06-028 (5) 6${.EONARD ST BP-2005-0042
GIS#: COMMONWEALTH OF MASSACHUSETTS
:a-028 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0042
Project# 3S-2005-0057
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID E SCHUELER 138325
Lot Size(sq.ft.): 16814.16 Owner: POWER JANE M&DANIEL T KEITH
Zoning:URA Applicant: DAVID E SCHUELER
AT: 68 LEONARD ST
Applicant Address: Phone: Insurance:
147 WORTHINGTON RD (413) 896-4596 WC
HUNTINGTONMA01050 ISSUED ON:7/12/04 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 14 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 Sienature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 7/12/04 0:00:00 1375 $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
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,AL •R, RdtE�YA To:. i'LASH A ONE OR TWO FAMILY DWELLING
G JUL 12 2D24 !; '
SECTION 1-STIR INFORMATION ) J
t� P04.141:17t
•c ':�'` ` ,1.1 Property AddreAs: a, rea `tacf
-av `" - t e ' '+ g .20y0..- ?f-
k(e Yan rT 0175‘
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SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGEt1T
2.3 Owner of Record:
Qavk }Cert .__ 69 {-Ponard t /'Beds An14 D/c5
Name(Print) Current Mailing Address:
4i3 5124 3"0.DS
...—.. Telephone
Signature
2.2 Authorized Agent;DI u;ii Rrtli/�h7n I
1050
Name(Pont) rsf1RllQ�2T- eI
Current MaiiittgMdre Address:
it Q- tid
Purieci E. t46.aQi , 1 4)3 - 951 '469&
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTIONCOSTs
Item Estimated Cost(Dollars)to be Offidal Use Only
completed by permit applicant
1. Building -part, .#,dc)p .ero (a)Building venom Fee
2. Electrical (1:4EsfimatedTotai Cost-of
Construction from(6)
3. Plumbing Braiding Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 + 2+3+4+ 5) ??000 . 00 -thesic Number
This Section For Official UseONy
Building Permit Number: ,i„— Date Issued:
Signatures
Date
Bulldog CmynissawfII�ector of Buildings
kk
•
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column m be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot ma ndnus bldg&paved
parking)
e of Parking Spaces
Fill:
(volume&location)
A Has a Special Per nlx/Variance/Finding ever been issued for/on the site?
NO _ DONT KNOW X YES
IF YES, date Issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT 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, describe size, type and location: —_
elaelOrria.sXe: t'N ai*• 'e:OS i wo =ch , • i ��Lc.L e.'`_
New House ❑ Addition 0 Replacement Windows Alteration(s)0 Roofing X
Or Doors ❑
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ J Other [ J
Brief Description of Proposed Work: FAmatnr Lr. ,' a : s. ' , ' • • ' a •
go
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative D Renovating unfinished basement _ , Yes No
Plans Attached Roll❑ - Sheet
t x+Bt eklalc dao:ietriditton:aaatentreaW
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, bimensions
e Number of stories? _
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance, Mascheck Energy Compliance form attached?
I"- Type of construction
i. Is construction within 100 ftof wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j, Depth of basement or cellar floor below finished grade
k. Wilt building conform to the Building and Zoning regulations? Yes No
I. Septic Tank— City Sewer Private well City water Supply
ry
aLs 264 s'a n'Ir {DktzAT1oN ' OBE OORIPEE7ED YrlREN„
'O ¶ O[ TRACTOR",APPLIES`FOR BUILDNO PER¢7Rr -
, as Owner of the subiect property
Hereby authorize to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
, as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Mut' E. e
Print(Name
– a4
Signatere at Owner/Agent Date
S€MONSWINS; Rl1GTION SERVIOES
$.1 Licensed Constructipp Supervisor: Not Applicable ❑/y
Name of License Holder ;_ .f • +817/ _ ,a H/ `-('1-ti //1/4/g O11
License Number
Address or' ln51113 potos
-L7
WC
teilExpi atonDate
Date
Siigggnaature IcNNr
1 .Q �/T-+ Telephone
Not Applicable ❑
1-R1I-4]Li Ppnc4-vt < +n r, f'?83,2s'
Camuanv Name ,+ Registration Number
Mn wor4t,tvl< Qcd ugMyin5ton mit PI- Moro ? Cure/Or
Address Exp ratio Date
Telephone 4117. 9% E4 5-?L
. E O` aR1 S COfi7PENSA'#fION1NS;%!ANCE:AFFIPAVIT(MIG.L, 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 et the issuance of the building permit.
Signed Affidavit Attached Yes V No 0
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-vear 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 buildine 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 he 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
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DEPARTMENT OF BUILDING tNSPECTtONSi' /7
212 Main Street • Municipal Building
INSPECTOR +'
Northampton,MA 01060
Is
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supe. isor. The state defines"Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or tumfamily
dwelling, attached or detached structures accessoty 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 the e 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
1, 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
•
Tru-Bilt Construction Phone# Fax# Estimate
147 Worthington Rd 1413-896-4596 1413-667-3984
Huntington,MA 01050 Date Estimate#
6/21/2004 It
Name/Address
Dan Keith
68 Leonard st
Leeds,MA 01053
I-413.584-5028
Project
Item Description Oty Rate Total
Labor Remove Old Shingles And Solar Panels(Customer to 850.00 850.00
Remove Wires etc going to Solar Panels)
Labor Install new Drip edge,t&W Banier,Ftashing,Shingles& 800.00 80000
Ridge Cap
Note Customer to Supply all Materials i.e.Shingles,Drip 0.00
Edge,1&W Barrier,&Tar Paper.
Note Customer to Supply Dumpier for Disposal 0.00
Customer Siure oft to propo. . .
/
Total $1,650.00