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Massachusetts - Department of Public Safety
Board of Building, Regulations and Standards
Restricted to: 00 Co nstruction Supervisor License
00 - Unrestricted License: CS 39970
1G -1 2 Family Homes Restricted to: 00
NORMAN F GLENN
18 ASHLEY CIR
Failure to possess a current edition of the EASTHAMPTON, MA 01027
Massachusetts State Building Code
is cause for revocation of this license.
Expiration: 6/28/2010
Refer to: WWW.Mass.Gov/DPS - Tr #: 30238
( .nnmisi■mer
•
,. ✓%ie ifomrmwvuuea`% o /./�C,ao
License or registration valid for in use only
�� Office of Consumer Affairs & Ba�nessRegataeonf
before the expiration date. If found return to =MT = � � HOME IMPROVEMENT CONTRACTOR
Office of Consumer Affairs and Business Regulation
10 Park Plaza a - Suite 5170 (( Registration: 109823
"a Expiration: 9/29/2010 Tr# 289650
Boston, MA Su
Type: Individual
I, BUILDING UNLIMITED
NORMAN GLENN
18 ASHLEY CIRCLE
EASTHAMPTON, MA 01027 Undersecretary
Not v • without signature
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:XISTING HOME i
,
This end of deck is I
;edar screen door/ near ground level
V
Deck Area
218x61 ; one riser
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arch Area 2x6 ceiling joist @16 "o c . a ,
CH 2x8 rafters @16 "o.c. DECK _____\,
; 9'2 12'x9'2
I New railing as per code 20'8 I
"10 - 12'6 ,I
40'4
gilding Assoc. Inc.
:N PORCH ADDITION 48 Hillcrest Drive Florence 1 48 Hillcrest Drive, Florence
70'
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9'6 28' 1 266 Sq. Ft. 114 Sq. Ft. EXISTING DECK RENOVATION AND
127'4 1 11'8 1 NEW SCREEN PORCH ADDITION
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1 11 48 Hillcrest Drive Florence MA
EXISTING DECK FOOT PRINT
Miller Residence
1601 ?6 R ivvA T'V 6- 0 ITO
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-
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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
iermits 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
- .
. The Commonwealth opfassachusetts
Department of Industriczl Accidents .
Office of Investigations .
* =t _ --. 600 Washington Street
Boston, MA 02111 . .
www.mass.gov/dia
.....
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ligiblv
Name (Businesi/Organiiation/Individnal): cle .-..1__(....." e:
• Address: / 2.4
City/State/Zip: ,',. Phone.#: -4'23 - _ 2 ? 9'076'
Are you an employer? Check the appropriate box: ' . Type of project (required): /
1. 0 I am a employer with 4. 0 I am a general contactor and I
6. Oyew colistruCticm
employees (full and/or part-time).1' have hired the sub-contractors
2. 0 I ani a Sole propzietor or partner- listed on the•attached sheet 7. If Remodeling
sub-contractors have
. ship ;aid have no. employees These .8. D Demolition
• ... workers' : ir,--, ......-; . _ • -
working for me in any capacity. LI Biuldmg ad:to
_ -.......iiisuimicel: .. _‘.._ . • ._-..- . n
[No vvorkers' comp. insurance' •
require]
5. fi' We are a corporation and its 10.0 Electrical repairs or additions
.
• 3. 0 I am a homeowner doing all work officers haVe4xereised their .
11.0 Plumbing repairs or additions
myself [No worimrs' comp. right Of exemption per MGL
12.0 Roof repairs . •
insurance required.] l' • c. 152, § 1(4); and we have no
employees. [No workers' 13.E] Other
• comp. insurance requirecLI.
• .Any applicant that checks box #.1: roust also fill out the section below showing their Worlcers* competsation policy information'. ,;-
1. Homeownera who submit this affidaVit iruficating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
Icoutractors that check this box must attached an additional sheet showing the nau3e of the sub-contractors and state whether or not those entities have
einployees. If the sub-contractors have amployeee, they must provide their workers comp policy number.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job
information. .
, •
Insurance Company Name:
•
Policy # or Self-ins. Lic. #: Expiration Date: - - • ,
. ,.
lob Site Address: ' City/State/Zip:*
• Attach a copy of the workers' compensation policy declaration page•(showing the policy nurober anctereiralion date).
.• . . _ __. ..... _
Failure to secure coverage as required bider Seetiai25A 152 can lead td the apoittititi of - ci4i1ri4l penalties of a
fine up to S1,500.00 and/or one-year iMprisonment, as well as civil penalties in the form of a STOP WORIC-O.KNE:R. and a fume
of up 6,5250.00 a day against the violator Be advised that a copy of this statement may be forwarded to ttie:Otft'ce of
J. &the DIA fdv
i'fiis Iran ,
. ' _
, riroweiok under the pains. an p ofperjury that the informationprovidedaboVelstille_alifioriPil -
_ . eo)., ,,./ .y,. /0 .
Siznatire Da
i ..,. _....„,,,--- - ft: .
Phone it: - '7 --..<27' 1 --. ' .... - ' - •
. - Official use only. Do not write in this area, to be completed by city Or townOfficial
• City or TOYEn: . Permit/License # ..
Issuing Authority (circle one):
•
:1. Beard of Health 2. Building Department 3. City/Town Clerk 4. ElectricalIzispector 5. Plumbing Inspector
6. Other
Contact Person: .
Phone #: f-
,,.
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable
Name of License Holder : ./ !/u i �' /f/ ��'V / I F 7 n
License Number 0
Address Expiration Date
Signature Telephone
> dlster 'ti:.l om ifiprov men
on rac ort`':1 : it.. +, 3 v . . . Not Applicable ❑
�b �=
/ I4'
Company Name . Registration Number
; f/c7.77/
Address 1� L,� Expiration Date
��i���� Telephone 7 /��4i2 7*a
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 [Y No ❑
hAlial towners re`np tl ,: rt
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding (D) Other [D]
Brief Description of Progpsqd ) 1 U R - - . 7 . - - 4 , C - 1 " ' 92) ' C -� �
Work: 7 E /7 S 6 ii�.V� / ✓ a,e c// .U.,L�' 0`'✓ (i'/ i� � ( F. S SI /''
Alteration of existing bedroom Yes _ 4 No Adding new bedroom Yes .,, No
Attached Narrative Renovating unfinished basement Yes �`' No
Plans Attached Roll - Sheet
.Y '''''0 te a. ® '0' -0'" r.1_ ar n ° ® 01 :- - : e o '..'6 ®: 36/Y / l:ii: / /./
a. Use of building : One Family Two Family Other 400�1��.L�cM
b. Number of rooms in each family unit: Number of Bathrooms ,6r/cs
c. Is there a garage attached? yf...5
/� /
d. Proposed Square footage of new construction. ,... 4 / - Dimensions 9
e. Number of stories? C)/t/
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? Y Yes No .
I. Septic Tank City Sewer Y Private well City water Supply �.5� /
SECTION 72 - OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I /14a)2,7* ,, /%j /�� , as Owner of the subject
property �/ i��
hereby authorize ./1/IX� C 5
to act on rryy behalf, in all matters-relative to work authorized by this building permit application.
Signature of Owner Date
I /d'r'y/ /i,7' , 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 erjury.
Print Name ,/--
Signature of Owner/ • .. Date
w
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 I I I I
Frontage E . I,'��°� I i
Setbacks Front 1 I I I 7)i..J
Side L:R:I L: R: I F
Rear I 4 . -!' 11.11
Building Height e i 1
Bldg. Square Footage 1 1 C-1 % 1 _ r
Open Space Footage II I : % I I 1 3 --�
(Lot area minus bldg & paved l_. M
parking)
# of Parking Spaces _ ET
Fill: .�.. �.�,�...�.._�__.,..._. �._..._. .,�...�.......,�.�._._��n.�.. �.... �� .��.��.w.J......� �_.....�.....�.n�
_(volume & Location)
A. Has a S al Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I V Page! and /or Document f#'
3
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ,Date Issued: ; TT_ 1
C. Do any signs exist on the property? YES 0 NO (
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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, a ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
v,
City of Northampton
Building Department
212 Main Street ' ,..-„,-,,,,,,,,-,, -.7„,_:7 `-, 1
Room 100 '
Northampton, MA 01060
' phone 413 587-1240 Fax 413-587-1272 lo.:
I. ..
...._ _-
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This sectieril° be completed by office
1.1 Property Address:
e C3
,.., '1 - ,''''''..s.j•`:''',1,1; - - %,:l', ,- -,,- , ,y. ..,_
h i_.1:1Z oes -.--- > -- 41 e-cPP -- ,:,,,.:,.t,:;::k-ifiv...,-.i.ti;c:.,7:fz-,;,,4:,:,z,.z:v.,'-'ie"At''---'--,,,''z--:''-'L'',-':,"Y-''-:.'..P.t3!-.'- . ..
: " 1,P : . ; 2 .:: ' ''''' ",-'-i4-3, 'f, t--,'''
''"
aEl DiShiCt
SECTION 2- PROPERTY' OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
0,077,2 re7//..t< ,,,,,,
Name (Print) Current Mailing Address:
i tire - ■ 4.i l Telephone
t.,
Signature
2.2 Authorized Agent:
//‘-;,4a.mitfo/ . .Ze ' 1.", C.16 0 /•1'9 1 ,9/ 1 2 , i'' - '0/i/
Name (Print)
Current Mailing Address:
..
v.....e. •_ ,...„,..7
...................,/
,
Telephone ‘7 / 73 5 -- 7 ./-,' d/O
Signature
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
•
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant . Permit F e e
(a) Building Perm
1. Building 2 : _.‹.?%' ( .0(5 —
' ted Total Co
(b) Estimated Cost of .
2. Electrical , “.3. -% . Construction from ( 61
3. Plumbing ' Building Pennit Fee
4. Mechanical (HVAC)
..••'*'''.
5. Fire Protection
ck
..._-
6. Total (1 + 2 + 3 + 4 + 5) , cx, Che Number 75 5
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Comrnissloner/lnspector of Buildings
•
File # BP- 2010 -0938
APPLICANT /CONTACT PERSON NORMAN GLENN
ADDRESS/PHONE 18 Ashley Circle EASTHAMPTON (413) 527 -4010
PROPERTY LOCATION 48 HILLCREST DR
MAP 17C PARCEL 316 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out � / #15
Fee Paid o
Tvpeof Construction: REPAIR DECK & CONSTRUCT SCREEN PORCH ADDITION ON PART OF DECK
SYS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 039970
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION PRESENTED: r - 9 --- , ,P r-o' )
V Approved Additional permits required (see below) rJ (<
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.
.�..
•
48 HILLCREST Dll: BP- 2010 -0938
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Bkck: 17C - 316 - '` 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 -0938
Project # JS- 2010- 001397
Est. Cost: $25000.00
Fee: $150.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NORMAN GLENN 039970
Lot Size(sq. ft.): 31973.04 Owner: MILLER NAOMI J
Zoning: URA(100)/ Applicant: NORMAN GLENN
AT: 48 HILLCREST DR
Applicant Address: Phone: Insurance:
18 Ashley Circle (413) 527 - 4010
EASTHAMPTONMA01027 ISSUED ON:5/3/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAI R DECK & CONSTRUCT SCREEN
PORCH ADDITION ON PART OF DECK SYS
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 5/3/2010 0:00:00 $150.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
48 HILLCREST DR BP- 2010 -0938
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 316 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 -0938
Project # JS- 2010 - 001397
Est. Cost $25000.00
Fee: $150.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NORMAN GLENN 039970
Lot- Size(su._ ft.): 31973.04 Owner: MILLER NAOMI 7
Zoning: U RA(lo0)/ Applicant: NORMAN GLENN -
_ .-- _. AT 43 HILLCREST DR
Applicant Address: Phone: Insurance:
18 Ashley Circle (413) 527 -4010
EASTHAMPTONMA01027 ISSUED ON :5/3/2010 0 :00:00
TO PERFORM THE FOLLOWING WORK :REPAIR DECK & CONSTRUCT SCREEN
PORCH ADDITION ON PART OF DECK SYS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: ... _ e Service: Meter:
Footings.
Rough. ` " ' Rough : / f House # Foundation:
ate Driveway Final:
Final: Final: p OA— � �,�
Lf i r4 cAtd �d O W R ough Frame: C (. l.-
Gas: Fire Department Fireplace /Chimney:
atiae) <-00-5 fi/ FRA-vniC .41 i I 0
Rough: Oil: Insulation:
Final: Smoke: Final:
5 --, Li t i - Ri etkl, OA- 0 Lij Ai
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
'� 444•44v4.4
FeeType: Date Paid: Amount:
Building 5/3/2010 0:00:00 $150.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo