07-019 (6) BP-2008-0722
GIs #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorr BUILDING PERMIT
Permit# BP-2008-0722
Project JS-2008-001132
Est. Cost: $2100.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TIMOTHY J LUCE 149288
Lot Size(sq. ft.): 174240.00 Owner: LOVETT ROBERT N&IRENE M&
Zoning: RR Applicant: TIMOTHY J LUCE
AT: 326 NORTH FARMS RD
Applicant Address: Phone: Insurance:
P O BOX 14 (413) 387-9800
LEEDSMA01053 ISSUED ON:2/27/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE PARTIAL 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 ft 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: Date Paid: Amount:
Building 2/27/2008 0:00:00 $25.00309
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
>✓l, lc ,"n Department use only
II Northampton Status of Permit:
Irk `� =-�BuildWgg Department Curb Cut/Driveway Permit
21 ain Street Sewer/Senile Availability
`q 1 7 iglu Room 100 WaterNVel Availability
Northampto\, MA 01060 Two Sets of Structural Plans
phefte.41 S8 '-124 Fax 413-587-1272 notate Plans
Otter Spedfy
tAPCLI@ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
>1c,r„ -71-i4,1/1 A
"�i ^+ Zone Overlay District
Elm St District CB District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
g
_�) 7L- .....
Name(Print) t
Jig:,c,y..,..�:�,��41 Current Mailing Atldrese'. �-
6/7eEh✓
Pt;iTelephone
Signature
2.2 Authorized Agent' / q�
my'S ��`c-<_., Yet (1.72 creek lel l_➢-AEAr7 AFC UAL's_
Name(Pont CurrentntMailing AAddress:s
'1715
"j
ti15 -t/ C?p 'j"-Kti
Signature Telephone
SECTION 3.ESTIMATED CONSTRUCTION COSTS
tem Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /.( 2/ I04)) (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 16)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
m
Q�tai l5 +2+3+4+tt.._— 1'�<- J Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:Signature:
Buildin8 oommissioneillns0edor di Md117mgs —"" Date
•
Section 4. ZONING AR 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 Department
Lot Size __. . . . . .. _...
Frontage _ ..... .. . _... . . ...__.
Setbacks Front - --
Side L ._ R: L: R
Rear __.... _.
Building Height
Bldg. Square Footage
Open Space Footage Po ---
(Lot area minus bldg&paved
narking)
of Parking Spaces
Filly _
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW (3 YES 0
IF YES: enter Book Page and/or Document 4'
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES (3 NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading excavation or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO (3
IF YES then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition 0 Replacement Windows Alteration(s) I Roofing Iv""?
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks fp Siding(C7( Other[O]
Brief Description of Proposed c t ¢ p
Work' 1
�Yy'r-rP_ �:r`G\. s 1-E rot y�. 7 .. ..
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil -Sheet
ea. If New house and or addition to existing housing, complete the following:
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 Woodstaves ,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 AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1,—/Per/Ver Le / // - as Owner of the subject
property I
hereby orIinlj L.t C—��
to act onaauthmy beizehalf,in all mattersc rela6 a to work authorized by this building permit application.
jii,ne oe'ne t
Signature of Owner Date
I-\III
I "� V [-, . CI --C .-----.
as Owner/Authorized
Agent hereby declare tri 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 p nasties of perjury.
Prim Name —}
„_----t..---- '2— 2— L-_— Of
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8A Licensed Construction Supervisor: Not Applicable El
Name of License Holder:_
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor Not Applicable 0
Company Name Registration Number
„, hoihi - /5' Jo
Address l l� Expiration Date
22 :�} �JL Rv� LeacI5 11 Telephone `l/ 3 SZ Sjd •
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT OLG.L.c.162,§25C(00
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 pjit.
Signed Affidavit Attached Yes C9' No ❑
it Home-Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied DweNinos 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 1083.5,1.
Definition of Homeowner:Person(s)who own a parcel of land on which hefshe resides Cr intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached stractures 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 he 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
•
The Commonwealth of Massachusetts
r,-
Department of Indust,-ial Accidents
'a
"==s:� - (Mice affrresziga:ions
gam_,
_ 600 Washington Street
Boston,14 02111
-.4:-�Ja www.mass.got/dia
Workers' Compensation Insurance Affidavit: Builders,Contractors/ElectricianstPinmbers
Applicant Information )1 L -^�,.f Please Print Leiiblr
Name(Busineszcgsizade ii—: 7'_l 1,.-Ceti--,-) , ._...._.,_
i J
Address: / Z 2 -42,C6,-- t2,--4 --
rity/Stats/zip: L2-�ad/j -414 0/05 5 Phone`:: cil`"L 3h 1- v
7eFe .i
Are you an employer?Check the appropriate box: I Type of project(required):
I s. lam a general contractor and I
ill
I.10 I am a employes with - - I d, Q New consultation
I f _ e.^a, 'royces(fall aad/ro paz2-tme).'
have b=red the ae ncaed s+actor
-red on a�raed SFSetI I-"1 v e,nod. j
am a salt prno emr or pan-her-
rThese sr:b-coacscton have
I ship and have no e Zo;rcesI l S. 0 Demolition
employees and have workers'
wet-icing for mem arty capacity. + 9, ❑B men-uo adcl tion
I [Nit wd4ers'corrm inra'rmce unit tasmipce.-
reaused] - 5. 0 We fie a cosporarion and it= I I0.❑Electrical impairs or addinon. I#
3.7 Z am a homeawx dares all work oicets have exercised thea I LE PYA^bag repairs or acv'dors
myself.INo workers'J . tight of exemption per ZvIGL f 12.7 Roof=pans
ins rant req,±ed.j i c. 25„§1(4),and we have no
employees.(No workers' 13.7 mer
•
comp.insurance segmsed] f
.
_- emea ,eases nae;1;4=so ono nil out mt son now mon then-won! eoma
pa ®apolicy mim;mnort
t Homeowne,who r nt this affidavit inning they are doing all work and:ban SAC outside CoptrC.OR muss:anon a new a;nvis tdimtzig suns.
tionaacmrs Ibat deck this box dastaaacned an ndtidoun on shoo/ins tin on of the suirwnanms and,tats wheth r or not not con ave
e-mioveen. lite.c,h<annacairs have=pioyes,theyroust provide their WOTS s'CCL .pan inyo,.—.
I am an employer thatIspree/ding workers'compensation ir.surmrcefor my employees Below is the policy and job the
information.
Insunnce Conauv Name:
Policy 4 or Self-ass.L.'c.r; Ewhznon Date:
Job Sire Address: i CiLy'Stats/Zip:__,_,
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Paiiw'e to secure coverage as required=de:Section 25A of 2401,c. 152 can lead to the imposition of crimnal pe^raides of a
5„P up to SL500.00 xvv'or ore-year iaTrisonment,as well as civil paints in the fonn ofa STOP WORK ORDER and a 1=*e
of up to 5250.00 a day aea+nct the violator. Be advised that a copy of this statement maybe forwarded to the Grace of
Invesi2abons of the DL>forinsrance cove:ase verification.
Ido hereby c refy underf&gp®s and penalties of perfury,drair the information provided above is true and correct
f2 2 7 cacF.
_..._3_...
.—
.--;---3,-.Z'-. '-''--- Dare: _
Phone Lira -5/• 3-. ? t?("` ._
'4-Ojiciai use ativ. L'u nor write in mis area.tO be completed by city or town officrat
_.._ __..3ermit'Liceaserc�
Issuing Authority(circle one):
L Board of Health 2.Buildlrn Department 3.City/Tows Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone v: ,t
met Cil J :J"1 Xmcfili?ITpLan �g�
alar' E•f,sa.l:u::t, . ='^9'e..r
: _
de?.'TA'=1:: OF edr�«dG egSPac- Ovs ,`_�i'
INSFK'CR 2i2 Main Street 1 Municipal Building 's
_i..---
Northampton,mpton, MA 010E10 l;t,
f
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
�t The State of Massachusetts allows the homeowner the fight under 78OCMR 108.14 to
act as rislher construction sup;.*0r_ The r'a:e 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 andlor farm manures. A
person who constructs more than one home in a two-year period shall not be considered a
home owner."
The building.departtent for the City of Northampton wants any persons)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 building inspection(before work is
cunceaIed4 insulation inspection(if reeuiredl and aiinatbuiidina-inspection.The
Jbuilding department requires these inspeUtions before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate ofoccunancv
untilthe work can be-insanted
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.