38A-082 48 CHAPEL ST BP-2017-0247
GIS 6: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 38A-082 CITY OF NORTHAMPTON
Lot: -000
Permit Building
Category: ROOF BUILDING PERMIT
Permit,. BP-2017-0247
Project•tt JS-2017-000427
Est. Cost: $19000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PEAK ROOFING CO
Lot Size(so.ft.): Owner: WILDWOOD COURT CONDO ASSOC
Zoning: URB(100)/ Applicant: WILDWOOD COURT CONDO ASSOC
AT: 48 CHAPEL ST
Applicant Address: Phone: Insurance:
NORTHAMPTONMA01060 ISSUED ON:8/30/2016 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 H 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 8/30/2016 0:00:00 $40.00
212 Main Street. Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
•
RFC-"PD
DepaNnentuse ad
AUG 2 A 2016 City of Northampton 9ldut otPamak
Building Department CIA*bIv y¢ia `
ait4
L _j 212 Main Street Sei Sd$ sitOty
Room 100
--- Northampton, MA 01060 1GMeS'1(1fMsMflSNts
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEWNG
SECTION 1-SITE INFORMATION
1.1 Property Address. c L This section to be completed by office4& C{Wlak. I uI (hat4- b-E -F Map Lot Unn
/1/0-111.4411110 i m4 o/06,0 Zone Overlay District
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(N(Ic)wcz e0. Current (34_ 1.6,oNan„,(P/lll)- (J /I 1
tY/
Telephone
Signa
2.2 Authorized Mont'
.7,1mc s S. PCNrl14/F-46/ -1 /_al-t j4e%l SI- C c rv), mil- 01o2 -
Name(PMt) Current Mailing Address: r
�1 4!3-203 Sax-2 * Tos Z
Signe e Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /9, ow. co (a)Building Permit Fee
2. Electrical / (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee /1
4. Mechanical(HVAC) /
5 Fire Protection
6. Total=(1 +2+3+4+5) A/9. OW 00 Check Number
This Section For Official Use Only
Date
Building Permit Numbe Issued. ✓/ q //
Signatu :id v��
Building Commissioner/Inspector of Buildings Date
SECTION 5-DEICRIPTON OF PROPOSED WORK lch.CA ed apolkabt.)
-_,
New House 0 Addition ❑ Replacement Windows Alt.ntlontsl ❑ Roofing E]
Or DoanAccessory Bldg. ❑ Demolition ❑ Mn Signs IC01 Decks IC] Siding 101 Other In
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Removal g unfinished beseme,d Yes No
Plans Attached Roll -Sheet
a If New house and or addition to existing housing. cantatas the followinc
a. Use of building:One Family Two Family Otter
b. Number of mom in each family unft Number of Bedrooms
C. Is them a garage attached?
d. Proposed Square footage of new conga on. Declension
e, Number of stake?
I. Method of heating? Fireplaces or W oodstoves Number of each
g. Energy Conservation Compliance. Masschede Energy Canlpdence form attached?
h. Type of comb-ad/on
i. Is construction within 10011.of wehande?_Yes __No. Is construction within 100 yr, f oodplain_Yes_No
J. Depth of basement or Cellar hoar below finished grade __
k Will bulling cordon to The Bulling and Zoning rapJat ons? _ Yes No,
I. Septic Tank_ City Sewer _ Private well____ City water Supply
SECTION 7.•OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /'
I, Whrt L.cvyhnr*j Ptrsrr' 4 f 1 Iv;kkiodd 624-1-- Ihducc�u�.-1- L.G ,as owner of the subject
property 1
hereby auherne sTMnA S T Pc4A/Alfil2V ,
•
to act on my behalf,In ell matters relatNe to work aulhorlied by thliFibildmg permit appli tion, '
°MtSh re of Owner Dote
I, 1Atte S S. Pl 4e4 ,as ownerfAufhonzed
Agent hereby dedare that the etateeiienls and-information on Me foregoing applicafon are true a%d accurat(to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
TAME-S S. Pe AwAr y
Print Name
�}„` kisllif f/
Signet of erlAgenr I Date
- The Commonwealth of Massachusetts
t Department of industrial Accidents
�(§( 1 Congress Street,Suite 100
Boston, MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO RE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Per J� PPICAS.PICAS.Print I.n'itrlr
Name(eusinescrganinatioNlndivideal): r/n//� &y,nau Ce Poe..)hn. LLC
Address: 1 Ln-eA-IcAt7 eSf (Wore 7tf1
City/State/Zip: AH-StIVAi NPYD N , m%- CI C 27-Phone#: 4/3-2_03 -s88? _
Are you an employer?Check the appropriate ho':
Type of project(required):
I.®I am a employer with 2 employees full andior parttime(-" 7. ❑New construction
2 ElI am a sole proprietor or partnershipand have no employees working for me in
am carmeay.[No workers comp.insurance Aspiredl 8. Remodeling
❑
9- ❑DCnmll[ian
,.❑I aua homeowner doing all work myself. No workers'comp.insurance recruit-A.1
4.❑l am a homeowner and will be hiringtracmrs to conduct all work onopropertyl will 10 Building addition
cramr
ens
ref that an contractors either have workers'compensation insurance or are sole II-❑Electrical repairs or additions
proprietors with no employees. 12.5 Plumbing repairs or additions
ADI am a general contractor and I have hired the subcontractorslited on the attached sheet 13.12jROOf repairs
mese sub-contractorshave employees and have workers'comp.insurance
fi-❑We arc a corporation and its officers have exercised their right of exemption per MUL c. 14. Other
152.*1(41.and we have uo employees.(No workers'comp.insurance requires.]
'Anyapplicun that checks box i I oust also fill out section below showing Weir workers'compensation policy infomution.
s Ilnrcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check 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 workcn'comppolicy number.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information ''''^�
Insurance Company Name'. ECSA4rIC /f.4-7/'filei' / 6o4t
�
Policy#or Self-ins.Lie.N: £2WC7-90X92 / Expiration Date: IA 7- //7-
f.
Job Site Address: '10 A-FtF913e I 3 r citystateizip:tvalkany, , `¢ 0 (O e.k6
Attach a copy of the workers'compensation 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
andior 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.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance
coverage verification.
I do hereby terrify under he pains and penalties of pedury that the information provided above is true and correct.
P-/12-1
Signature: i. Date: P,/ /1(a
Phone 4: 41 20 -
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 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: 48- Chap ( S+
The debris will be transported by: TA MTs 3. FtifaPUFA/
The debris will be received by: VAciE\y Zee yr lT1U Et
Building permit number:
Name of Permit Applicant OW-Me S 5, RSA/CT
Date Signature of Permit Applicant
City of Northampton
7eassachusaG[s �'`. .
p1115PARf®R' OF seXLOING INSPECTIONS
212 ,bin area • ibnlelpal saute; /C
NctthYMPma, ,n 81860 'V. ,t
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
flOMA.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 coda and regulations.The inspection
process requires that the building department be called to inspect work at various stages,which include
• i • . •• nn i • - •.y , c .1 . , •, , • n,: .: or •. A• • . 'L. Ue it- to. 1
a-n• a ,ea.. t- • ,.. •.- n •„ ,� . oe , c.• •.•.< i t •. d,• ,.. . , • ,
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
IitBpec�d-
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