23C-050 48 WILLOW sr BP-2004-0694
GIS#: _ COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 2r-050 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0694
Project# J5-2004-0998
Est. Cost: 2-tT ORO
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Cla Contractor: License:
Use Groin- K &T PAINTING & REMODELING 11113
Lot Size(sq. Il 16204.32 Owner: CROWTHER FRANK W&BERNICE K
Zoning: c-: \ Applicant: K &T PAINTING & REMODELING
AT: 48 WILLOW ST
Applicant Address: Phone: Insurance:
8 BERK P.L I Y ST (413) 527-0139
EASTHA 'i.PTONMA01027 ISSUED ON:12/16/03 0:00:00
TO PEX FORM THE FOLLOWING WORK:STRIP &SHINGLE ROOF
POST 7i IS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Undergrir ,d: Service: Meter:
Footings:
Rough: Rough: House ti Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PI .tIIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY 01 iTs RULES AND REGULATIONS.
CBrtificv l cf Occupancy Signature:
FeeTvin Receipt No: Date Paid: Check No: Amount:
Building 12/16/03 0:00:00 2023 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
•
City of Northampton ,!
Building Department z
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 µ
it;itiAifi
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
#te W' tiY'otTa<,e
1.1 Property Address:
.aril '
<7£CLL/III:- , Cr eats � � �
Plot enc •?
a
SSECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1.Owner or Record:
. 'out Th
Name(Print)int) Cola/MaBiny Address:
DOns/e (" fiOC!/(N/L/ P /t Telephone
Signature 58% 5237
2.2 Authorized Avant: // !!
L 4 Sra TA
Name(Print) Current Mailing Address:
/Ca 7
fir' if•e rnocri/n�
Stgnature yP)�y.f�.s.d' Telephone 5.0 7— o 3 J
SECTION 3- ESTIMATED CONSTRUCT/ON-COSTS
Item Estimated Cost(Dollars)to be OffidafUse Only
completed by permit applicant
1. Building 1/0 D (a)BuIdktg Permit Fee
2. Electrical .(b)'Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(I +2+3+4 + 5) :Check Number
This Section ForWidal 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 colunm to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:_.. R: L: R:
Rear j
Building Height
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
p of Parking Spaces
Fill:
Jvolumc&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T 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 q
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 arty proposed changes to or additions of signs Intended for the property?YES.
No
IF YES, deet ibe size, type and location: _.._
S OTaD mirMCiaTs O OS e'WJO d ec'`a'It r rca 'z•»
New House Ct Addition O Replacement Windows AReration(s) 0 Roofing glee'
Or Doors 0
Accessory Bldg. 0 DemolitionD New Signs ( I Decks [ ) Siding[ ] Other[ ]
Brief Description of Proposed Work:_/9 p ._La 9'7 4 fit U fa.e
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative U Renovating unfinished basement .Yes _No
Plans Attached Roll U-Sheet O
?r`e:sy To -' . t.."--)% * •itiSnntobeli "tih�ighoUsh -o-.,. fie fae i w q:
a� Use of building : One Family tr� Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? A'O
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?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes ,No
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
5 T.1O "aR t R (7'�}`�ORIZATION
;TO BE COMPEf7Eo l r;v
Ei a agTR'AC-TOR APPLIES FOR"BUILOi GPE$'Mi72='
_, es Owner of the subject property
hereby authorize to ac: on
my behaf, in all matters relative to work authorized by this building permit application.
..{ •
Signature of Owner > Date _
I, , as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the test of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
S€C..130 , ioNORDOTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
e tf•
TingfelnibiereffirrternentreontilaCtOr Not Applicable ❑
zr I// //3 // r
Company Name Registration Number
"twin inf,�c 2 � ,eynelet / -n9
Address Expiration Date
giefa/1'/S/"et cey 5/ E s/ L?fll/'tor Telephone 4TQ711 a/32 _
ECe Ab*W E $'E,QMPENSATION INSURANCE AFFIDAVIT OW Gil. 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.
Signed Affidavit Attached Yes 0 No 0
—i.
7ttEFaMeaAb,';An'7`akth?` ae`n`,, a'
The current exemption for"homeowners"was extended to include Owner-occupied 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. 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 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 performed 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,you may be liable for person(s)
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 Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
. 4—
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1�� Q.lin) of No ti amptnn
1 e S .ss.:4::ar:(, .
tldo, ' f I
U EPART1.fENt OF BUILDING it. SPECI'IONs l- /
212 Main Street ' Municipal Building -
Northampton, MAss- 01060 "'"��-'
W'ORKER'S COMPENSATION INSURANCE APh D)AV1T
i., p
pte:f tr _.r --�
with a principal place of bu_iness/raidence an
!fr'Itorrc ')
do hereby ceetfy, 1 cr rho pains and pen cf perjnry .h,_. -
O Cara an employer providing the [ollt wi'_,v orkers cfm pensa[ion coverage for my
employees woticing un this job-
(incmnro Company) —..._ (Folic Nambe:) (". .pin on Dole)
() C am a sole proprietor, general contemn-tor or homeowner (circle one an; leave hued
the coctractors ist„d below who hhvhe We' of ':-;O K c CJmp2 OI pokes,
(Ilene of Canineor) (L-s.::z:.r. Ccnl>;:c 'poli-; Nu nbai ir`: :=coo- Data
(Name of Coe cel (hsuronce Corm>a;:y .olic Number) ? clhni:on Dale)
_—_ ._
(Name of Contnncr) (la:a tac; r o.opto,rPgRe. ti:u,li;_r) N: :- y-=Date)
(Name of Con—Gr) ( ertc-,ntr Com,,._,r policy Numtc) enrommniea Date)
(14 C 'wl it ;:.011.! to i .)ura: - hr :e PX) 0:1C sa for me_
( 't f am a home tnamor neenneininu =11 (:. ..
molt, k Lcn ic - r .;)1-=,, , ....
IW ..aha v.roc m-v _et4}_.- :r. .tti r,“Ca-' .11.V'''"'".2";;;"krt
a'ploytr,adz Or:uro4 .(GL.. C? .. . .osr_ r a Lcc : s._c ..
1=sal ev.an of an employer%odFdto We(kcel Cur tatom,-a--
I
sI umic...ed the a<.:,,y of uy. _ _ vGo is v.•D-y of lndus:iJ Ag-cm,:,'(Yr: a(':: f
enc -a ,,acifcttien and fiatLolc_1o . J ^_S.A of MCL an 1Y2 iut.m fl
un i ,itim —,-. f.il
t6tt
ooifay:of
g oft fay: toi RCOCo,tL - or p r _ e,-.1 c.il pmtGc in-x f s wi.OtiY•ni,.
1 of 510000 a day rUIna m'_
1. ys. meJ IY
Pa mit Sieh r r 1
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nn rctil l.tc.. < .0 (at1
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`,s{y �e Citify 0{ TOI"'I�fFt11t}Td'IT IAf,
yam, CFi"n-a6 .ssa.finadt. a +f�j"� '.
DEPARTMENT OF BUILDING tNSPEGTIONS ='1
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060 • = =
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction super,i sor. 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 accessoire 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 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