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32C-101 (4) 36 CONZ ST BP-2007-0403 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C- 101 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-2007-0403 Project# JS-2007-000591 Est. Cost: $22500.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KRIS THOMSON 084152 Lot Size(so. ft.): 12414.60 Owner: CLARK GORDON E&JANET F& 7nnino UP..�`. 4L /h._fent: KRIS THOMSON _...: AT: 36 CONZ ST . Applicant Address: • Phone: Insurance: ]4 LIBERTY ST _ (413) 584-1737 FLORENCEMA01062 ISSUED ON:10/11/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR SOUTH WALL FROM CAR 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: L2 _0 Rough Frame: Oh /0 /7 OG Gas: Fire Department Fireplace/Chimney: Ron h: �1il: Insulation: Orl /)-- Final: Smoke: Final: y,3'/< i r:-),,t.it;6 THIS PERMIT MAY BE REVOKED BY T At, CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGGUU ATIO Certificate of Occupanc- 7' Signature: FeeType: Date Paid: Amount: Building 10/11/2006 0:00:00 $100.00579 212 Main Street,Phone(413)587.12.40,Fax: (413)587-1272 Building Commissioner-•Anthony Patillo File ft BP-2007-0403 APPLICANT/CONTACT PERSON KRIS THOMSON ADDRESS/PHONE 14 LIBERTY ST FLORENCE (413)584-1737 PROPERTY LOCATION 36 CONZ ST MAP 32C PARCEL 101 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 5i9 4/ o Typeof Construction: REPAIR SOUTH WALL FROM CAR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 084152 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INIOTZMATION 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 Co • •n ,,, /4 e Lett 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. rNorthampton Status o ` ,r,ty Ih°�Department c r� B 212 (Wain Street :_e ea - 01060 ': T U v ' Room 100 i Y a1e� va a i iortha ton, MA �W , " 44V� v ^b * t � y� � i phone 413-587-1240 Fax 413-587-1272 RaIS ansfi � , i _ t 4 °, — *-a v,1. rli ", is,i fi I: APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATION 1.1 Property Address: - TEris sectrorrtabe comptetet byoffrce -Ma Lot Unit 3( Cov Z � . Zone ■OverlaDistrfct N 67,046k„,...\) t"Es2_ A4 a. • 0 J 6 6 0 ?tEritw ois�u�; c�r3�sto* . SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1—Q,w ► e GtairIZ._ 3C <dW/Z N `k - Nam (Print) Current Mailing Address: Telephone �- 49,5- Z-VY6 ynature 2.2 Authorized Agent: k- 12-15 1-1a M s b NJ 1¢ --I 'k-L c---. f 6i f U , kick ONO— Name(Print) Current Mailing Address: �g4 - 1 7'37 Signatu a Telephone SECTION 3-ESTIMATED-CONSTRUCTION COSTS, Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2'o 00 0 (a)-Building-Permit Fee 2. Electrical 5 a (b)Estimated Total'Cost of 1 Construction from(6) 3. Plumbing / (I U U , Building Permit Fee. 4. Mechanical(HVAC) 5. Fire Protection /Myam 6. Total=(1 +2+3+4+5) Z2-15©O Check Number 679 JlN- This Section For Official Use Only 'Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of 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:......._. R:i Rear Building Height ; Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved , parking) i j #of Parking Spaces • Fill: (volume&Location) ,__ _____-- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 4 YES 0 z IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book _ ! Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0(4 DON'T KNOW Q 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 (,) NO s 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 j IF YES, describe size, type and location: 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 Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [E] Siding[K] Other[ l] Brief Description of Proposed , 11 Work: P.e.Qair ItakerioV'�S icf ViCUV' o Soc k. w4U -I-11at wCtA GQ.QWLU LC.A 16ii A- GCC�..Y" pkWIKS ;N�lo 1T l Alteration of existing bedroom Yes 4 No Adding new bedroom_ Yes ( No • Attached Narrative Renovating unfinished basement Yes Dc No Plans Attached Roll -Sheet 6'a Cf New oiuse iffi d bled tatez s€�d O E itiWI: 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 Nb. I. Septic Tank City Sewer Private well City water Supply SECTION Ta-OWNERAUTHORIZATION;--TGBECOMPCETED' WHEN OWNERS AGENTOR CONTRACTOR APPLIES FOR:BUILDING PERMIT I, L 0.v r 1 e_ C..(ar IL , as Owner of the subject property —�] hereby authorize [1—r i s 1 Vt b(M S o V\ to act . my behalf,in all ratters relative to work authorized by this building permit application. ■_ ..L.! g— d C o‘ Signature of Owner Date I, k i' l t .0 GbtStSY■_ ,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. e-1 ( /I CMS 611 Print Name i V I o/3 0 Signature of ner/Agent D e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:( Not Applicable ❑ Name of License Holder: k_V'15 1 Vl O(/L1 S O 014/5" Z License Number I 't 6,2-v'r`, Aorettc.e . •Lf4 0 bz 4J7jo7 Ad ress Expir tion ate Sign ure Telephone 9'.Rec T s rere:WHk - $; . 31 Not Applicable .❑ I -1-75 -S'� Company Name Registration Number Address Expiration ate Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MMG.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 t No 0 Tr a >E> µ �, , 'll;l 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 • w • / ,R.30� '+ E LLri�7 o aritja111ptoii 1 3= 8 '_ E �ias.+crfln u.- re`we':re^.' , c_1 1-_-_-=—f-. _ DEPARTMENT OP BUILDING INSPECTIONS • 212 Main Street ' Municipal Building Northampton, Mass. 01060 o- ` WORKER'S CONCPENSATTON LNSURANCE AFF1D1i\rl - >r.i. r -'")cr). (liccns- permictcc) with a principal place of business/residence at: • 14 � � tc 5 • 6.etn C-�..4 a. 0 Z(phone?') ,erg¢ - L737 (s ticity/statz/ap) do hereby certify, under the pains and penalties of perjury; lhat . ( ) I an an employer providing the following workces comoensa ion coverage for Iny employees worl6ng on this job: . , ari ur-..s=Comte•) (Policy Nu_mbcr) (Expiration Dale) . ( ) I alz-I a sole proprietor, general contractor or homeowner (circle one) and have hired the conaactors listed below who have the following workers compensadon policies: (Name of Conhcwr) (In uranc: Cotnoany/Pouc; Numb::) (r?:pinuon Datc) (N:mc of Contractor) (Insurance Comoa.avrPolic Nurnccr) (Lai lion Date) ()`lame of Coanaaor) (I.nsurance Compa.o}-/Policy tvumlxr) (Expiration Date) • • (Name of Coatractor) (Lasuranca Comczay/Policy Number) (Expiration Date). • (..rich d ocal rt...t if nenena.ry to Meru&inform,-ion pertaining to.1r ooar-r.ors) • ,,- .'-- n a sole proprietor and have no one worddng for me. ( ) I am-a home owner performing all the work myself. NOTE:plc-se be comic th,.,+{ ]a hemco.+vcra wbo employ pa-:„oto w do •-s f.- ,,.n o�.rJoo c rgau',Wk.oa a d..c0.1:74:of clot react-tboo throe toita in w'aich the bomoowo -rid or oa the ouo;a appu.rtcnam the-en err Dot cxlly cca:daod to he eixployc,uor',,e the..-ca-k&Y cempatioa Act(GLl S7 a 1(5)).applitrion by a homcoo-ocr f _or permit tnoy e idcoee the legal.t-me of an cxmloyo<under ttao Worker'.Compon atioa Am_ t•+od.a*aaad that a copy of till.=acme=may bo torronu-d4E to tbo acpo.tmmt crl•,ek•*•ia1 Aoadcta'Off.00 orin'ur+aco for tb. coveo v cst'oo c-id th1 Eirtac to L.:curt to`trace to r' r soot oo 25A of MOL 152 an led to the isxmaifioa arc-tali/ill pca,ltia coousceg of a fiat of tip to 51300.00 and/or o(up to con ye-.r end affil peaaltia in the form or.Stop Work Order and. 1iuoof5100.00adtytgiaaox. - / For dep.rtm�sl u.e only '/d 29•� Pcrmit Ntrml�c • ?.iap:-- Lot ° I S,H.z turc ofvilpermiucc e F ¢ou►rpTO (tat( rif NIIrt antpti t Z =* S 'f T gent' \-4. =is __— DEPARTMENT OF BUILDING INSPECTIONS ,VI_{ / 212 Main Street • Municipal Building INSPECTOR 5°°y Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:,.isor. 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 any 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 permits 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 3 to Cam►. -z- tr-Jasz. ck cot r, c v w e e-s et_ 12 ; f bLt 0 . k - b v t ft,� C e i �c -i�(„ fV S lM w s�,c �pest fe J\ )� --�(�-e..A°i X wt..a ■ „' cQ• dcutAA a U cn.- -; ( w cS..ah - ,fz.. d t. cwt..o I k;�-- )) o-o -L w� (it t c r i IAA o s f sr y,0 0 it s k uc)L5 i s H o f t.-P" i s hGA.Sr G. r Scc* .vt. ' c 4( ? - �� �- � �� 7 1 i j I Agook s 1 I i ,I I i i i f +'I I i ( it i t i 1 I 1 E 1 I I i f I i