38A-035 (3) 72 CIlAPE1.ST ,. BP-2008-0547
GIS#: COTIM01 WEALT14 OF MASSACHUSETTS
N ap:Block: 38A-035 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categv :Non structural interior renovations
BUILDING PERMIT
Permit# BP-2008-0547
Project# JS-2008-000372
Est. Cost:
Fee: $50,00 PERMIS;SIQN 1S HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Cir ut _ Homeowner as Contractor
Lot SizeCscl. its_ 11282.04_ Owner: ROBERT OB1
Zoniir,: URB Applicant: ROBERT'OBEAR
AT: 72 CHAPEL ST
Appltcuitt Address: _Phone: tnE�rrunc,�:
P O_BOX 951 _(13) 367-2424 0
M C)'l TAG U E i��lA01351 ISSUED On':121412097 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE EXTERIOR SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE,STREET
Inspector of Plumbing Inspector of Wiring D.P.W'. Building Inspector
E.�!u!r rtl:-ound• Service: Meter;
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
hough: Oil: Insulation:
uina:l: f'� T J,
THIS PEItN1IT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
f.,
Certificate of Occu anc ,-� signature:
FeeType: Date Paid: Amount: x
Building 12/4/2007 0:00:00 $50.005384
212 Main Sheet,Pho (413) �87-1240,Fax: (413)587-1272
Building Comissicdner-Anthony Patillo
<:_..�.
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BP-2008-0547
GIs #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
hermit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categyory: Non structural interior renovations BUILDING PERMIT
Permit# BP-2008-0547
Project# JS-2008-000372
Est. Cost:
1,ee: b>0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group Homeowner as Contractor
Lot Size(sy. ft.): 11282.04 Owner: ROBERT OBEAR
Zoning. URB Applicant: ROBERT OBEAR
AT. 72 CHAPEL ST
Applicant Address: Phone: Insurance:
PQ BOX 951 (413) 367-24240
MONTAGUEMA01351 ISSUED ON.12/4/2007 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE EXTERIOR 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 12/4/2007 0:00:00 $50.005384
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0547
APPLICANT/CONTACT PERSON ROBERT OBEAR
ADDRESS/PHONE P O BOX 951 MONTAGUE (413)367-2424 O
PROPERTY LOCATION 72 CHAPEL ST
MAP 38A PARCEL 035 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE EXTERIOR SIDING
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 ZMATION PRESENTED:
INF
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 Permit DPW Storm Water Management
_ Demolition Delay
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.
Department use only
City of Northampton Status of Permit:
Building Department Curb.Cut(Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot[Site Plans
Other Specify
APPLICATION TO CONSTRUCT,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 office
/
7,) (-�� /�� � ('.J . Map Lot Unit
1 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT /
2.1 Own- r of Record: j`Sy
Name(Print Current Mailing Address:—) t
W�� S !- .2
Telephone
SignatuAe I-V
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 permit applicant
1. Building (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_t5
Check Number
This Section For Official Use Only
Building Permit Number: Iss e-
ssued:
Signature:
_ - - --
Building Commissioner/Inspector of Bw mgTd^s — Date
Section 4. ZONING 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
Side L: , , R. L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved
Darkin )
..._..._.._.....
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever 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 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Cnservation Commission?
Needs to be obtained 0 Obtained Q 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 0 NO
_p
IF YES, describe size, type and location:
E. Will the construction activity disturh(clearing,grading eImFivation, or filling)over 1 acre or is it part of a common pian
that will disturb over 1 acre? YES 0 NO CU
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House F7 Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors r7
Accessory Bldg. ❑ Demolition New Signs [❑] Decks [C] Siding[❑] Other[❑]
Brief Description of Proposed
Work: bCryexk '' 4'l
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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
I. 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
I. 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
I, , as Owner/Authorized
Agent her y a ments and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed nder the ns d enalties of perjury.
Print Name
Signa r /Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9 Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
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...... ❑
11. Home Owner Exemption
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 issue
Also be advised that with reference to Chapter or rs' Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in o e assachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you er rmi .
The undersigned"homeowner" ertifi compliance with the State Building Code,City of
Northampton Ordinances, St 1 ni d State of M chusetts General Laws Annotated.
Homeowner Signature
• The Common -Uh of fassachusez-s
- Department bfIndustria.,Accidents
1 EEiR Ot'iince of Inveszigazions
600 Washington Street
_ C
Boston,,JkL4� 211y1
., {
Workers' Compensation Insurance A.ffld;aNit: Builders/Contractors/Electricians/Plumbers
ABDlicant Information Please Print Legibly
-Narae (B•mess/Orz=z=on/In(iividual):
d 1 eSS" (..alt)X 1>
City/State/zip: " tc one.
F-Are you an employer?Check the appropriate box: Type of project(required):
I am a employer with 4• ❑ I am a Qepe al contractor and I ❑New construction
employees (full and/or part-time). have hired the sub-contractors I_ lisied one lilt shed sheet 7- r1 Remodeling
_. 1 am a sc�e proprietor or partaer- !
ship and have no loyeas These sub'-contractors have 8. D emoliuon
wo �e s
rkirg for me in any capacity. employees and have workers' ❑Building addition
,-No w„ 'cowiin
. suramce comp.iusu"ance.+
required] 5. ❑ We are a corporation and its i0.❑Electrical repairs or additions
I am a homeowner doing all work ol5cers have exercised their 11.❑Plumbina repairs or additions
myself. [-N o workers'comp. rid t of exemption;per MGL 12•❑Roof repairs
insurance required-]t c. 152, §1(4),and we have no
employees. [No workers' 13-7 Other
comp.insurnce required.]
------* v app i�u caerrs oox waist a so out me se aoa oezow snowing 46FFY wor=s-compere,Qaon policy M:[ormauon-
Homeowners who submit this affidavit indicaring they are doing aD wont and thea hire outside contractors must submit a new affidavit indicating such-
:Contractors that check this box must.anached an additional sheet showing the name of the suircontmctors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'rntp.policy number.
I am an employer that is providing workers'compensation insurance for my employees` Below is the policy and job size
information.
Insurance Company Name:
Policy r or Self-ins. Lic.r- Expiration Date:
Job Site Address: C k1cc(w 1 City/State/Zip: X,14A4,4 k 1-(q,
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as rey der Section 25 A of MGL c. 152 can lead to the imposition of criminal penalties of a
zine up to S 1,500.00 an o -ye irr risonm=4 as well as civil penalties in the form of a STOP WORK ORDER and a Ent
of up to$250.00 a as ' ti lator. Be advised that a copy of this statement may be forwarded to the Office of
Investizations of ' D ce coverage veriEcation.
I do,hereby r}uxy that the tnformarion provided above is true and correct
/ZJ 7—
Phone=:
LOtheir
e ong. L'o not write rn this area,to be completed by_ •or town o�ciaL ,
wn: ---- --- --- ---- .---Per-mi#/License
thority(circle one):
Health 2.Building Department S. City/Town Clerk 4.Electrical Inspector S.PIumbing Inspector
son: Phone
r N
L"rIP, ?I�rt :► _l j
DEPT aTMZNT Or BUILDING L`,SPEC 0-N'7S _ ;_i
=Main Strut • Municipal Buiiding
I NS P ECTCPc
Northxnptnn, MA 01060
ntI;NrV� t � n�rT/lTrrAC 'T�?!l�'7,F'�rFI�FI�'ir
11 V ►11\ill L L111 �1v. � �s s�_._�_
The State of Massachusetts allows the homeowner the right under 7840 a 108.3.4 to
act av his'ller construction sup : or. the state defines "Homeowner" as, "i erson(s)
who owns a parcel on which he/she resides or intends to be, a one or two fanzily
welling, 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 I
home owner."
The buildin?-.department for the City of Northampton wants any person(s)who seek to
use the home owner exemption, to act as their own const uC*u^vn Sl penins^; to he aware
that by doing so you become responsible for compliance with state building cedes
and regulations. The inspection process requires that the build-ing department be called
to inspect work at various stages, which include foundation/footings (before backTHM.
sonotube holes (before uour) a rou4h building insaection(before work is
con-cealed) insulation insoe+ction (if recuired)a.nd_aTmal_huildina 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 occupancv
until-tie-work pan-be-insbected.-
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
L `� understand the above.
(Home owner/resident's signature requesting exemption)
I w-il1 call to schedule all required building inspections necessary for the building permit
issued to me.
Date C�
Address of work
location