17A-140 (9) JCM HOME IMPROVEMENT Estimate
P.O. Box 3219
Leeds, MA 01 05') Date Estimate#
1005 16
Name/Address
131AI
Prcied
Description Qty Rate Total
RFPI.ACE R(M,,INSTALL NEW WINDOW AND 11)I3
SURROUND DE'l AILS LISTED BELOW.
-'R)
i:R.F.M(.)V'E EXISTING ROOFING(MULTI LAYE
1REPLACU ALL FLASHTNGS'IT)SIDE WALL.S,R1 ('XJF
EDGFS,Cl1IMNT`.3 S AND T>L,tjNfRTNG STACKS.
3:INSTALL ICE AND WATER BARRIER TO AL 1,EVE"S ANT)
VALLEY"S
4: DiSTALL ]5ib.FEI,T PAPER TO IN'nRE R(W.)F AREA.
5:A 3f)y-r.ASI'ffALT SHINGLFTO BE TNISTA,11.ED WITH
CONTINUOUS ROOF VENT AT RID(-,E.
6.1 VINYL I-IOPPER WINDOW TO BE INSTALLED fN 2nd
FLOOR BATli ABOVE,NEW TUB SURROUND.
TSIDE WALL,SHINGLES TO HE REPLACED AS NECESSARY
AROI)ND DORMER AND BELOW NEW WINDOW,
8.PERMTTFEE'S AND DUMP rEES'INCLUDED,
TOTAL,PROJECT COSTINCLLTDTNG AN Al.LOWANCE OF 15. (A),i-x) 15'(x)0xK)
(SI,000,00)FOR T1.1B SURROUND,
A DEPOSIT OF S2000.00 DUE UPON SIGNING
$60(M.00 DCIF AT START$7000.00 DUF UPON JOB
COMPFTION
DAIT�,
(Li" STOMER Sj(jr ATURE
Total
r 4
,..Gz p of Narthampturn
� � �i asaaclt�isetfa
DEPARTMENT OF BUILDING INSPECTIONS /
f �
INSPECTOR '212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i:is/her construction supe.: :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 f ry-
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 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.
Date
Address of work
location
r
O _
(yii� f �rlrfljalli}�iolt
47 a itch ncclIs* _
o DEPARTMENT OP DUILDr>,,G INSPECTION'S
212 Main Strcet ' Municipal Building
Northampton, Ifass. 010GO
-- WORICER'S CONIEPENSA77ON MSURAI�CE AITD�:iVIT
with a principal place of businessfresidence at:
-
Qe,,� 106 phone-,') �
i
(st? tici ty/statcda P)
do hereby certify, under the pains and penalties of perJury, I11.I
( ) I am an employer providing the follo%vinL!%vorkcr's cotnocnsado, cove s.0 "or Iny
eluplovCcs Nvorlong on tilis job:
I
CL=su��c Comm-) (Policy Nu_ bcr) - (T;•pirtior,Dom t)
( ) I aat a sole proprietor, general contractor or homeoi�,-Der(c ciz one) amd have hired
the contractors listed below wbo hive- the following worker's asadon p I-es,
-
i
Of COnt^Cior) On--u dnc--- CoInpan)-pi o6Ci (Expir d 0n D.1IC)
(Name of Coo naor) (lnsaranc;. Comp_ an}vPo!.in, \umc^r) �»irGon Date)
(Name of COUMCt07) (iaauaacc Compan)-/Po(-q- N:rsber) (Expiraen Datc)
(Name of Contractor) (112suranc-- Comcaay/PoUcy Numb-zf) (Expiration Date).
(aIISC��::oca1>3c�,irnccci._-ti-to mc�u�iaformi7 oa pctaiaias to.L mcr-_c.o:�)
( I am a sole proprietor and have no one wor-Ling for me.
( } I am.a home owner perfor-r=g all the work myself.
NOTE:plr be zwzm Lfia_ ,t jc bocxx, -n.to ccc l
P oY P--Long w ctO -. c=--zc:j-m c ncpaa—oric on.d..clL= of
ant mote th a t17tr tmr�in«tw=h the bomoo..vcr rcaida or oa the ffouodx z�purtran tbeen L c ox C Dy oecaidnrrj to be
enploye�unc`.e the..-i a'a qa(GLI152-=I(5)},apptiaoon by a bomroa-Dcr fer a!ice_or pemil t=y cvidmoc the
ic-ga1 n=^•of ea cr�loyer coder dto Wocicalr CoosPom,yion AcL
I
- r uoda-na.nd t>za a Dopy of tb;a mt®m¢may be foco.nrd..d to the p�cmmd of ln�.ssicl Acidc��'Offioo or Ira�•nw for th.
OOvea sc•eiCatioa and th1 Liltac w soauc 1 ov���yf soq;�23 n of 1 fdL 152 no ied to the i=raoaIIiw of Qimin+i peoaltic
oo—iS.mg of a fine crup to S 1}oo.00 ar>drnc'm?nwemo of up to ooc yor=d civil pmahio is do roan of a Stop Work Ordc acid a
fim of S 100.00 a d_y apiasl tzx
i
i
For 6ep.rta+�"t u.e oril7 --------
J �+ Pcrmit Numbar
Map —_ Lot.
i CrrruU.CC e
SECTION 8-CONSTRUCTION$ERVICES t '
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: r � t `v's`'�C & -71410
License Numb r
Address Expiratio Date
C1 14
xlt
re Telephone
9 e` "ia's&r—e*� t,Tiw " e 'orr ractoi' ' Not Applicable ❑
� SSA /'2 , ►1 e^�
13119 7�/
Company Name Registration Rum— er
'�-�to CJcx k .� 'lin'�✓1 c� .!''Z,l Olt�lO.� �•���Q XpS`
Address Expirat' n Dat
Telephone` y�
SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAYIT(M.G L.c.`152,§r28C(fi))
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
i
SECTION 5-DESCRIPTION OP,PROPOSED WORK(checkWI applicable)
New House F-1 Addition ❑ Replacement Windows Alteration(s) F Roofing
Or Doors 2
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding W Other[0]
Brief D crip�tion of Pro$�ed_ /� y e? � 9
W ork: O�tLt 1C®FAT Z'�c t o 14C+i
Alteration of existing bedroom Yes 'V-_*'�No Adding new bedroom Yes y No
Attached Narrative Renovating unfinished basement Yes V No
Plans Attached Roll -Sheet
+ten`--«..'__' ,�'.• L '^'�` u r: �'� '�°°: ..s.- - '�R`.xrun,.--`g"-`e�as^ s�»�:*^ __ :�.
sa { I�ew=hoasean rchtcoiaO eis#incl�iOiingcamialet� heo nu:
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-
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
L+S�rt � ✓� as Owner/Authorized
Agent hereby declare that the st ements 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.
'54f_55c Nn amc
:Print Name
f..
Si of Own Date
r ,
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`
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Section 4. ZONING All Informat-i6h 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
(volurne,&Location)
'
A. Has Special been hsuedfor/on the sha?
' �~� �
NO 0 D�TK�W �� YES ��
IF YES, date issued:
IF YES: Was the permit recorded ut the Registry o[Deeds?
NO «����
uu." . ="""" 0 .E^
IF YES: enter Book P d/ r Document#1
'
� B. Does the site contain a brook, body of water urwetlands? NO 6��10101\17 KNOW 0 YE3 0
�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
'
Needs tmbeobtained �~� Obtained ��` Date Issued:
�~� �~� . .
C. Do any signs exist onthe 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 x�*�
�
IF YES, describe size, type and location:
�
� E Will the construction activity disturb or filling)over 1 acre or is it part ofocommon plan
/ thaw0distu,bove,1ooe? YES � NO Kv�
i |F YES,then o Northampton Storm Water Management Permit from the DPW is required.
/
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�
ity of Northampton
A l Building Department
212 Main Street
� ���
Room 100
��i
AUG 1 5 2Q05 t t..ironampton; Ma o1 oso
-' phon 413 87-1240 Fax 413-587-1272
F"?4P�PLfC: 1C�11�' UCT,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,'aft'<ce
/,'� � ��$T `�`J"� �,JI'. Vlap� ' 1L±c�;E �` r� � U�►t#r
1c)try nC e 1,4 d! b Zone OverlaY`x3istricf
t
r
��EIm S�District '���`�`�rvv� ' �' - •+� GBVDistrrct .'.
SECTION 2-PROPERTY OWNERSHIPIAUTHOMZED AGENT
2.1 Owner of Record:
7A,j C"f [ 9
I ,.s C t7 t�S+n1•t- s4.
Name(Print) Curr nt Mgt' ng AddrW
/ ..�5—SQ`7 0i !-7
Telephone
3igr�atui e
2.2 Authorized Agerit:
Name(Prin Current Mailing Address:
S' a Telephone
ECTI 3 (MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building QU(? (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) Check Number
This Section For Official'Use-Onl
Building Permit Number,: Date
_ sued:
Signature:
i
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: Building
Category: BUILDING PERMIT
Permit# BP-2006-0167
Project# 35-2006-0256
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 Signature:
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