23C-009 I
i
l i
1
1
I
1
I
�
�l
I
1
I
4.
I '
II
I
1'
Ii
I ;
I
I
il
l 4ti1 ■
LS / f
<�� l c `� Ott t4 �� :, r' l i
i'lC(`‘ ► (�/� c s c�?r.c ^- ^r+►V.Aw�c�c ; i
(-411 -- im . P. '-*=9/ u" c-aq-,\yev rex z 11
1
II
,, .
/ / "4(
)/
J w
/ ''''',,,,,,,.
O
/ \ / ' \ ,Y 3. 5 L
EXISTING GARAGE \
/ -,c j;
N N, EXISTING DRIVEWAY
c'? / . 4
4.411
....____________4. 114 NEW ADDITION
EXI
PRA
NEW DECK - �'
EXISTING GARAGE
N "
s4N)til°11 HAF
� PROPERTY LINE
Y''',(
L _ ,c;
et
N
I (I) 0 SI PLAN
�tl _ 201_0.
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 pi cess 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] ermitissued,_ 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.
n� +o
Address of work
location
•
r
The Commonwealth of Massachusetts
...—. Department of Industrial Accidents
=I ' Office of Investigations •
t =mn 600 Washington Street
Boston, MA 02111
-0 . www.mass.gov /dia •
-Workers' Compensation Insurance davit: Builders / Contractors /Electricians/Plumb.ers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): Clifr2c /4/(7
Address: / ti' c / .
City /State/Zip: r�t� tee 0 /O62 Phone #: 5----:1- _. fr15'
Are you an employer? Check the appropriate box: Type of project (required): /
1. ❑ I am a employer with 4. 0 I am a general contractor and I 6. ew construction
..i.loyees (full and/or part- time).* have hired the sub- contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ RemodelinZ
ship and have nn e- alo Tees These sub - contractors have g. 0 Demolition
working or me in any capacity. employees and have workers'
g Y P ty. 9. iulding addition
[No workers' con. insurance comp. _insuranre_$
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am-a-io-meo-wner- ioing- aj1-werl ce __ used their _. 114- Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.}
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. .
I 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. If the 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 51 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
Investisations of the DIA for insurance coverage verification
I do hereby ce . under the pains ; an ' d pen •s ofperjuzy that the information provided.above_it true_aiuLcorrect.____ _ _
Si . .. tore: ,�r�! i �0 _ -
Phone #: / " /f/ 3 _` 5 — q 6 1 — 91 .
Official use oifly. DO 71ot write Ili this area, 10 be Completed by city or town offciaL
City or Town: Permit/License #
Issuing Authority (circle one):
I. -Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector __ __ _
6. Other
Contact Person: Phone #:
X
• a
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ci i h vvi l - /t
7 License Number((
ciit ' orp^e/te, „ 11/ "") 72zit
Address Expirati Date
-•s ScG
S Telephone
B.. Registered l ainu lnn ri+vernerst Contractor , , '' .. _...... Not Applicable ❑
Oavts 4 c 1 /6/76(
Company Name Registration Number
f 5 / ct/7 /ay. 7) / (// /fit o
Address � Expira on Date
r ki7 t/ICe ,//4c CVO 6 Telephone S - a 6
_ 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 ,.. 61 No ❑
Iti .2 .oti a *Or.:-x'cm i
The_current_exemption for "homeowners" was extended to include Owner 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
p ort ampton • ri mances, a e . m •
•• - .1 • - ° •: —• - , - s- General•.Laws - Annotated.
Homeowner Signature
F •
R
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition IV Replacement Windows Alteration(s) Er Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [El Siding [D] Other [0]
Brief Description f Propose /
Work: .4, L ee°G 1 00wty'64 94- -1:704-4 O4-4 ,'C D '4 L -
Alteration of existing bedroom //Yes No Adding new bedroom Yes t''' No
Attached Narrative Renovating unfinished basement Yes t---
Plans Attache. gip - Sheet
sa_ if tiii# hofiseanti.c r ad' #ion k - )dstiticf housing; co pi&e'the. it q:
a. Use of building : One Family Two Family Other `
b. Number of rooms in each family unit: ti LA.. Number of Bathrooms l
c. Is there a garage attached? /Z(3
/ r �/ /
d. Proposed Square footage of new construction. 6 6 Dimensions ' :2. I( z
e. Number of stories? 0,1-C
f. Method of heating? r; /41 /9' /— Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. f Masscheck Energy Compliance form attached?
h. Type of construction _ L,/ ''. , ta_ ' /
i. Is construction within 100 ft. of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes t"
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 to
SECTION 7a! - OWNER AUTHORIZATION - TO BE COMPLETED WHEN ,
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ;'L , i •• ; • , ", , AO. _- as Owner of the subject
property
hereby authorize 7,..--`r / /%/ /
Y Ued
to act o behalf, / in all matters relative to wo a this application.
� b Y building permit PP
S nature of Owner Dat
rt $ , as Owner /Authorized
Agent hereby e that the statements and in ation on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed and r the ains and penalties of perjury.
e r . e0y7 7'
Print Name
s '
Signature of Owner ' gent .r. Date
! a
$
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 ...,_rlbT!
��m .
Frontage ..,_ _. ., „_.,. - .,._-...._. �........
Setbacks Front 70•ct :L,7. 33
Side L: R :: .t.2; 1.,:1`'X R: 2 -7
Rear x.. µ `
Building Height i
Bldg. Square Footage V1 = i _ % e _.-
Open Space Footage
(Lot area minus bldg & paved
parking) 15 f 3 /)O ` r 3 /47,9C' V-
# of Parking Spaces °-Z
Fill: � .� I �_w
.
(volume & Location) _ _ ...�._ . _I i _., _ ,
1
A. Has a Special Permit /Variance /Finding ver 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 0 DONT KNOW 0 YES
IF YES: enter Book € 1 Page and /or Document if
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
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 a
IF YES, describe size, type and location:
— u. — Af there any 'proposed changes to or a ltlons o signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exo- fation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO sil
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
f
• n
City of Northampton _ _ erirtil�
Building Department �w evi+ay ri�' t , . ri
s s1 i; 2�
MAY 2 4 2010 212 Main Street �_
Room 100 =I u `laji � ;
. Northampton, MA 01060 .. = . ? f_
phone 413 -587 -1240 Fax 413 - 587 -1272 PI i'
--- - - k 4 ' ;� v s ,r„'4 �} � �; ,, •
Otter . y
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONTVROCFA1>ai> DWELLING
i
SECTION 1 SITE INFORMATION 1 l--- - 5 �1
L:"
Thii section to be completed .by- effice "'-
'
1.1 Property Address: _ __ -
- /9-- / y�c. / ,1./ Map Lot Unit
�J / Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (P •nt) C ent ailin dress
/ma y/3 ,5
��-- (�- (,jliP % T elephone
gnature o
2.2 Aut orized A ent:
r / <e47 l __
,' z - ,- rc( li°
Nam Current Mailing Address: +a12.
Signature Or L Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building , llC� (a) Building' Permit Fee
Ll f G
2. Electrical (b) Estimated Total Cost of
ldeo. Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection ,g
6. Total = (1 + 2 + 3 + 4 + 5) ,% '7. i- a co- Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissionedinspector of Buildings Date
--- iZ i
t'
• File # BP- 2010 -1058
APPLICANT /CONTACT PERSON C & T CONSTRUCTION
ADDRESS/PHONE 15 Fairway Drive FLORENCE (413) 586 -4965
PROPERTY LOCATION 54 LANDY AVE
MAP 23C PARCEL 009 001 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 Q
Fee Paid U 1 p �
Typeof Construction: CONTRUCT 28 X 22 ADDITION(BEDROOMBATH & REC ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 062884 Aolted p&t<2
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
6;?, 512
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.
f
4 34 LANDY AVE BP- 2010 -1058
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:"23C - 009, 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 -1058
Project # JS- 2010- 001559
Est. Cost: $127000.00
Fee: $368.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: C & T CONSTRUCTION 062884
Lot Size(sq. ft.): 20995.92 Owner: GOODWIN -BOYD KATHLEEN A & G P
Zoning: URB(100)/ Applicant: C & T CONSTRUCTION
AT: 54 LANDY AVE
Applicant Address: Phone: Insurance:
15 Fairway Drive (413) 586 -4965
FLORENCEMA01062 ISSUED ON: 6/21/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:CONTRUCT 28 X 22
ADDITION(BEDROOM /BATH & REC ROOM
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 5/27/2010 0:00:00 $368.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo