The URL can be used to link to this page

25A-161 (2) Board of Building Re ulati�bris and Standards g g One Ashburton Place - Room 1301 {.. r Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 144334 Type: DBA Expiration: 9/24/2008 NEW HORIZONS ENVIROMENTAL PERMIT JOSEPH DUNN PO BOX 413 GOSHEN, MA 01032 Update Address and return card.Mark reason for changle. Address Renewal Employment Lost hard r-\ Board of Building Regulations and Standards License or registration valid for individul use only H7 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: E a Registration: 144334 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 9/24/2008 Boston,Ma.02108 Type: DBA NEW HORIZONS ENVIROMENTAL PERMITTING+L JOSEPH DUNN 92 SOUTH CHESTERFIELD RD (a�,...., GOSHEN, MA 01032 Deputy Administrator Not valid without signature :`lee 600�rcnmo~,aal 1 4",&va�t BOARD OF BUILD"REGULATIONS Licetne: CONSTRUCTION SUPERVISOR Number: CS 088718 Birfltdaa: 07128/1 965 Expkw:07/28!2008 Tr,no: 88718 _ Reuriet9ed: 00 JOSEPH G DUNN PO BOX 864 GOSHEN, MA 01032 Commissioner / O � � � jffiIassacltusetfs DEPARTMENT OF BUILDING INSPECTIONS /= INSPECTOR 212 Main Street m Muuicipil Building '>o�44 ,< 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 sup,,.,-.-'sor. The state defines "Homeowner" as, " ierson(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 � s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv 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-" I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ' hip and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' co insurance.$ 9. ❑Building addition [No workers' comp.insurance mP• required.] 5. ❑ 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.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.p Other ftj,.,tr 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. $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$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certiLL under the pains and penalties of perjury that the information provided above is true and correct Signature: -� Date: 0 Phone#: LAI Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ( Not �j/Applicable ❑ ( Name of License Holder: �JCSe�� `n ` ✓` (AA-71 License Number LAI tok Oiv32- 61b 1/0Y6� Address Expiratic6pate Signatur Telephone , Not Applicable licable 11 g"Redistereil'`Homelnpiovemerti Gontracor � -- G � (' H 3 3� Company Name Registration Number �Yh ) X21,,, 9 -2'1-0$ Address Expiration Date �°l�'��l!✓� �� I(� G�JL'Telephone � SECTION 10-'WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M.G.L.c.151,,§-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-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 buildine 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 Alterations) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [nj Decks [Q Siding[p] Other[d] Brief Description of Proposed ` 1,1 1" Work: i�Dlutt' Y�C yl, �rOWC) a1Vrr)3 ,54I?s 9'►h �f' Alteration of existing bedroom Yes_ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet sa :lf New,house;and.:or dcdfion#aexrstrnar rorlsrnu:-comptefe Chic oo 16Wfna: 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 L 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 QR CONTRACTOR APPLIES FOR BUILDING PERMIT I, A N f as Owner of the subject property hereby authorize )1C'511!V� ,v ti to act on my behalf,in ali matters reia ive to work authorized by this building permit application. U Signature of Owner Date -T 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 V>'�' I oV Signature of Owner/ ge 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 Perm it/Variunce/Fndi ever been issued for/on the site? NO �N� DONT�NOV YES 0 0 IF YES, data issued: IF YES: Was the permit recorded at the Registry nfDoads? NO �� D �_� u/x / mxuvv 0 ,cu IF YES: enter Book Pogo and/or Dooumenc#� B. Does the site contain obrook, body of water urwetlands? NO 0 DON 7KNOV 0 YES 0 IF YES, has o permit been or need to be obtained from the Conservation Commission? Needs tobmobtaioed �~� O��a�ned � �~� Dote |ssoed. «~°� �~/ . . C. Dn any signs exist nn the propert �� y? YES \�� NO �_� ' IF YES, describe size, type and |unuUon: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe d location: . r size, ocu�on: ' E. VVUthemonoUnotiononUvdydistur grading,excavation,or filling)over 1 acre nris it part ofo common plan that will disturb over 1acre? YEG ��] NO ��} IF YES,then a Northampton Storm Water Management,Permit from the DPW is required. - ! Department us'e oniy City of Northampton status of elm ' 4 Building Department C�Cunzrea� 212 Main Street user Room 100a dWeAyaa rli � � ' Northampton, MA 01060 phone 413-587=1240 Fax 413-587-1272 RIS arts apt APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION i This section�to he completed by office 1.1 Property Address: Maw Ldt Unit. Zane Ouerlay:Distract r EIm St Distract CB A�stFict �= SECTION 2-'PROPERTY OWN ERSHIPIAUTHORIZED AGENT" 2.1 Ow r of Record: . Name(Print) Current Mailin ddr Telephone Signature 2.2 Authorized Agent: J g �b of ou Name(Print) Current Mailing Address: $3-2,�-1 -3339 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, 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"; Date Building Permit Number Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-1108 APPLICANT/CONTACT PERSON JOSEPH DUNN ADDRESS/PHONE PO BOX 413 GOSHEN (413)268-3383 PROPERTY LOCATION 54 AY AVE MAP 25A PARCEL 161 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tpeof Construction: REPLACE WOOD STEPS New Construction Non Structural interior renovations Addition to Existing A�tructure Building Plans Included• Owner/Statement or License 088718 3 sets of Plans/Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: ed 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 lrom CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 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. r BP-2008-1108 GIS#: COMMONWEALTH OF MASSACHUSETTS - _ `- I CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CatejZory:Non structural interior renovations BUILDING PERMIT Permit# BP-2008-1108 Project# JS-2008-001635 Est. Cost: $700.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOSEPH DUNN 088718 Lot Size(sq. ft.): 7187.40 Owner: MURRAY ANDREA M Zoning.URB Applicant: JOSEPH DUNN AT. 54 DAY AVE Applicant Address: Phone: Insurance: PO BOX 413 (413) 268-3383 GOSHENMA01032 ISSUED ON:611212008 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE WOOD STEPS POST THIS CARD SO IT IS VISIBLE FROM THE ST_REET 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 6/12/2008 0:00:00 $25.001544 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 54 DAY AVE -2*008-1 108 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A- 161 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cat"ory:Non structural interior renovations BUILDING PERMIT Permit# BP-2008-1108 Project# JS-2008-001635 Est.Cost: $700.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: JOSEPH DUNN 088718 Lot Size(sg. ft.): 7187.40 Owner: MURRAY ANDREA M Zoning: URB Applicant: JOSEPH DUNN AT. 54 DAY AVE Applicant Address: _ ?'hone: hisn,ance: PO BOX 413 (413) 268-3383 GOSHENMA01032 ISSUED ON.617212008 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WOOD STEPS 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: .i:ac. . Qk !'J THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU IONS- Certificate of Occu an s; nature: ` '' FeeType: Date Paid: Amount: Building 6/12/2008 0:00:00 $25.001544 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo