11C-046 is WMNEa:ROW BP-2005-0093
GIS#: COMMONWEALTH OF MASSACHUSETTS
`' "' 14C>-046 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-2005-0093
Project# JS-2005-0112
Est.Cost: $4200.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BARRY BOWEN 122412
Lot Size(sa.ft.): 6708.24 Owner: BANKS MARIANNE
Zoning:URA Applicant: BARRY BOWEN
AT: 10 WARNER ROW
Applicant Address: Phone: Insurance:
129 STARKWEATHER RD (413) 238-7726
WORTHINGTONMA01098 ISSUED ON:77/22/04 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOF OVER W/METAL ROOFING
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: Receipt No: Date Paid: Check No: Amount:
Building 7/22/04 0:00:00 3801 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patina
f •
- -*
[� s ilding Department
ItyofNorthampton
'12 Main Street �
JUS 2 2 7904 Room 100 t = s
L o r .mpton, MA 01060 ' itt ,r S
3-5:7-1240 Fax 413-587-1272r
DE Dr R:"t;�ie`qua Ol"Fg . ., rt:�--1= :ry
• •LICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: � mPloted�yo(fice• .
ID Warner 120 co
& s rT
0 as ryW 01053 zmte# t-credal feati a:r
1mT OrSt r"> DsNct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIED AGENT
2.1 Owner of Record:
Marianne Betrn.K.S POPA2X134 (0.4S- Mrel'O3
Name(Print) ^ Current Mailing Address:
n� n^ 985•ouors
[flF�
Telephone
Sig
2.2 Authorized Aaent
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 ¢42NOD (a)`Building Permit Fee
2. Electrical `� (b) Fstmate&Tatal Cog of
Construction from{6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fre Protection ri'1w•e+L
6. Total =(1 +2+3 +4+ 5) c 4-12-00a :Check-Number 3s / 14-7s
This Section ForOffdal Use Only Tr
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R:_ L: R
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces 3
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW V' 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:
; I '
:. , ctyrt
a.' vi .nr*rn .-.. = = .. . - zsac- . z,,
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing al,
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs ( ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: (b Of• oVera" e. [+ 0i4 44
Alteration of existing bedroom Yes v7-No Adding new bedroom Yes Ler". No
Attached Narrative❑ Renovating unfinished basement Yes ✓No
Plans Attached Roll❑- Sheet❑ /
o tait9ot"atdi3argt'IitQ�1iC"usn D `. -"4' : n( A
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? T
d. Proposed Square footage of new construction. Dimensions „_-
e. Number of stories?
t- Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. _ Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ftof wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
I. 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 welt-, City water Supply
ir
y _. —
�=i -% —7, a s -,. .- h..;TA B[r COMPLIED W}jEN.
9 �jAagr e tt e� •' gTOR reL”"IES FOR BUTLDIt1G PERMITT n I�,
I, Mar cane 64244 as Owner of the subject property
hereby authorize _ to act on
my behalf, in all matters relative to work authorized by then building permit application.
Signature of Owner /��y Date
I, a'EUl/id�r"2 / , 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.
Man/uw nLtc
Print Name
Signa ure of Owner/Agent Date
SECd;fONE1Z-401.1ST UCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
p
Name of License Holder : T !Y U Tho w ✓d er cbq 3g l I
1 License Number
121 Stare-weave Qd in& latem- v i m4 °D1 b?, 4pi )o0
Address Expnatio at
/A. 238 • "772(0
Signal a Telephone
/ �t�td/eL
:f: ia- jai Not Applicable ❑
E'.tNrt.1 3o w2t7 1 2.2.(42. -Hie
Company Nam6 Registration Number
121 stout-1460w 1i vanIttulizs 6119 oiotg
Address Expirati n 23i (0 (/
,D(a e0/ /
��„. Telephone � •772
"$•E o {L9BLEt$,,,COMPENSA'TIONINSURANCE•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. ,f
Signed Affidavit Attached Yes 0 No tR. No Fait to fltr"s —
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-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
I 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 fc-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
It uffrTG - _
2 �y
(city Lei r Ilrthxln fnn =g
i iA? ete'sari art s /
t)EPN2T>.1P.N! OP BUILDING INSPECTIONS
212 Main Street Municipnl Budding
Northampton, Maes. 01060
WORKER'S COMPENSATION INSURANCE .VFTDAV1T
(!i�,s[dcrini4[ci
with a principal place of business/residence nc
tph neat
1,sureetuDelebeefaap,
do hereby certify, under the pains zid pen::itier.otperNry, !ilnl -
O I am an employer providing the fo?lowirtg .:o.ars compensation coverage kr my
employees working on this job.
(7.cnlrano Cora-„anY) (.-oi_c;Number) (Expir_;icc Data)
( 1I ara a sok pronreror, ee^.eral conucrc. ';.r hcn;eownel (d c!e one and i-:zve
the contrachttors list:,d heio)' IMO have e th oil. - oke 5 colo ns.-on ;C:hCies_
Mame of Con[.ac:o.l ihistrancriCr ?&f N urate . _ Date)
- Mame ai Contae.c-) t s _.ct o . - zv(Pclieu Number) fEbt,Drane Date)
- (Name of Coni actor) alusneet l ,...);IPoli 1 ul.a'.. ) .. Dale)
(- Nameap Q ) __..
of Contncosumoc: Cem",.:ry/"i wiry h'umi._l (L:C?raie.=_Date)
)(Clam a sole prop ritith ani ha ::nt;o ()ace kingIvor mc.
! ) i :ha a holt_owner -Iging ?di rscif.
NOE:plc.ae t< 1 . ,:Ic - e:-p —„. . _-AC-2=10a%C.Cfrt.Y.tYCI aapair‘‘, it a‘sail=a,
o n three units Ctth - CCIthY 4r,r4 ±CC_act act{c* aDa
aapioan'una W u',—ken mra_. a /Y,G.' . _c(5)),a ra1aaanza x honianaaaai...raa_ u
legal Wawa an clover ww'r Wu W o kc t Cav,a.sv»a Ace
i tari4eatand Wca awry of tbiAc ctatee•m+yba fora n,Nd.{to:`:n1}_,w:awn:of Ldu[nil uevGzcg O:Lm Om
coverage w.-uCapoa xd that Libra to'tart wtvrasi3r tcciz115Aof MCa.151 can Ld1301c impa wmo'R_ad aaaa m
r tt of II Gmofup to St}CO.00 near.keepriir_rxd of vp to mm_rar dal lwnitica In tt in ora Sir!\V`v3.(Wt ar4e
f n(SI00.00 t thy*gaunt n=
roc 3-:uvmeal t1 c Sol-i
Permit Number
..x . ._ .Smnnwrc errnc .xJl rvix¢r,
"
'ea (�tf of Northampton i- — l
viii. Y,r= Ysri,� u ¢.ex,rha.ru. t_
«'J r DEPARTMENT OP BUILDING INSPECTIONS a F=J`
' `
INSPECTOR 212 Main Street • Municipal Building yy ,.
Northampton. MA 01060
1
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as itis/her construction sups.,icor. 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 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 backfin),
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.
(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