32C-237 (2) 10/19/04 01:43P P.002
CERTIFICATE OF LIABILITY INSURANCE ,CSR Cz
•Reol•eve THIS TDICATE IS ISSUED AS A MAMR OF WFORMA
Neill dt NCi111u>,vsance AgCnLy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFMATE
622 Riverdale Street ALTER Ti E OVE AFFORDED 0y THEPPMi0"MOW-
West Springfield,Ma 01089 COMPANIES AFFORDING COVERAGE
David W.Neill COMPAW
A Underwriters at Lloyd's London
MlStlll® COMPANY
Martin Roofing Co..Ltd. a Commerce Insttlarrcc Compaay
P.O.Box 4585 COMPAar INA r
Springfield,Ma 01101 C
COMPANY
Q
COVERAGES .•
TINS tS To CERTIFY THAT THE POUCIPS OF INSURANCE LISTED 00.Ow NAVE 8"N MUID TO 7HE NUMED NAMED ABOVE FOR THE POUCY PERIOD
wNtAnO.1407VMWSTAMONG ANY REOUIREWff.TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VYMCN THIS
CEfMAC^j*MAY BE ISSUED OR MAY P¢J1TAN,THE MSURArMa AFFORDED BK THE POLICES DESCNWO,HERMW IS SUBJECT TO ALL TW TERMS.
EXCLUSIONS AND COWMONS OF SUCH POUQES.L*ATS SFIOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OO TYPE OP MSUMNC[ POLICY NUMNER POYCY SOWTPIE POUCT flv+Ni Im CHITS
LM DATE OWAIOOVI DATE PWAM M
OPIVAL UAW" GOMPAL ADOWMATE • 0
A COPMAURcLOW G&AMAL LWINUry BA980234 06/16/04 06/16/05 PAOOUM-COMPS Am •
CLNMS Mom OCCUR Pa1S0•LAL a ADV NLAATY •
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PSIS DAMAO MAW w 60 •
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AUTO"01L1E L Awrrr COMV*MD SOKU UMT • 1000000
B my^u,� 4tzMMN59131 12/31103 l2/3 U04
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DESC"Pfl=OF aPelAr�O+aAOCwTiOidtVeaLY PF�AL rFeM•
Roofing Compwy
CEATIFWATE HOLDER CANCELLATION
Noribaw-1 6MOULD ANY Of THE ADM D6se"ID rOL CM SE CAMCOAAD WON TML'
OL*mTTDN DATE TMa1EOf.THE L UmQ Ca•IPANV IMLL EMDIAVOR TO Mm
City of Northampton 10 DAYS WhIrM OUrKI TO THE C0ff"1CATE M X=W MAMBA TO THE UN'r-
35 Eastern Avc. WT FOAM TO HAIL SUCH NOTICE PIALL M W NO ONUOATroM UAWW Y
Noflhan"ort,Mass. 01060-3309 of AWV KWO UPON THE COMPANY. s DN
ALTR�I¢�11ESA4sEUrAnvE �
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ACORD 26-S WSW David W.Nei '��TtlBB
Lz#-p of Warthamptan Z
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Muuicipal Building S,
Northampton, MA 01060 ,
Y
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
act as his/her construction sups: , sor. 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 eegulations. 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
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F e Cri of {nrf flu 111f.lfol1 - _—
i
DEP1,LRTME14T OP DUILDI)\'G INSPECTIOI.•S
212 Alain Strcet ' Municipal Building
Northampton, Mass. 01060
WORICLIZ'S COi\IfPENSr1-'nON GgSURANCE A17FMA.All-l"
I
(li ccnS--CJperMAcc)
\VILh a principal place of businessfresidence at: --
—
hone.'-
(sr?r...ticitJ/ aIrrap)
do hereby certify, under tlie.painS and penalties of pc 'ury, hzr
I -
j ( ) I arm an employer providing the followine'worlcer's comocnsaoo, cove In)
emplovees worlong on this job:
I
(lmnul-an Corer ) (Pork:NU-ter) -- (-E:-pir`66n DzL)
( ) 1 am a sole proprietor, ngeaeral contractor or homeowner (ci c:e one) and have hired
the cony actors listed below who have the foflo«ring worker's co:-.2oen–sa aon policies:
(N+11IDC, Oi CO21^CiOr) (InR ranc; Cotnoarlpli oi.ic; Numh--) (E-\ IT-OUOil DaIC)
i
(Name of Coaa-aaor) (Insulancz Como_an`•/Polim• `umCrr) E.-Dir-,6on Date)
I
I
(Name of Cofactor) onsu-ane; Compare)-Ip0tiq- tvasbu) (Expimaoa Dale)
(N2-Mc of Contractor) ansuran� Comrzay/Policy Nu.mbci) (Expiration Darr)-
(atxxh :oCal�ccc,tl act�u_-y to inCiu<�c-iaformL.Eoc P--L aa.as to.1r occ=-1-0:7) -
i
O I
am'a sole proprietor and bave no one working for me-
j ( ) I am..a home owner perfon-wng all the work myself.
I�
? NOTE:pl=rc be CF jfC ti,..Mt}G CDRm9=T3—>o cmpiay paicrm to do C` -1 v. =--aloo c rcgac wam ca a d.•ctL^y of
cot moce th_a ' :pis is u'aeh the bomoownc rend=of oc the Vound,zyp%�tbeco�- wt g=) -Uy oec::d.-cd w be
eiVI0Y--u the-v ka"z oc�ca Act(GLI152-=1(5)�:pplinboo by a bomeomaa fcr_Uc---.or p=rui cr_y cvi& x the
I cga!C_^,•or m<�loyer under d3o W otkd a Comp oon.y;�Act
i
i I a+odezx.aad the.a Dopy of thi.ml®ma may yo fo.-�.nrded to tbo poputm.�r of In�atiiJ Acddr�s'OQoe of 4rJUranoe foe t!m
oova�c verb-aioe and lh1 L i]ca c to secure Fx�vera�e tia�d�soetioa 23 A of?10L 151 tie tee to the iz:p u2ioa of aimiaal pcusrvo
eoaxisiag of a fine of up to S 1300.00 and/oe or up to ooc y=r znd civU peaJtia in 6c form of a Stop Work Ord- and a
run of S 100.00 a(L.y aPjaa me
For d,:p.rtai-�u+c onfy
i
- Pcrm.tt Nu.mbcr
Lot
iSt�naLun of L-1.11 JPctmiucc —�EF l
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sue r: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
_ _ , , � Not Applicable licable ❑
92eau t �ome' mt�royemer► Contractor} PP
Company Name Reg'i]stration um er -----"--
Address �.. Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION'INSURANCEAFFIDAVIT`(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 @nm () lner
it
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-apnlicabie)
New House F_� Addition ❑:,: Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[0] Other[E]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa-��New�hotas��nd�oi� " tlit>z�n,#aseztstinrt�ious�ng.:carYrptQte=tti �oflowina:
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;-OWNERAUTHORIZATIONi-TO,BE.COMPLETED WHEN
OWNERS AGENT:OR CONTRACTOR APPLIES FOR:BUILDING PERMIT
I, 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 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.
Print Name
Signature of Owner/Agent Date
F r
Section 4. ZONING All Informatibh 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 I "
Setbacks Front
Side L: R:� L:I R:'
Rear
Building Height " 1
Bldg.Square Footage % a�
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: 3,
volume&Location) '
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW U YES U
IF YES: enter Book Page; and/or Document#` r
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES
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 0
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
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 r NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
v
City of Northampton
Building Department
--- X12 Main Street t
Room 100
�Nbrj�pmpton; MA 01060
p, qpe 44$-567-1240 Fax 413-587-1272
()
.Fri.,.. ....., u._ .
APPLICATION TO CONSTRU�T,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SEETIBN"t= ' INFORMATION
1.1 Property Address: ,, This section to be completed byc office
it Un}t
Zone Ouerlayl tstrict
Elie Sf District 'Distract
SECTION 2-PROPERTY'OWNERSHIPJAUTHORIZED AGENT
2.1 Owner of Record:
�5:1, 6?!--A �77-r-94 V-K
Name(Print) Current Mailing Address:
Telephone
Signatur
2.2 Authorized Acient:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 00 (a)Building Permit Fee
-
2. Electrical .(b)Estimated Total Cost Of
Construction from 6
3. Plumbing Building 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 Issued:
Signature: +
Building Commissioner/Inspector of Buildings Date
35 EASTERN AVE BP-2005-0479
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-237 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-2005-0479
Project# IS-2005-0630
Est.Cost: $8900.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARTIN ROOFING CO LTD 104821
Lot Size(sa.ft.): 4486.68 Owner: MASTRANGELO DOMENICO
Zoning:URC Applicant: MARTIN ROOFING CO LTD
AT. 35 EASTERN AVE
Applicant Address: Phone: Insurance:
P 0 BOX 4585 (413) 785-5333 WC
SPRINGFFIELDMA01101-4585 ISSUED ON:10120104 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & 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• Receipt No: Date Paid: Check No: Amount:
Building 10/20/04 0:00:00 9850 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
ow