22D-077 54-56 CROSS ST BP-2017-0296
GIS it: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22D-077 CITY OF NORTHAMPTON
Lot-ROI PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit BP-2017-0296
Protect N JS-2017-000496
Est, Cost:SI5000.00
Fee: $10000 PERMISSION IS HEREBY GRANTED TO:
Const.CI ss: Contractor: License:
use Grorps_ Homeowner as Contractor
Lot Size(sq. IQ: 17336.88 Owner: CHATTERTON JOHN P&.LISA M
Zoning: URA(1001/W$P(100)/ Applicant: CHATTERTON JOHN P & LISA M
AT: 54 - 56 CROSS ST
Applicant Address: Phone: Insurance:
56 CROSS ST
FLORENCEMA01062 ISSUED ON:9/6/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:CHIMNEY, ROOF & SIDING, SHED 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 d 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 sienatnre:
FeeTvpe: Date Paid: Amount:
Building 916/2016 0:00:00 St00.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR C_MCI-ISM A ONE OF.TWO FAMILY DWELLING I
SECTION I -SITE INFORMATION
1.1 Proae v,Ad(d�re_ss. Tr section to be con PlerRd by o Ice
5' _ '.a \%VS `S1-ctar" :friop
cioccAtD. MA b\utcZ ;Zone OvecIa Disco
--„EIm St O str et ' CSD§Pref ,
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED ACENI
21 Owner of Record:
La'-x.:, 0 0-ertarl 66 0 t t>s Sktv,A- i P10ZJ (V4 aobz;
N me eInt,:,.. (/�' , Gu” Mailing ntltlress: 1
1 IF Tele.^.hone i
2.2 Authorizsd Anent
11
IL Name(Erma ........ ...... Cret VT,img Rdoress: I
Signature Telephone
1
SECTION 3-ESTIMATED CONSTRUCTION COSTS
hem Esemeled Cost(Cohere)to be 1... Oflao Use Ong
comerp
Bred by ernit aeolhnt
o
r, Building . / Feei Bubaing Perm:
4_. I
12. EElectscal ( (e1 Esernated Total Cost of
1 Construction Prom(5) I
d. Plumbing I Building Permit Fee I
III I
4. Mechanical (HVAC) ���
5. Fire Protection . 1
n. Total 7(1 +p .3 =4+5) /6,0C°- --- I, OnesicNum6sr
This Section Far Official Use Only I
Hutldtng P=mit Numbers Dote
Issued 1
I._...... /,j/ / .5/J/� p p
Sanature: ��/ht'S� _............ /—/" ���
I B Wales iml iocearsp v cuG3icyy Date I
o
Email :
Section 4. ZONING I an Information Mcso Be Consts:ed, Permit Pan Be Denied Sue To 11:.317plete IPS or inoson
akeinea§, ?reposed Required by Louisa
Buisres z •befilled i'.:os
t
This 5 fv eem.
Lot Size _ _, _._ 1
Frontage
Setbacks Scent
Side
Rear
HuilEtrig Height __..
Bldg Square Footage — __w..
Open Space Footage _ to
areadoor rims sign Seased
parking) Ir i
salsa:king Spaces ,.—.. _"'-
tenure&l.o«tn) ---- . .,. ,.... _ .w_ _m.. _ _,. ..».,,,
A. Has aSsecial e
Permit/Variance/Finding ever been issued for/on the 'r .
0
NO DONT KNOW 0 YES 0
IF FES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 Y
EF YESenter Book • Fag andier Docunentp
6. Does the site contain a brook, body of water or w lands? NO Q DONT KNOW a YES 0
IF YES, has a permit been or need to be obt, ned from the Conservation Commisaion?
Needs to be obtained Ob'eined 0 Date Issued: T
C. Do any secs exist on the property? S 0 NO
IF YES, describe size, type and' cation:
0. there any proposed cha to to oradditions of signs intended for the property? YES Q NO C
„.
IF YES, desaare site yoe and location: .. .. _,.........,__ ...�...�.—,..e=—.,..—_ .. __
E V411 the ocrostructic Jetty distem Idectins, ea Ing excavation, or tilling)over 1 sore or is it pado ' common plan
that scitr dieturn,c _t 1 acre? YES U NO 0
IF YES the a Non-Manning Storm eser Maseeemen1Paceir&cm te DPW 1 recui
19
SECTION 5-DESCRIPTIOR OF PROPOSED WORM(r, sck all ean!ioable)
Or pLD :e ort Windows Il 11 3
New House E Jdi°.dgn ❑ 0 ni - �Lomr ) Pooling
Accessonr Bicg. Li Demolition ❑ New, arks[❑I tars i❑ Siding i�i Other[ClBrief De.s, ipt on of ProposedPrpcct>F}-.h 64k._ yy p-
.
X Work Det
n 4:ark 9- i,�.�.u. "3LSt iTrc
Alteration of existing bedroom Yes No Adding new bedroom Yes _ No
Attacned Narrative Renovattno unfinished basement . Yes
Plans Attached Roil -Sheet
ser If N1ewr.'hoieseand'or addition toozia:trta haLis3nq; comnlet=tFe`ottotflrftto:
a. Use of building_One Family Two Family O' er
b. Number of rooms in each family unit: Number r, Bathrooms
c. Is;here a garage attached?
d. Proposed Square footage of new construction Dimensions
a. Number of stones?
f. Method of heating? .,_ Fireplaces or Woodstoves Number of each
g. Eneray Conservation Compliance_ f'. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. ofweilends? Yes No. Is construction within 100 yr. floodplain Yes No
Depth of basement or cellar flour belyW finished grad
k. Will building conking to the Bu mq and Zoning regulations? Yes No
I. Septic Tank_ Ci j Sewer Print ' well City water Supply
SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1/471C
, �..r_:f'\ ,as Owner of the subject
-op f
hereby authorize
to act on my behalf, in alt matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ,as Owner/Authorized
_ Agent hereby deduce that the statements and information on the foregoing application are true and accurate to the bast of my knowledge
and belief
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Cate
SECTION€.CONSTR'CTIO18 SERV CES
$.'i Licensee Cuns'tru:ion Suoensisor: Not Applicable Z ,
9l3rne o'lLicorice sio!der
6i. se Number
Address Expiration Date
Signature Telephone
Registered Home_Ifnorovement Contractor Not Applicable E
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.G.152,§25CM(
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 _ No
11: 8f Dame Owiaer EAetptioif..
The current exemption for"homeowners"was extended to include Owner-occuuled 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.CM.,33 780, Sixth Edition Section 108,3.5.1_
Definition of I3omeowner'.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 Oficial,on a form acceptable to the Building Official.that be/she shall be
responsible for all such work performed under the building hermit.
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 he advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees f'or injuries not resulting in Death)of the Massachusetts General Laws Annotated,ypu may be liable for persons)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the Stare Building Code,City of
Northampton Ordinances,State and Local Zoning LOWS and State ofMa'sachuscr,s General Laws Annotated,
,>Ci Homeowner Signature 4$ n_ _,,,, . . A
The CorteEmonvecith C is'" s. -
�.�, 1epar "5rt of r m d'e ..
7._�Y
r' 'r 0).172.e ,, b//aJ dY 0.. -.ib'..
6% WashinVgn &peel
Dor in, t ,A 921£1
Wolters' Compensation linsummnce r eavTht TLi;IueP'$/ m aMor L _ mete iflur mem
AnDllc2ntInfc toktice 99e,zae Prtntirmairn.TM
Name(Busine srO:ganizadonfindividuat):
Address:
City/State/Zip: Phone -:
I.. Are you an employer? Check the appropriate bor.: Type of project ( e n:red):
1.rl I an a employer with 4. 7 I am a general contractor and I
Ti
(full and/or part-time).* have hired the subcontractors ti. New uunssucnon
12 _ I am a sole proprietor orpa her- listed on the attached sheet, 7. J[1 Remodeling
ship and have no employees These sub-contactors have 8. Demolition
waling for me in any capacity, employees and have workers'
tom insurance. p. U Building addition
���NNNo workers' comp. insurance _ p
quired) W e are a corporation and its 10,17 Electrical repairs or additions
3.1 7 am a homeowner doing ail work officers have exercised their 11.1 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MUL
12.7 Roof repairs
insurance required.] t c. 102, §1(4), and we have no
employees. [No workers' 1.3_n Other
[.. coma insurance required)
"Any applicant that checks boa#1 must also fill out the sxtion below showing mail workers'compensation policy infornatian.
Tido meouners who submit this atudavit indicating they are doing all work and the:hire outside contractors must submit a new aft davit indicating such.
:Contractors that check this box must attached an additional sheet showing the namc of the sub-mut:actors and state whether or not those entities have
employees. If the sub-canttacto:s have employs',they must provide their warkeri comp.policy number.
I am an employer that is providing workers'compensation insurance for niy employees. Delon)is the policy andfob site
information.
Insurance Company Name:
Policy#o;Self-ins.Lic.,`r: 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 MGL c. 152 can lead to the imposition of criminal 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 DLA for insurance coverage verification.
Ido hereby certffy under the pains and penalties of pe u rythat
the information provided above is true and correct.
jimature: . .., CAA,Q�J.,,v Dare: q-'?—tb
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Tolm: Permit'License{± _
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/I-own Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone ':
'Cv r off a�� SpJllr' li•'l '", .,��.
V
41
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NS"r5CTeR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOJvfl OWNER EXFMPTION fiC KNOWi EDGENENT
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 dwelf€,ng, attached or detached structures
I accessory to such use and/or farm structures. A person who constructs more than one home in a iwo-
f 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/footinas (before backfill), sonotube holes (before pour), a rough building inspection 1
(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
I, t.—t •.- CANo t-.E.p Occerl 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, R—)- -u
Address of work location 5 $tco Q ss c80pte .&
ra.o mot otot0z
•
City oS Northampton 21 Main Sheet,i ti ere ha-rrtoc,1MA 0.1060
SoEd 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 150x",.
Address of the work: -5Z, e oss S}ra„ 9 Ftote,ticQr M
The debris will be transported by: 4.\
The debris will be received by: \\at\ \Le c W
Building permit number:
Name of Permit Applicant Ass C iAcr cc ore,n
Gate Q-Z-' Signature of Permit Applicant