEN CIRCUMSTANCES, PROBLEMS OR CRANGE.S WILL
BE IN WRITING AND SIGNED APROX START DATE OCTOBER 19 200.9
FINIX9 DATE A PRa, v OCTOBER 30 rlf ,-'