06-035 (5) 244 HAYDENVILLE RD BP-2008-0312
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map;Block:06-035 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRAL t ING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Perr�ita BP-2008-0312
Project a JS-2008-000443
Est. Cost: 541300.00
Fee: 825.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Groun: Homeowner as Contractor
1,0E Sizc(se. II): 23435.28 Owner: GINGRAS LOUIS
?on n: LIRA Applicant: GINGRAS LOUIS J
AT: 244 HAYDtivVjLLt NU
Applicant Address: Phone: Insurance:
246 HAYDENVILLE-RD (413) 586-7420 0
LEEDSMA01053 ISSUED 0M9/21/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 it Foundation:
Driveway Float:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Einal:OH //m J-O7--1/4-14
THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON UPON VIOLAT !N OF
ANY OF ITS RULES AND REG ION
Certificate of Occuean / - i Brute:
FeeTvpe: Date Paid: Amount:
Building 9/21/2007 0:00:00 525.001197
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillu
cam- *.� erFtse',o '.sa-
_ City of Northampton 5�Ga4ae��� -�'-
ir t;Suilding Department rem€ -- � T
-i' 1 - - 212 Main Street wersepe""s
Room 100 4VafeacelCA z' -=,- t
tl Noljhampton, MA 01060 Se1rpESirx[tsaFP -J - _ '
`" phone 413-587-1240 Fax 413-587-1272 P.lasze " _ -. -g _�
a spm r" _ "
APPLICATION TOLCONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1- SECTION"C•SITE.INFORMATION -I
'IA Property Address: Ttuwo
s serto e-
Eecotopleted byo fiv
J0_,vV, t l_ /tn ,
1-- E6- 4-5 A14 ' 0/ 05-3 -Yooe - Qvetc tncE
o€ SEOishiEE_ CE:Ortr
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDAGENT - ' -I
2.1 Owner of Record:
L-ca S T. 6,^-o.nf$' 54 tE AS 4aof/E
Name(Print) Current Maifing Address:
`4'n r Telephone
t. �4 .< . 5 ,%to — 7 41 ^0
Signature
2.2 Authorized Agent:
Name(Print) Current Mang Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRHCTfON-COSTS
Iter Esdmated Cost(Dollars)to be Official Use Only
comoleted by permit applicant
1. BuildinggP
(a}Buildinennd Fee ow- DO
2. Electrical Will Q 4bf.Estimated Total Cost of
Construction from(6)
3. Plumbing N1J1
^ _ !Building.Permit Fee
4. Mechanical(HVAC) /1"/4
5. Fire Protection q
6. Total=(1 +2+3+4+5) I 9) 000 -40.
OO _Check Number //9 5—
This Section:Far OfficraFtlseOnly
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZON(NG I AU Information Muss Po Completed.Permit Can Be Denied Due To incomplete Information
Existing Proposed Required by Zoning
This mlunm to be filled S M,
Building Department
Lot Size i ..- _
Frontage
Setbacks Front
1 Side L.�� Rr— L_= R_ '
Rear _ • —
iial
Bldg.Square ®
rMIMENSIIIIIIMia
Open Space Footage cu ®®®
(La area Maus bMa&Pavel
parking .
IIIIIMIII _®®®
PRIME
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
- -.. NO 0 DONT KNOW YES0
—_._......._-_
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW 0 YES 0
IF YES: enter Book Page. ~ and/or Document B'
8. Does the site contain a brook, body of water or wetlands? NO ri'r DON'T KNOW O YES O
W YES, has a permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained O Obtained O , Date Issued: '
C. Do any signs exist on the property? YES O NO g
•
IF YES. describe size, type and location:
D. Are there an proposed signs sed chan es to Cror additions of ns intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it pan of a common plan
That will disturb over I acre? YES in NO fK{S7tF
net
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [l Addition ❑ Replacement YYindows Atteradon(s) D Roofing ED
Or Doors .25.
Accessory Bldg. ❑ Demolition ❑ New Signs ICJ] Decks [q Siding[C] Other[0]
Goof Description of Proposed
Work: Z' .5illLL A6,4t9eEw, .vperw,S
Alteration q7 ebstirig bedroom Yes X No Adding newtedroom Yes No
Attached Narrative Renovating unfinished basement Yes S( No
Plans Attached Roll -Sheet
ea_-�lft3ero'v,-k�ciLse�Nd ofa5'dt�fioes.._k�ez€s'f'iici~.FSoDssaaz
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit Number of Ballrooms_,
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_p
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
, Type of constmotton
i. Is construction within 700 ft of wetanci Yes No. le cons •. m r . •• • , .... , es-- No
]. Depth of basement or cellar floor below finished grade
k. Wiii budding conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7s•.OWNER.AUTHORIZATION--TO BE COMPLEfED-WREN
OWNERS AGENTORCONTRACTORAPPLIES-FOR BUILDIK6PER$fl
as Owner of the subject
ProPedy
hereby authorize
to act an my behalf,in a0 matters relative to work authorized by this building permit appikatior.
Signature of Owner Date
__ as OwnerlAuthonzed
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-
Levi3 – c; -'cVIAS
Print Name
J✓ - X �. 1 rr...- `1/1 ''/o ?
Signature of Owner/Agent Date
•
SECTION 8-CONSTRUCTION SERVICES
87 Licensed Construction Supervisory Not Applicable C
Name of Li ensa Helder _—
License Number
Address Expiration Date
Signature Telephone
A2Req`¢T¢fad.HBificfmt}roveiperitCpptracffg 23 7,:" '1 -? 73) --w P= */ Not Applicable 0
Company Namq Registration Number —.
Address Expiration Date
_, ,,,,_, ,Telephone
SECTION 10-WORKERS`COMPENSATION INSURANCEAFEIDAVIF(MG-..L c$52;§25C(6)).
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit wilt result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes Ig No...... D
`..v is A,. •.t _L 1 t i
The current exemption for"homeowners"was extended to include Owner-occupied Dwellin 2pfone(I) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owuer acts,
as supervisor,CMR 780. Sixth Edition Section 1083.$.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 ht/she shall be
responsible for all such work performed under the buntline 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 perfu,, 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 5ignatnre
L\ The Commonwealth of Massachusetts
Department of Industrial Accidents
i �-' Office of Investigations
600 Washington Street
'' Boston,3M02111
�•' www.massgov/dta
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Crganizm onEndividual):
Address: _
City/State/Zip: —, Phone m:
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 5. 0 I am a general eo¢aactnr and I
employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction?. 1 nm a sole proprietor or partner-
7.on the attached sheet 7. 0 Remodeling
ship and have employees These stilt-contractors have g_ 0 Demolition
worknig forme in any capacity. employees and have workers' 4. ❑Building addition
H4is workers'comp.insurance comp.insurance.:
required.} 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3X I am a homeowner doing all work officers have exercised their 11.0 Pitmbmg repairs or additions
myself o workers' right of exemption per MGL
[� comp. 120 Roof repairs
insurance required.]t a 152, §7(4),and we have no
Other
employees.[No workers' 17'0
comp.insurance required.]
____ _
..._ -'t3tr�per rSar�.-cis box 41 iodrst also till out the=cam below belowshowigtheworkers'compasauoo PoEeymforttnrloa
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contrxann must submit a new affidavit mdiatag sues
k;o=afford that checckthis box must=died an additional sheet showing the name of the sub-contactors and sate whether or not those entities have
employees, If the sub-contactors have employees,they mast provide their workers'romp.pohcry number.
I am an employer that is providing worker'compensation insurance for my employees. Below is the policy and job'site
information
Insurance Con-many Name: .__,..
Policy/4 or Self-ins.Lic.re: Expitatioa 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 MOL c 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 aadior one-year imprisonment, as well as civil penalties in the form of a STOP WORK.ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
InvescsaSons of the DLA for insurance coveraee verification
_______.—
Ida hereby cern),under the pains and pend/ties of perjury that the information provided above is true and correct.
_—SYCature: -�t{ ...� r' Date: I j/al jo 7
Phone 5710 - 7t90^o _—
oniciai use only- Do not write in this area,to be completed by civ or town official
City or Town: PermiuZicense#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.CitviTown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone d:
s
zfu of N srth 3u ton i' 'e—tFa
'Cali:*l T,
DEPARTMENT OF EUIlDLZG INSPECTIONS �_ =n/
212 Main Street i Municipal Building
INSPECTOR "
Northampton, MA 01060 .
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lisi9ter construction sups. ,cor. 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 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 buildingdepartment 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 buildine inspection(before work is
concealed.insulation ins+ection if required: and aSnal...huil.-.v ins t ection.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
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