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32C-223 79 HAWLEY ST (wrong map block on card) 79 HAWLEY ST BP-2016-1505 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 35-040 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1505 Project# JS-2016-002566 Est.Cost: $40.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sa. ft.): 485415.00 Owner: ST HILAIRE ALAN Zoning: SR/WSPII Applicant: JAMES FLANNERY AT: 79 HAWLEY ST Applicant Address: Phone: Insurance: 56 CHESTNUT PLAIN RD (508) 294-4052 WC W HATE LYMA01093 ISSUED ON:6/16/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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: OI: 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 6/16/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner t"���/ City of Northampton Mesa Pam* Department use onlyG'� Building Department ( ltSAWIDTIWTO VePrvt \ 212 Main Street SeraNSepticpyailebih7y `\\\ �5 Room 100 Water/Well avaflth ty \ i Northampton, MA 01060 prierSettetStreauide pans j phone 413-587-1240 Fax 413-587-1272 .. Other Spdr$y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property IAd'dress: This section to be completed by office 14&2e/� J 1— Map Lot Unit / Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1/Owner of Record: Name CuMai sa `ha - 1/pS Telephone Signature 2.2 Authorized Agent: r7k111F S ,T. POW416-a/ Z LoveAeld St C'4, , mg- oloz3- Name(Print) Current Mailing Address. (1 1/3-203 77- 50 =z 1'0 Ca Sign a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Constriction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ,�/ o 6. Total=(1 +2+3+4+5) �} Stft . CC' check Number foga 440 This Section For Official Use Only Building Permit Number: Date Issued. Signature:Signature: Budding Commissionernnspector of Buntings Date Section 4. ZONING AU 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 I.: R:. L: R' Rear Building Height - -- - Bldg.Square Footage % Open Space Footage % I (Lot area minus bldg&paved _ packing) ft of Parking Spaces - -_-- -- Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? - NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page, I and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW ai YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: I C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: , D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, cavation,or filling)over 1 acre or is it pad of a common plan that will disturb over 1 acre? YES O NO 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 ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing TN Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [C] Decks [0 Siding[O] Other[❑] Brief Des�cripption of PrcposGdani work V221141.2G��cr.Sv7nc rq /Y deri7.Cc. Insfl1(P/ytc-obc1-ins-/' r_TM i lel . Oral CI r 374_, S Alteration of existing bedroom Yes f----go Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 'i No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing. complete the following: a. Use of building i 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 a 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 ). 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, ALMA ST 6YLL4ZI1 E ,as Owner of the subject properly hereby authorize rT4./i1G C 7. FLAAJAM&Q to act on m behalf,i all matters relative to work autho' ed by this'bailding permit application. �e " �i9,,� SignatuTof Owner Date i. T'}'IES 3 F(flR11t/ _y_,as OwnerfAuthorized Agent hereby declare that the stilts andlnformatio.n on the foregoing application are true affd accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. T HES s. C,bVNEiey Print Name /y11/Q/.,`.1.1 I/r1yM6 0/g//& 9" /& Signet WE of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: JA,�^E WERA _IO 3 Qk2 License Number 5to CkVs7AJuY potty A 1/2/49- Addrea{ l Expiration Date �Me� Sob-.�4t-4052 Signet Telephone 9.Reoistered Home Improvement Contractor Not Applicable ❑ PE-WC PE,ear-Ailliva Roo F. LLC /834098. Company Name Registration Number I_ Love of Sf Ji/IJ,9- Address -5E-fir Expiration Date Telephone 1(3 203-Jou e 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 H No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or 1wo(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 108.33.1. 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 building permit As acting Construction Supervisor your presence on the job site will he 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 __ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 71t-✓LES/ S 7l The debris will be transported by: JA-14E1_5 //S- The debris will be received by: VfK-LES/ Pceyr(J+UC Building permit number: Name of Permit Applicant OW-Me S5. FLi(JNE,C/I ZL l7 /iL. ) Date Signature of Permit Applicant The Commonwealth of Massachusetts Department oflndastrialAccidents 1 Congress Street,Suite 100 :_ Boston, MA 02114-2017 wtvwnrass.gov✓die Wakers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO RE FILED Willi THE PERMITTING AUTHORITY. Applicant Information mm VV /� / "� / Mace Print I.v ibly Name(Business/Organization/Individual): r 41 r"e/-y-vr that Ce roolm j LL( Address: 1 Law Aid Sf I' th51 J City/State/zip: thu9/4nWrtAJ , nail- 01 027-phone#: 4/3-2o3 -5d-8? Are you an employer?Clint at appropriate box: Type of project(required): I,®Iamaemployer with 2 _employees lroliamVorpuruimct' 7. 0 New construction a_Qlaii a axle proprietor or partnership and have no employees working for me in 8. Q Remodeling any capadty.(No workers Ctsillp.iaxonmcc mpdied.l 3.Q l nm a homeowner doing all wink myeelt I No workers cow i0Mirallecryuir.al' 9. ❑Dcmnlition 1Q I:m,a honed d illi bi tae oI t 1 ro k sop pay. I will IO❑Budding addition ensure hat all contractors either hkers compensationinantanteo le.sole 11.0 Electrical repairs or additions improvers With no employes. 12.Q Plumbing repairs or additions 5.11II in a gen nil contractor I have hired the sub-coniratR s listed on the auae!cd sheet. I3'�ROUf repairsI he i-sub-commamors have employees and have wml¢n'comp.iosrn:a e. 6.1:We are a emponainu and its ofams have exercised thein right ut exemption per Mil.e (d.QOdter 152.§I WI,and weImve Da cmpinyees.l No workers comp.insmmnce required.l -"Any applicant dad cheeks box el mow W<o fill not the,titan bola‘‘showing their*whoa'conpensnaon policy inlinnntien. 1 llonwowneth who submit this nfidav It indicating they are doing all work and then him outside unm muton MUM.w hmit a new affidavit indicating melt. tum 1rators that check ibis box must attached an additional when showing ata name or sub-convaeturs and vale whether or not Ihuae entities have mpinycee, it the sub-cant'ILO or,have emploweee,I hey most provide their sorkem'comp.policy number. I am an employer that is providing workers'compensation insurance for my enrplol'ees. Below is the policy and job site information. /�,� /�,, Insurance Company Name: d/t�^ rP( E H1*/"7'4lfw/4-t/ 67 U/ ,Af Policy 11 or Self ins_Lie.N: EZWC9-9041 / ,_. Expiration Date: �T�02 7- 7/ .__ Job Site Address T t /146.42/ -St _ City/Stale/Zip: b,,,i-h-13't sP 4 deo 2+ Attach a copy of the workers' comnsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the ham of a STOP WORK ORDER and a foe of up to$250.00 u day against the violator.A copy or this statement may be forwarded to die Office of Investigations of the DIA for insurance coverage verification. �I ' 'mu I do here!'.real -d-- :••• 'yuQiggrnemip l ler.•...:iirr that the information provided above is true and correct. Signnture:,t- (;�Jfj.�,,.,y/,I/f 'y/-�p"p�.,�j..�k� Date: Cr/9//� Phone IF: 413".Oo ..Gm Q)Jicial use only. Do not write in this area,to be completed by ei0•or toren official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector h.Other Contact Person: Phone#: • City of Northampton Massachusetts ws c J G . DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Vb Northampton, 10 01060 1jr" .1� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 backfilll sonotube holes(before (tour). a rough building inspection (before work is concealed). insulation inspection(if reauiredl 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 occuoancy until the work can be inspected If the homeowner hires other trades to perform work(electrical, plumbing 8 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 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