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17D-034 (4)
McCutcheon Construction Full Service General Contractors 87 Chestnut Street c� Florence,MA 01060 (413)584-3352 ,Olt f scot? p d z y ._. �_ -- - STAII e S I ' I 17. Rk�WAU� QrF R �A -T At — FtxMi4q Tz� 1A 2�r � i McCutcheon Construction Full Service General Contractors 87 Chestnut Street Florence,MA 01060 (413)584-3352 t :f s N 4 s f t � X O�'SHAAIP�O i "� Crzt r of Worf4a itp#on $ � �lassachusetfe DEPARTMENT OF BUILDING INSPECTIONS /= ` 212 Main Street • Municipal Building "°�., 5 •`�r INSPECTOR 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 s sor. 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 your), a rough building inspection (before work is concealed), insulation inspection (if required) Ind 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 4 f7N � 6 fi�csearflnsctts I DEP�uzrl rEr�rr Ott BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 woruCE,R'S COMTENSATION INSURANCE A +MANT 1 vAlli a principal pla&c Of bL1S11iessh-t`iidcnce CIO het-6by CCri i1 . UI]acr tl]c (p<:ii1S 1'.iid Pcil I am an employer providing the follo'.vim: v,orr:crs compeilsoiloI] cpVCra' C [Or llly employees working on t?Iis job: (Inrsranc Cor ipam') ( clic.Nu:,7bcr) --- (E p;r-,i on Data) < ) I act a sole proprietor, general aon*=c`or c- 'tlomcov�oer (Circle Oct) and 'gave tared the COr1ti actors lISted beiov ;,,to la.,, th coCilpeIlsrauorl ( (1nSll u.lC^ Comp—l—'Po[ic Nurlbcr):1RC Of Contr lcr) T?:%:Cr:°CCIl D2tC) (Name Of CODnczor) -- (11]surapice CDmf=i ti'(PG(ICi Numbcr) DaIC) (Name Of COIItTnctoi) (lns-L!r3Ilcc (_omn-ally/Polio Nwilbir) LAIC) (Name of Cont-actor) _ ( coiratic- Comr. y!P'olier Numbz-r) ( 1 Zuni it :;ole pro})r1e C)i and it lv i10 011c. 11'0r1 ;i`{ t0i SI1 l 1 <,111 a 110111C 0\'1?1Cr pCIfc,-ming ?ll L��ix- ;n a> i_,;-u:� a:.:_naLm�::i_air c- NO•lT::plcsc be n:+'arc L:n::r�•i]c fxtr�o�llr_;s�+�r�r.=.� :t not uxYe than three uniu in«t ci Gc a; cmploycs u_ne. t}r tvc:�:r=cc x•_ ion (t L152 s ,:p1:_a:icn Iry hortco:vncr for a Lc='-c cc legal rtawz of an cuployar under 4`.n Worker Co per–.tion Act I undo:txad ti i a copy of t}ui ctiL=-cct nuy bo forwnrci j to t]»IY_txirtzrsz of It his ri I Arci&=&OfS=of for ttx covcz&&C vaificlioa and tlit L.durr-to r•=trt co�c ag to cC.iM 25A of?.tGI,152 can Icsd to tlx imposition c 4R -a cvosisting of a fu),of up to 51.300-00-nt 'or in:i rin:x4mc;1 oft:p to cr-}-a r.:.I civil pc=16v in d,c fonn cf+Sic-.1 Lttw of T100.00 5�dly ig?awtl mt _ �+ t'cr rail Numir.:.r — - -- T- L Ji na urc of i.icz n_cJt'r..rnrittr„, _. I SECON 8 nCOhISTRUCTION SERVICES I 8.1 Licensed Construction SuR gv1sor: J ( Not Applicable ❑ Name of License Holder : 6 I CC�z S-7A License Number 3k:7 Address �-- Expiration Cate ilk Signature Telephone Re ere 4 rn m : :.,em'en on ractor Not Applicable i❑ co Z 1 l Company Name Registration Number CIS% Address Expiration Date Telephone SEGTI01�110 1M110RKERS' COMPENSA,T,ION INSURANCE-.AFFIDAIVIT(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 108.1.x.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"homeo,,vner"shall submit to the Building Official,on a form acecptable 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 ` I SECTfQNS ©ES ., P7k OF ROPOSED1,W RK check all a lica�ble New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: V S Alteration of existing,bedroom Yes No Adding new bedroom Yes A _No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll Q• Sheet . : m1nd or ad,itionto exstin? hosnoifhe" foll.woin 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. Mascheck 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 SECTIOERRLIT} ORIZATION TO BE COMPLETED WHEN, QWNEft,��1,� Q CONTR�ACTOR�APPI.IES,FOR BUILDING PERMIT Tr I, as Owner of the subject property hereby authorize �, 1 ' llo i-< to acT.on my behalf, in all matt Ws relative to wor orized by this building permit application. Signatuio6p Date It L6 1, v as Owner/Authorized Agent here are tha e statements and information on the foregoing application are true and accurate, to the best of my knowle ge and belief. 1 Signed under the pains and penalties of perjury. Print Name i Signat e 0 ner/Agent Date w :4 Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department i Lot Size s,?, -Frontage j Setbacks Front Z 1 Z S I Side L: L: R: Rear Building Height Z� Bldg.Square Footage jLfc©IF 31 % Nck� 39 Open Space Footage � % (Lot area minus bldg&paved !�-7 co�9; , 33 Zcca - parking) #of Parking Spaces i Fill: ✓ ✓ (volume&Location) A. Has a Special Permit/variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO __X_ DONT KNOW 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: w c City of Northampton Q Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,,RENOVATE OR"DEMOLISH A ONE OR TWO FAMILY DWELLING L_ SECTION 1 SITE INFORMATION, _ 1.1 Propertv Address: MA- --------------- SECTION 2 P.ROPERTYbWNERSHIP/AUTHO1=D-AGENT 2.1 Owner of Record: Name Tint) Current Mailing Address: -��"`•.�, — ..mac.- �2- Telephone Sig natSe 2.2 Authorized Aaent: II ---) '] / / R,:.I.G T Name(Print) 'i Current Mailing Address: Signature Telephone SECTION 3-- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) Official:Use Only )to be c m leted by ermit applicant 1. Building , ;`(a)Building'Perm 2. Electrical ..� �. , (b)gstimated-Totaf Cost of 'Construction from .6: 3. Plumbing zcc'- , Q: Buildinq Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 3q S- 6. Total = (I +2 +3+4+ 5) C> Check Number 19 C6 - `s Section-For Official Use-Orif Building Permit Number: _ Date Issued: Signature: Building,Commissioner/Inspector of Buildings Date File#BP-2004-0698 APPLICANT/CONTACT PERSON Paul McCutcheon ADDRESS/PHONE 77 FOREST GLEN RD FLORENCE (413)584-3352 PROPERTY LOCATION 30 STRAW AVE MAP 17D PARCEL 034 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid , 7/OD l Tpeof Construction: INSTALL 3RD FLR FU L BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 062544 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOVAATION PRESENTED: _IZApproved 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 Stree ommission L 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. r 30 STRAW AVE BP-2004-0698 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-034 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0698 Project# IS-2004-1003 Est.Cost: $3450.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Paul McCutcheon 062544 Lot Size(sq.ft.): 5096.52 Owner: BARRETT JOHN MICHAEL zoning_URB Applicant: Paul MCCutcheon AT. 30 STRAW AVE Applicant Address: Phone: Insurance: 77 FOREST GLEN RD (413) 584-3352 FLORENCEMA01062 ISSUED ON:12117103 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 3RD FLR FULL BATH 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 QccupanC y Signature: Feel e: Receipt No: Date Paid: Check No: Amount: Building 12/17/03 0:00:00 5760 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 30 STRAW AVE BP-2004-0698 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma :Block: 17D-034 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0698 Proiect# JS-2004-1003 Est. Cost: $3450.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Paul MCCutcheon 062544 Lot Size(sa. ft.): 5096.52 Owner: BARRETT JOHN MICHAEL Zoning:URB; Applicant: Paul McCutcheon AT. 30 STRAW AVE Annlicant address: .a �-�- one: Insurance: 77 FOREST GLEN RD (413) 584-3352 FLORENCEMA01062 ISSUED ON.12117103 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 3RD FLR FULL BATH 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: d (,-� Rough:Z zw House# Foundation: r� Driveway Final: Final:J—!l"1�d�"�'�� Fival: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: �a,,,,ltip: - Final: Q}< QLf. THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 12/17/03 0:00:00 5760 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo