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23A-005 • 36 MEADOW ST BP-2006-0029 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-005 CITY OF NORTHAMPTON Lot:-001 Permit: Building_ Category: BUILDING PERMIT Permit# BP-2006-0029 Project# 3S-2006-0039 Est.Cost: $1500.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: William Gnatek 100088 Lot Size(so.ft.): 34020.36 Owner: STEVENS HEMAN JR&MAVIS L Zoning:URB Applicant: William Gnatek AT: 36 MEADOW ST Applicant Address: Phone: Insurance: P O Box 204 (413) 584-5682 HADLEYMA01035 ISSUED ON:7/12/05 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP &SHINGLE GARAGE 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: O1: 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 7/12/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo City of Northampton Building Department a tri„-- a .\ 212 Main Street „a- ,� r r* ,-r 4 Room IQQ Northampton, Fax 01060 ���ane GJB?587.1240 Fax 413-587-1272 7`^!tCe jlll � - APPLICATION TO.S INSTI‘CT,ALTER.REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEC11bW1.-SITE1T FORMATION MI Property Address: s31. (o � This-secftomtub®cowQPeLett bXb(fice . /Ile add to S`1`. t tat __ trrd€ �orenee 7y7GtiilaNerr:20:14rTL, r SECTION 2-PROPERTY OWNERSHIP,AuTHORREO AGENT p,1 Owner Record: / f l.411" 7e rens S6 1l7 ad,<• St —*renee m4 all Lao Name(Pnnl) Curt nt Malting Address: iu rr,� r + 5��-Lc aS/r� 3., y ' .�}-C.n ,,..6.l LXI� Tel. hone ✓ Signature 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 Construclion.from(6) 3. Plumbing Building Penult Fee. 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) '+i<' id-22e. DO Check Number This Section:ForOtfcial Use.Only Building Permit Number. - :Dste. issued: Signature: Date Building Commissioner/Inspector of Buildings Section 4. ZONING All Informatlkn Must Be Completed. Permit Can Be Denied Due To Incomplete Information Required by Zoning ng a s etaDepartment by Setbacks Front Side 10 I A gar Bldg. SgBldg. Square Footage ® ® _. Open Space Footage ®®®al® dot area minus bldg&paved Fill: ' volume ffi Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW ft YES 0 IF YES, date issued:.: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 • IF YES: enter Book . Page, and/or Document B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained t..+' Obtained O , Date Issued: • C. Do any signs exist on the property? YES Q NO 411, IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO • IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan that wiD disturb over t acre? YES 0 , NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r.. SECTION S-DESCRtP11QN OF PROPOSED WORK(check ail applicable) New House n Addition ED. Replacement Windows Atteraflon(s) O Roofing Or Doors ED Accessory Bldg. El Demolition ❑ New Signs [©I Decks (p Siding(a) Other(E] Brief Description of Proposed C"tiu,, reYO � n work: ,_ _ O"Y y/{Y1xy8. rOO y.'. Alteration of ebsting bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet fiZI NetfertibOUS baba`,, hast , ti __ 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?_ }1-d. Proposed Square footage of new constructioni. _Dimensions M a Number f stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck 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 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 Ta-OWNER AUThOPJZATION-TO BE COMPLIED:WHEN OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMIT I, fl?Q Y/S T veris as Owner of the subject property f/ `^' hereby authorize I/O)LLi z nt. ('na_tetc _ to act on my behalf,in all matters relatve to work authorized by this building permit application. r (2z/ft, �u.1�z 7 Signature Owner Date I, 1))17-4-a t}1 go 4f e{/ 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 off-perjury. A. A 1 t A. Pont Name 2oJPh« 1 . -,41.10--- — ?_ 9_&s_ Signature of Owner/Agent Date SECTION.8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Haider: _ License Number Address ..--..— Expiration Date Signature Telephone �..:e .1,a.. <.iaTD.N, . . g r e=^...:- • =..s s,.4.t Tht'Vi•,E' Not Applicable 0 Uhl. nt- i?nalek fan racier Looe?d Company Name r � RegistralioFlu mber — o• ' .,.O1 11/4411 )17a, C/d /rea-6-)9-46 AddressExpiration Date 141144 i"Af"‘---SEZ24 Tlephoe605,&w-071.2 SECTION 10-WORKERS'COMPENS'ATIONINSURANCEAFFIDAVIT(G..L C.Ts2,525C(6)). Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial at the issuance of the building permit. Signed Affidavit Attached Yes No ❑ {a 411-012i1l-v 9"Wri) 3*(TAX T 41 ;, :- The current exemption for"homeowners'was extended to include Owner-occupied Dwellings 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 gets - as supervisor.CMR 780. Sixth Edition Section 108J.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 le in 0.T lwrnro ti e Crtii� pf Northampton 1(. ,., E gt.a..ebae.«e. nal war/ DEPART MENT OP aLJrwiN.G INSPECTIONS 212 Main Strcct - Municipal Buildinc Northampton, Mass. OI OGa r` WORKER'S COMTENSATION INSURANCE AFFIDAVIT Lt0/`Ilia Yr' (.T.natek (liccnzccil iu&) villa a principal place. of business/residence at: - a9 igseSt .uley /J/ (phone;,) if)f-a7JZf (sacUciryrslacy P) do hereby certify, under the.pains end penalties of perjury, 0121 (✓j 1 :m an employer providing an kilowatt t:orkc(s comocnz_tion covemgc for my unetovees worlhng on this job. guard i-liSuranCe Gr:aap Wile ,3r,�y _-._ g cg)-oG Rostra=Coap-sv) Noticy NatiNO (Etpiruon Dat) ( ) I am a sole proprietor, genera) cona-aaor or homeowner (cocle one) and have hired Che conaaciors listed below who have the following worker's compensation policies: (Name of Coe,nc:on (Inwraect Cmnpany/Poie Nominal (F__piracon Datc) (Name of Concur-au) (lnstu^�c Compa:.v-RoGcv Mutat) {'imirvon Due) (Name of Caun cto:) CLosw'2nc Compauy/PoUc' Numbvl (Expiration Date) (Name of Contactor) (astral= Company/Policy Nionlarl (Expiration Date) (oars b mf mcwt io!«masa pcwuio5 in 41 Win) ( ) I an a sole proprietor and have no one woriOng for me. ( ) I am.a home owner performing all the work myseLf NOTE:pints:O .,ti!t ..m cplcy pot nn 1-gazt t ,a,.�ttt aof not axon(.1 =to;n tch‘ac bwoo.oe tom oe on s<pounai nwantona tho-enrt co(c s.cceidamf,o to cplcron M.-taa"aikd.'c oa An(CLhslr.l(S)).no,Iienzioo by•bwicoem fv_b mal n pa's 2y niY he I.gl.vva of.on cpley.r.edo.Un webs.Coutponon ioa A.t I aadca+addna a depy at this<w®.=ossy b Io.-.N.e to shit Ow.otisoi or f4as,4a.mSm+.Y Oa.et Ironac 6w. e++7t.i.t cum W N1Gitaze to nanorincown.gn tea 2)ANA{QL!SR a at to-4 a the..rin`m ata,sw'E Pa46a -:_i.not.Coe of up to n-?aa_00&Mice inettocsa of w one ye-.d d.9 pm.t a o 64 In at.sit*wok cIma..d (in o(S1 00.01 a any.pias ax. ._.._ Foe onn.r .- ow 011Y Puritan Numbs' Signature of Lic sc/Pcnniucc . C ifp zrt Xorflfainptun tj # !.;0. �i; Alassacbpurpa �l vt fart • DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 to act as his/her construction supe. :sqr. The state defines"Homeowner"as, " Person(s) who owns a parcel on which he/she resides ur intends to be, a one or two fizz r 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 he 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 t`egulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings(before backfill), sonotuhe holes (before pour), a rough building inspection(before work is concealed), insulation inspection (if required)and a final building inspection.LThe 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 L understand the above. (Borne 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