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07-027 (9) 549 NORTH?ARMS RD BP-2009-0857 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) Category: BUILDING PERMIT Permit# BP-2009-0857 Project# JS-2009-001262 Est. Cost: $8500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: TIMOTHY LUCE 100515 Lot Size(sa.ft.): 268329.60 Owner: ZIMMERMANN ROBERT A&ATHLEEN Zoning; RR(100)//WSP Applicant: TIMOTHY LUCE AT: 549 NORTH FARMS RD Applicant Address: Phone: Insurance: 127 Audobon rd (413) 387-9800 LEEDSMA01053 ISSUED ON: TO PERFORM THE FOLLOWING WORK:STRIP AND RESHINGLE LOWER BARN 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: 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 4/24/2009 0:00:00 $35.001082 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Vg-4..g v . Departs it tbsevnly .‘-f-e:- af. a,: City-of Northampton ' -r' ,� 2,f , Building Department CurbJ.' `- 4- 'f 7 212 Main Street - . xt APR 2 1 2009 '.:Room 100 e k` Nodharnpton, MA 01060 Two m€S1ral Plans phone-41%587-11240 Fax 413-587-1272 115je Paas ' r ;'*_ — _ _, . . y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 PropMAtltlress: This section to be completed by office S y¢1 /Address: NOrlftvisMS POO Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � -{7t . 12e ‘ P '' Le-I I,y Litt u � w . N- stvt c y6�c 5 r (—ww-S Pc( me(Pring Current Mailing Address' Li ( 4 4-4444-4—"-- A 'kif lr^`�N-�i fry,. �u ���Io oZ ILlcz:-.� anti "U7(`�s^'r• Telephone r ignature 2.2 Authorized Agent: 5 Liu PO Bor. l4 (Leeds Name(P Cunent Mailing Address: c-42.......,,.,5 y0 S84 87- 134 Sign ural Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building lil g`oo�s (a)Building Permit Fee 2. Electrical O J I (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4 Mechanical(HVAC) 5 Fire Protection 30Ar 6. Total=(1 +2+3+4+5) Check Number /QA Z This Seecc/tioon For Official Use Only Building Permit Number ISA 'Z�—CW / Isste Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can De Denied Due to Incomplete Information Existing Proposed Required by Zoning This column to be filed in br Melding Department Lot Size Frontage Setbacks Front L:___ f L _ R:i__... _..__._.. Rear :_____ Building Height —.._.._._. _____ Bldg.Square Footage ._.__._. _... Open Space Footage _ ....___ % __ __. — (Lor area reams bldg&paved ' � ._....__.: : '_..__. . ___ parking) r. p of Parking Spaces , Fill: ., _ . . _ . ..__. _. (volume&Locrion) _ —_._.__ _ _ ._ _.._„... �._..._.___ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES Q IF YES, date issued:* IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES V IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained fl , Date Issued: _�__ C. Do any signs exist on the property? YES C) NO IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO O IF YES, describe size, type and Location: E. WQ the construction activity disturb(de"°artng,grading(e'x'�cavation,or filling)over I acre or is it part of a common plan that will disturb over I acre? YES 0 S✓ 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 ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[p] Brief Description of Propose d I ,� rl ,t Work: STI". Q5�\ ' IvIN1?� {'� r($O) - • t/-�l� t I,nv'`)'n"`•'t`'^O-`,'W� Alteration of existing bedroom Yes o Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Ron -Sheet Ga. If New house and or addition to'existinq housing,complete thefollowing: 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. 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 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING:PERMIT / I. ., "" e`" 2`u_. �. • . Q-' -. , as Owner of the subject propeity hereby authonze 1 Tv .0 J. to act on •-"a ' all matters lative to work authorized by this building perms application. �L-/ /Ix Si. .ture of.• _II Date I, /1:1.411 -5 1.-.(J(� , as Owner/Authonzed Agent hereby dre 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. Lc/w Print Nam evy Signature of er/ en Da SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor)) Not Applicable ❑ Name of license Molder::_'Tri/s1-111 lU t.�L ✓r5 IOOj}>7 License Number 9 \ 14 Leek •t) �A (JiGS �j 7/ ) l AtlgreSs Expiration Ca e r73 ()zoo Signature Tel phone 4:RenisteredHome mpi 'CORtrar- °' ,.,,a _, ,, " "uF" Not Applicable ❑ury Company Nameds i� Registration Number Address Z..�'-}vt U-� Kul 121/‘;0/0aterj Address Exaon ate c c L2e,lfJ /V\A C/r3>3 Telephone /� vj$ Jp J SECTION 10-WORKERS'COMPENSATION.INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(611 Workers Compensation Insurance affidavit mut be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the builk n miit. Signed Affidavit Attached Yes Q' No...... 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 10853.1. 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 homeowwner. 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 ender the building permit. As acting Construction Supervisor your presence on the Lob 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 4 The Commonwealth of Massachusetts Department of Industrial Accidents h' X Office Of Investigations 'e 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatio ndivi TJM inich Address: 12:1- Ai e" Q City/State/Zip: Mk p,t3 Phone;*: `//3 5-Ey 8,18G Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a toyer with 4. [DI am a general contractor and I y 6. ❑New construction oyees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp. insurance.` required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Pl a repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c.152, §1(4),and we have no employees. [No workers' 13.0 Other camp.insurance required.] *Any applicant that checks box.1 nest also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional shat showing the nam of the sub-contractors and state whether or not those entities have employe&. lithe sub-coneacmrs have employes,they must provide their workers'comp.policy number. I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 15[1°"P]"$1,50000 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cernfy a pains and penalties of perjury that the information provided above is true and correct Sienamre'CC %` Date: (AVat Phone#: '7f3 7JY 21--EL Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r . HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 backfill), onotube holes !before Dour) 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 \lassachuutts- Departmcnt of Public Safcte Board of Buildin_Rt_ulotions and Standards Construction Supervisor License License: Cs 100515 Restricted to: 00 TIMOTHY LUCE PO BOX 14 LEEDS,MA 01053 Expiration: 7/15/2012 f nimd�.i. ,er Trp: 100515 �.. -` Board of lloadiag Readadoosd SetodonbLicense arregistration nS far ladWWgl ase only y '..` HOME.PR0VEIENT CON1RACTO4 before dm cxp1nSa date If fogad Man to: Rapmadar: lane BaadWP Board ofBadding arRR Rlfdate aad Standards Expiration: 12/15,2009 M 263459 Bony Ma.02108 Type: Ir4wktal TIMOTHY J LUCE TIMOTHY LIKE � 122 AUOBON RD. �p { �. � /� ` .. _ LEEDS,MA 01054 AduL W Mer lama°"artlbgat ipatne