35-245 (5) Mar 26 07 03:33p . 413-781-5722 p.1
JALBERT ELECTRIC
591 ELM STREET
WEST SPRINGFIELD, MA. 01089-2601
j4131 734-4975
NORTHAMPTON [413j585-8449---"-__' __ _
CELL 413-537-3483
TO; fir'/'� 2 ' .
BUILDING COMMISSIONER ; C�,
TONY B.
PER OUR CONVERSATION ON 03/26/2007 MORNING
HERE ARE THE SPECS ON THE HOT AIR FURNACE
MFG-RUDD
OIL FIRED FURNACE
MODEL# OUBB-112A
1122000 BTU
'?HP / 120 VOLT/ 15 AMP
IF YOU THINK WE NEED TO USE A LOUVER DOOR, OR AIR
MAKE UP LET ME KNOW.
I'LL IN STALL A CO2 & WE ARE GOING TO REPLACE ALL THE
SMOKES IN THE HOUSE SO THEY CAN INTERCONNECT WITH
THE CO2.
ANY QUESTION PLEASE GIVE ME A CALL
THANK YOU
JOHN JALBERT
JENNIFER URFF & JOHN WESTERN
27 LADY SLIPPER
FINISH DEN & INSTALL 112 BATH
W-4--
IX-0—
10-6" X- 7, 1
X-0"x 6-
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co
FINISHED AREA ZD
DEN
oo Lo 10-7" Z 6"x 6'-8"-4
X-0"x 6'-8"
CA)
112 BATH
X
ED AREA
FINISHED
5'-6'
C)
17
x STORAGE
Lo CV)
Lz#y of Northall pion r
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n DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR 212 Main Street • Municipal 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 has/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 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 your), 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
The Commonwealth of IVIassachusetts
Department of Industrial Accidents
Office of Investigations
a 600 Washington Street
Boston,MA 02111
°,M =�• www.mass.gov/dia
,Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibly
Name (Business/Organization/Individual): /Li
Address:
City/State/Zip: �� �� c Y Phone.#: 9�7 V91-2-6
Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. E] I am a general contractor and I
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees 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. ❑ We are a corporation and its 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions
myself. [No workers'comp. right of exemption'per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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.
zContractors 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.
I am 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. Lie.#: 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 crimingl 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 file
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
Investisations of the DIA for insurance coverage verification.
I do hereby certify under t p ins and pen es of ter' ry th, t the information provided above is 7�2 nd orrect.
Si ature: Date: d a� _
Phone#:
Official 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 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SE TION 8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable(❑
Name of License Holder: CJ V /�✓ v�l� 'J /I " ��
License Number
Address �— Expiration Date
Signature Telephone
Redisteieil'Horrielmproveneit•Contracto � a ,, _ , rv � , Not Applicable ❑
Company Name Registration Numbgr
Address (i 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...... ❑
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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable
New House [❑ Addition ❑ Replacement Windows Alteration(s) Roofing Roofing ❑
Or Doors ED
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [EI] Other[0]
Xef Description of Proposed `
or
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa l€kew'F ouse;and or addi€ior ta=ezFStiiicl housinct2camp efe fhofat(QUi sic:
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.CONTRACTOR APPLIES FOR BUILDING PERMIT
J- -77, as Owner of the subject
property
hereby authorize
to a my behalf,in all m ers relative to work authorized by this building permit a plicat'on.
2
Sign u of Owner Date
1
5i5! //L^7-1-) 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.
Pri Name
ZL
Sign ur of OwnerlAgen Date
^ p
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
Setbacks Front
Rear
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Vohance/Fndi ever been issued for/on the site?
NO 0 DONTKNOW 0 YES K 1
IF YES, date issued:,';
IF YES: Was the permit recorded at the Registry ofDeeds?
NO
��
D
�� um / ^muvv 0 'ES
IF YES: enter 8nuh Page and/or Dooument#/ |
'
B. Does the site contain a brook, body of water orwetlands? NO 0 DON7KNDVV 0 YES
IF YES, has o permit been ur need tu be obtained from the Conservation Commission?
Needstobeobtoioad �-
` Obta�nmd � �-� Date
�
«�� v�� '
C. Dn any signs exist on the property? YES 0 NO 0 '
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ��x�� NO
IF YES, describe size, type and location:
/
E. Will the construction activity disturb(clearing,gradingexcavation,orfi|Ung)over 1 acre nris it part ofo common plan
that will disturb over 1acre? YES ���l NO ���l
IF YES,then a Northampton Storm Water Management,Permit from the DPW is required.
'
1
Department use only
City of Northampton Status ofPermli `
Building Department Curb,CttlDr�veuva} Rerrntt�
212 Main Street SdWerlSept d-_w' abil"t
7 Room 100 Waf- ell Ava lability ju
Northampton, MA 01060TwaSesofStrucraktans
phone 41'3-587=1240 Fax 413-587-1272 it Plans,ti ..
Other Specrfy
x~
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION: `
This:sectlon to be completed oy office
1.1 Property Address:
y _
Zone ^ «Overlay Dts4rict
.Elm St Dlstnct CB District
SECTION.2-PROPERTY OWNERSHIP/AUTHORIZED T7
2.1 Owner of Record: / J
Name Print) Current Mailing Address: sri^"4— Telephone i
Sign e
2.2 Authorized Agent:
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 / Q >C G (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. Totai=(1 +2+3+4+5) Check Number
This Section For Official Use Only'
Building Permit Number. Date
_9 Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
I
l
File#BP-2007-0833
APPLICANT/CONTA UE ; RSON JOHN JALBERT
ADDRESS/PHONE 59 I ST W EST SPRINGFIELD (413)734-4976
PROPERTY LOCATION 27 LADYSLIPPER LANE
MAP 35 PARCEL 245 001 ZONE SR Al.->06
THIS SECTION FOR OFF
PERMIT APPLICATIC NO -Olt-PXJ
El �u.J^J
ZONING FORM FILLED OUT
Fee Paid AA:9 Gd .00? SO
Building Permit Filled out
Fee Paid
ypeof Construction: FINISH BASEMENT
New Construction
Non Structural interior renovations �� D
Addition to Existing
Accessory Structure
Building Plans Included: �S' zi�
Owner/Statement or License 011019
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON TI
INFO ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDEI /41—u��'OKr'
Intermediate Project: Site Plan AND/OR /—
Major Project: Site Plan AND/ORS
ON
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit
Received&Recorded at Registry of Deeds F
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 ssion
2
Signature o 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.
File#BP-2007-0883
APPLICANT/CONTACT PERSON JOHN JALBERT
ADDRESS/PHONE 591 ELM ST WEST SPRINGFIELD (413)734-4976
PROPERTY LOCATION 27 LADYSLIPPER LANE
MAP 35 PARCEL 245 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Al
Fee Paid
Typeof Construction: FINISH BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 011019
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 ssion
Signature o 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.
I IN BP-2007-0883
GIs#: `` COMMONWEALTH OF MASSACHUSETTS
� CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: BUILDING PERMIT
Permit# BP-2007-0883
Project# JS-2007-001441
Est. Cost: $16000.00
Fee: $80.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN JALBERT 011019
Lot Size(sq. ft.): 38202.12 Owner: WESTERN JON W&
Zoning: SR Applicant: JOHN JALBERT
AT: 27 LADYSLIPPER LANE
Applicant Address: Phone: Insurance:
591 ELM ST (413) 734-4976 WC
WEST SPRINGFIELDMA01089 ISSUED ON:3130120070:00:00
TO PERFORM THE FOLLOWING WORK.-FINISH BASEMENT
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 3/30/2007 0:00:00 $80.00377
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo