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06-031 (10) • BP-2008-0206 GIS# COMMONWEALTH OF MASSACHUSETTS 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-2008-0206 Project# JS-2008-000307 Est Cost: $3000.00 Fee: 525.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: use Group: Homeowner as Contractor Lot Size(sq. ft): 21562.20 Owner: CHIAMIS DANNY& Zoning. URA Applicant: CHIAMIS DANNY & AT: 61 LEONARD ST Applicant Address: Phone: Insurance: MARIE DELUCA-CHIAMIS W ILLIAMSBURGMA01096 ISSUED ON:8/27/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:ST RI P & INSTALL METAL ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/27/2007 0:00:00 525.00521 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo City of Northampton Status ofPermit: Building Department Curb Cut/Driveway Permit -,, fr„ ,Z12 Main Street Sewer/Septic Availabdxy i (; f 7 t i1,. Room 100 Water/Wee Availability ., '-�Worthampton, MA 01060 Two SstsMSaucturatelers phone 413-567-1240 Fax 413-587-1272 Plot to Plans AUG 2 / 44J/ Other$peclfy APPLICATIONTo CON' RUC}-,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address- This section to be completed try office bl /tell .y rG"l �y Map Lot Unit 44 edi I "f` O«/)J„L Zone Overlay District I` Elm St.District - CO District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record; Danny Chiamis/Marie DeLuca Chiamis P.O. Box 66 Williamsburg, MA 01096 Name(Print) Current Mailing Address: 413-628-4468 vaA so Telephone Sig rre 2.2 Authorized Agent: Name(Print) Current Wang Address Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3,000 (a)Building Permit Fee 2 Electrical (b)Estimated Tota(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 t �p1� sac-- This Section For Official Use Only Betiding Permit Number: Date issuu ed: Signature', Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rete Building Height Bldg. Square Footage Open Space Footage ,o (Lot area minus bldg&paved parking) S of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O 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 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES O NO V IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 part of a common plan that will disturb over 1 acre? YES O NO O 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 ❑ Addition ❑ Replacement Windows Alterations) 0 Roofing n Or Doors D J Accessory Bldg. ❑ Demolition El New Signs (0] Decks IC Siding(01 Other(0]] Brief Description of Proposed Work: Re1110‘C and dacard old roofing ninwnoh.Install New Metal roof Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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 healing? Fireplaces or Woodstoves Number of each _ g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?_ h, Type of construction i. Is construction within IOC ft.of wetlands? Yes No. Is construction within 100 yr. floodplain 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject property hereby authorize _ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date i. .. y (a /414 /5 as Owner/Authorized Agent hereby dec a 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 penplties of perjury. t Q 1?�y1 t7 t / Print Name � eAdtlise -4"7 Si tree o Owner/lent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable td Name of License Holder: .... License Number Address Expiration Date Signature Telephone D.Registered Home Improvement Contractor Not Applicable E9' Company Name Registration Number Address Expiration Oath Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.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 of the issuance of the building permit. Signed Affidavit Attached Yes 0 No...... ❑ 11. - Rome Owner Exemption 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 7$0, Sixth Edition Section 108.3.5.1. Def nition 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 faun 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 andjndLocal olc�allZZ�oning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature Y-1 U \--..) .. • The Commonwealth of Massachusetts _ Department of Industrial Accidents �- ' Office of Investigations • I' —_ 600 Washington Street Boston,MA 02111 +�" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organiratiortandividual):, 12hh Rnn V( GP) i aj .4 Address: pr) .5„t,/ a;,‘, • ` City/State/Zip: . , _ / r tA ' O/ &hone#: Are you an employer?Check the appropria e box: 1 Type of project(required): I.❑ I am ato er with 4. D I am a general contractor and I e� Y 6. Q New construction employees(frill and/or part-time).* have hired the sub-can actors listed on the attached sheet 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no tmployees These sub-contractors have S. 0 Demolition workingfor me in anycapacity. employees and have workers' P Ty * 0 Building addition [No workers' comp.insurance camp. imsumnce.r - quired.] S. 0 We are a corporation and its 10.0 Electrical repai.a or additions I am a homeowner doing all work officers have exercised their 11.0 PIumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t a 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] .-.�t Homt,atat tho cox o aFi-vviandictngt they arowork id their workers wcontmar must sibmita nm. t onrnrnvmess who submit thibox must indicating a additional nal doing all work end then hiore ub-cou iss d st submit t a yew affidavit indicating tis such. :Contractors fth check -cthis boxs have emplodyees, t adetimutsheet ide eir thew rams' thecocouHcynumbrs andstt¢w3tcCraor not those entities have employees. If thu.mbcontracrors have msployxs,they must provide their workers'comp.polirynumbmc I am an employer that is providing workers'compensation insurance for my employees. Below it the polity and job site information. Insurance Company Name: u _ Policy m or Self-ins. Lie.#: Expiration Date: Job Site Address: _City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.90 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Iavestisarions of the ULA for'. .ince coverage verification. .-I I do hereby certify under the pains an penalties of perjury that the information provided above is true and correct S'enature:.i/�� �r<i pip. /7 --c) 7 1 w Phone#: ./3 54 3-- • I Official use orzij rNwrite in this area,to be completed by city or town official City or Town: Permit/License# ` Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: iT 419 0311-g of XUrf1&}tt} lan it-4400, irad„„chmitii, .-,..,." - PS T - DEPARTMENT OF BUTLDLNG INSPECTIONS xMI=_. .i INSPECTOR 2t2 Main Street s Municipal Building �•y��,'-, Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.34E to act as his/her construction sup'.: 'i201'. The state defines "Homeowner"as, •`Perrson(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 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 ins.ection if re.uired and a.final.buil.'. • inssection. 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(eiectrira 1, 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 RELAY the project until such time as the proper permits and inspections are made J n // 41111yl C-1 /41,i)i _ understand the above. (Home own&/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me, /{ y Date D " A7- (/ / loca of work 6 / /eon aro/ 6i Ace des A (c` ✓f/� V/// /dC-j-