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32C-102 (10) _67 Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 143023 Type: Individual Expiration: 6/9/2006 DAVID M. CLARK DAVID CLARK 116 ROCKLAND HEIGHTS RD. _-------.--_._-- NORTHAMPTON, MA 01060 --- Update Address and return card.Mark reason for chang Address Renewal r J Employment ❑ Lost Card P 50M-0- 04(,101216 Board (/]C.N6// (1?((4'a11/e (j'� l((l`,)(fe d oV'Building Regulations and:Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Board of Building Regulations and Standards Registration: 143023 Expiration: 6/9/2006 One Ashburton Plac in 1301 Bost , a. Type: Individual DAVID M.CLARK f` DAVID CLARK 116 ROCKLAND HEIGHTS RD. NORTHAMPTON, MA 01060 Administrator of%all wt out signature =F t t)",t0'I��( � t� L/I /' Board of Building Regulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 11/06/1951 Number: CS 000635 Expires: 11/06/2006 Restricted To: 00 DAVIT) NI CLARK — I I s ROCKLAN D HIS N()UR-I'I-1 A M P Y 1,ON, M !�� 6.vin rraow,weaCa o �.daJJackuteat BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR O Number: CS 000635 rceipt and change of address notification. DP CA1 SOM-o4,u�0101 0 Birthdate: 11 06/1951 Expires: 11/06/2006 Tr. no: 4329.0 Restricted: 00 DAVID M CLARK 116 ROCKLAND HTS ,� NORTHAMPTON, MA 01060 Commissioner V. pT r_ IIf . arfIlaniafon ¢ins:RCh nr�iI� DEPP,ATMENT OF IIUILDI)C INSPE�fOt�S _ l::SnErTOP 212 Main SLrctL " Municipal IIuildino °jam Nor(Jump Lori. A!faz-s. 01 OGO • Square Footage Amount Basement C - y$_15 1st Floor @ 2nd Floor @ $ 1/2 Floors, Attic. Garage .$_15 - Deck Porches $_15 • TOTAL " -7/!�( ` • • - • 'St1AMP , 4...., ,-,,,, (!i x±p of Noel-la-11103 r 117 -- " /,r.i .� b..a 0 1.4 idassacirusctts =__ I_ 'G" f.:,--,/ DEPARTMENT OF BUILDING INSPECTIONS ., =-52-_ /_ INSPECTOR 212 Main Street • Municipal Building ' -1y=,•�' Northampton, MA 01060 . HOME OWNER EXEMPTION ACKNOWLEDGEM ^ T The State of Massachusetts allows the homeowner the right under 780'MR 108.3.4 to act as his/her construction supe: .•isor. The state defines "Homeown- ' as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one it two family dwelling, attached or detached structures accessory to such use . d/or farm structures. A person who constructs more than one home in a two-year peri.: shall not be considered a home owner." The building department for the City of Northampton w. is any person(s) who seek to use the home owner exemption, to act as their own co : ruction supervisor, to be aware that by doing so you become responsible for compl':nce with state building codes and regulations. The inspection process requires ►.t the building department be called to inspect work at various stages, which include f:undation/footings (before backfill), sonotube holes (before pour), a rough buildi. inspection (before work is concealed), insulation inspection (if reouir• •) and a final building inspection. The building department requires these inspectio s before the work is concealed, failure to secure these inspections can result in fa' ure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to .erform work (electrical, plumbing & gas) the homeowner will be responsible to m.4 e sure that the trades hired secure their proper permits in conjunction to the build' g permit issued, and that they get their required inspections. Failure of the indivi•ual trades to secure the permits and inspections as required can DELAY the proje' until such time as the proper permits and inspections are made I, understand the above. (Home owner/resid. is signature requesting exemption) I will call to schedule 911 required building inspections necessary for the building permit issued to me. / Date /// Address of work location / ti • • a, ` •�� (rill) of Northa ltpfon 1 _ 9 41:-A E nZ.nanr nsrlte' — DEPARTMENT OP BULL 1NG INSPECTIONS • 212 Main Street ' Municipal Building Northampton, Maas. 01060 far' «'ORIQ.R'S CO NITENSATIO N INSTJ-RAJCE AFFIDAVIT • (li ecnsi permi ties) with a principal place of-business/residence at: c« c , 4 -1 O� I (phoney') CC ‘-'131-17" ‘-'131-17 N 1�r,/\ P jf rt n t/city/s tc p) y ( Q 6 do hereby certify, under the pains and penalties of perjury; that ( ) I am an employer providing tale followint worker's comoensaiion coverage for my employees worming on this job: (Insurnc Company) (Policy Nu.•aocr) (Expirrion Dam) ( ) I am a sole propr-,et general contractor or homeowner (circle one) and have hired the conn-aciors listed below who have the following worker's c000ensadon policies: • (iNamc of nt^cLor) (In uranc; Col D1rry/?oUei Numb: ) ration D:1lc) (Name of •ontraor) ('Insaranc;, Co,.DaawPo!ic Nu1nc_r) (Ex■iretion Date) (Name of onnaao,-) (1asuran=. Co..t }•/Polio lvumbu) (Exp ,tion Date) (Name of Contractor) (Lnsuranca Company/Policy Num r) (Expiration Datc) (ntlxh ..ter:yr 1 rte'ca.ilnco=.ry to cncu&iafoct-uaon pc-tniaias to.11 coc-rc.ors) I am a sole proprietor and have no one worlg for me. ( ) am_a home owner performing all the work myself. NOTE:plesc be eorxrc t*z wt Jc becccowocr w1 o ccaplcy pc--t-nu to do work on.d..<it:-`of not mote then ti roo=it.is u3ich the botmootwer raidm or cc the g ouncb zppurtccn t•eeo L-r DO( e-.11y a. d.TC,i to be employc-a uar'.c the oon:p.--.,;ca An(0 LI S7 a 1(5)).application by a bomm.vocr fat a be a permit by cvrdeaoc tre • k J nano of an a;:tloyx under tbo Work.Ccc oon.tioa Ad I undc-, o4 d a•Dopy of this co-L=9931 g},yy_ho..focxsasi to tha Dcq.rtmaoa of Inek,-,41 Acod 7'ofLoo of Lo c.00e for the env -o vc iamioa,4 • ent re to scrsure`oovorycc tndrt soeito 5A of MOL 152 can led to the inzpossnon of eimiaal pcatlbm -• • • of to ..51.300.00 and/or ampriso®,at of up to one and civil pa:attic to 6c form of.Stop Wok Order.ad finnof5100.00 ••yt .•.•me ` _ _....._____.....,.. For dcyclzr.�1 use only / ` M I 1 ?, Permit Numbc t Y D hL7pe—_ Lot sip:a in cc r:: Date --• • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: I O1W C �&At 6 3`S License Number 6t Lk LANtO S 61 IDA) Addre Expiration Date S 1134 i1/C? Signat '- Telephone ' -Eft Not Applicable ❑ 11- eq�ster'"eel�oni`e�nipro�'enaent�on"t a;to� ��„t:�; � , T�k^�� w� �,�t Pp p.A3 I 1p, CL art cc Company Name Registration Number ;l!z Rte CA l_ AvoD t-{--r3 Address Expiration Date Na R T `k M P t © `©b Telephone $U 31-r) 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 ❑ The current exemption for"homeowners” as extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage : individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edit'i n 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 : •ly dwelling,attached or detached structures accessory to such use and/or farm structures.A person who construc more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to e Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work p: formed under the building permit. As acting Construction Supery sor your presence on the job site will be required from time to time,during and upon completion of the work for w • h this permit is issued. Also be advised that with ref: ence to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not r suiting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work fir you under this permit. The undersigned"homeo er"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinanc:.,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signat e • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing El Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [DJ Decks [IJ Siding[0] Other[01 Brief Description of Propose d N L}Cccti,e NI— C���'ADZ W OM D S Work: skc-PLA-C� ` a; VAN TO P R,eP,At&S iN Sit k-Oit)6_ Alteration of existing bedroom Yes No Adding new bedroom Yes X, No Attached Narrative Renovating unfinished basement Yes /, No Plans Attached Roll -Sheet roc•s e* �"' - W .' ^' ._ + °°` . �""'..r^,a-' s..�.'�,'^".. .d?r' "° y -'?'.Y " ' sa 1f Ne o�rsei ann r.. d tiorr ©exrsttrlwF oustnq om ife e#ie WIfl : a. Use of building:One Family Two Family Other N\k- 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;AU , 9 RIZATION-TO BE CO' na D-WHEN OWNERS AGENT 0-` _ '9 1' -,APPLIESFOR.BUILDIN -MIT' DAL)l MU PHA' ,as Owner of the subject property hereby authorize v‘D CL-41/Lt, , to act on my behalf, in all matters relative to work authorized by this building permit application. T Signature of Owner Date 1 U 1) CL a f iC ,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. D VI V\17 C L Print Name I Fa . C L Signature of Owner/Agent Date I 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 i 1 ! parking) #of Parking Spaces Fill: ' (volume&Location) #` A. Has a Special Permit/Variance/Finding ever been issued for/on the site? a-, NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book — i Page! and/or Document# R. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: 3 C..--- Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: i 31)1►-D)i - F P- 1•31-- " D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO e 1 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 ,then a Northampton Storm Water Management Permit from the DPW is required. l ` ■ -� � 1]ee aeeISer'n1 City of Northampton Wi ` �.t. -,, 1-K Building Department u ,`_ Q @ � s 212 Main Street Room 100 e x t- 5"s n ;„,,:r...,, Northampton, MA 01060 ',.';4::::::'t1.74, ep k` phone 4,1,3,-587-1 240 Fax 413-587-1272 ®� - i�� * :; APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE..INFORMATION 1.1 Property Address: This sectwn to be coropiefed by office �-�--- r 4 Cif�� z I 1�,g6.1 Ilan 1 of Utz Zone �Oveday Oistr�ct sElinA District ,3'. i- CB Ilistrlct SECTION 2-PROPERTY OWNERSHIP-,/AUTHORIZED AGENT 2.1 Owner of Record: +� V t MUR P ClLf( 1}N ST Name(Print) ^, Current Mailing Address: ;/ Nc �LTAvxt? S o-N _V Telephone c g R t 9 0 Signature 2.2 Authorized Agent: \` t C\�- A+2t� 1I� �IQ - ( I JO iIr C5 fi\ t> 6t Name(Print) __ Current Mailing Address: �� _.___2 s 8 b 3 7 Signature ■ Telephone SECTION 3-ESTIMATED'CONSTRUCTION'COSTS- Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (aaD 00 (a)Bnilding Permit Fee 2. Electrical (b)Estimated Total Cost of` Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) — 9 A' I' 0 5-D - 5.Fire Protection 6. Total=(1 +2+3+4+5) I 00 L� Check Number This;.Section For Official Use Only Building Permit Number. IIsssued: Signature: Building Commissioner/Inspector of Buildings Date I- 44 CONZ ST BP-2007-0655 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 102 CITY OF NORTHAMPTON Lot: -001 :i:SONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NO HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0655 Project# JS-2007-000989 Est. Cost: $1200.00 Fee: $50.00 'ERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: C:wid Clark 000635 Lot Size(sq. ft.): 10802.88 vier: MURPHY DAVID A Zoning:NB plicant: David Clark . I': 44 CONZ ST Applicant Address: Phone: Insurance: 116 Rockland Hgts _ (413) 586-4347 NORTHAMPTONMAO1060 ISSUED ON:12/19/2006 0:00:00 TO PERFORM THE FOLii )WING WORK:INSTALL BASEMENT REPLACEMENT WINDOWS, BATH VAN7Y TO POST THIS CARD SO IT IS VI LE FROM THE STREET Inspector of Plumbing Inspector firing D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: House# Foundation: Driveway Final: Final: Rough Frame: Gas: 1,_r e I)epar it Fireplace/Chimney: Rough: O i I_ Insulation: Final: Final: THIS PERMIT MAY B1: :\ 1) BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES Al` ;) .t E( ;,ATIONS. Certificate of Occupant: Signature: FeeType: 1' raid: Amount: Building ):00 $50.003989 2 12 ' Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo