25C-070 (3) 34 DAY AVE BP-2016-1157
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-070 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2016-1157
Project# JS-2016-002001
Est. Cost: $4000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RANDALL ROBERTS 042573
Lot Size(sq. ft.): 7797.24 Owner: BIVONA GARY F
Zoning: URB(100) Applicant: RANDALL ROBERTS
AT. 34 DAY AVE
Applicant Address: Phone: Insurance:
41 HEMENWAY RD (413) 530-2703 O Workers
Compensation
LEVERETTMA01054 ISSUED ON:4/5/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 20 REPLACEMENT WINDOWS
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 4/5/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
DM1
x'
City of Northampton 3`
APR = 2o�s ! Building Department
212 MainStreet
Room 100
r s n r
Northampton, MA 01060 r
_ phone 413-587-1240 Fax 413-587-1272 Y
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING,
SEC"ftD11r1 t S��jP�1 `BO{c�.. ;;
1.7 Property Address:
Thfik sectlost:to be c6iiiplbfeEl b*:ailfte
map
joafw Lot Uni3
�aikie'� ,, �C!i�erl�r�Arstr�at:
�`�3is�idt= GB Disttict
SSC I3O1 #�I 1= OlESlilRl�klt
21 Owner of Rec
Ci .1 ) ✓1 /"i w AV/'r Ms OI 00 L
Name ' —•
(fit) Current Mailing Address: .?�75 w q
J 7 t3
Telephone /4
Signature
2 A hortz 6 e P f
1
ZN,amet)j; Current Mailing Address:Telephone
Item Estimated.Cost4Doitar4to-be Baal Use Ogly
completed by permit applicant
1. Building ,G*� 4 �l"� g
}Buifiiie Perrmt.Fee
2. Electrical
sUrraed'To
ii Cost:of
Const€uction1rom ti
3. Plumbing Building Perstiit Fee
4. Mechanical(HVAC)
i
5. Fire Protection do
6. Total=(1 +2+314+5) ' 1 edc Number
Date
Building Perm
it Number, Issued:
Signature:
BuiUng CommissionerlinspecW-of auiidings. Date
j
i
I
SECTION fi DESCRIPT1OKOF PROPta$EE?WGRK.(check all abplicabiel
New House ❑ Addition ❑ Replacement Windows AI rations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Sighs [0] (Q Siding[0] Other[a
Brief Descriptio f Pro '7 Q ` �� �t' � C)r.
work: �L G C`� I Z� S �'
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basem nt Yes No
Plans Attached Roll -Sheet
r .«ax .w2 :+"' i.N+r3:. ,"'�.
a. Use of building:One Family Two Family Other
i
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 Woodst Ives 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
RECTION Za 01lVhi X- H R7 IIQN TO,BE tMIIpE:E ED HIH N =
RCQOVNERSAsE1OBr FA- R IC PER i11T.
✓0VL) as Owner of the subject
property
hereby auther+ze CA,
to act on my be If,in all tters relati a to work authorized by this building permit application.
Signature of Owlevory/YY.�I 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
i
KSECTIQN 8-CONSTRUCTION SER1f1CF—$
8.1 Licensed Co on SupervisorNotricable 0
Name of License tiohder:
License Number
Add ? _ -7 / Date
Si Telephone '
i
,ssC.... ...
IEFI
' _ z _ u Not Applicaple D
7Z
Co pane Name Reg' tion Nu r
7 too
Addre f L Zxpikbon Wte
Telephone
SECTION 1.0 WOR RS'COMPENSA lON Il gURA CEJIIMFIE?& -(.ALGA-CL'i52' ZSR I
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit V411 result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yes....... 0 No...... 0
The current exemption for"homeowners"was extended to include Owueroccunled;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.E
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 Dome 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 ander-the building permit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion e€the ---- -
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 w#h the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts .Laws,zutotated.
Homeowner Signature