17A-140 (8) WN4 f 10ME IMPROVEME NT Estimate
P,O. Box 329
Leeds, MA 0 1053 Date Estimate 4
Late
"281,2005 16
Fame Address—
al
Description Qty Rate Total
RFPLACF ROOF,INSTALL NEW WINDOW AND'TUB
SURROUND.DF'I AILS LIST BELOW,
1*F'M0VF'FXIS-��G ROOFTN'G(MIJLTI LAYER)
21RE'PLACE ALL FIASHINGS T10 SIDE WALL.S,ROOF
EDGT-S,CHIM`NT,'YS AND PLUMBING STACKS.
3:fNSTAI.L ICE AND WATER BARRIER TO At 1,EVE"S ANT)
VALLEY"S
4: DiSTALL I Sib.FELT PAPER TO FNTIRE R(W, )F AREA.
5'A 30yr-ASPHALT SHINGLF TO BE r,\TSf A1.1-ED WITH
CONTTNIJOUS ROOF VENT AT RIDGE.
6-1 VINYL IfOPPER.WINDOW TO BE INSTALLED fN 2nd
FLOOk BATI-I ABOVE NEW"R.IB SURROUNfiD.
TSIDEWALI..SHJNGLESTo BE REPLACED AS NECESSARY
AROUND DORMER AND BELOW NEW WINDOW.
8-TERMITFIT'S AND DUMP FT-ES'INCLUDED.
TOTALPROIECT COST INCLUDING AN ALLOWANCE OF
($.;,000.(X))FOR T`UB SURROUND.
A DEPOSIT OF S2000,00 DUE UPON SIGNING
S6000.00 DUE AT START$7000.00 DUE CT ONI JOB
COMPFTION
CUSTOM E R ly'()N'.
DATT,
Total
4'itSAMP�.
� � �lassacltnsetfs ^ '
VIZ
` DEPARTMENT OF BUILDDIZG INSPECTIONS /=
INSPECTOR 2212 Main Street • Municipal Building
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 has/her construction supf:,'s or. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be,a one or two famuly -
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 hour), a rou-zh 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.
Daze
Address of work
location
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R `f. �I(�I L7� �\Tarf L41 I 1 10 11
- _-
� A ' f 31a�ahrhntrtta• _ -°
o DEPART}tE 14 OP 13UILDr>\)G INSPECTION'S
212 Main Strcct Asunicipnl Building
jNorthampton, MASS. 01060
I -
!, «'OMCC;R'S CO\III'ENSATTON MSURA3rCE A II 1 A..VIT
z, S e --
i ccnsxlperm�ttcc)
%%,ILh a priflcipal place of bUSIDesSfresldeIICZ at:
C'l�rs ee f-� jl G d� nC-c -414, 63'CQ6: (.phone?) ,-�40Q—Wlt4 j
I (SUCt/C1 t}istat.crD p)
do hereby ccnif under die paLM and penalties of pcguty, :-hai
( ) I am an employer providing the followinp,workces cotnoc:ls-Zion cove 2gc Ior Illy
eluplovccs workang on tills job:
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(Insure Comp) (Policy Numbcr) (r:-pirztior,Dzir)
I •
( ) I am a sole proprietor, general contractor or homeowner(c cie one) and h2ve hired
the coouaCors listed below wbo have the following worker's cocoen_-adon policies:
(N+amc Of Co:?rMao') (1n urzncz Cornpaji),iPOUci NIL1IIlt-Cr) -- (-EtiJlruuon Datc)
(Name of Contractor) (Lasurancc Comoa-ativPoUm, Numcrr) Date)
(N.me of Con=do,-) Glasurane; Company-[PoUq- Nambe-r) (Expimaoa Datc)
I -
(Name of Contsactar) (insutan Comp
aay/Poticy Numbs) (Expiration Dais).
(ntlxb: i�ocsl�cct.ilnca=sa_�•w ascrut�iafortaaEoc Pctainiac to art cacm-cLn:2)
{ am a sole proprietor and have no one working for me.
( ) I am-a home owner performing aU the work myself.
NOTE:pl=y be we Ifi••aizDe bomco .D,�..•bo CCaplay pcioaa to do •:,-j,•••-• c,,rjoa Cr rgau •orz an c d-JI-i-Z of
i not moct th-- tbroe>mrj in we cb Utx bomoownc r=d=o<oa the Qvua z,�purteo_r1 the cn tc nx aca:dft�m k
czgrltjycs utc d the-=k-Cm cc=:p •*,oa Art(GUI 5L=1(5))� pptccatioa try a bomcoava far a 1 cTV or pc-m rr_y -i6—the
of as<-tPloyx under dto WoAr, -Co�a Act
I uodcn.od tba a oapy or tbi.mtcncm may be foc.-,t d tv ttw DcQartmco¢ roc tb.
eoverasc v+cr c=ioo and ttit L•Um to Leone'M%'c�tinder scciioo 25A of 1.101-151 tea Ind to the iarxuaioa cda minal Pc-bi°
ooasi isxg of a floc orup to 51-�OO.00 and/or es�Ciyo�of up to ooc yt3r end eiva pcoaltia a tk form ora Stop Work 0-i,--aid
fim of S 1 n0.t?0 a d y Lpi=t>x
For dp-na,='-�j u.c oily
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parrIItt NuIDbcr
ll f (!�J �5-- fit :
i crcniucc e
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SECTION 8-CONSTRUCTION SERVICES, f,:
8.1 Licensed Construction Supervisor: Not&7-74410 Applicable El
Name of License Holder: � i/�,w" N"en
License Numb r
t. C k �f rC�'+� cola / /916
Address Expiration Date
re Telephone
9t s om �mpiemea c14r Not Applicable ❑
j
Company Name Registration aum er ` --- -
�I cicz k �S m lc --iic . r1rt��.� /V//g Xps
Address Expirat' n Dat
Telephone `e' 7 --�4(41
SECTION 1'0-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...... ❑
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
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�^ Y
SECTION DDEESCRIPTION OF-PROPOSED WORK(check all applicable)
New House [] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding W Other[0]
Brief D cri ion of Pro _ed_ n � 7 y e- w ✓t,1d�+w, 14cr '"C"sid'
Work: � �F)E�T L✓� O �1t�fg�E'. f4C+i;
Alteration of existing bedroom Yes K No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes V No
Plans Attached Roll -Sheet
sa { 1Vev ogse n r �di ' o xlstlnc fiou`SlffW omaleteu#h o gnu: _
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
fl 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 OWNERAUTHORIZATION-TO_BE.COMPLETED;WHEN
OWNERS AGENT.OR CONTRAC7gR 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
C55c'r►?��'�l ,as Owner/Authorized
Agent hereby declare that the st ement 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 _
r4
Si of Own - Date
f �
Section 4. ZONING All Informatibh 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
Side L: R:' E L:' R.i
Rear
Building Height
Bldg.Square Footage F-7 % 7----1 —;
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces r----� i
t
Fill:
(volume&Location) '
A. Has a Special Perm it/Variance/Findin ver 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 0 DONT KNOW 0 YES
IF YES: enter Book Page; nd/or Document
B. Does the site contain a brook, body of water or wetlands? NO 8, �/ODON-r KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 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
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradinge ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES r NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
h
t-1City of Northampton t
building Department
212 Main Street
1 l Room 100
MG 1 5 2005 �'JS o hampton;'MA 01060
phon 413 87-1240 Fax 413-587-1272
IS
_ 'APPLIEt N&aG9142114UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE°INFORMATION
1.1 Property Address: Thrssection to be completed byoffice
F� h
(>✓"c-'lc e Ilk d r b `zone Overlay Olstnct
9
�Elnt S�Dlstnct' xt,u�,'�4- Y ":«n CB T115ytnCt._'"
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
c%esFnlfi S}.
Name(Print) Current M ' ng Ad
Telephone
3igriature
2.2 Authorized Acierit:
CS t ate �-wr�_ PO. P(K 9:5Lcl I_ef-t5 A4, U05-1
Name(Prin Current Mailing Address:
5 e Telephone
E'CTI 3 IMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
1. Building QUd {a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Constriction 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
Building Permit Number: -Date
_ . ' Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
215 CHESTNUT ST BP-2006-0167
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 140 CITY OF NORTHAMPTON
Lot: -001
Permit: BUiidim
Category: BUILDING PERMIT
Permit# BP-2006-0167
Project# JS-2006-0256
Est. Cost: $15000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JESSE MONTGOMERY 134274
Lot Size(sq. ft.): 23870.88 Owner: CARRELL JUDITH B
Zoning.URA Applicant. Jesse Montgomery
AT: 215 CHESTNUT ST
Applicant Address: Phone: Insurance:
P O BOX 329 (413) 585-8482 ()
LEEDSMA01053 ISSUED ON:8116105 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF, REPLACE WINDOWS &
SOME SIDING
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 Sienature:
FeeType: Date Paid: Amount:
Building 8/16/05 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo