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38A-008 39 CHAPEL ST BP-2016-1504 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38A-008 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2016-1504 Project# JS-2016-002565 Est.Cost: $12700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq. ft.): 22476.96 Owner: BLUMENTHAL JOSEPH HI&BARBARA BLUMENTHAL Zoning:URB(104)/ Applicant: JAMES FLANNERY AT: 39 CHAPEL ST Applicant Address: Phone: Insurance: 56 CHESTNUT PLAIN RD (508) 294-4052 WC W HATE LYMA01093 ISSUED ON:6/I6/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE SHINGLES AND REROOF PORCH WITH METAL AND SHINGLES ON MAIN HOUSE 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 6/16/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner !'9 Department use only - \ \ City of Northampton StMUS afPetmiL ° Building Department + tCUUDfifeyvSt F�ehmk 212 Main Street SSAe/Sepifc Avtridy Room 100 WateMM311Avaltablrcf - � Northampton, MA 01060 rr sa of Strudal'Mplam sly;cc. phone 413-587-1240 Fax 413-587-1272 pfatrief8tma 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 39 C'ic ( Sf- IMP Lat Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 4444/11.th4 edu-emF,2 7-7,94c 89 (Gc l J'f Name(Peet) Current ' Address -c ekphophone IC S— Si tura 2.2 Authorized Agent: TkmE s T, POW4/EN/ Z to ehe/d St C Itiv, MN- oioz7- Name(Print) Current Mailing Address [��)�� ���Y,� /3-2c3 � sdx;z�9- TosZ Signatgk / Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1- Building /ozr;-0c .CC (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 1, 6. Total=(1 +2+3+4+5) /Z, CO Check Number (Oro V7 `7 10 This Section For Official Use Only Data Building Permit Number' Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Depanment Lot Size Frontage Setbacks Front Side L R:. L: R::.____ -__ ' I Rear Building Height - a Bldg.Square Footage _- % .. _.. Open Space Footage (Lot area minusbldg&paved - . . ._- parking) #of Parking Spaces - - — ' -- Fill: (volume,&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES 0 IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW G YES IF YES: enter Book Pagel and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , 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 O NO V IF YES, describe size, type and location: ; E. Will the construction activity disturb(clearing,grading,ex avation,or filling)over 1 acre or is it part 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 S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Rooting Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs (I7] Decks [CI Siding[C]] Other[C7f Brief Description of Propos. - /S _//).51d( 7 win: of Pr LOS ✓NDS h4Fo yw<c -Abri f mit;4_, rca{ Ald 3 -Shinf/os m ArrLn Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.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? o. 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 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, kV/W-4 g SLAinta 77,<4 L ,as Owner of the subject property hereby authorize <T4-MG_S T. FL_AuAJ6_i / to act on my behalf, in all matters relative to work au r' by this building permit application. 36‘42-774,1/4- rpt ,a.,., h " °Hu, Signaure of Owner Date 11.111111111111111111111111111111111111.111.1.1 I, I isieS .S- ri.NAhuSIuy/ _ as Owner/Authorized Agent hereby declare that the statelhents and9nformation on the foregoing application are true an accurate, the best of my knowledge and belief. Signed under the pains and penalties of perjury. TAMES J. LYAUA/E27/ Print N e Signatu r/Agent s_ Date /l/1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction AAS..upe�ervisorT ��I rrr�����Q��,��/ Not Applicable 0 /x// 7 Name of License Holder: JinrwS S. ole 103 c/ui / License Number j(o s'ry n- Pe-AM A -7/2,A ress S1 Expiration Date ignature Telephone 9.Registered Home Improvement Contractor Not Applicable ❑ PFa Pere FP-41f rc ROOFS-A6 LLC /83(9E> Company Name Registration Number : Lae 4e/of Si I/111/+ Address cptfi Expiration Date Telephone 413103—an 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 Ef No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 980, 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 acceptable to the Building Official that he/she shall be responsible for all such work performed under the buildinv 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 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: ,3q C1-If PE L ,S7 The debris will be transported by: JA-MGS ,7. FL *UiUF$/ The debris will be received by: Vkite / /Leer U u Ei Building permit number: Name of Permit Applicant 3-.19-416 S S. FI/ UNE�r bitt Date Signature of Permit Applicant The Commonwealth of Massachusetts Department ofbrdastrialAccidents 1 Congress Street,Suite 100 • Boston,MA 02114-2017 www massgov/din \V. Jeers'Compensation Insurance Affidavit:Builders/Contractors/Electrkians/Plu utters. TO BE FILED WITH THE PERMITTING AUTHORITY. Ann ISTUI Ivformatinv PI^+ere Privt LeniMv J\ Name(Busiess.Organivatioiilndieidtml) Peat /31r (mance £Oc(7/ j /1 Address: 1 La e74i'cf of St r Yere 462 City/State/Zip: 44671fringOrt", Mn- 0102 Phone#: 4/3-203 -5588 Are you an employer?Cheek the appropriate boy Type of project(required): LED am a employes with 2_employee;t full a,Wur l*rrFnn,el. 7. ❑New construction 2.❑Iamaautepmprictor alpartnership and have noengdoyasworking for me hi S. ❑Remodeling eapneay. No worker'cont.immrmwe mrywi,ed 1.0i nm a homeowner deing nil work myself:l No workers a ml,. m sm, ve req iii real 9. ❑ Demolition 10❑Building addition ana homeowner nod will1 hiring contractorst d t all work on myP i rty. I will ensure mareH conintehlrS eller have ,rker non t nt rant or re: IM 11.❑I-.lee ui cal repairs or additions Innprictane with no employees. 12.❑Plumbing repairs or additions 5.❑Iain a general contractor end l have hired die suFnmtractms lined on the attached sheet 13.'�Roof repairs ahese.sult..onteatocdhavu employe, and have workers comp-unornee' • 6.0 we are a corpmvtion:nt its officers have exercised alert right of exemption per MGL c. N.['Other -- 5Li114Eand wehalo noemployees.INi worker:cony,.insurance required' • 'Any applicant Mat check box Ili most also fill on the section below-showing their workers'compensation poise)!Inl'onnatinu I ion who submit this;nlidevitindicating they the doing all work and then hire outside contractors:must submit a new affidavit indicating sod,. =Uonhactnrs Ilea eheek this box must attached an adding/110 sheet showing the name til the sob-ennuaaers and state whether or not ho:e entities have employees. It the sub-contractors hew employees they Mita provide their winkeri comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she ✓✓ information. //�jj Insurance Company Nance: iirrE / 1/4/91el/ L GUAA1 eta Policy/I ur Self-ins. Lie.8: a p2 WC+90 3-41 / Expiration Date: T/oZ�- // Jab Site Address:_5 QNf6k. „T_ ('sty/Stave/Zip:ItacktAikio clad dl/4 0 /0(aC Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGI,c. 152,p25A is a criminal violation punishable by a fine up to$1,900.01) and/or one-year imprisonment,as well as civil penalties in the form ora STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy 0r this statement may be Forwarded to the Office oft avcnigatiots of the DIA For insurance coverage verification. /do herr,,rectify under le pains and penalties ofperjnpvhat the information provided above is true and correct. • Signature:,f' IE. I __ - Date: 5/5/AP Phone H: -r1 2or -55t OJrcial use only. Do not write in this Urea,to be completed by city or town official City or Town: Permit/License fi Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone h: City of Northampton , . Massachusetts = i. ,s`, u x t. : DEPAR1I ENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building x '•'.':""°� Northampton Ma 01060 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 • 11 , . . . . . 'r . • . V .r - . r . r • - . Si •• •. r : •• r (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 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 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