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INSPECTOR
212 yfain Street • Municipal Building
Nortbxnpton, MA 01060
HOME ONVINIER uXEMPTION AC1'NOWEED E'MrEN T'
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as hisIer construction sup-. --or. TI.e 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 I
home owner."
The building=-department for tlhe City of Northampton wants any person(s)who seek to
use the hone owner exemption, to act as their own construction super iso. 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 worm at various stages, which include foundation/footinzs (before back-fill).
sonotube holes (before pour) a rough building inspection(before work is
concealed-) in-sulatio-n.inspection (if required)and_a- inal_buildin.g.insoection. 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 occupancv
until-the-wo-rk,can--be-insaected-.-
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. y
Date
Address of work
location
The Commonwealth of!Ylassachusetts
Department of Industrial Accidents
Ofr'ace of Investigations
600 Washington Street
A;✓/z/
--- Boston,MA 02111
`✓ www.mass.a ovIdia
Workers' Compensation Insurance Affida-vit: Builders/Contractors/Electricians/Plumbers
AD licant Information Please Print LeaibIv
Name C3usiness/Organiza6on/Individual): 2_ t
Address: -
City/State/Zip: Phone.:=:
Are you an employer?Check the appropriate box: Type of project(required):
4. I am a gene-al connector and I
1.❑ I am a eamIoyer with � � 6. E]-New construction
employees(full and/or part-time)-* have hired the sub-contractors I
I � r- T listed on*dze attached sheet_ 7. 1-7 Remode ng
1 am a sole proprietor or partner-
ship and have no ez;p Ioyees . These sub-contractors have
8. Den70lIUQIl
working for me in any capacity. employees and have workers'
,No workers' co=p.insurance comp.insurance.-
9. Q Building addition
required_] 5. We are a corporation and its 10.0 Electrical repairs or additions
=-❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. rift of exemption Per MGL 12.❑Roof repairs
insivance required.]t ,c. 152, §1(4),and we have no
employees.[No workers' 13.[1 Other
comp.insurance required.]
xnv agp ican caerz ooz 7 gnat a= out me soon oe.ow s wing - ea worms'coition poiicy mforz=a:.
Homeowners who submit this affidavit indicating they are doing an work and then hie outside connacro=mustsubnat a new affidavit indicating such-
Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and st=whether or not those entities have
employees. If the sub-contractors have empiov= they must provide thei workers'comp.policy number.
I am an employer that is pra•ridingr workers'compensation insurance for m_v employees: Below is the policy and joh site
information.
Insurance Company Name:
Policy n or Self-ins.Lic. #r: 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 i=osition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as we11 as civil penalties in the form of a STOP WORK ORDER and a Erne
of up to$250.00 a day against the violator. Be advised that a copy of this statement tnny be forwarded to the Office of
IIl restigatlons of the DLA for insurance coverage verification.
I do hereby Gerd under the paths and penalties of perjury that the information provided above is true and correct
�gnafufA�
Phone=: 0
t
LOther e anry. too not wrrte rn thLT area, to be eompleied by city or town of icial
_ wn- - ------- --------__—_-- _-- - –P-er-mit/License
thority(circle one):
f Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
r son: Phone.-:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: an m fl� �k mrr G 05 0 3
License Number
X52 Ca �,r�rr �� ► S ,D&dfie IJ 1MA - 013`7 I-�_ ]13IU7
Addrefi, S&Aj� Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
71 CITY r Y 11kPACK _)k A C1 10-73q —
Corn any Name Registration Numbe
5/11 Q�
Address ( Expiration Date
Telephone
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...... ❑
11. - Home Owner Exemption
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-vear 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
A
1051AAT16f) 4 5AE)6_1WAC_ ) Kmilir SiD6 twiT
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 7
New House ❑ Addition ❑ Replacement Windows i Alteration(s) Roofing
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other[❑]
Brief Des�c�rii ti of Pjop l nS V f
Work: Yi► P S J S eY (0 f,\ �t � j ry (.14r Je—p rrm
bedroom Yes�No Adding new bedroom Yes cL No
Attached Narrativ Renovating unfinished basement Yes No
oll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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,
1. 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, 1ROp�P l l a as Owner of the subject
property h n
hereby authorize ��'
to my behalf, in matters relati e to work authori ed by this building a it application.
5 ti 4
Signature of Owner Date
�j '2- CAMaZOU as Owner/Authorized
Aqent hereby declare that the stateme is and information on the foregoing applicatioK are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
a.
Print Nam
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
Lot Size _,. . ...
Frontage _...._,.
Setbacks Front
Side L: R: L:.,,....,.,1- R. .. , ...
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
narking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW a YES 0
IF YES: enter Book ! Page 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:
C. Do any signs exist on the property? YES 0 NO
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 JR
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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
_ City of Northampton Status of Permit:
B,t Ming Department Curb Cut/Driveway Permit
_. 212 Main Street Sewer/Septic Availability
Room 100 WaterfWell Availability.
l)7Northampton, MA 01060 Two Sets of Structural Plans
Cd phone 413-587-1240 Fax 413-587-1272 Plot(Site Plans
' Other Specify
AP�LiCATION 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:
Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERS HIP/AUTIORIZED AGENT
2.1 Owner of Record:
Name(Pr' t) Current Mailin
Telephone
Signature
2.2 Authorized Agent: 1 r,J' l Co ��
-Tom S�EQ 99A T-1- CAYb�� 5 -per �e_la ' MA 613B
Name( t Current Mailing Address:
1l 6
Signature Telephone
SECTION 3-'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ! (a)Building Permit Fee
2. Electrical . (b) Estimated Total Cost of
V Construction from 6
3. Plumbing / Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) ' Check Number 164L 7
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
--- ---.-
Building-Commissioner/Inspector orBw mg–"ld s —^ Date
File#BP-2008-0489
APPLICANT/CONTACT PERSON THOMAS P SHARPE JR
ADDRESS/PHONE 152 CONWAY RD SOUTH DEERFIELD (413) 665-3047
PROPERTY LOCATION 13 KINGSLEY AVE
MAP 32C PARCEL 158 001 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
Typeof Constriction: INSULATE&SHEETROCK RIGHT SIDE UNIT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 054083
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 on Permit DPW Storm Water Management
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.
3" ' 8 �assacf{usciis �` _
DEPARTMENT OF BUILDLNIG INSPECTIONS
INSPECTOR 212 Main Street • Munic;ipd Building
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 super .•:-,or. 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 backfil1),
sonotube holes (before pour) a rough building inspection(before work is
concealed) insulation inspection (if required) and a__finad_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 occupancv
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
r
The Commonwealth of Massachusetts
Department of In dustrial Accidents
W,
Office of Investigations
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): WINDOW WnRI D
- 56 Dimock Street
Address: Leeds,, �A mn �
58�871
City/State/Zip: Phone
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. E] I am a general contractor and I
mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.elam a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no erTloyees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers 9 Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. Fj We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.7 Other
comp.insurance required.]
-* iiy app scan a c.ec ox must a o out a section a ow s owing eu workers'compensation po'cy information.
t 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.
lam 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$1;500.00 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: Zkle 7
Phone SX 9 7)
vfficiai 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):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone#:
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
- t Not Applicable ❑9 Reiiistered Nome IMi3rOYeRe6t.0 , __
/4 f aeo
Company Name Registration Number
WINDOW WORLD 7Z1,414
Address 56 Dimock Street Expir tion Date
Leeds,MA 01053 Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE;AFFIDAVIT(M.G.L.c..152,§Z5C(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"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 suuervisor. 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-vear 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable
New House [J Addition ❑ Replacement Windpws Alteration(s) ❑ Roofing ❑
Or Doors P_/
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0]
Brief Description of Proposed
Work: —� f�S(R<<- j-�L�Y 1 C✓i v�.l `��LG�t wu -:ar' c
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.if New hous"nd of additlon 10 ezistm4 t ousrt�c,:cornptgi"he_fo[towinc%
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 stones?
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 o. s cons ru ion wi i Yes- - No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
1. 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
1 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 Owne Aut rize
tgepq1preby declare that the statements and information on the foregoing application are true and accurate,to the best o -knowledge
anU75elief.
Signed under the pains and penalties of perjury.
Print Name
Signat wn r/Age Date
'
,
All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Section 4. ZONING
Existing Proposed Required by Zoning
'Mis column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg,Square Footage
Open Space Footage %
(Lot area minus bIdg&paved
#of Parking Spaces
(volume&Location)
A Has Special Perm it/Vah nce/Fi nding ever been issued for/on the site?
IF YES, date issued::
-------
IF YES: Was the permit recorded at the Registry u[Deeds?
NO ����
� DON-r mxuxv 0 ,="
IF YES: enter Book Page� and/or Document#'
B. Does the site contain u brook, body of water orwetlands? NO 0 DON7KNOV 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtoivad x�\ Obta(mmd �~� Date
� i
x�� ^_� '
C. Do any signs exist on the pnoperty �� ��V YES �_/ NO v��
IF YES, describe size, type and location: !
D. Are there any proposed changes to or additions of signs intended for the property? YES �~� NO 0
IF YES, describe size, typo and location:
E. Will the construction activity disturb grading,excavation,or filling)over 1 acre orisd part ofa common plan
that will disturb over 1acre? YEGy ) NO ���}
��
|F YES,then e Northampton Storm Water Management Permit from the DPW/arequired.
1]epartrertfc�se anf7w �
City of Northampton ,StatusfPern F
Building Department fr C%txf�Dnrrew� rPet �"
212 Main Street Sewer/SepticivaEtaS[lr u
Room 100 mater,MtetlAca#at�tl�Ety WWX
Northampton, MA 01060
P Fora Sefs of�trcictural'P:!`ans<
phone 413-587-1240 Fax 413-587-1272 E'talSEfe Ptans
Other Spectfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE QFLDEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This secttan to be completed by office
is 1 i dot UnEt.
F I r
fr_ otse s , Overfay Drstctct
i l<► s�-� �Lj e
E °St Distrrcf. CB D�stcf
SECTION 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT-
2.1 Owner of Record:
d'�v��r S>�Lc,o��-- �� Pc�lh e u'es�' )�.rr— �./a u�r �i✓;}-�ty1 r o
Name(Print) Current Mailing Address:
Telephone
elephone
2.2 Authorized Agent:
d r– ^e:LL S / G — S
Name(P t) Current Mailing Address:
Si re SSG 2--7/
Telephone
SECTION 3-ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total`Cost-of
Construction-from 6
3. Plumbing Building,Permit Fee
4. Mechanical(HUAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) ` / Check Number :6 P55
This Section:For OffkW.Use Only
Building Permit Number. Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
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13 KINGSLEY AVE BP-2008-0396
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 158 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit# BP-2008-0396
Project# JS-2008-000166
Est.Cost: $4000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS P SHARPE JR 054083
Lot Size(sq. ft.): 3920.40 Owner: SALLOOM ROGER W
Zonim,: URC Applicant: THOMAS P SHARPE JR
AT' 13 K!NGS!_FY AVE
Applicant Address: 'hone: insurance:
152 CONWAY RD (413) 665-3047
SOUTH DEERFIELDMA01373ISSUED ON:10122120070:00:00
TO PERFORM THE FOLLOWING WORK.-SISTER NEW FRAMING MATERIAL TO
EXISTING ATTIC
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:
_:. niI• Insulation:
Final: Smoke: Final: 6 k Ic4, (�,� 7
THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA IONS.
Certificate of Occupancy si nature:
FeeType• Date ai d- Amount:
Building 10/22/2007 0:00:00 $50.00429
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo