25C-171 Complete shalt, l= te, i c� Rt,abher Roofing Systems and
Repairs, Sidin(y
Customer: t
Richard Parker }
40 Orchard St.
Northampton, MA 01060
586-0217,
Work to be done:
Rear upper left valley section of roof, both sides of valley, and,flat porch roof beneath
above stated section:
Remove one layer of existing roofing material.
Re-roof with Tamko 30-year designer roofing shingles, color to match previously
shingled sections.
10 year guaranty on labor, 30-year Manufacturer's Warranty on material.
.Dick— This is a quote far the rest of the left side. We are currently scheduling for early
May. Any questions,feel free to call or e-mail. Todd
Taal Cost $ x#,115
(Labor and materii ) r
Deposit required of: 2,000 Homeowner: _ ;
Balance upon Completion: $ 2,115 Contractor:
(Sign and return one copy with required deposit) r'
�KtiMpT �r r , '
� � �i'ilessachasetts
DEPPaTMENT OF BUILDDdG INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building '>a
Northampton,MA 01060 ,~ 5
r
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., 3or. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a oine or t►vo fan-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 boil Ing department for the City of Nc rthampton wants any persorr(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 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
Dates
Address of work
location
r
4111:P toil
o DEPARTMEI,7 OP DUILDD\10 INSPECT rOl"S
212 Main Strcet Building
Northampton, Mass- 01060
W0FJ:CER'S CONOENSATIO.N 0'�SURACF A1', Ati IT
(lic�usxJpermitt�)
principal place of businessfresidencc zt: —
'�
(stst^.t1c�rr ts-ta.tcf�p)
do hereby cera.f--, under dic.p?IrIS and penalties of perjury, hat
( ) I am an employer providing Lie followin ''�:orl cr's coinocasa�o coverv�e for iii),empl(DyczrS «V0630g on this job:
(Polio:i:��r) — piruor. DzL}
i ( ) I am a sole proprietor, general coniraaor or iotneow�er (cc:e one) aid hzve hired
l the coatractors list°d below wbo have the 50DO Mg workers c0mpen—�a6on pokiest
i
i
0";amc Oi Contnaorl (IRS 3ttt COIIlDIS]}"fPGIJCi }�i1 =< ) �'•�IFdRO l�llC)
-
(Namc of Councior) (irsatanc:. CompazyiPoUn, Numc_r) (E%pp m:ion Date)
I -
(Name of COa=czo:) (LaS rarlC` Compa.n)-/Pot;c- Naseb:.r) (xpira6oa Datc)
i
(Namc of Contractor) (Illsuranc-- Comcan-y/Policy Numbs) tExpi-,ion Daic).
(aC�C 1 d<�i�oc l cScC.itna _ La iafor=L ioo is.tl
( I am a sole proprietor and have no one wortr ng for me.
( ) I am.,a home owner performing all the work myself.
NOTE:pl==be cw-am th,w-; ,tc cx:Ploy pczoci w C�o c rcpa-ir WCrx oa c d%"-LL--t of
i orx Moto Ih---tf�ve tmti in%=�ch the bomoown rcmida oc oo the pvsnc4 =the%s z-ox C—_+r!}y ce��d—ni w be
eirployc-i" the---r--- An(GLh 52=1(5)),r-ppiin-6w by.bommaa=fc c b ---«peat:==7�the
1,91 r-^„of=e=Ployw undo duo WorScdc Compom+.tioa Arm
I—6—Lad tha a Dopy of thi. m.y b. D<p.rtsyat of In�svi<1 Aeod sn'off°°of Zn�r•°°°far the
eoversc vcrTicztioo and ilia LL -c to Lc=re tov=m.Cc undo 3-�oa 15 A of MOL 152 naa lc d to the iaxamoa of eiminsl pen+>rie
oo=i:xi�of a fiat of up to s i}oo-oo utdfoc i�izo® of up to Doc y-=-caI cvit pc j=is dx form of A Slap W orb O da•nd• _
firi 0(5100.00 i d_y cpiaii�
jFor dq.rtc.�u,c mJy
Pcrmtl Numb---
Si otLtc�scJPcaniuc:. e -- -�
R
y..
1
SECTION 8-CONSTRUCTION SERVICES f ?
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Realsfe�redopme/ iirovetr/e�n Coitractt�r'r `� -F..• Not Applicable ❑
Corn a v Name
Re gi tration um er
Address , 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......
3m ► er c
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
r
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑,, Replacement Windows Alterations) Roofing
Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[[--3] Other[M
Brief Description of Proposedr�_
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa .If I�TeviF k>louse an—m2i li#iat� o exult c islnu Comp fet a fottnuuirri is
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.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION=T0 BECOMPLETED'WHEN
OWNERS AGENT.OR'CONTRACTOR APPLIES FOR BUILDING'PERMIT
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
as Own uthorizedd�
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best��Caewfcd"ge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Sign re of t Date
� .
*
Section 4. ZONING All Informatj6h 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 7-1
'
#of Parking Spaces
(volurne&Location)
A. Has u| Perm it/Vuronce/Rndi ever been i�uedfor/on the sha?
' x�� �~� �
N0 �� DON'T KNOW Y� ��
IF YES, date issued: `
IF YES: Was the permit recorded at the Registry of Deeds?
NO K % DONTKNOVV 0 YES
IF YES: enter Bonk Pug and/or Document#
�� ��
B. Does the site contain u brook, body of water orwetlands? NO ��� OONTKNOVV �_� YES \_�
—�~
IF YES, has permit been or need tobe obtained from the Conservation Commission?
^
Needs tobmmbto[ood 0btaimmd �~� �ate �osamd�'
k_� '
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and |unodon:
D' Are-there any proposed changes toor additions of signs intended fo h ��7 YES NO
`
IF YES, describe size, type and location:
E. Will the construction activity disturb grading,excavation,or filling)over 1 acre orisd part ofa common plan
��wW|din��mm,1 �e? YES / NO ��T
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
•
Department.use only
City of Nortf ampton S�h Pe x
Building Department. , _ Ga�fb Cttt@fty_ y"�Permit".�
212 Main Street
Room 1.00
N6rthampton; MA 010T'�
phone l 3-= 87-1240 Fax 41�.-587-1`272 µ c
APPLICATION TO CONSTRUCT,ALTER,REPAIR,',RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
qzx-ff jo fills Js�t Untt
7
Zarie Overlay Distnct
Elrn S> Dstuct CB Dis#nct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
K"�o �
Name(Print) Current Mailing Address:
Telephone
Signature
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 / / — (a)Building Permit Fee
2. Electrical y (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee 1
4. Mechanical(HVAC) eaA
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number 3 U
This Section For Official`Use Only'
Date
Building Permit Number Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-1110
APPLICANT/CONTACT PERSON TODD BOYNTON
ADDRESS/PHONE 83 SILVER ST GREENFIELD (413)772-8829
PROPERTY LOCATION 40 ORCHARD ST
MAP 25C PARCEL 171 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
L,13uilding Permit Filled out
twee Paid
T_ypeof Construction: Partial reroof
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building_Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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
�o &
ui
ignature of B ding 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.
40 CFIA "1 BP-2006-1110
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:a1_%gk:25C- 171.,„ CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1110
Project# JS-2006-1641
Est. Cost: $4115.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TODD BOYNTON
Lot Size(sq. ft.): 10062.36 Owner: PARKER RICHARD JOSEPH&GLORIA
Zoning: URB Applicant: TODD BOYNTON
AT. 40 ORCHARD ST
Applicant Address: Phone: Insurance:
83 SILVER ST (413) 772-8829
GREFNFIELDMA01301 ISSUED ON:411912006 0:00:00
TO PERFORM THE FOLLOWING WORK.-Partial reroof
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 4/19/2006 0:00:00 $25.003710
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo