25C-001 (7) DEC-26-2555 55 '56 PM STAN 4136159986 P_ Gii
WORK PERFORMED AT
410
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DAT OUR WORK ORD NO. OUR BID NO.
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All Material Is guaranteed to be as specified, and the above work was performed In accordance with the drawings and spectficatif
provided for the above work,and was completed in a substantial workmanlike manner for the agreed sum of
This Ia a 0 Partial 0 Full Invoice due and payable by:
Month Day Year
In accordance with our 0 Agreement 0 Proposal No, Dow
Month Day Yew
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 149010
Expiration: 11115/2007
Type: Individual
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STAN GUILLEMETTE
STANLEY GUILLEMETTE "
1023 HAWLEY RD. -"
ASHFIELD,MA 01330 Administrator
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DEPARTMENT OF BUILDITjG INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building >o
Northampton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supc.-.-iSor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or-two ami y
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 bull rng 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 fegulations. 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 buildine 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
L understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building perriiii
- - issued-to me
Date
Address of work
location
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o��itl.7•!ADO f.. / "i''c-\
R E (rI ff Of Tcri[JR11143foil
£ _51;oakrhasrtle' °_
d DEPARTMEIJT OP BUILDD�G INSPECTION'S
212 Train Strcct Municipal Building
Northampton, Mass. 01060
.I - -.... .... WORICERIS CONITENSA770.N LNS'V LU iNl-E AF=A,%,TJ.
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(1�c>rnsxJperm�ttcc)
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%frith a prtricipal place of businesslresidencc at: - -
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(szr VcirJlsa.tcdap)
I do hereby certifjr, under chc.pain.s and penalties of perjury, ihai
j ( } I am an employer providing die follo.ving!, orkcr's coinnensado, coverage for im
emplovecs woriong on tills job:
(Las -_nc Corer ) (Polic-:Ntlxnbcr) _ ( :pirdoR D2i^)
( ) I am a sole proprietor, general contractor or homeowner (CL' cie one) and have hired
i the contractors used below wbo hzve the folloiviog worker's comoen–tzdon po>_icies:
i
Of COn- IMCiO"1 (IRR!I3ncc Compan)YhoUc (F�:T)Induon D'itc)
(N2mc of Counzmor) (In_7aMC~ aM0an'YI?0UM' NutMC_r) (Lxpimuon Dait)
(Name of Cotlaaczo,) 0muranC~ CompanyfPoUcy Namb:_r) (Empirae0 Date)
(Tame of Cootraaor) (L=ran� Compavy/Policy Numbs) (Exp boa Dau).
(acid, -661 oc=J 6cc.ircoo= -y to cc?v�v iaform,�oo patasass to.11 cocrcorz)
I am 'a sole-proprietor and have no one working for me-
( ) I am..a home owner performing all the work myself
J NOTE:pl=sz tx cayrt tfi,• .!v}e hem o,= x to employ p=Iacz so d� cs.: oo cr r.paa..ork oa.d••<U of
1 wort th s t Esc r,,in u'seh the bomoovwc nida c oa the pv�ad,zpputten:z�the Li ox C=�.rny c,. _c—oJ to tic
jeitploy� the v v i c=p -,o.qn(GUI 52.=1(5)�._pptiaaoo by a boaeoavo fc_be. or P ma o_-Y16-1"the
Ilc-�.I c1`1u of ea en,toyer under tlso Worfvcl�C-oacpom._tioa Act
I uadcaaad>h-a oopy of tbi.rat_-=_y be forgeed to tbo Dcgnrtmm¢of Ir�+ss��I Acod�� Om—orlt�—for Lb.
! cov,�'gc v=ire27ico cad atz'Lihae to tow- c lorcz,--c uaSC=x oa 23A ar).tUL 152 cna Irk to tb.=Position of eimical pcc.W=
ooaiisi�of a&oc of up to s 1}00.00 araVor ra or up to ooc r._.tad ci,•if pcmrio io d,,form of a Stop Wort Orc1-. and
ru>r of 5100.00 d_y LPimt mI_-
rt
For E—L]
! r ?< Permit 1lttmt>es
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Si�nat—of LirsGJperrrtitt e J
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SECTION 8-CONSTRUCTION SERVICES f
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
It—IS--D 7
Address Expiration Date
Signature Telephone
is errnelm resye ec�toi�tra"coo Not Applicable ❑
Company Name Registration um er
Address Expiration Date
e- Q ri t 3 3 U Telephone y/3 4 2 S-
SECTION 10-WORKERS'COMPENSATIOMNSURANCE AFFIDAVIT(M.G.L.c:1'52,§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...... ❑
ififfiffieP MM"
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-n Death)of the Massach::settw 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 applicable)
New House ❑ Addition ❑.; Replacement Windows Alteration(s) Q Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [p Siding [0] Other[O]
ief Descption of Proposed
ork: ��l�iG�e w1N�a�r�s
Alteration of existing bedroom Yes No Adding new bedroom Yes No -
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa:f�New°housean >`��tl�i�n#a�ez mc��iorising�:comg e'tewttie� Inuri�na:
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
Masscheck Energy Compliance form attached?
g. Energy Conservation Compliance.
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
OWNERSAGENT.OR"CONTRACTOR`APPLIES FOItBUILDtkf ,,PERMIT-,
l 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 and penalties of perjury.
;;Print me
z- 72-nature of Owner/Agent Date
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Section 4. ZONING Al I Informati6h 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 u| Perm it/Vuhunca/Findi ever been �suodfor/on the she?
N°' 0 DON7KNOVV *~~\ YES 0 �
IF YES, date issued:';
IF YES: Was the permit recorded at the Registry ofDeeds?
NO �~��
� uu." / m"v"" 0 .^"
IF YES: enter Book Page, and/or Document#!
B. Does the site contain u brook, body uf water orwetlands? NO «�� DON7KNOVV �_� YES
IF YES' has permit been or need to be obtained from the Conservation Commission?
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Needs mobmobtaimed v�� �6tmined �~� Date
^�~� �.� ' .
C. Do any signs exist on the proporty �� ��� YES �^� 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 0
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IF YES, describe size, type and location:
E. Will the construction activity disturb grading,excavation,or filling)over 1 acre orisd part ofo common plan
that will disturb over 1acre? YES r NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
, $W Department usen1y; M y=
City of Northampton
Building Department ��
212 Main Street e : tll A �zwti t �
Room 100
_^ Northampton; MA 01060 .
phone 413-587-1240 Fax 413-587-1272
Ow . �
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: n to be cotnpteted by office
This sectto
AG/^ l f 5T!^e cT ap Lot, w: .. UnEt
OverlaraDistract
Elm St<District ._ GBiDistflct_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
sue! G /l G,i e 77-e-
Namee(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 (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=0 +2+3+4+5) -tom Check.Number
This Section For Official Use Only"
. Date,
Building Permit Number. Issued:
Signature: ✓`�� y����,.e:-�eGz�
Building Commissioner/Inspector of Buildings Date
108 NORTH ST
BP-2006-0682
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU:Block:25C-001 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: windows replaced BUILDING PERMIT
Permit# BP-2006-0682
Project# JS-2006-1011
Est.Cost: $15000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STANLEY GUILLEMETTE 149010
Lot Size(sq. ft.): 33628.32 Owner: BARNETT PAUL C&MARJORIE CHAL
Zoning.URC Applicant: STANLEY GUILLEMETTE
AT. 108 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 562
ASHFIELDMA01330 ISSUED ON:1212212005 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
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 12/22/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo