23B-030 (2) BP-2003-0793
GIS#: COMMONWEALTH OF MASSACHUSETTS
wMallow4ow- CITY OF NORTHAMPTON
Lot: -001
Perm t Building
Category BUILDING PERMIT
Pemdt# BP-2003-0793
Protect# JS-2003-1302
Est Cost $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: KEITH HAMILTON 074129
Lot Size(sa.ft.): 5793.48 Owner: ROSSI AGNES G
Zaninw URB Applicant: KEITH HAMILTON
AT: 11 HATFIELD ST
Applicant Address: Phone: Insurance:
3 LORD ST (413) 527-7767 n
EASTHAMPTONMA01027 ISSUED ON:3/28.103 0.00.-00
TO PERFORM THE FOLLOWING WORK:REPLACE REAR STAIRS
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: Receipt No: Date Paid: Check No: Amount:
Building 3/28/03 0:00:00 3437 $50.00
212 Main Sheet,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-0793
APPLICANT/CONTACT PERSON KEITH HAMILTON
ADDRESS/PHONE 3 LORD ST (413)527-7767 Q
PROPERTY LOCATION 11 HATFIELD ST
MAP 23B PARCEL 030 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled Out
Fee Paid
Typeof Construction REPLACE REAR STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074129
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance-
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Pemit from CB Architecture Committee
�'tfrom Elmee[Commssion
Signature ofB Building
Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all caning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
rty nf-Northampton
Lr �� D �..� I_Sd 1 ng Department !0 'rs'a y1212 Main StreetMAR 2 7 20Q�orthaRoom 100
mpton, MA 01060,,,phone413 587 1'240 Fax 413 587-1272 Luv e Cu e
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This sectionito be co pleted b office
1.1 Propertydress'. } as
Map Orta nrt
r;iim
j A)o Cl /� ( Zone �"`�"'9"velyy District p r
Elm SL District CB Dis"1rict
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Dn�cA J RoSSi 113 '7
Name(Pont) / Currentailu,Ad tress:
ZL'� /T 1 Telephone
Sgneture rr��
2.2 Authorize A ent:
� Glm 0 � LOV�CI Sl . ��WM /`1Q' c5(o37
Name(Print) Current Mailing Address:
— z- 6 7 3
S nature �oZ a. 6
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
completed by permit a olicant
1. Building SD� C1 •oma (a) Building Permit Fee
2. Elecirical (b)-stimated Total Cost of
Construction from 6 _
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only _
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled In by
audding Ucyartmam
Un Size
Fronta e
Setbacks Front
Side L: R: U R:
Rear
Euilding Height
EId6.Syuare Footage
Open Space Footagc el
not area minus bldg&ravad
akin _
N of Parkin S aces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ___..._ DON'l KNOW . — YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW _ YES
IF YES: enter Book Page _., and/or Document #
D. Does the site contain a brook, body of water or wetlands? NO DON I KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained --Obtained _ 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_
No
IF YES, destribe size, type and location: —_..`
1)WORK(check all applicable)
New House
11 Addition El Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg 11 DemolitionO Decks Siding[ ] Other [
Brief Description of Proposed Work: RCIP 101 f flj&X17��6i
circ-� rs
Alteration of existing bedroom—Yes—No Adding new bedroom _Yes No hxl-7.
Attached Narrative 0 Renovating unfinished basement —Yes No
Plans Attached Roll D Sheet 0
EaajlftNe ho—u�-sWn-dWr.Yddit-iU-rrttb?-tFxistitff.h—oatina,'_cdfffi-Siele-�h-effo-I[Win
a. Use of building : One Family— Two Family Other
P Number of rooms in each family unit__ Number of Bathrooms
C Is there a garage attached?,/1 0
d 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._ Mascheck Energy Compliance form attached?
In Type of construction_
I Is construction within 100 fL of wetlands?—Yes No Is construction within 100 yr floodiplair. 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
SE N TH 17A ION � BE COMPLETED WHEN
OV
SECTION
7. M A'o PP 0
VNERNGiijoff R RORTORTA ITEOF R BUILDING PERMIT
L. 0 W IJ as Owner of the subject property
hereby authorize to an! on
my behalf, in all matters relative to work authorized by this b ilding permit application,
I-
S'g-"Jw4' Date
Ke
— ----
1, Kp l4k �4 M 1 as Owner/Authorized Agent
hereby d dare that he st tements an information on the foregoing appfica tion are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and rallies of perjury.
e I perju --
Print Name A
grature of w r Agent
SECTION 8.: tltlltTRUCTION SERVICES
g 1 Lipensed CansirutIch pip yr Sart Not Applicable ❑
mber .
LicenNumberse umber
f O 4
Address ExFhatmn Oafe
S- nahne Telephone
�'RRepReeedvigo'nif5lm r 3e5i"nt Not Applicable ❑
Xfbi` �i /-!(A� '
omgfTny Name Registration Number
—.--
Address Expiration Date
Telephone
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M:G.L. c. 152, §25C(0))
P the building pletL tted with tins application. Failure to provide this affidavit
Workers Compensation Insurance affidavit must be completed
I¢ted and sunml
will result in the denial of,the issuance of
Signed Affidavit Attached Yes.... .. ❑ No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or Iwo(2)families
and to allow such homwwner 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 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 atwo-yGNr n od sh211 not be considered a hometown r.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official hat hefshe shalt be
realglu ble for all such work perRlrmed under the buildine permit. '.
As acting Construction Supervisor your presence on the job site will be required fn;nn time to time,during and upon
completion of the work for which this penal 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, jou maybe liable for persons)
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 Coning Laws and State of Massachusetts(icneral Laws Annotated,
Homeowner Signa[mre
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DEPI 2TMFNI OF BUIIDI?\'C: INSPECTIONS
INSPECTOR 112 Main Sueet s NlumcStlat Building
Northampmn, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the fight under 780CMR 108.3.4 to
act as i.is/her construction sup;.:-sor. Tho sta,e defnes `Homeowner" as, " Person(s)
who owns a parcel on which he(she resides or intends to be, a one or Ano family
rlivelling, 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 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 insnected.
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 ire permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
11 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