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18C-038 76 COOKE AVE BP-2017-0101 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C-038 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-2017-0101 Project ft JS-2017-000170 Est. Cost:$8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FINN 88014 Lot Size(sq.ft.): 7318.08 Owner: CLEARY JANET R Zoning: SR(100)/ Applicant: JAMES FINN AT: 76 COOKE AVE Applicant Address: Phone: Insurance: 29 HICKORY DR (413) 584-4566 O F L O R E N C E M A 01062 ISSUED ON:7/26/2016 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 k 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 7/26/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner fitiAb Department use only City of NorYhBnpiori Statin of PErmn Building Department ciurb,Cut/Daveway Permit IA- 2 6 2016 212 Main Street SewerSeptc Avadab dp Room 100 ,Water/Well Availability) yp.r,ocaaow;amseecna+s 61erthamptcn, MA 01060 TwoSets ofShuaura;t `ans is domwulerorv. _1060 • -587-1240 Fax 413-587-1272 PIoVSta�Plans� OtbEr.Sp-ev.ify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING [SECTION 1 -SITE INFORMATION ,�.. 1,1 Property Address: I This section to be completed by office 31e C.-00/.< fV� , LoY_ _ dbl\TN Atnf Tool fill 01o60 'Zone Overlay Dts.rtct, Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT _..... 2.1 Owner of Record: q-Ad Cr CLEAR y 6 cab v' p10RT/wihr7& Name(Frani) n /) Curie =daTnq r•aso, 4.1 w♦ Telephone Siynat 2.2 Authorized Anent: n/c/<oay pa (cv2Fdc( M 0100 Name(Print) Current Mailing Adores: N/3 - 9.19- 5.i sgnatureif _ret phone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Ostlers)to be Official Use Only com.leted by peat applicant f °O (.�' .. a)8uldmg Permit Fee 2 Electrical (b) Estimated Total Cost of Construction from(6V 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6 Total=(1 +2+3 +4+5) ZOO 0 �,Check Number //667 This Section For Oficiat Use Only Building Permit Number: Isste Issued: Signature: Building Commissioner/Inspector of Buildings Date Email : Section 4 ZONING.+ AU Informattkn Mus:Be Completed.Retiree Gen fie Denied Due To Jncommtete lnfoimatGoo Existing .Preposed Required liy Zoning This wean to he filled in by Badding Deportment Lo.Size __... _..... -.__... Frontage — — -' Setbacks Trent j Side Lf Rear Building Height ' _' BIag. Square Footage Open Space Footage . Y .... (Lot aream:nue bldg S paved . othrtt^i #of Parking Spaces .._..- _. ----- Fill twines&bambini A. Has a Specie! Permit/Variance/Finding ever been issued for/on the site? NO — DONT KNOW Q YES 0 IF YES, date issued:', IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0.. I , IF YES: enter Book Page and/or Documents B. Does the site contain a brook, body of water or wetlands? NO 0) DONT KNOW 0 YES 0 IF YES, Sas a permit been or need to be obtained from the Conse nation Commission? Needs to be obtained Obtained 9 , Date Issued C. Do any signs exist on the property? YES 0 NO e 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 IF YES.describe size,type and location: E. Will the construction activity disturb(clearing,grading,excavation, or tilling)over 1 acre or is it part of a comrnon plan that will disturb over 1 acre? YES 0 NO IF YES, than a Northampton Storm Water Management Pern-dl from the DPW is required_ ii SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aooiiceble) 1 New House nii I Addition n Replacement Windows Alteraticm(s) ] 1 Roofing Or Doors 0 Accessory Bldg TI Demolition L New Signs [q) Decks [Q Siding [0] Other[DI Brief Description of 9 ,� Work 111111 04-1) _t0-i3T41-G lJ iW Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovation unfinished basement Yes No Plans Attached Raft -Sheet ea.if New house and or addition to existtnn 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 a. Number of stories? t. Method of heating? Fireplaces or Woodsioves 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. Wil 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 AGENTpOR CONTRACTOR APPLIES FOR BUILDING PERMIT ` I, y / ET C cf.A / ,as Owner of the subject property hereby authorize SArils f,ioil r1 to act on my behalf,in ail matters relative to work authorized by this building permit application — , , I L. .y: ,I, )4,14 Signature .wrier j Date I, Mtip IP ov , as Owner/Authorized Agent heteloy 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. TAnf-S F/dr} Print Name _...---- � 7 .:$ /10l6 Signature of Ow,IA. I Date 1 SECTION 8-CONSTRUCTION SERVICES Cl_Licensed Construction [Superr isor r' 1 T"�) Not Applicable £ Name or license Holder: �j A tc1rl (S � cs- ono,'II �. bounce Number Mwxtxb oz kegrect rig ofns �a/l �?��f Addre p aeon ate _'"' q13-02t7- 915.+ Sig fr. Telephone 9.Registered Home Improvement Contractor: . Not Applicable £ L 4 -4c F/1"" / t629a? Company Name Reglsir tion Number n AI( tOYy OR rcc>RQ..,cE` M ft 0)06i /0 eY lvad Address c Pup/ h o Date _ ._. Telephone4/3-16-2/f( SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT MGL,c.152,g 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 11. - Rome 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 Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on whieh there is,or is Intended to be,a one or two family dwelling,attached or detached shuctures accessory to such use and/or farm structures A person who constructs more Wan one tome 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 +erfonned 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,von may be liable for person(s) you hire to perform work for you under this pewit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Budding Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Cc la acn vea,?t acftr"s¢aca se?9s Deorinm P1i Thos mel 4Ic idei,:2s �.1 Office ©f1la2ves'`ges6Je>,es PrO, ,alJas TOtasI:da gten Streeg AO .. .J ',..r Bevan, MA *#2111 mo ureocaheise.geo/disc • Workers' C'eumppeau5att on tams-anise Lrurcasit: ilu ers/T'trmCra c'.tars/p'lectriciaosf➢'laarbers Applicant I nff©rrnzftknn Time Print TLegfl lv ,Name{Businessr'Organizatiorvrntattimty Lt$ rjj1 Address: d g J' )c.XOR Cahrftitate/Zip:_ LOPfr(g roti * 106.2 .... Phoneell: tJ-2i9- �)St _ Are you an employer? Check the appropriate box: Type of project(required): I. I am a employer with 4. [] I am a general contractor and I _ employees (full and/or part-time).* have hired the sub-contractors 6. [] New construction 2.i' lam a sole proprietor or partner- listed on the attached sheet, 7. Remodeling stip and have no employees These sub-contractors have 8. ❑ Demolition working forme in any capacity. employees and have workers' comp. insurance.} 9. _l Building addition [No workers' comp. insurance required.] 5 corporation Electrical repairs or 3. . I am a homeowner doing all work Icer have ex � r i ed h it I I_ � Plumbing repairs or additions bons myself.[No workers' comp. right of exemption per MOL 22ri Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 131_ Other comp.insurance required.] *Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information. 'Ho meowners who submit this affidavit indicating they are doing ail work and then hive outside contractors must submit a now affidavit indicating such. *Contractors that chock this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. "/ Insurance Company Name: Policy#or Self-ins. Lic. #: _ _ Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the foto,of a STOP*WORK ORDER and a fvue of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi under the pains and penalties of perjury that the information provided above is true and correct � p Signature: "" � n h //dW} Date: 7 . • 20j4 Phone#: tart- Ili- q/5/ • Official use only. Do not write in this area, to he completed by city or town 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 6. Other Contact Person: Phone#: r Nor -,yc'Lt acrd `s . � WINTE.p.ohy r s t IE' vtliLIE2AIRS=NTn < n r Cmrcaa E't 212 M Street o ., > vOa1 Building . ' Northampton, PA 01050 tl'Et 1 INSPECTOR Louis Hasbrouck Chuck Miller Butldina Commissioner Assistant Commissioner HOME OWNER EXEM7TION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under MOCKUP' 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 tto 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 building 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, 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 wirr 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 ail required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affdavit In accordance of the provisions of MGL c 40. S54, I acknowledge tint as a concition of tie builcing 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: 71 Cook AUg NoViAneTal The debris will be transported by: _fit A Er 5 itoci"off Co.jTA)pas The dccris will be received by: Vila Cy RQ G 2t CyL' C Building permit number: Name of Permit Applicant q-AnLS f,rt-) V)/i0 Date Signature of Permit Applicant