Loading...
36-071 (11) ` 00 y arc, 4ae � �V t i . t �—� c1 ce CL I � ..,_.... N l 1 C/ Is ff 3, C,o r-.fr kd, 7 9� " �.1:yr' � CRr'(�f.:�lZ r/,� �-4'wc+•') (�.C..0 t'4 � � '.: �,-.��/f f � � Y; I dul 7 Z _ _ / Jrt , THE COMMONWEALTH OF MASSACHUSETTS Board of Building Regulations and Standards or DPS Use Only. Home Improvement Contractor Regisiratioe One Askburton Place,Room 1301 RL-r�istrat onNo: + i Boston,MA 02108 Effective Dale: a Application for Registration as a Expiration Date: Home Improvement Contractor or Sub- Coa#ractor Date Processed: MGI..c-142A;780 CMR R6 I. Li BUsINESS NAm: APPLICANT PHONE# — J 'F 2. NAMING ADDRESS' Q J STREET Cnyj STATE ZIP 3.PERMANENT ADDRESS(IF DIFFERENT): STREET CITY STATE ZIP (PLEASE HOTS 7HAT A P.O.BOX IS NOT ACCE VIABLE FOR PMUAM NT ADDRESS) 4.ArrucANTTYPE(cowRONE):_k/INDIVMUAII D/EVA PARTNERSHIP TRUST PRtVATECORP. PUBLIC CORP. L.L.P. LL-C. (SSE INSTRUCTIONSRw.4RDINGTHEBNCLOSURFoFAcI]"Y/O/RmWN�RE1Gy/wTzAT(I;N)CEJR7r/Q cATzIFDIB/ALSCAD) 4.SOCIAL SECURITY OR FEnaRAL TAX I.D.NU9IBSR: �? T L� ~ r 1 T • d.NUMBER OF EMPLOYEES: 7.HAVE YOU REGISTERED PREVIOUSLY UNDER TWS LAW? YES �NO IF YES,PLEASE PROVIDE THE NAME AND REGwrRATION NUMBER IN WHICH YOU WERE PREVROUSLY REGISTERED: NAME: REGISTRATION NUMBER: f S A)ARE YOU CURRENTLY OR RAVE YOU EVER BEEN APL OF4l I74 rAR"INL%Olt YELi IZ1REIt(WAN APPLR AN7 WHO PREVIOUSLY APPLIED FOR REGISTRATION umDeR THIS LAW(ALG.L.C.I42A)? Yi s No B)SF YES,PLEASE PROVIDE TEM NAME OF THE APPLICANT AND NAME OF THE BUSINESS(0 DIFFERENT)AND REGISTRATION NUMBER: APYWCANTISUSI!`1ES3 NAME: REGMTRATWN NUMBER: r' 9.A)ARE YOU CURRENTLY OR SAYE YOU DEVIOUSLY MEN EMPI OYED BY A RZG1SML%XT OR APPLICANT FOR RE TION AGAINST WHICH DI30PLINARY ACTION WAS TAKEN BY THIS DEPARTMORT9' YES ' NO DO NOT'KHOW B)IF YES,PLEASE PROVIDE THE NAME OF THE INDIVIDUAL AND BUSINESS(IF DIFFERENT)AND REGISTRATION NUMBER: APPOCART/AUSINESS NAME: REGISTRATION NUMBEW . 10.PLEASE PROVIDE TAX NAM[,SOCIAI.SECURITY NUMBER,AND TITLE OF THE WDIVIDIIAL(I THE CURRENT BUSINESS THAT I3 RESPONSIBLE FOR THE O VERSIGRT OF HOME IMPROVEMENT CONTRACTS: LAST FIRST SOCIAL SECURITY# TITLE 11.96ES THE APPLICANT OR RESPONSIBLE V4MVIDUAL SOLD ANY OTRU CONSTRUCTMNREIATED ST ATE,CITY OR TOWN LA:ENSES OR REGISTRATIONS'. YES NO if YES,PLEASE FILL IN INFORMATION BELOW.ATTACH ADDITIONAL SHEET'S IF NECESSARY.. LICENSE TYPE ISSUED BY LICENSE/BEG.# -EXPIRATION DATE LICENSE HOLDER NAME x 12. LIST ALL PARTNERS,TRUSTEES,OFTICERS,DIREETORS,,AND-MAJOR OWNERS(16%OR GREATER OF OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR CORPORATION,BELOW.USE ADDITIONAL PAPER IF NECESSARY AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS).PLEASE;INDICATE BY AN"X"IN THE LAST COLUMN THOSE(NDIVLDUALS WRO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D.CARDS. USE ADDITIONAL SHEETS IF NECESSARY. FULL NAME TITLE %OWN ADDRESS { 37277!M343D2-N mo Mm i ti 7 mm I z - -�i[n I t .Lj)Uf� rtt+ aR 7,. t n.. S f j 4i.w '!CJa f} 'ty 'a )'3 t f do>1•' 8 7ST s ttt rt Ob 4 f I 3,3 A ➢7St-!t IE t Al i M7 7 �n +c�k Asa�t a + #. -➢ _. �a+ �4 b S�(?f� t ) �➢ t 9v t .tti c t .f➢tt m -•,0� � .. ��t:ros.r1c41 ra t +. Di '51 M3 s)a u,oa7;.,f➢r�Cia„x&.i*sq),anic��+f t). ;€:'�43 "t n 1um JJ 1{ t kAC LO Ci!E '- ”, tl ❑ 'uiopa 3 '} t t G L€t "J lljd,,N ru , j#iaaf �sa._i�1t� �• lai � f �„? �'1Z I ❑ 0M l� m Z� O € ><)>: Cr3 I Cl 0 i —] ®Z. 0-3 _ i Cp �,< Ln . IN, O ono! ®. I 0 o® O 0 A� AM o -� 1 W i nc: v0 :D=W Ci)m " li i r•w e om m m D Q-t g4'ro T, 27 r D` ynr Z Cn N -Z bQ3� y MG) o M-c !°r' x00 C) m' z! tea., WC m`°aa 0S'3i �m t -f� P t; c� mm rz� Zm a 33 m mo ° �m ` t ,�i 1 tSJr .➢� kf 1 7"r d. m2 D(A r< _ m ory m co M6 n { t{)k {, E t {fit J A4)WA,'3 3:3' A.3NOO t' "t E."'.OifiN M d W 4!!U. r . -4r- ` Now �r f f , �t q .1 b W �e � ` y ��`,�-�� ./Z� v"""im (/a�°°t.-4-/" �i "°� .g.l��Q f I � r s � r rI v r -- � t .� 3 if e2 3 , a-� A-,� �� A 1-3 41/6 , Ot, '0 G �-- r A� W-41 klz (nflJ(y w a', 4 L + s &�T-„e./ v ` Vim' (•!// iG/�'�/''Y/t+�-� y c 41-�—4 IJ G� 71 �� r Dn Handyman Services as ati C�-Q AIII of - C AL David H. Westcott 2 Allen Coit Rd. Huntington, MA 01.050 (413) 667-5546 cell: (413) 575-3449 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office bf Investig,ations 600 Washington Street .1 Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2,0 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. F-1 We are a corporation and its 10.F-1 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ 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 c Tr comp.insurance required.] L, *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. *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. 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. 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 S 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 zei�fy un a ins and enalties of p jury that the information provided above is true and correct. Signature: Date: Z �� Phone#: �✓� S 7 S (7 O ficial use only. Do not write in this area,to be completed by city or town official Citv 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: f Not Applicable ❑ Name of License Holder: ��Y + e/u�S�C C License Number Cs q7� �2 Address Expiration Date Si ature Tel oneJ ,, 9.Registered Home Improvement' or%tracior . �-, . �. _-�. ,. _ . .j Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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...... ❑ 1`1. - Home;©wrier kgemptio> 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,voa may be liable for person(s) you hire to perform work for you under this permit. The undersisned "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 Irk SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [[J] Decks (C] Siding(O] Other(O] Brief Description of Proposed (1 /��y l Work: �' (,LI.)1 � � ' =-C.(.• �('(- CL''�F�, (` ,V tX�l�— �4, Alteration of existing bedroom Yes >< No Adding new bedroom Yes %X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house arid-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. 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 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 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)I and penalties of erjury. a>av 1 d l4 Print me Signature of Own gent tate 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 LotSize _ _,._ .__._. ., _.... „. .__.._.__ _..._,.. Frontage Setbacks Front " _..._. Side L: ----- R:'---' L Rear Building Height Bldg. Square Footage % Open Space Footage ° _ __ -- -- (Lot area minus bldg&paved parking) #of Parking Spaces Fill: . e.,_....__ ...._-... _..._.. (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 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 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. �'` Ile artntept use or>y Y� �- City of Northampton status of Prnirtz p ���� ��` ',',wilding Department . Gust* ;utfD e"y Pemirt 212 Main Street S6Wdt/SepttcA aria Fhty p r" N Room 100Fa#eet/eN Auaifab►1it x5 ryn� o mpton, MA 01060 Tv ciSets ntS#r11durar "lans �^ ,y h me�4�13-58 1240 Fax 413-587-1272 PIotl tte Plans � �„ Other Specify '*APPLICATION TG-Cfl)45TRU—Cf,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEOT10O " -SITE INFORMATION This section to be completed by office 1.1 Property Address: Nv L Map Lot Unit Zone Overlay District �.�..p•'�.-k.��..e'.� �' ( �l � Z Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Cytrent M *ling Address: elepho Signature J 1 2.2 Authorized Agent: „ _�� V r r� / / ��:J���� ,-ys G•�. �f 112 L lei Nam,I(Print) Current Mailing Address: j Signature `Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �/ , �- o F`) (a)Building Permit Fee 7"� ��s 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =0 +2+3+4+5) Check Number A5 6 This Section For Official Use Only Date Building Permit Number: Issued: Signature: 2 ll DY Building Commissioner/Inspector of Buildings Date T3 IZAct E tf�- PERnn I 1 -1 l A 4-611)ltt- 1 [',6L4_E0 C©�NI RAC762 D ISCgS SE R Dot-pd PAC, f-169 ll(ZE <AiI,f BP-2009-0599 GIS#: COMMONWEALTH OF MASSACHUSETTS 36 OX 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-2009-0599 Project# JS-2009-000862 Est. Cost: $40250.00 Fee:$241.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DAVID H W ESTCOTT 97872 Lot Size(sq.1): 384199.20 Owner: HASHIMI MIR HABIBULLAH GOL M HASHIMI Zoning: SRSIOOZ/WP/WSP II Applicant: DAVID H WESTCOTT AT. 934 BURTS PIT RD Applicant Address: Phone: Insurance: 2 ALLEN COIT RD (4 13) 575-3449 HUNTINGTONMA01 050-9770 ISSUED ON:1211112008 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR REAR PORCH & CONVERT TO 4 SEASON ROOM 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 12/11/2008 0:00:00 $241.001504 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo € �� x•33 °v, 4X �t tZ Xx r ' ,3 � .�" *w� a�i '. - � as ?� ems. � E° ,�:�. r>• e � :,^ �,',,. ¢... r� r z < .r fi 3 a ? € A �. s ni+ Ail _ s a r . 934 BURTS PIT RD BP-2009-0599 #s COMMONWEALTH OF MASSACHUSETTS Ma0lock:36-070 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category._ BUILDIAN.G PERMIT Permit# PB 2009-0599 Proiect# JS-2009-000$62 Est.Cost• $40230.00 Fee:$241.40, PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: Use Groan; DAVID H WESTCOTT 97872 Lot Size!%ft.): 384199.20 Owner: HA.SHIMI MIR HABMULLA—H GOL M HASHIMI t- zoning: SR(l00)/A'VP/WSP 11 . .gblicant: DAVID H WESTCOTT Aflrrli ant Address T: q 3 y Butt P j{" W hone: Insurance: 2 ALLEN COIT RO (413) 575-3449 HUNTINGTONMA01050-9770 MEDED O_N•1211Y/2UQ8 0,00.UU TO PERFORM THE FOLLOWING WORK.-REPAIR REAR PORCH & CONVERT TO 4 SEASON ROOM PO 'T THIS QAU SO; T IS VISIBLE FROM THE §TREET 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; Gus: Fire ftartniient Fireplace/Chimney: Rough: nil; Insulation: Final. Smoke: Final: OK fi - $''4 Q THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU TIONS. rt' to of Occu a nat re: : .. . . • : D to Pz+�d A r -F. •• ` i4smy.: Building 12/11/2408 0:00;00 $241,001504 212 Main Street,Phone(413)387-1240,Fax:(413)587-1272, Building Commissioner-Anthony Patillo M.-