07-009 (4) •
422 E, RD BP-2005-0084
GIS#: COMMONWEALTH OF MASSACHUSETTS
P7:40 - 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-2005-0084
Project# 3S-2005-0103
Est.Cost: $12000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use croon: Jeffrey Bott 101227
Lot Size(sq.ft.): 1032372.00 Owner: WADE ROBERT N&AUDREY S
Zoning:RR Applicant: Jeffrey Bott
AT: 422 NORTH FARMS RD
Applicant Address: Phone: Insurance:
32 Pine Street (413) 584-6251
FLORENCEMA01062 ISSUED ON:7/21/04 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW CEDAR SHAKES & 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# 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 7/21/04 0:00:00 4251 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
.r C
ci of Northampton '„ , ,�,.. "
lF l'J I1 'l7.Ir g 9 rartment t, ' .tea s.,, �t' 1..�.a*:
I RN'r 00
,,,. .- 4.2 r' a lc'r '-7-% ;, ,
JJ Jl1C 2 1N m•tsrf, MA01080s,, �, „�.,� � -. , .
phone 413-587- 1240 Fax 413-587-1272 �" -'� '""
APPLRCA r ' r . - . , REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: s5 � �mpleted' affice
€12.-2...„, tJo }t grtvl ) taw�-s a I t =wna'
T- f-Qr 9Yl f.G lMi , bite Z. 1°14",,,z::::!,-----;-, OVe"iayDistr'c
E[in 'his t 4 "J cavi
SECTION 2-PROPERTY OWNERSHIP/AU7flOR72EO AGENT
2..1 Owner of Record:
Bob 14J4d,- '122 , PeYY/5 go
Name(Print} // e� (^ Cement Mailing Address: .
-;- 4 /,
`i ^`C "" ...cit._
-� Telephone
Signature
47_,2 Authorized Anent y{-
Olt si film& sr Li ?cnC*e. .., —
Name(Pont) Cement Malang Address:
Tr
Signature Telephone
SECTION 3".ESTIMATED CONSTRUCTIOM.
Item Estimated Cost(Dollars)to be Official use Only
completed by permit apPlilnt
1. Building t 2 (a)"Building.Permit Fee
2. Electrical / (b)fstitr�ted Total Cyst of
Canstrucilon from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
S. Fre Protettion i
6. Total =(1 +2+3+4+5) fJ 01::13 .....—e Check Number
This Section For ONie ODate
Building Permit Number:
dal 7!suedUse
Signature: _�
Pudding ConvnJs oner of euAdings Date
/Inspector
Section 4.
ALL INFORMATION MUST BE COMPLE FED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This colon to be line m M
Building Dcpwmcnc
Lot Size No C HANG
Frontage
Setbacks Front
Side L: L: R:__
Building Height
Bldg.Square Footage
Open Space Footage
(Lot arra minus bids&paved
pakingl
of Parking Spaces
Fill:
(volume&Landon)
A. Has a Spedal Permit/Varlance/Finding ever been Issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ..._ DON'T KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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:
+L`ranif3i" a e 0t05 Dao ORK cr ail= E'a le Y . ..
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0
Or Doors.%
Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ } Siding
y }�+ Other[
Brief Description of Proposed Work: 4 + a .. 4 • I c3' 8 e..W4G2
Alteration of existing bedroom Yes /' No Adding new bedroom Yes X No 6001d NFO
Attached Narrativell Renovating unfinished basement Yes X_No
Plans Attached Roll❑-Sheet 0
tOnai , , + .itiOnStb'Te":ilstin'"ahOUSIn + + O•:.e ` '&44114 c �c.. _.
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 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 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
5E4 + y3s a R‘011itOFSIsL'ATjON -TO•BE COMPLETED
OWN .4 " c/0)�tTRACTOR-4"FPLIEs Tort BUILDING PERMIT. < '
B(,7 ---I-,f `r'� as Owner of the subiect property
hereby authorize J en-r is F7O 1 i to ac: or
my behalf,
,iin/J all matters
+.rre at ve to wo�+authorized by this building permit application.
O/eni
Signature of Owner Date
I,_ Te FP 1— 36 as Owner':Authorized Agent
hereby declare that the s tements 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
3e}�'ren- 't oTi=__.
Print Name r� =
4 I
Signature of Owner/agent p� � Date
S€CYTON& CONSSRUC-TION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Ho1414f ey Holt
32 Fine St License Number
Florence,MA 01062-1925 0 5-3/f 7
Address Expiration Date
SignatureTelephone
-7 'b Stir'
5I 6 2-S-
77-
- tst 1m` if tion a to tt-- s _ '"G=„w. -<' € Not Applicable ❑
Jeffrey Nott Con-rx4crin /0 /Z27
Company Name 32 yule St. Registration Number
Florence,MA 01062-1925 G/ZS/o G.
Address p' / _ Expira onD e
Telephone 584 b Z`5 /
:skittonal wdam{RS ,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 issuanceof the building permit.
Signed Affidavit Attached Yes `fle No 0
-r
���ic18§a'ri;J aeAabeir-J 3s "do a,Fle i
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
stmctures.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 sit will be required from time to time, during and upon
completion of the work fur 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
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i Ci,iijt Ili 1tstI1ai { foil
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'iS-m- UCPAR7")SENT OF BUILDING INSPECTIONS �_ =�..(
212 Main Street * Municipal Building
Northampton, Muss. 01060 "`= -
WORKER'S COMPENSATION INSUAANCE AFFIDAVIT
ii
I, v'+ -rw..
Cceonotteccono
with a. principal place o:business/raa'ideuce a:
32- Plink, ST' FOrefiAdo,, vviti -01"-z pho 58L! 6Z5
do hereby Ce:uiV, odder :ho_pains end pcncltics of perjury,
‘CS I am an employe; p ioviding the folloo, t_ " ors comp:Ins:moo oro for lar
employees working on this job:
I\515 Wi til 10' Att. y f LA, vv t� b
Sa� �0( ot ( (12.5- VS----..
- Qoauano COClrvmi (.=oa__:hn t - ( uTir i n Dao) _.
( ) I am a sole prepritt.01, 2e,; .m r_r'r ctc. _.os=.ec n:.e. (ci:dc a,. ) and have hired
the contractors listed beio.: who 1-oore the f&ls n--,-,2 wo t s c ronen n o[i es:
(Ne me of Cost'oc:0C) r2rIe.. L.r 'tto Orzs^_'t
..... (tare of Cont .aar)......__ tlu- rncc C ./Po c-r Vvnb_r) (FA..te(tp Dare)
(Name of Contractor) 0.nseeaace e _solo: t -u co 4 7172C_Date)
(Name of Contractor) Rnseauce.CorartAzyrEolici i :umtr_"; EA nate; u'Pe1
''. ) I am a sole p;oprecol LoO have 00 cxi for
r
') I am a home l _ a ill:2I1
NOIT..pant-...M. .c.t%rx _._ _. _,.
i(UCIt th'o 0vw e:Ip ir.Mk:6. .a -. -my ... .,h
c npIovc utic th,,.o.t r( cpr _..
elf.:u.,,of zze:r=ply,q wan ow,,:n. ' _, ..m,..c
ILL mad the accpy o(Juv . ..raybn:a v.M1v.� afhglu ndM�af.
co.e,-vciti=tiee and tat Ci!u — _ ruurr A eMOI 152 can ie:u to thetray-siticc -i'-1 pcur.E
tiuvtg aft(inc of up t'w S 1.500,CO o('Lpl t- , _ r..al n f- S :c4 OP*. arid
..rc o(SI0000 tG 1p: n .Ka't,o
b
t'aW� Y _ . .
tk
1i f�Jzr 4 Permit Nruntcr I
t
,.. ._ . , n i Lica gJFc ,r.,.. " ' ,L.
a, ;ill:* Citify of Northampton • ► _
M�r1 ytt� $taanvdnr<tb h
f_c.�.4`r Tna
DEPARTMENT OF BUILDING INSPECTIONS J.
INSPECTOR 212 Math Sea • Municipal Building . -37.21
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.:isor. 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 foundationffootings(before backfill),
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 RELAY 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