24A-172 16 TAYLOR ST BP-2017-0151
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A- 172 CITY OF NORTHAMPTON
Lot:-003 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit BP-2017-0151
Project# JS-2017-000247
Est.Cost: $8100.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WILLIAM CORBETT 100136
Loot Size(sq. ft.): 16465.68 Owner: GRIFFIN JILL A&KIMBERLY R LUCEY
Japing:URAII0O),t Applicant WILLIAM CORBETT
AT: 16 TAYLOR ST
Applicant Address: Phone: Insurance:
16 UPPER HAMPDEN RD (413) 267-4211 WC
MONSONMA01O57 ISSUED ON:813/2016 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 If Foundation:
Driveway Finai:
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 8/3/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
rc=c- I
D artmen use ony
4 RiCiJ�. j City of N icaNtn
t StuofPerrn
BLit )na DeDartm n,• Curb CutDwaPermit-
e 2I2 Main j _ei Sewe S pti vailab y
3 LOW Poor
Water Neu 100 Availability
/el cTharepton, MA 01E160 iu TioS sa tru-r a Pans
Or BUILDING 11L5 axA13-587-1272
urnmPT MA taeo 4'I -587 1240 FaxPlotSlm Pans
Other Spent, _ _ _
APPLICATION TO CONSTRUCT,ALTER, REPAIR, REENOVATF.OR DEE 1OL]St?A ONE OR TWO FAMILY DWELLING
SECTION 9 •SITE INFORMATION
td Prooertr Atldresa. Isis section tc be conple'iec by oice
-
-
t ' .YTQyIbi— _Map Lo. : Unit
I �br,�,�\��\ -Zoo Cve lad District _
'lC' ISrDstrc• " - --- = CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-----^
�y
� le.-Co
�� v-tF\ . \ M
t -,CP,_Y vlP l CA` .1bt- C
1 Name!Fant) :Dural/lading Addres- z,
V\(O.- CtiV1te-62.—
Signature ep e0 4 5 % 7
2.2 Authorized Aoent
LA, 9 0\t C0 \ e ,��e,p_�- .n , �>a W
N e(Pnnf) /t Coram[Mailing Address v-%-lo— n4-"•-
SECTION
C/..�� 210-7 — 4z kf
Signature Telechone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dolls e)to be Official Use Day
comcieted by permit aoo!Icant
1 1. Building I /J9 Pt (OD (a) Building Penni`,Fee
f7
2. ElectricalII (b) Estimated Total Cost of
Construction from(E)
3. Plumbing 1 Building Permit Fee
4. Mechanical (HVAC)
5- Fire Protection
5- Total=(1 +2+3+4 +5) I Check Number SSS 4_,,,,. no
This Section For Official Use Only
Date
Building Permit Number
Issued'
Signature:
Building Commissioner/Inspector of Buildings Date
Email : ,
ISection 4 ZONING I All intorhatior.Nus lite Competed teen ran re Dented Duo ro it-1Zr mese 6 .amstion y
Enintax, Proposed I Required by Zoning j
Rl ! s!'
tot "n by
Bening /e-n :
t
"
I (t - .y >
Let Size f ._. __.. 1 c t
._... - _ __.. _ ., ..-�. _..�..�
Frontage
ISunbelts Front
ISide L:
IRear .... ..
�. .�..�
BuildingSleight — ,
OSquarepaceFi.ootage ee I — /
09tHpen Sp Footage _ ..-
mat nes rise Nag Rinrea I —
DiatiteS
al olPrkino Sues — I ^— -
I I
r s Lo_aaorr I »
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON L/
KNOW YES O
IF YES, date issued:':
IF YES: Was the permit recorded at the Registry of Ceeds?
NO 0 DONT KNOW cD YES 0
IF YES: enter` Book Page': and/or Doumentf.
B. Does the site contain a brook, body of water or wetlands? NO C) DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained }` Obtained CD , Pats Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES; describe size, type and Iodation:
0. Are there any proposed changes to or additions of signs int en ed for the property ? YES 0.., NO 0
, ..—
tF?'ES, describe size, type and iodation: .,.___e._..—._� �.__....,._.�..._
E Vbll the construction activity disturb(clearing, grading, excavation. or filling)over 1 acre oris it par of a common plen
thatHill disturb over acre? YES
0 NO O
IF YE:S,then a Naeamoscr Ma:a,Nment PerwE :om ine DPVtlis resumed.
1. t ,
1
SECTION E-DESCRIPTION OF PROPOSED WORNfehsck all aoolicaale)
Nevi noose 7 Addition aaa,wen Windows Alteration(s)its)
Or p: P,oc�ic, ^�
Or Doors C
Accessopf Bids. ❑ Demollfon New Rippe [C] Decks in Sidlne]D1 Other 10]
Brief Description of Proposed
Work: �"a r• i Up v�l.re'.+ C v e
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
__.
sa ifh
New.Efoi;se and oraddition to arsf'sila €taus¢na. comnPete Ehe foi€ovtiDa:
a. Use of building :One Family 1 Two Family Other _
b. Number of rooms in each famiN unit: — Number of Baths-amps
is there a garage attached?
d- Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of healing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Massheck Energy Compliance form atache_d?
h. Type of construction
i. Is construction within 10D fl. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes
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
as Owner f the subject
Property
hereby authorize
;o act on my❑ehan,in atl matters retative to werk authorized by this bunting permit application.
Signature of Owner Dei
I, L 1 ✓ ' CbN. \t*e ys Owner/Authorized
Agent hereby;stare that the statements and information on the foregoing application are true and atiourae,to the best of my knowledge
end belief.
Signed under the pains and penalties perjury
1 \j\‘ 1g„ 64--S.(4
Print Name �... .—. .—
CA k
Signature of Owner/Agent Date _�
SECTION 8-CONSTRUCTION SERVICES 4
El Lk3')sed:obstruction Sucxrvisor. Not Applicable
Name a -" ._eo "� 1^
,� su X.. - x.17 ' �4 ,no lSCo
....—
teesese Number
Address Egoirorice Date
Signature -` Telephone `t�Vr \ ^ Li?
Lo_eIvtn 1 t
9.Registered Hornelmnrove tContractor : Not Applicable £
(P' Gtv ��rA`' `f %CPt7 t _
I Company Name i Registration Number
Lt upE'— v,rk -R - \z�
"'VC)"
y Expiration Date
V v'\2' G^ Telephone"2..L.—/ ��/V
SECTION 19-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.
Sinned Affidavit Attached Yes✓e.. E No .... £ .......
IL - Horne °yeller Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or rvo(2)families
and to allow.such homeowner to engage an individual for hire who does not possess a license,provided that the owner act§,
as supervisor.CMR 780. Sixth Edition Section 308,S5.1.
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 ant(or farm
structures.A person who constructs more than one home in a two-veer period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Oficial,on a fpm 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 sits 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 resifting in Death)of the Massachusetts General Laws Annotated,von may be liable for eerson(e)
you hire to perform work for you under thispermit.
The undersigned-homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinarmes,State end Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature - - --
�;•.,` The Commennteatth ofnetenmzenttf,
Department of Intinsteetal Accidents
Office of Tyt ,estignetinns
,a -+ 'ga 59O Toned t g e Streea`
r. Best s, 14.4 02111.1
Workers' Cemttensedsn assamenee A.-_,rs,.r r r iislers/Ccmmecter ,±, c. racSar, in inni,srs
A_nui eant rusiornsation PSease Print Le tstPv
Name (Bu ness'Organizathn' dividnal): y Ejr Cc. v cr-.^c
Address: \ C., �-� �gyp,..-\t�.Q�^'i
1110 ei-
City/State/Zip:- Ov' 0 t--- Phone e: 2-7 ({ L (
Are you an employer? Check the appropriate bet: Type of project (required):
1.1/1 am a employer with 4. LI I am a general contractor and I
employees(full andior part-time).* have hired the sub-contractors 6. 7 New construction
2. I am a sole proprietor or partner- listed on the attached sleet, - 7. [1 Remodeling
ship and have no employees These sub-contractors have 8, 11 Demolition
work's for me in any capacity. employees and have workers'
4 p
9 Q Budding addition
[No workers' comp. insurance comp. uuurance.r
required.] 5. 7 We are a corporation and:as 10.[ Electricalrepairs or additions
3.Q I am a homeowner doing all work officers have exercised thein 11.,_ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGI,
12.0 Roof repairs
insurance required.] t c. 152, .1(4), and we have no
employees. 11\.7o workers' 13.71 Other
comp. insurance required.
"Any applicant that checks box#1 must aiao fill out the section below showing their workers'compensation policy infoormation.
tHo meowners who submit 8ils affidavit indicating they art doing an work and then hire outside contractors must submit a new af5davit indicating such.
=Contractors that check this box must attached an additionalsheet showing the name of the anb-contactors and state whether or not those entities have
empkves. If the sub-contactors have employees,they must provide their workers'camppolicy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
infotmnation.
Insurance Company Name: R L' x•^C'C rjv--eoA^-
Policy#or Self-ins.Lie. #: Expiration Date: n -I "- l °1
Job Site Address: t4 "—CI; \e--- � C'ity/StatefZip: (;ta`�r-..•-� —
Attach a copy of the workers' compensation policy declaration page(showing the policy number and aspiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crin nasal penalties of a
fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
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 DL4 for insurance coverage verification.
I do hereby cern ' under the pains and penalties of perjury that the information providedid�
:Yvi/ above is true and correct
Signature: _ DateU — b
Photc,#_�( -7 -- 42_1 t. .�
Official use only. Do not write in this area,to be 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 #:
City of IfirtForaidt.on
.AOACyA>et 4
i C L •�
7" l ,S�viY
It r�� a?)-1R T G L" 'F . IDMP'. 'OBE r Gr {
l7" 2_2 Hain Street s PrrnicLpal fl-' a- ^. T.6T
r.�.n_ten, aruoc �
-NS[EcToi.
Louis Hasbrouck Chuck Miler
Building Commissioner Assistant Commissioner
HOME OWNER EEMPTIONACKNOwLED?GEMF-NT
Theof Massachusetts allows the homeowner,. Stater the right under TBOCMR 900.3.a 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 borne 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
foundationffootinas (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 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)
will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
City of Northampton 212 Mahn Street. _ L1 Lam-OtC.R; MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MOL c 40, 354, 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: LLe
The debris will be transported by: Q:JoC /1/43\\. \S
The debris will be received by: \,c/011•(=
Building permit number: /�
Name of Permit Applicant \42_`0"— ( "�\--
t
Date CI3 — Signature of Permit Applicant
J'a
Residential Roofing/Siding
The Boss
16 Upper Hampden Road
Monson,MA 01057
Office: (413)267.4211
Cell: (413)668-4410
Fax: (413)267-4211
Fulylusured
MA License#CSSL100136
Reg#160293
CONTRACT
Name: Kim Lucey and Jill Griffin
Address: 15 Taylor Street
City: Northampton State: MA Zip: 01060
Home Phone: Cell Phone: 923-2101 or 658-4512
Strip roof down to decking
Install ice and water bather in valleys, eves around chinmey and stack flanges
Install underlayment
Install white drip and rake edge
Install vent on peak
Install stack flange
Install 30 year shingles
Total � Q DC)
112 down $ I<6' >/remainder$ 3 T v nn completion ofjob. /
6A- 3 fio
Signature Date
l �✓ t/ -_ _ - e �a 2- — 1 �v
Signature Date