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23A-003 27 MEADOW ST BP-2006-1152 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lon iii Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1152 Project# JS-2006-1702 Est. Cost:$11500.00 Fee: 825.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 10802_88 Owner: GUNTHER.JOHN F&PANAF.MARK Zoning:URB Applicant: GUNTHER JOHN F & DANAE MARK AT: 27 MEADOW ST Applicant Address: Phone: Insurance: 27 MEADOW ST FLORENCEMA01062 ISSUED ON:4/28/2006 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.N. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chhnney: 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 Occu•anc si:nature: FeeTvpe: Date Paid: Amount: Building 4/28/2006 0:00:00 $2.5.00228 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ae s City of Northampton '' er x 'Building Department 212,Main Street .,,,-,/ r �, r c. `� 1� em 100 �-`- 'Northarcpton, MA 01060 Ss,n4V- +. fi E` phone 413-587-1240 Fax 413-587-1272 cs' `'z r APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-.SITE INFORMATION 1.1 Property Address: Thts section to be completed by office 87 Mead+, s✓ Tit Unit jort^cc Zppa- - - Ov€tlayDistrict- -ElriiSC Rbtrrcct - CBDtslnct" - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner-e- of Record: V ,t,�•o\1� an .“- Name(Print) ' Current Mailing Address: firTelephone Signature 2.2 Au i orized Agent: 'n 'Dpe/c J 1 kmA. `11 (ane- Lift R4 £J./Irc..-yl 4 r orlyName(Print)( I) Current Mailing Address: 13-6.76 - 4/ U7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION.COSTS Item Estimated Cast(Dollars)to be Official Use Only completed by permit applicant 1. Building /(r s-V -(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 6. Total=(1 +2+3+4+5) /II<VO Check Number This Section For Official Use Only • Building Permit Number -Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Depamnent Lot Size — Frontage - - Setbacks Front Side L:-- R:— L: R:_ Rear Building Height i._ '.. Bldg. Square Footage % Open Space Footage % __, —, (Wt area minus bldg ffi paved ,_—_1 parking) #of Parking Spaces — Fill: (volume&location) I. . A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO el DONT KNOW 0 YES IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds?try NO DONT KNOW 0 YES IF YES: enter--aBook Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Cr DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained © Obtained Q . Date Issued: C. Do any signs exist on the property? YES O NO er IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO e IF YES, describe size, type and location: E. Will the constructon activity disturb(clearing,grading,excava on,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 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 n Addition ❑ Replacement Windows Alteration(s) n Roofing N Or Doors 0 ���iii"' Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [O Siding[0] Other[Q] Brief Description of Proposed ((�� Work: KQ.^'vwi. nc.F Alteration of existing bedroom Yes_No Adding new bedroom Yes �No Attached Narrative Renovating unfinished basement Yes Y No Plans Attached Roll -Sheet ea:�ifNeiv=tiltiii andgraddtlotnto.alatill hquslnq compleink& OWTtiq: 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 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 7a-OWNER AUTHORIZATION-TO BECOMPLETED WHEN OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT V 0\e? l0 V.-) ,as Owner of the subject property ! hereby authorize DCIU" to act on m ehalf,in all tters r lative to work authorized by this budding permit application. -y_ _2N_ Signatureer Date I, bet krt. t VW..LZ ,as Owner Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of m nowledge and belief. Signed under the pains and penalties of perjury. .ra. Print Name Signature of Ow -r/Agent / Date M SECTION 8-CONSTRUCTION SERVICES 8.t Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ... License Number Address Esplration Date signature Telephone - J.3RDDI ratsNanlRilii emkentediiilai-r .,23. rradalak.x . s Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone ._ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.„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 tithe building permit. Signed Affidavit Attached Yes 0 No 0 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 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 andl or fano 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 fromtime 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"certif • assumes responsibility for compliance with the State Building Code,City of arm Northampton Ordinances,State and . gj s an• 'tate of Massachusetts General Laws Annotated. • Homeowner Signature )47- r ._......_.. • ♦ e (rit')p of Northampton iti ra • 4 MOP om- DEPARTMENT 01' OUI LIN° INSPECTIONS a 212 Main Street Municipal Building Northampton, Macs. 01060 woRICIES COMPENSATION 1 SLR A_ CE AITDA\CT _ Qiccnsx/p.rutincc) with 2 principal place of bushiest/residence are ti &Ntr k t 1 . 1 it-j)itc "d (lift (phoncr)_ 0,24- NA, ' (=tic-ivy/swnfnp) do hereby certify. under the pains sad penalties of perjury; ha ( ) I am an employer providing the following worker's compensation coverage for Illy employees worinng on this job: Catsam'c Coo -may) (Polis;Nunbcr) __.. (Expiation. Dar") .. ( ) I am a sole proprietor, geoeral contractor or homeowner(tide one) and have hired the coomactors tasted below crbo hive the following worker's compe_anon policies: Came of Contractor) (Insurat cc Cmnooayreoncy Nu[n_zq (F.:_=ijesa Date) (t1anc of Coon nor) pn uranc,c ComnaayrPoity Numt-rt) (Exp naan Dale; (Name o(Cans-aco:} (l c nnc:Crmpany/Poicy Nw±L s) fcspintion Date) (Name of Cooaacor) (Instrrmce Comcauyft'olicy Number) E.xpirvion 'Yak). (.arta oar or'as Jam..-...u.is xw.S ufo a.Em pcut:,ivc to tit r—cert) • ( I am a sok proprietor and bave no one woridog for me. ( I am a home owner performing all the work myself. 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Lot: Signatuec of Li... • Pcrrniuc U3te . .1 F - 0 451UMP70 ` # Crifg of yorthant}rfon �, rata. � � 9ax..«.hu..tt. 0 h DEPARTMENT OF BUILDING INSPECTIONS z 212 Main Street • Municipal Building INSPECTOR Northampton,MA 010(50 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 784CMR 108.3.4 to act as itis/her construction sup::_. sor. The stale 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 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 backlit!). 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(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. (Rome 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