31B-284 (4) lT BP-2004-0253
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0253
Project# IS-2004-0373
Est.Cost:$4000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin A3 ALAN HOUGHTON 073925
Lot Size(sq. ft.): 3179.88 Owner: SUHER ERIC
zoning_CB Applicant: ALAN HOUGHTON
AT. 21 CENTER ST
Applicant Address: Phone: Insurance:
103 SOUTH ST (413) 210-0329 (�
NORTHAMPTONMA01060 ISSUED ON.915103 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR & REFINISH FLOORS PAINT REPAIR
DRYWALL
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• Receipt No• Date Paid• Check No: Amount:
Building 9/5/03 0:00:00 mo66913 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
r
a �( i f Northampton
'I g Department
Main Street
SEP 4 V1 R om 100
Nor am ton, MA 01060
N $CX87-1 40 Fax 413-587-1272 t
DEQ OF�O��OK,MP 01060
ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE tNFO12MATION
This section tob; coni m eted,.. '
z
'� P Eby ffice `�
1.1 Property Address:
u Y
o( � �C MaP
�Zon Oyerl' y District �" F
EIm St1District x rywCB�As, r�ict".
SE ,2 - PROPERTY;OWNERSHIP/AUTHORIZED:AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
5� ��� Telephone
Signature r
2. uthorized A ent:
Name(Print) Current Mailing Address:
Signature Telephone
S.ECTION21 ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building PermitFee
2. Ele c`.rical (b) -stimated 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 Check Number
This Section'For Official Use Only
Building Permit Number: P-2CX'�</-0 -3 Date.Issued: S' 24 3
Signature:
Building Commissioner/Inspector of Buildings. Date
T
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 -4
Lot Slze
Fronts e
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
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 DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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, des6ribe size, type and location:
x
SE TIONI� S Rr O�IC4��PRt)POS D�'YYORx cher� 11 a lica`hie � �
.sx.�kN -45-^••fr $�5="�^iNR s"R,x1 rt Y '411Pp
a-:fin»= +q
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ Siding C 3 Other
Brief Description of Proposed Work: t ?
Alteration of existing bedroom Yes l' No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 . Sheet 0
6a .��I±te.�rv""�ous�ea'Fid ora"�di�ron�toezis�irr��to�ta�in" am�'l-e a ?�e�foClowin�
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
SEG!'{�0 � N�R AUTHQRlZATlON TO BE CaMPf=ETED WHEN
OY11NEkSAGE TOR Ct7NTRACTOR APPI_lES FOR E U, Dlt+iG PERMIT
as Owner of the subject property
hereby authorize 1.- � j f"� to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner _ ^"^ y Date -
I' 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 Owner/Agent Date
SECTON`8 CpNSTRUTION SERVICES
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name of License Holder :
O 13 Z15
License Number
r
Address 4 Expiration Date
U 6 � 2)
Signature Telephone
0Reg -e a 'om t»a ovement oritractor G m ,, Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECT10N10 WORKERS' COMPENSATION INSURANCE,AFFIDAVIT(M:GL. c. 152, § 25C(6))
IV
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...... ❑
f z
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 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
"1 m !.?EPiu2I'htER I Cif' BUILDT?�G INSPLcTIONS
212 Main Street ' Municipal Builcling
Northampton, Mass. 01060
WOPICL 'S COINIT {NL Sr, TION ITNSURANCE AFFDMr1VIT
L
1}rich a principal place of buslesslrewdence a..
!? '
do heretoy cendy, under dic pains ,aid pCi3altl�c.. of �,Cryaj illrii
i
I am an enjoyer providing the Wllo`+'v`ng '•:or cKs eoinpenS�,6on COVCrr::{C "OF my
employees working on this job:
(1nc3ranG Cat�F=�`) o--c;Nu Iixr) Y (ExTi ton Date)
V, i 2cl a sate prol�rzetor, yenPra con ctor hens o.>rner circle ne) Pod l;�v� '
o n .., hired
the ccnNadws listed be:o -,-,to iollr .-v'pr ���Oi kers CO i7eIl"u '7011 O11 .uS:
_ :f3ZIIC Of Cbfl[T1CiGr) (III�U:-nC COrP.^.';]t�mGl3�f NllCTI�Cr) ?'� ria i0ix Daae)
(Name of Cont actor) _ (1'-L';-j r:--.n CZ Corn aay/Poiiet' NUSi71/'r) 17_ o rain. Date)
Name of Contractor) tnsu"z cti ( - - ,
� _ow;�n_;iPolic, ivuintr�r) ('=z, 1.aoa La[e)
(Name of CommCtor) -- (Iasitance Corn'-':.':yfi'oticv Nlumb'2r) (l:#wo-' Dare)
l 1( cLTl Ci Jole l?IOI)i1C C)! C':iJ ha';C 110 one worhng Ibr _Ile.
.l i71I1 <� 1"Orne OWilCi- ;JCFfc-ming all
NO•I`E:plc_sc Lr awzrt tt;s;',Li)c h<r�v ilrra -�c;:piz,;)<z-::= a= ruL;m r_r:rpair -..1 c"mi i::v c.
not stere th_a Lf3too units it;zoo to n z"mct-r=10z a a:on P: os
e.^.'•pioyca u1''.er tlr_ivc;}'ws':cc:x:-.�:aim r,,=t(rLI S�-.:.s l{Sl),at'(•i:retic:;by s horteou-ter to a Gecu c�p:rmi:r. ,...tirtic t.c '
3cgil r arae of an xztployer uttuer thn Wo kcr't Cor •o Lja D'n?.cf-
i undc_^sis-nd iha!x copy of t}is ctatc::tet r_:iy to fawnrcio-J to tt;o[Ytnrtzr,n;of Iz�dlutriJ Ar.�l.�t:f 4''iLcw of i:_rua•>>e for ttx
covcm&c vcrifiCI.tioa and that f=ilurc to+- :coy ra urd x�.im:5 L of?.{GI,i 52 can lr d to tttc i• pa'i#ion o;r^ir_1 pcn: *:=
comuzing of a fur of up to s i.3Q .00 a "Jar i :pri r� of top to er,-}-„ ..,j c vii-)exult cs in r I< to cf a stc-"`Vr'Ti Or"='d.
finz 5100'W z ds :Zzimt m
For cin,wumatsl um way j
T., -----
Grity of Nart4amptan
DEPARTMENT OF BUILDING INSPECTIONS
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 his/her construction super-vii sor. The 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 buildinL7 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, fail u re 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
1, 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
GIS#: MONi"N. A-L-t SET
,
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit_# BP-2004-0253
Proiect# JS-2004-0373
Est.Cost: $4000.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor. License:
Use Group: A3 ALAN HOUGHTON 073925
317Q.Q
Lot SzP(s�ft.l: $ Owner: SUBEF EPIC
Zoning: CB plicani: :=�`rA"� 6- �U-GH i O
AT: 21 CENTER ST
Applicant Address: Phone: Insurance.
103 SOUTH ST (413) 210-0329 (�
NORTHAMPTONMA01060 ISSUED ON:9/5/03 0:00:00
TO PERFORM THE FOLLOWING WO-RK.-REPAIR & REFINISH FLOORS PAINT REPAIR
DRYWALL
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: &XT74.6
10h 7`0 3 � Rough Frame:
�4"14
Gas: Fire Department Fireplace/Chimney:
Rough: (til:
Final: Smoke: g Final:
THIS PERMIT MAY BE REVOKED BY"TIiE'J t, 'Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu an Si nature.
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 9/5/03 0:00:00 mo66913 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
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