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35-085 (2) �. E= Board of Building Regula ions and Standards �u One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 152814 Type: DBA Expiration: 10/3/2008 JACK WALTON CONSTRUCTION CO JON WALTON 130 COUNTY ROAD HUNTINGTON, MA 01050 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card .f17P (.='r�d72IIL[yJl{1P.(xt�l1 r:rF f[1rJ3e'fl lZLCcif'�' Board of Building Regulations and Standards License or registration valid for individul use only aj HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 152814 Board of Building Regulations and Standards —� Expiration: 10/3/2008 One Ashburton Place Rm 1301 Type: DBA Boston,Ma.02108 JACK WALTON CONSTRUCTION CO .o JON WANTON / _ � - 130 COUNTY ROAD 1 („°`�`, (,•"`—t HUNTINGTON, MA 01050 Deputy Administrator Not valid without signature BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 052591 Birthdate: 10/15/1959 Expires: 10/15/2007 Tr.no: 5967.0 Restricted: 00 JON P WALTON 130 COUNTY RD HUNTINGTON, MA 01050 Commissioner i Ktt�PT �� X04` O,y cl ity of Worf4amptou z r � diT+tassxc3�usePls I� - DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building '>a Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108:3.4 to act as hds/her construction superr,-*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 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 - �O 0 F E Crif-�3 of 4 o DEPARTMEbrT OP DUILDr)�,,G fNSpEC IONS 212 Main Street Municipal Building '- Northampton, Afass. 01060 WOMCCR'S COi�'fPENSATZON MSURANCE A17FMAVI-l' 01 CCULCCJpCrIDJ tics) a=nt-L a principal plat.- of business/residence at: �30 6d i Y 66733, � (st�t/o ty/sea-tc�a p) r, do hereby certify, under t}ie.pam and penalties of penury; hzt ( ) I an an employer providing the follo%vinL workers comocnsa:J*on covc:mge for my etuptovices «vor ong on this job: i (Lasur'anc-- Conr;>,) fPCUC- )~u. cr) -- (–,pirrtior, Dpi-) f O I am a sole proprietor, general contractor or hotneow�er(c tie one) zed have hired the contractors fisted below vvho hive the fotlov - R workers coonoerL�aon pokles: ([amc of Conr771cwr) (InRr-anc:; COIr703r1)-/roue; (—I—x: j' (Name of Coors.-tor) (Lnsarancc Comoanv1pouc Nu-mc:r) (%.x-om6on Date) (Name of Connector) (Ialsurmc:. Compan)•/Pouq- Nwnb�r) (Expiraden Datc) (Name of Contractor) (Insurancc Company/Pot cy Number) (Expirttioo Datr). (aIIx-b .,ta:�ocaJ bad.ifnccc -,v o ctc!uci iafo mjj. oa pccniaing to aL Does-rc:z) I am a sole proprietor and bave no one working for me- ( } I aat.a home owcer performing all the work myself. NOTE:pi�be LvrtlC t+,,• jzijo hea�acra w'bp etaplay p�-s, w rl��- •,..••,,•r c=--:x��o c rc au work on L dx,--U^g of aot tnoct th:a ltsoc t�fr in u�.neh the bomoowocr raido«oa ttu pvunca�pv.ttcn_r3 the-en c-c ax�rlty arsd-sai w be �ployea uar'.c the va-kd�c�,-.,.,oa Aa(GLt S2�l<S)��plic�oa try a 6omu�ava fie_l�c�_a pa-ma ray c•�dmcc t1:c I c-g!ctaau of ca—Ployoc aadcr dto Wock; -r Co�o Aa- (uadcsl+-od 6a>Dopy of Uais mt®c=m,.,y b-fxxardnd to lbo Aced—ty OIL—of lrn—for IS. covcnsc vci c=6oc and tttl L-ittac to smtrc covcry�tmd(s zoCYion 25A of MOL 132 cza Icd to ttx impol Oc of mutest pcail - eoas m3s of a riot oCup to S 1 300.00 and cc mPtt of oC up to occ Y 1 Lod chit payPja in tk focm of a Stop Word;Order and a rim 0(S100.00 r dsy rpin-a Ml- �Clt� For dcp.na�.=il u,c only / Perm it Numtxr !d 7 htap Lot Si�naiun of Liccnscc/Fcrrn-iucc ce -- A F r SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: t / Not Applicable 0 Name of License Holder: -ZAC K (A IA x-7714 o s 259 License Number 13o Coc1,�(�Y 4 ut4 T hl CJO MA • I5 7 Addre s Expiration D e 3 3 Signature Telephone 9 Redis"t'ere&Home<rMiSf ver`bent Contraefo � 3 Not Applicable.0 . -4C&� lzy LEVA/ lQ14Sr`2�c`�-vim Company Name Registration Number 12�0" 14-Vd�.�ror��f 1 10131/o� Address / Expiration Date Telephone 47-33 SECTION 10-WORKERS'COMPENSATION INSURANCE,AFFIDAVIT(M.G L.c.152,-5,25C(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...... 0 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 SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors C] Accessory Bldg, ❑ Demolition ❑ New Signs [[:I] Decks [p Siding[0] Other(0] Brief Description of Proposed Work: -5 rierd' 4 &E-Iz!c or m4 f^F 14OUS-E Alteration of existing bedroom Yes >f No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ f No Plans Attached Roll -Sheet sa t : le .�io>ise and©Fad`diticsrito exist""ia ii-6',U.Sirt cycFirnt i etf6 M 6auurrrc: 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`CONTRAGTOR.APPLIES FOR BUILDING°PERMIT I, f e4s'Ca[- (ZO AA A(0LA).s4--( as Owner of the subject property here byauthorize to a n my behalf, in aip,649ers relative to work authorized by this building permit application. Signature of Owner V Date I,_ -6.1111114M J +' -�C �?( (Z- � 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 a nd penalties of perjury. ^�-� LA/A(21>4 Print Name 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 Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 0 YES 0 IF YES, date ioue& IF YES: Was the permit of Deeds? ' NO K ) DON'T KNOW 0 YES IF YES: enter Book Pa and/or Document#| ( ' �� �� B. Does the site contain a brook, body of water urmet(un�? NO W-9 DONTKNOVV v�� YES �~� / IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tobmobtoinmd �~� Obtainad ��� 0ote /s Issued: �~� �~� ' C. Do any signs exist un the property? YES 0 O IF YES, describe size, type and location: 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,gradingexcavation,or filling)over 1 acre orisitpart ofo common plan that will disturb over 1 oom? YES ^�� ) NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. tr r�X&�3 Fie eo�uSe Q&CWu` hu �. City of Northampton Building rlc artmea n+ 212 Main Street e e et i> fuz M Room 100 atere Northampton, MA 01060uiiaSe phone 413-587-1240 Fax 413-587-1272 a APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION"11--SITE INFORMATION o be completed byoffice ! 1.1 Property Address: This section�t Vv5`�1/U�C��`'ice t^ Map Cot UnrC 5 d V�Z Z"Ofte QYer�aJ�QI5�tL7Ct4 ir3 k Elegy St �IStFILt •, � EIStEltt SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED>AGE NT 2.1 Owner of Record: F(.0kir,"t CIC, Name pint) Current Mailin/�Address: Telephone Signature 2.2 Authorized Agent: rn AL7C:4 130 &Vf4 xi). 010 Name(Print) Current Mailing Address: - � 6, 73 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 Construction from 8 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 Date:_ Building Permit Number. Issued: Signature: Building Commissioner/inspector of Buildings Date . . " File#BP-2007-0496 APPLICANT/CONTACT PERSON Jack Walton Construction ADDRESS/PHONE 130 County Road HUNTINGTON (413)667-3358 PROPERTY LOCATION 57 WESTWOOD TERR MAP 35 PARCEL 085 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM LLED OUT Fee Paid 6 Building Permit Filled out Fee Paid Typeof Construction: Strip and Reroof main house New Construction Non Structural interior renovations Addition to Existing AccessoTy Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO�LLOWING 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 C ssion lv300 ! 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. 57 WESTWOOD TERR BP-2007-0496 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -085 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-2007-0496 Project# JS-2007-000722 Est. Cost: $5340.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Jack Walton Construction Lot Size(sq. ft.): 9713.88 Owner: ROMANOWSKI GRACE M&DAVID T Zoning: SR Applicant: Jack Walton Construction AT. 57 WESTWOOD TERR Applicant Address: Phone: Insurance: 130 County Road (41-A) 667-3358 HUNTINGTONMA01 050-9727 ISSUED ON:1013012006 0:00:00 TO PERFORM THE FOLLOWING WORK.-Strip and Reroof main house 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 10/30/2006 0:00:00 $25.002815 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo