24D-051 ,
.
,
1. isoard of tieaitn L. Building Department 3. laity /lown Clerk 4. Electrical inspector . riumomg inspector
6. Other
Contact Person: Phone #:
I N
PEPIN ROOFING & SIDING C0.1 Page No. ` A, of A Pages
MA HIC #107104
..~ meet 5a- c o'l \ A qe_ s P `l- -..e ti .,, P SAL
EASTHAMPTON, MA 01027 U All home improvement contractors and subcontractors
527 -3640 tengaged in home improvement contracting, unless
t Ispecilically exempt from registration by Provisions of
Submitted : t\ ._.1, VW) (\\ \\ , ; � j Chapter 142A of the general laws, must be registered with
To the Commonwealth of Massachusetts. Inquiries about
registration and status should be made to. the Director,
Home Improvement Contract Registration, One Ashburton
Plac Room 1301, Boston, MX 02108 (617) 727 -8598
i, JOB NA E f NO..
■ ,, I l i .
PHONE DATE � �� � � JOB LOCATION
1 1 ARCHITEiCT t i DATE OF PLANS'
> 1 , t✓-t \ --\ k t I--.
We hereby submit specifications, and estimates for work to be performed and materials to be used: +
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ? �� �� L- /So 7 V
License Number
33 G / 1 _ o l c = 2 le-ct J ae t p ,te . O(? 9 - 9 - ab /,y
Addres ` 7 Expiration Date
/
7 �, J 7 feo `!
Signature Telephone
9. Re • istered F#ome,lm • aovemen# Contractor T ; ,; ;Y 7 z Not Applicable ❑
Per. r /o7/ '
Company Name ✓ Registration Number
s rec_r ��1 �.� � 4 6)/05'2 2 f -do /a
Address Expiration Date
Telephone 1 1��L5 1 YI
SECTION 1 0 - WORKERS' COMPENSATION INSURANCE L c AFFIDAVIT (M.G "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 7 No ❑
I ": oiris-Ownenz xempto
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, 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
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SECTION 5- DESCRIPTION OF PROPOSED WORK. (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing
—1 Or Doors D
f
Accessory Bldg. I I Demolition ❑ New Signs [D] Decks [D Siding [O] Other [D]
Brief Description of Proposed
Work: 5kr / 'Deck pa rCI
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa If on to existi.ngahousinq7omplete the.followi:ng:
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 7a = OWNER AUTHORIZATION- TO BE COMPLETED? WHEN
OWNERS AGENT OR CONTRACTORAPPLIES FOR.BUILDING PERMIT
S /Q l etlED coAfr pAu ( , 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
, as Owner /Authorized
Agent hereby decl a 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 perjury.
Pc M :(Izz
Print Name
Signature of Owner /Agent 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
r 1!
,
Lot Size
Frontage
Setbacks Front
s , 1
Side L: ' Ft.: I..: i R:'
Rear
Building Height i ,
Bldg. Square Footage r - — I , , %
1 I
Open Space Footage %
(Lot area minus bldg & paved
J 1
, 1
parking) ,
# of Parking Spaces
Fill:
(volume
(volume & Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:l
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Book I
1 ,
Pagel 1
I and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
0 , Date Issued 1 ;
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: 1 i
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
t I
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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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Fa eat use A> ay zig �� `
City of Northampton Status Pe i . ,
Building Department Cui ! !fly -way'Bermit
212 Main Street SewertS iC Va abtli ,"3"
v
Room 100 Yat l y
Northampton, MA 01060 w• a,1r R' {a
phone 413- 587 -1240 Fax 413 - 587 -1272 Plw a ans'
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR • EM • LISH A ONE OR TW • FA ILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
O Q U kW--- 5 M p Untt �
s7 s 1 Lot t
1\1° /'J '''r 4( j/, /y /y� ' f O Distri
n 9
District" " CB District `;
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record::
/le_ Po cr.s J? JL� d S� a/o /v. - .ti
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
P ep �.. 1 .1 � sa ��� �� s . r <<
Name P ' t) Current Mailing Address:
1 7/i3 s 7 - �� y'a
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS !
Item Estimated Cost (Dollars) to be Official Use Only .,
completed by permit applicant
1. Building 0 (a) Building Permit Fee
2. Electrical '(b) Estimated Total Cost of
Construction from (6)
3. Plumbing Buildin Permit Fee !
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number ,
This Section For Official Use Only
Building Permit Number. Iss
Issuetl:
Signature.
Building Commissioner /Inspector of Buildings Date
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37 STODDARD ST BP- 2012 -0918
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D - 051 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0918
Project # JS- 2012- 001603
Est. Cost: $1950.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PEPIN ROOFING & SIDING CO
Lot Size(sq. ft.): 7013.16 Owner: POWERS DANIELLE S
Zoning: URB(100)/ Applicant: PEPIN ROOFING & SIDING CO
AT: 37 STODDARD ST
Applicant Address: Phone: Insurance:
52 COTTAGE ST (413) 527 -3640
EASTHAMPTONMAO1027 ISSUED ON:4/24/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & SHINGLE ROOF
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 4/24/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner