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17C-125 69 NORTH MAPLE ST EP-2008-0167 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 17C Lot: 125 ELECTRICAL PERMIT Permit: Electrical Category: WIRE BASEMENT BATH Permit# Electrical P IS ON IS REB G NTED TO: Project# JS-2008-0002 Est. Cost: Contract o : tcen e• Fee: 55.00 Timoth R ck tt Jou yman 38451 J Owne . P SAL AMY Ap cant: Timothy ockett 69 NORTH MA LE ST Applicant Address Phone Insurance 7 UPLAND RD (413) 584-7560 () , LEEDS MA01053 ISSUED ON:8 12412007 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE BASEMENT BATH Call In Date: Date Requested Inspection Date/SignOff: Reinspect?: Trench/UG: Special Instructions X Rou h 0r2A if "/2L w Si Zd A M X Special Instructions• Final: SRE Called In: Signature: Fee Tvpe•• Amount: DatePaid Electrical 55 0 8/2412007 0:00:00 121 212 Main Street,Phone(413) 587-1244, Fax(413)587-1272-Inspector of Wires -George Fournier (,,� , /�� �J 7 �' � ` 11CJ" f � � ` - CHECK A,fO � 0 AMOUNT J r I S S UNIFORM APPLICATION FOR PERMIT TO CO PLUMBING Mass. Date /3 �22 Permit _ Budding Location owner's Namelgn�Z jPCh If SAU Type of Occupancy r?,--3 V New © Renovation Replacement C1 Plans Submitted: Yes El No FIXTURES _ ra z , m a z u &U 4 N Z 2 N y - S S - C d < z ¢ m to U1 r O 2- _ C 0 eu ti x ui ! of O m p .� uJI Q N Q SUS-85 T. W 0 sAStsK12- _ f r koIST FL oR 2N D $ oOR 3RO F OOR 4TH F OOR 5TH FL 6TH FLOOR TTH FLOOR 8TH-FLOOR:ii � Installing Company Name 4 ��E' �r 1� i�f��C�2 t�t C_C-� � Check one: Certificate Address 1�'1a 1 cl 11 i-An 'A le S�L21_�- © corporation Mnf ZIP ❑ Partnership Business Teleph . t _"I 1-5o 'Fg FimVCo.. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy Or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No Q If you have ecked rtes. please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. - Check one: Owner ❑ -Agent❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted for entered)in above application are true and accurate to the best of my knowledW ant ttft-ataft plumWng erotic #hcs-+,fication will°be in compliance with all pertinent provisions.ot the Massachusetts State P Cade and.Chapter 142 of flea General Signature of Ticensf3d Plumber Title Type of License;Master' Journeyman City/Town t APOROVEB(OFFICE USE ONLY) license Number PAiNTeSHOP i t. I C2� i loy I ool 3 S I 1 I I I I I ' i � � � ', i i i i ! ; {y, �" " �f�.,! 1 .._ � ....j. �:ewa�w+.s�nw j � � i � � � _.._ . �� �,-�{� ��r5 S rr� ��__��� _�___ __ -��w��--- - - - _ _ .v _ � - � � � � � ', I I �, I f � i �� �' J '' i �; �I � r�� � � , ; ! '"' A �ta ,� i j � � �� � 1 � j { v �� I�� �. ,�,✓'A t ! �}, i r � ; � i�, i r �S + � � �' �' -- -----_ w O O �$ Lz#y of �1'rrz�l��nz��zrn z DEPARTMENT OF BUILDI.G INSPECTIONS INSPECTOR 212 Main Street • Municipal Building 4 Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup : :7Sor. T he 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 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 occupanev 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 of Investigations 600 Washington Street Boston,MA 02111 5.1 www.mass aov/dia `Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/7ndividual): Address: City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. Fj I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no ey^toyees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp,insurance comp. insurance.1 required.] 5. F-I We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L 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.❑ Other comp.insurance required] 'f�iy applican a c ec ox must a o out a section a ow 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature- d--'"' ,Date: � O Phone#: vfficiai use oniy. 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 Applicable ❑ Name of License Holder: y/-J k C) 013 >1111 License Number Address Expiration Da Signature Telephone yZ - c�/ 66 9v.R eyed Florae Ini rovemerit.Corrfractor M W qtr ... -) Not Applicable ❑ Company Name Registration Number e-"J&Zo Z Address Expirafion Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE,AFF1DAVIT(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 k_: ©m nerx ry M� >ii 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 v 1y SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [� Addition [7 Replacement Windows Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[C1] Other[0] Brief Description of Proposed Work: /4l ff 1:�4 J"e Alteration of existing bedroom Yes No Adding-new-bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa_[f.IVenrhoitse and or adc[Ition to exslna=[odsin 'rtcap[eteheo[tav [�ta: 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 stones? 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 o. s cons ru io wi in 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 as Owner of the subject property hereby authorize to act on my behalf,in al afters relative to authorized by this building permit application. Signature of OwneV Date 0 0 Q 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 Signature of ne gent Date * ~ Section 4. ZONING7 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 % #of Parking Spaces (volume&Location) A Has a Special Permit/Variance/F for/on the site? NO ~~� ~... . ....., ~~� .E~ —_—_-__ IF YES, date bsua IF YES: Was the permit recorded at the Registry of Deeds? NO [ } DON7KNOW 0 YES IF YES: enter Book Page, and/or Document#; �� �� B. Does the site contain a brook, body u[water urwetlands? NO ����� DONTKNOVV t_� YES �~� IF YES, has u permit been ur need to be obtained from the Conservation Commission? Needs tobe obtained v~~\ Obtained «�� Date Issued: �~� �~� . � C. Do any signs exist on the pnopert �� ��y? YES «�� NO �_� /F 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 IF YES, describe size, type and location: / E. Will the construction activity disturb grading,excavation,nr filling)over 1 acre oris it part ofo common plan that will disturb over 1acre? YESy��) NO ���) |F YES,then a Northampton Storm Water Management Permit from the DPW iarequired. F ' E7epar€rne �rse o � _ ',Qty of Northampton = tatus of Pennr '` t -Building Department Crsrlx �rillDnve�;,avefe� Y .- 212 Main Street r - Sewer/Sept�c�Ava"tla6 .,Room 100 Northampton, MA 01060 .Fvvc�Se�s�fStrucfura�PJans� � 77� x y pHo ne 413-5$7-1240 Fax 413-587-1272 Plat7sEte Plans �, sJther Speedy MOW:- APPkICATION`Tp CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This seetioa to 6e completed;hyoffie� Lflt Etrttt torte _ Overlay Drstcict ElnSt District -. ! '_:: CB D�si�rrct °' SECTION 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT` 2.1 Owner of Record: Nam- a(Print) Current Mailin dress: Signature Telephone 2.2 Authorized Agent: cleaF Name(Print) Current Mailing Address: zoc. r, ' 0- ye-3 .S'z7- o e, c,a Signature Telephone SECTION MATED'CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building G(9 G, e,�-ca (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) 7 �C✓. p Check Number %j D This Section for Official Use Only Building Permit Number.: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-0313 APPLICANT/CONTACT PERSON LOUIS MONTGOMERY ADDRESS/PHONE PO BOX 951 WILLIAMSBURG (413)522-0160 Q PROPERTY LOCATION 69 NORTH MAPLE ST MAP 17C PARCEL 125 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSE REQUIRED DATE ZONING FORM FILLED OUT A 14 Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction:_RENOVATE EXISTING BASEMENT BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013471 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9XMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site 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 Co sion 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. BP-2008-0313 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-2008-0313 Project# JS-2008-000262 Est. Cost: $3750.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOUIS MONTGOMERY 013471 Lot Size(sq. ft.): 9888.12 Owner: PEARSALL AMY Zoning: URB Applicant: LOUIS MONTGOMERY AT. 69 NORTH MAPLE ST Applicant Address: Phone: Insurance: PO BOX 951 (413) 522-0160 () W I LLIAMSBU RGMA01096 ISSUED ON.912612007 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE EXISTING BASEMENT BATHROOM 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 9/26/2007 0:00:00 $100.00636 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo