29-463 (3) 39 CRESTVIEW Di BP- 2010 -1089
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map4Block: 29 -463 ° 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 -1089
Project # JS- 2010- 001604
Est. Cost: $7000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HEARTWOOD CONSTRUCTION 043443
Lot Size(sq. ft.): 10018.80 Owner: STEIN LESLIE B
Zoning: URA(100) //WSP Applicant: HEARTWOOD CONSTRUCTION
A T: 39 CRESTVIEW DR
Applicant Address: Phone: - Insurance:
P 0 Box 993 (413) 268 -7484 0
WILLIAMSBURGMA01096 ISSUED ON:6/16/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE 2ND FLR BATH
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: j /_10 i al: 1 / - /0 �`��
p P f leas . „ Rough Frame: OK ?-3-0 C WA4
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation: l
Final: Smoke: Final: (} k P �1� %4 :A
SC / /ac,\
THIS PERMIT MAY BE REVOKED BY THE CITY i F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND RE dr . S /� e":".
Certificate of Occupant ,' Signature:
FeeType: Date Paid: Amount:
Building 6/16/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
e
HEARTWOOD CONSTRUCTION
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Hestrictea to: 00 4,,.
ARTHUR G SILVER
PO BOX 993
WILLIAMSBURG, MA 01096
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file 6 ..1 -/P4lz"."r £G
.:1:\_. \ Board of Building Regulations and Standards License or registration valid for individul use only
�_ , -•,_ o HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Buildin Re ulations and Standards
.g — Registration: 100056 g g
Expiration: 6/8/2010 Tr# 267696 One Ashburton Place Rm 1301
Boston, Ma. 02108
Type: DBA
HEARTWOOD CONSTRUCTION
Arthur Silver 6 f ,
109 NASH HILL RD' Q�, _ „,,. �1 1 ,
WILLIAMSBURG, MA 01039 Administrator Not italid without signature
1,Ag.oim,, i s 11.11 MAIL_-_ lk
413•268•7484
P.O. BOX 993 • WILLIAMSBURG MA • 01096
MASSACHUSETTS LICENSE CS 043443
Famnwnrrea/ a/Madarizae&J
HOME IMPROVEMENT CONTRACTOR
Registration 100058
HEARTWOOD CONSTRUCTION
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413.268.7484
P.O. BOX 993 • WILLIAMSBURG MA • 01096
MASSACHUSETTS LICENSE CS 043443
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HOME IMPROVEMENT CONTRACTOR
Relistratiou 100050
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 • — won s I • • t t, t i t it � • t , 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 occunancv
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
•ermits 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 ofMassachusetts
i• �, ___ Depa of Industrial Accidents •
=►� t Office of Investigations •
�1= 3
600 Washington Street
Boston, MA 02111
www.mass.gov/dia .
•
- Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business / Organization /Individual) A[C AAIZ. . J 1 L \ E ' A T \/ CSY VVtllC
• Address: P. Q . $Ok 1'13
City /State/Zip:\l ilL4410nS43U.R.0 - r tit -01014 Phone. #: 413 . g ' 7'f8
Are you an employer? Check the appropriate box: •
Type of project (required): /
1. Q I am a employer with 4. Q I am a general contractor and I
employees (full and/or part-time).* have hired the sub- contractors 6. Q New construction
2.. 0 I am a sole proprietor or partner listed on the attached sheet 7. (Remodeling
ship and have no en>Ioyees These sub - contractors have. . 8. 0 Demolition
working for me in any capacity. ersm1oyee.s and_Iiave workers'
9. addition
[N$ workers' comp. insurance c� rrtsnranr #_.. _ —_
required.] 5. 0 We are a corporation and its 10 ❑Electrical repairs or additions
•
3. 0 I am a homeowner doing all work officers have Zxercised their Q mepairs or additions g 11. Plumb' r
myself [No workers' comp. right Of exemption per MGL 12.0 /coo' repairs
insurance required.] t ' c. 152, § 1(4), and we have no
ees. o workers' 13.Q • `.�
comp. insurance requited. }
* Any applicant that checks box #1 must also fill 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 anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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 ,ny employees Belo w Es 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 Mid Sectzon 25A ofMGL c. 152 can lead to the imposition of cnnainal penalties of a
fine up to 51,500.00 and/or one -year imprisonment, as well as civil penalties in the form ofa STOP WORK - ORDER and a fuze
of up to 5250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the Office of
Investisations of the DIA for insurance covera'ire verification
_ I do hereby certify under the pains and penalizes of perjury that the information provided .abave_cttrue_and_corrert
Signature: . Date; 7,0
Phone #:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector
6. Other
Contact Person: Phone #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. e ' Not Applicable ❑
Name of License Holder : ( • 5I Li `r CS 3 LN-1 3
License Number
I 4 tb d . u. SAKeC -r t . -114 • Zo I (
Address Expiration Date
Signature phone
8. ai to Boxtiid -Unit rou lGtrepl' ari idtor� � i 7 _, s ,M, g i Not Applicable ❑
AKTFRA4 00056
Company Name Registration Number
_fi v ocsb C4 G • •�/
Address 1 ' 1 Expiration Date
- � Wr� j ∎ Telephone 11 . -d• •` 'R t_i 5
O•'•
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 NO ❑
w E o Witt X -lei r On
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 1083.5.1.
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
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) IYS Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [D Siding [D] Other [D]
Brief Description of Proposed ( ' r- —�-� , ,^
Work:SEUGOND VLOQft 1 '� L�C� 1W�$J f • 3I∎ll'c' Iii (9.1'fw3ER
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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, pl �S�/ _ �/ � � � � , as Owner of the subject
property
hereby authorize e
to act on my • If in all ma ativ uthorized by this building permit application.
Sig • = of o ner Date
I 7 Go 1—"NI R__— , 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 perjury.
-U, 2
Print Name
., -,
�JIM) 1 6..- 1 ■■ l O
Signature of Owner /A 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 i 1
Frontage I J 1 1
Setbacks Front I
Side L: R:' I L: _____..__a R:` 1
i l
Rear 1 1
Building Height !
Bldg. Square Footage = I I% [ j 1 L
Open Space Footage
(Lot area minus bldg & paved i i J ! i w-
parking)
# of Parking Spaces = ,
Fill: . . . * - . ,* „,, i _ , ,
( volume & Location) ' i
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 4, YES 0
IF YES, date issued:I
IF YES: Was the permit recorded at the Re stry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book ! Page£ i and /or Document ft
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 ,Date Issued. __
C. Do any signs exist on the property? YES 0 NO e
f
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 d
IF YES, describe size, type and location: I
E. Will the construction activity disturb (clearing, grading, ex vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton , ,, ," .
Building Department �' ,
y , 212 Main Street . g ' .. $ ; •
2 2C�0 ' Room 100 . 4_
,,
Ncthampton, MA 01060 .-_ � ..,� � "� ..
\\\\ phor4e 41 87 -1240 Fax 413 - 587 -1272 EL ,. y�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
This section to be completed by office
1.1 Property Address:
3 er l C ∎ 1v - Map Lot Unit
Zone , Overlay District
FLiO '' Jv Y
Elnn St . GB District.
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
1,— E5L��. 5T (1 4 'tV € bit' . 01662 __ Name P .- Current Mailing Address: 5�� .7937_
0 I . G-
�+►�� - _ Telephone
2.2 Authorized Agent:
'y -- TCctA,K. e 1 1..\)E. 1>0 gaxT13 ' w & &tntZe � M. K . 0 11
Name (Print) Current Mailing Address:
Sig Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 0�
I (a) Building Permit Fee
2. Electrical G 0 • (b) Estimated Total Cost of
Construction from (6) _
3. Plumbing ( 50 0 • Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) e l 0 00. Check Number / 0 er•- 5/ ..,
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -1089
APPLICANT /CONTACT PERSON HEARTWOOD CONSTRUCTION
ADDRESS/PHONE P 0 Box 993 WILLIAMSBURG (413) 268 -7484 ()
PROPERTY LOCATION 39 CRESTVIEW DR
MAP 29 PARCEL 463 001 ZONE URA(100) //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 /, ? / 5�t7v
Typeof Construction: RENOVATE 2ND FLR BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 043443
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
W (-4j ilitC,)
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.
34W:RR BP- 2010 -1089
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:lock: 29 463 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 -1089
Project # JS- 2010- 001604
Est. Cost: $7000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HEARTWOOD CONSTRUCTION 043443
Lot Size(sq. ft.): 10018.80 Owner: STEIN LESLIE B
Zoning: URA(100) //WSP Applicant: HEARTWOOD CONSTRUCTION
AT: 39 CRESTVIEW DR
Applicant Address: Phone: Insurance:
P 0 Box 993 (413) 268 - 7484 ()
WILLIAMSBURGMA01096 ISSUED ON:6/16/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE 2ND FLR BATH
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 6/16/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo