Loading...
25C-068 (2) A �.i kx)��cx, O'V�" Y-4�11 /v csL`Ci(rta �cs�.� LA C�� ►S� 11 D(-V\- CA- (C awe el\- 0\,- O Lct� C 9 0') A a ►c ct/L-ec,'- o I� cd6 /L -tom eo v e s C62A-SA4 c o�tkl) re On thisa3 day of.�, 20-0 8 before me, the undersigned notary public, personally appeared 94'-s //.M SM (name of document Signer), proved to me through O issioy ., i� satisfactory evidence of identific-.a , v V���,BER�sc�I :'Y i o�. which were_HA-Ss D+P, ��crz.✓sE _ -Z :* ,m — to be the person whose name is signed * on the preceding or attached document j C'O0TgRY PV.\\ A G in my presence. CH 7 =E� b GEPa RTMENT OF BUILD)' G ENSPE=0INS INSP-CTCR 2i2 Main Street • Municipal Building -Northampton, MA 01060 HOME ACKCIN01WLEDGEMENT The State oflvMassachusetts allows the homeowner the right under 780CNM 108.3.4 to act as [.is/her construction sup..: :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 dweMmg, 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 buildin -department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as thew`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 back-Fill). sonotube holes (before oour). a rough buildine insnection(before work is concea led) insulation inspection (if required)and_afinal_bu�ginsnection. 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 occupancv until-the-work can-be-inspected_- Ifthe 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 T 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_ y Date Address of work location s The CommonxealrIz of AIassachus ,s — Department of Industrial A ccidents Ofi�ce of Investigations 600 9 ashingion Street Boston,U,4 02111 wxrw.massgov/dia Workers" Compensation Insurance ffida-v-rt: Builders/Contra etc)rs/Elertricians/Plumbers ADDlicant Information Please Print LeaibIv NaMe(Business/Organim on/Individual): �Y'1 S MAO M S 0 L\- Address: ?.5 7 .�t rsv► �cti e.�,P t-•e y N e O 1 O City/State/Zip: Phone-: -/3 > 41� - I 0 Z'7 Are you an employer?Check the appropriate box: Tvpe of project(required): 1_❑you am a employer with ?• ❑ I am a general contractor and I emplovees(fail and/or part-time) have hired the sub-contractors 6. ❑New construction T listed on the at*ached she 7. Remodeling girl a sole proprietor or partner- I ship and have no employees These sub-contractors have 8_ ❑Demolidon working for me m any capacity. employees and have workers' 9. ❑Buil- addition [No workers'comp:insmam-ce co=.insurance.`+ requited-] 5• ❑ we are a corporation and its LI ❑Ele�ical repairjaddimriom I am a homeowner doing all work officers have exercised their ❑Plumbing repairmyse>f [No workers'comp_ right of exemption per MGL ❑Roof repairs ir,tttrar,ce required.]t c. 152, §1(4),and we have no employees. [No workers' comp.insurance requimi] l ------'xny app ican caeria oox K nurse a:so rill out we s=on oeiow snowmg their workers'campeasaIIOa policy in2ormaiion. 'Homeowners who subrnit this affidavit mdicauk-z they are doing all work and:hen hire outside contractors must submit a new amdavit indicating such. 'Contractors that caeck this box must-attached an additional shed showing the name of the sub-contractors and state whether or not those entities have e-npIoyees. If the sib-conuactors have e:nplovers,they whist provide their workers'comp.policy numb . 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 worriers' compensation policy declaration page(shoving the policy number and expiration date). Failure to secure coverage as required lender Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ilne up to$11500.00 and/or one-year imprisonment as well as civil penalties in the form ofa 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 DLk for insurance coveta_e verMcation. I do hereby certify under epazns andpenalties ofperjury that the information provided above is true and correct 1 1 114 f/ot Phone=: L e only. Do not wrzte to this area, to be completed by city or town ofil-ciaL wn: _.-----P--er-mit/License M thority(circle one): f Health 2.Building Department 3. City/Town Clerk ?.Electrical Inspector 5.PIumbing Inspector Per Phone SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: I S 1 VIOINLS ply C rJ 84 J License Number 7-5- 7 2cl - Le tig2ce- _,etc, • 4Igl'o� Address 0105— Expirat�D to 10 Sig ure Telephone 9.Registered Home improvement Contractor: Not Applicable ❑ Company Name Registration Number l' 7� 19 /0 g Address Expira on Dat 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...... ❑ 11. - Home Owner Exemption 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 ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [tom] Other[O] Brief Description of Proposed ll t� / Work: (N5}all 5k (itCS +s INSco�i�+6�-�S�.c,2�rOC.� CIG C�y'2C�r ( Ft0(,.s S�ol+rt Alteration of existing bedroom Yes No Adding new bedroom Yes �_No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. If New house and 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 L &A r--AJJ a- , as Owner of the subject property hereby authorize rl I l/l6�lsb�- to a7 behalf, in all matters relative to work authorized by this building permit application. Si re wner Date ' 'ISvB 5 1 A S61— 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. -_ --V. r'15 b W S-6►^_ Print Name ) Signature O gent 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 I �._ Setbacks Front Side L: R: L::. R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved narking) - #ofParking Spaces - Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON7 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 19,11, DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 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 Sl- 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/ rive Perm 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability +„ w arthampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Ste Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Z / Dad Avg Map Lot Unit Zone Overlay District U 10�0 Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: CL.L-%r,el,. Meade Zfo Dga!� Ave, oyAkcLw�ptot, O)orao N e P' t CurrentS liq Addres� l Z r+ 3 J y► U Telephone " natur 2.2 Authorized Agent: Kris 7 ,,,UotAtc-GU c. 2G1 L.e.Vtzel 0, Name(Print) Current Mailing Address:J � 13 _ Sr 10 27 Sign ture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS - Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 2 (a)Building Permit Fee f 2. Electrical 000 (b)Estimated Total Cost of 1 Construction from- 6 3. Plumbing -- Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 0. Tutol- 0 1 ,' 3 5) QQQ ('hark Nnmhar This Section For Official Use Only Building Permit Number: ate r. Issued: Signature: Building Commissioner716spect6r ofBui ing(d Date File#BP-2008-0643 APPLICANT/CONTACT PERSON KRIS THOMSON ADDRESS/PHONE 257 MONTAGUE RD LEVERETT (413) 549-1027 Q PROPERTY LOCATION 26 DAY AVE MAP 25C PARCEL 068 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out lk Fee Paid _ Tpeof Construction: INSTALL SKYLITES INSULATION&SHEETROCK TO FINISH ATTICE AREA FOR STORAGE New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included• Owner/Statement or License 084152 3 sets of Plans/Plot Plan THE FO , .OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 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. ( `:. ; f BP-2008-0643 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 c.142A) Category: renovation BUILDING PERMIT Permit# BP-2008-0643 Project# JS-2008-000980 Est. Cost: $4000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: KRIS THOMSON 084152 Lot Size(sq. ft.): 8015.04 Owner: MEADE LAUREN Zoning: URB Applicant: KRIS THOMSON AT. 26 DAY AVE Applicant Address: Phone: Insurance: 257 MONTAGUE RD (413) 549-1027 O LEVERETTMA01054 ISSUED ON.112512008 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SKYLITES, INSULATION & SHEETROCK TO FINISH ATTICE AREA FOR STORAGE 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 1/25/2008 0:00:00 $50.00754 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 14M IIIIF53,1,15, v I 3 a a 1 - ' x M a t - - „ Er ` 4 t d` tt a M z^s roux "w r s "�` -., a w x s t x t 4 ;t •� Y t j.'m�•`Y ,�kt.+,5 Jr�wY f'"{ a3; h a ;� gyp- 3 t ' �$ � r 's i�y� + .t ✓. `�� x '� ' t xt`' �{�'"�rCrN.11 t• rew,^5 11 a� t '',,r ° :c �. - v a -^5.'t t `" p,• w r 3+ "�` �s; y tqY �t 1 '14 4 � r a r u ' 3 , r ixx a , `a` 4 'a6 t �t, [ "' , i 4 z� f r k 5 il .�.'{ gj il �3 ,cam r ,� a `- # ,.fit 2'S; ate' a z ° x ,*� x ' i sr 3 r �. '� ''ex. +i a.�e "`` 11 11 r.V g ;> - - x � a a ,�' w 'L e 'a t` c ., '�- ,t 7 i i��Z 1wT - <., w r ,�, "t- r tom' h; rut' s ss 1. x P xr, ' ° t, c; a yw 11 S ; "" ' a tr I a , . 'J s ,,� ,a w `f t �5 Pc# L- —, � � � y a' ° > t .t - 3 a. � W' { =s a � � y5 c L .a {b - tt 3 x , I- Ir � 'r 1 to I I 'k,' ,. 26 DAY AVE BP-2008=0643 GIS#: COMMONWEALTH OF MASSACHUSETTS Map Bloch:25C-Ors CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS permit: Buitdinci DO NOT HAVE ACCESS.TO THE GUARANTY FUND (MGL c.142A) Category:renovation ;l,J BUILDING PERMIT Permit# BP-2008-0643 Project# JS-2008-000980 Est,Cost. 4s UU0.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grogp KRIS THOMSON 084152 Lot t Size(sg. R.): 8015.04 ©weer: MEADS LAUREN Zoning URB Applicant: KRIS THOMSON AT. 26 DAY AVE _- - A riatt�gat Arch,&s& _ _;:�_. .---_ Phone: Insurance. 257 MONTAGUE RD (413) 549-1027 O LEVERETTMA01054 ISSUED ON.112512008 0.00:00 TO PERFORM THE FOLLOWING WORK INSTALL SKYLITES, INSULATION & SHEETROCK TO FINISH ATTICE:AREA FOR STORAGE 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: riveway Fin Ft#t:rt: Final.. ,e 76 Dg Rough Frame:&C _ y.d Gas: Fire Department Fireplace/Chimney: J Rough: Oil: Insulation:J/1 o2, I/PI Final: Smoke: Final: f41<(-4A —a9 O� THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULA NS Certificate of OccU anc "` Signature: FeeT.ype: Date aid: Amount: Building 1/25/2008 0:00:00 $50.007,54z,,, 21,2 Maize Street;;Pbone'(413)587-1240,Pax: (413)587-1272 Anthony Patillo Building Conunissioner-