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06-022 (13)
44 EVERGREEN RD#304 BP-2005-0719 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:06-022 CITY OF NORTHAMPTON Lot: -014 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0719 Protect# JS-2005-0996 Est. Cost:$2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RAYMOND MITCHELL 142270 Lot Size(sq. ft.): Owner: MAZZA WENDY A Zoning:URA Applicant: RAYMOND MITCHELL AT: 44 EVERGREEN RD #304 Applicant Address: Phone: Insurance: 37 HIGHLAND AVE (413) 527-2159 WC EASTHAMPTONMA01027 ISSUED ON:1/13/05 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & DOOR 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. Certiflcate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 1/13/05 0:00:00 4266 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo City of Northampton %. Building Department 212 Main Street Room 100 Northampton, MA 01060 � ;Lo raE ns- ' phone 413-587-1240 Fax 413-587-1272n '� A '-`srhrlt4i _drew 1. fis-z©thewlecEV APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.•SITE INFORMATION 1.1 Property Address: .- yiiss—ssection to bee ccumpreted blcofce --:ii ., ; 4--4 �:) ,. ;- � _Mats` ;C Lot .tT #. 1it91 G/-Ll h` Zone OvedayDisfrict G/l»f._ - t7±521— SECTION 5_S—SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .L'c 1111/% 17115- �H GCt:rf>'r all hi I,[<-.i i P'>7fl Name(Print) v / Current Marlin Address: Im . ; SY/+ .22(ad Sigrid c-!ft 6 n N-4 3(�. Yt.ir6, ;y 19G. Telepgo - ne 4."1.1,1c Signature J 97 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection -1 V 6 r Y 6. Total=(1 *2+3+q+5) ��.�, . Check Number This Section For Official Use Only Date Building Permit-Number.. _. Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4, ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete information Required by Zoning This column to be fined in by Building Depunnent INIMIIIIMannaiMa Setbacks Freest Side Rear Bldg.Square Footage ®® Open Space Footage allallalill (Lot arta minus bldg&paved MalIllnllMIIIIISII ®MIIIII.HallMnllMIIM Millile A. Has a Special Permit/Varience/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:', IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book . Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: • • C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: 0. Arethere arty proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is It pan of a common plan that will disturb over 1 acre? YES 0 . NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House in Addition in Replacement indows Alteration(s) r( Rooting Or Doors Q Accessory Bldg. ❑ Demolition El New Signs [M] Decks [O Siding(DI Other[Dj Brief Description of Proposed f< • y/� Work: liJ�Jl.?.� (.jfi. ^'ff Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa FFNevs hoaseaitt�or.�edr7etiotn3arxfsftitp.�oDstna:�comp�ekir"ifi@tt�[tour��tti: a. Use of building:One Family Two Family Other ., b. Number of rooms in each family unit Number of Bathrooms c, Is there a garage attached? 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. Masscheck Energy Compliance form attached? it Type of construction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes iNo j. Depth of basement or cellar floor below finished grade k. Wil building conform to the Building and Zoning regulations? Yes No- L Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED.WHEN OWNERS// AGENTOR CONTRACTORGAPPLIES NJ I, ( t/c-A;,(C /2);; ,as Owner of the subject property J .7 / hereby authorize /1.-;‘ (dirk.I I 14417(ht,L.,m., to a on my behalf,in al rpatters relative to York authorized by this building permit application f,' ((i5 Signature of Own-r "rTT - •Sj ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the hest of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of OwnertAgent Date • we . . SECTION 8-CONSTRUCTION SERVICES 8.1 licensed Co» sirvction Su prison I,/ ' - Not Applicable 0 NamA_e of License Holder: +- -" _,,c,..,-41 / 7 ,,,. - .,J 'A",,,� ziisile Num_77be .•�•.� ./- der � 4:74's/ . ^171 y+ License Number Address .� /; ExpiyOat ✓� mud S nature :'� Telieepcnn i / d and * elm. ." Is TtLiis! Sit ?". *tx:` '"'?.C` s`:4 Not Applicable ❑ 4is-r77,--A,='nr.:.f;1.-, .-9 .A..?n.LEvy%�-Jry7 Y' - ,2 -` Company Name / Registration Number —' '-- Address -/ / Explratldn Date ' .d.' 1M c'-Jsr vi. _ < _7A/ /1_' -/`.- / Telephone= T SECTION 10-WORKERS'COMPENSATION INSURANCE.AFEIDAVE-(M.G.L e.152,i25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit veli result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No 0 : oat i v a , 1 At The current exemption for ahomeowners`was eateaded to include Onner-ee%pied Dwellines of one(1) 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 act - as supervisor,CMR 780. Sixth Edition Section 108.35.1. 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 faint structures.A person who constructs more than one home In a tyro-ver period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,,that befshe shall be , responsible for all such work performed under the buildiozpermit- 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,von 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 .. 2Oq$1[M1PrOy . . a (rifg of Northampton n 9 b�f-„_u.•l B• Mavna _� DEPARTMENT OF BUILDING INSPECTIONS _ _ 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 sup:;:.Lor. The state defines "Homeowner” as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two faniil 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 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(elect.;_t plumbing dc gag) 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, 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 • cPilwr<ro _ - , "�"5 QLii>2 of Pr-initial-lupin!' E ,--. ��\M 1¢lf u • 11 DEPARTMENT OP BUILDING INSPECTION:S `� 212 Main Street. ' Municipal Building = Northampton, Mass. 01060 r' WORKER'S CONE'ENSATIO.N GYSURio c.6 AY1t L1)AVII I, ks��2 (Jit %f:/7i� 3I A.-2, ." ** A/'�,—L -_ / (Iir'nazlis,oJttcc) With a principal place or businesJresidence at. ------ fi%r7!%! ' , J %. /t.% ( hon _ ,% (samcciryr rap) do hereby certify, under hepains and penahies of perjury, Thai ( ) I au an employer providing the following worker's cornocnszaon coverage For fly employees warthog on this job-. Giro mr anv) - (Polio Nu r) (--t6 roof Due) ( ) I am a sole proprie(or, general contractor or homeowner(c cie one) and have hired the couaactors listed below cubo have the following worker's cccn en_sbon pe!icies: (N cruc c i Contractor) (In2ran.cc Comoany?ciic- Numtc) (ExpLaeer.Dam) (N:m<of Coeuaaor) Orasuraucc Cnmpa yiPo!ic Number) (ape-aeon Date) , (Name of Comano:) (Innuancz Cowpan /Policy Nusbu) (Expiration Dale) (Name of Contactor) (ino rancc Company/Policy Number) (Expiation Dale). (,c,a,ad,nc[al cel tr... .."to mewa thfccroo4w pc-tithing u.0 ocCcon) • () I am a sole proprietor and have no one working for me. () I area home owner performing all the work thyself NOTE:71=be ewyr y;..t,'e hcuv+eea'to ploy pea=t to u e--'c-.-..++ cr . a rGau curt on aEc.1.1=or oat rete thou 1_`ae v=ia in*rich'Sc bommrae tort=or cc'Sc croucth ivw ten n that az'out LsaRy ec.L_-d u be oplayca uaL-thc',talc . 'cc Ac(GLIS2p1(5)).wmtictoo M.harem=m rv.car m permn troy nit the luso:coact or,.yleyn uv6e to Wo&a'.Corucctecica Act Iuodca.agdo a mpy ar Wv...a quay be rurvddw W.Douthtmccr of Wauiti oualcmY Oder of l r tic mveast.eifeioe cad nu Coact to.muctovoc5,rot=wioo 25A of FIOL 132 no 4t.Le the.mmmaa ale-Sinai p-^eV= mmieg or a Bac of up to 11J00 00 ac /or y ornp wao r�ant coil paP+o:vcc r or.Shp wmt ONc.aa. f 0(510000•thy.piny¢c F .tanm�al'..c W t. ?' C ' j----7 - / c 7 Pmn Numb= / // � /j,;�. ha''P:-- root; j;. tut or Lac /Pc vu¢ T ce .. J F. isc (-____ 1