22D-063 (2) 63 FLORENCE RD BP-2017-1344
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D-063 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-1344
Project# JS-2017-002231
Est.Cost: $700.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use croup: Homeowner as Contractor
Lot Siae(sq.ft.): 10236.60 Owner: JONES STEVEN& SHEILA
Zoning: URA(00VWSP(lO0v Applicant: JONES STEVEN & SHEILA
AT: 63 FLORENCE RD
Applicant Address: Phone: Insurance:
63 FLORENCE RD (413) 552-8802 0
FLORENCE ,MA01062 ISSUED ON::5/22/20170:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 2 SQ ROLL ROOFING WITH ROLL
ROOFING & ICE GUARD REAR LOW ROOF OF HOUSE
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:
FeeTvpe: Date Paid: Amount:
Building 5/22/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
`>� Ny of Northampton Swot of Poona
- \9 (ding Department Curb CuVDnveway Permit
'‘'°‘ 77 22 Man Street Seat/Septic Availability
j Room 10C Water/Well AvalladMy
Northampton. MA 01060 Two Sets of Scnrcs<sl Plans
c phone 413-587-1240 Fax 413-5871272 PlotrSee Plans
Other Specify
APPLICATION TO CONSTRUCT.ALTER.REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION t&P- `I - 13 Ye/
1.1 Property Address TMs section to be,ccombined by onset
63 r� loaeWc.o RD.
Map Q _ Lot t //.j 3 Unit—
r toa_eNt. yina . of DG2 Zone Overlay District
Elm St Gana Ce Pana
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1
5`Tcve p p So uresis A e + 64. A Jaws' c1 c/a G&s Ft.e,v eo
r!m- r!m• rte, :: W > r>ws ‘,12 L s 6- rilteditP1
( � ,G
1i_ 3cle `ut_ S3-'Z Bio Z en-o-96
2.2 Authorized Agent.
SECTION 3-ESTIMATED CONSTRUCTION COSTS
- - _ _.__.___ .._____—- — _____
len Es n Pa Les 1 u s I es Oft. al Use Only
. u! eo Gap r1 a Ican
I Bi,ilmn) 1 ,a 9...e.".; Perm'
Elecn'.a ib;Estmated 1:1a1
t.I'St'.ct trn
Bus:N g Permit Fee
5 h
This Section For Official Use On
Dale
f. 6.Immg Perri-it Nun' r ssuetl
snlalbre "red, / 5.-27'17
e -Jr. r Inee le'if _4drr-.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all agPlicable)
New House Addition Replacement Windows I1 Alterations) Rooting
Or Doors I
Accessory Bldg Demoldlmr :' New Signs I J Decks I ; Siding j . Other I
aw ef Ces:rviunolF ..,te- � t.� `/+<-Qi 2 SCI , poli / Dol—;I✓c W/ ol( <oaC)rNG
t.AR
-it ice Gva4.4
:.Jr 1 r.l •uun,. Y.... N: :irrry L 1 : ait Yrt. Nil ,, /
nttat el Na- <titC Rr l':atlnl ur 'htri basenerl Yoe No Req.1p t Lott
Pan A'Ia be. RJ S'ePt l
•
/?o0 F tsr
sa If New house and or addition to existing houslna,complete the followlna tis-c.
a. t'.- :-ft, :rng unt. FI— r TouFrill , C:hr (814ct)
N l e r. .JO tt Fr, F.11" tilr.rlr Lino' N.Nit. 0'Hair-• ...r
^._ Pro reser S .er'e'oc aqe Or net.-cns ruptir- ❑Ter-ions
I e .r. . e.:rl,,..i' { u.r.d.n::r.. Nm.nl of r.n•
W.INttl hrok Inrty'. 6 r',Inu_chrn nl'a 1ut11
.. T I rl r:onzprlar n
', rurto' will!' ':'tat of tie'lii•., !tit t. t ii tmd,m nfrn 1 iU yr rrJLIlIa- Yes No
< 1 11 ..,.«?Neil' •i .:eus-Want _eluw Ynr..hen giddy
il Iiii,. r • nn r at"He , y Art lr;.ug g Prrnr.. Yr,. h:r
„ Sepnc Tank. Cr.., $ewer Prua:e lee _.. Cit *e'er Supo'r
SECTION Ta.OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
`. I. - as Dane'a'the subject
her ‘ aut^rrn:w
I I : Iry b,•Ih.rt II i, tt't.”.re Itrr I . a .k :rrbmirl.i'j : I :•y e.rr i:glir AI.III
'Jr aloe of Jere' Ce:
1 gv`^, 9' Gore.;A. 1 1
Ayr I Iy 1'r lir lir ,.'.itrn er A al ,.1,-^1.1.1t 1.11r res y y sjpbnalr. t ue XI.,a lir ti 1'e, r _ n.alrr
arid brlr
. Srq e •r 'rtle pa" l :cnalru: r '.equr:
STS"I 4> - S°p' e S
car i .. ii y, it. -jr 0 _ate
Section 4. ZONING Yost Gc Co-1p ctcc. Pcrnit Cr 3c De•itt Duc To IncornDlctc Inbrna:m-
I \Lnn 1'-.•prvcd Petit' -cdhe/ar.m£ r
I nndae:
N,nac k. hr
Sick I K- I H F
f3w:u11s Iluylu
Iime Squ.ar;1 o.rt.rec
r rpur ?p.r. I r 1,
-..1 P.a
1
IrP
r •
.
A. Has a Specal Permit!Yanance+Finding ever been issued for eon the site?
NO DON'T KNOW YES
IF YES, date issued'.
IF YES: Was the permit recorded at the Registry or Deeds?
NO DONT KNOW YES
IF YES: enter Book Page andior Document t
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 properly? YES NO
If YES. describe size, type and location:
D- Are there any proposed changes to or addition. of signs intended for the property ' YES NO
IF YES. describe size, type and location:
C. :Nr I the c®rmm_tier aLtivrly d SWrp Wearrtyyrajrr ry. ux_aratiun,or fill rig vie, 1 auto or 5 it par.of a vrurvv Dian
that Will drsmrb ewer ' arra) YFS NC
IF VES Hunt a No'll I Sturm Watur Na'iayuruorr:Pet Ii!burr the DPW is ruymred
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Nct Applicable =
Name of Lactase Molder
Lip II le_. .
if
9.Registered Horne Imp-oatmeal Contractor: N. Appb..ahle -.
Company Name _ ... Re.,...1.1111111 NMI'is
Address EHp('abc Date
Tele,ore
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MGT..c 152•h 250181)
rr H mlH l u n l u a 0 albla It noel be v[E G. and ,,,,brr rod 1h IFs applica,r3n r marc l 4 h ar h Alda.I ni resin'
II 1 IIt. 1.kIRct ) rl
Se/ "or lu l A '1(lnl . . N.::.
11. - Home Owner Exemption
lu , %are,. •n leiI. .nn .I. .t s_-n.lc.l I ni...:Illi mr owcuplrA Isnrtl ICs kf., 1•..•1:.: Laudic.
Hn.l L.;11. 1 '. I - n _ in ndn.ld.I:l 1.•I hu ti d'cs 'cl wc._ H . cr c.prolidS that the onner acts
as supenisur.('1k'1111, Sixth Edition Section 109,3,5.1.
Definition of Uomco s per Person SI ntiv Oda H pike: 1 I;rad;r.n:udt a >t.is i4:o of mlcnd,Ic red .r...arch ticra
1, . • L. ilink. , b. .1 1510. _ . ...u: ' .cllu all Nil J...ctc.l Iv -> . .. nI ..I.I. .-c .1 .•i ,akin
i \pr son tho roma roil.emnr than one ha ow m a tun-.ear prnal.hall lint br rams ulrrrd a Wanton net
vet-t:m uI'..ull :ubaat o Itt Uu1,1.NiHtiaal. z knit at.,:rk:cm Inc Umldi1e I_plis:al,that he she shall be
rnpmisible ha all sack um Lyertnrivied under the buildint pet mit.
a Construction Supcn isor'nar r .;nc Cr,. In: h: s.:I he^quir:d Ynm:.n o- r.mc.dinr4:and upon
„ 1.1: I11J1 1 II. N!II I I. ..ad
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I i !.c. . ' iHO tc. c.t'suers; I D_:ah:lot'tile M1l.ry , crura. I,.:n: al Lass \.1,1,1.t sou max b. liable t.": N:' .•els:
r-.
1ca hit palcm;'acrL lot ,au ar.Jc :hs.AC:T.Lt.
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Ilon nmr
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rc 3 /-c-c.,
Citi, of Northampton 212 Main Street, Nonhamptun. MA i11060
Solid AVali, Disposal :Aflidn it
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility. as defined by MGL c 111, S 150A.
Address of the work: 63 PI 6 2CP) CSG Abe Vi c&'ce frog .
0 / 061
The debris will be transported by: T _S QooC ) AJG„
The debris will be received by: U 4 It LoSTC gotiTN S�
l /I -'U nl 414
Building permit number: 0 f Deb
Name of Permit Applicant
I
Date Signature of Permit Applicant
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City of Northampton
Massachusetts
1 t
A DEPARTMENT OF BUILDING INSPECTIONS
� ^f
212 Yob sirenWn el pal Building
Wnnawvt o un. a otoeo .. ,
L ._
Louis -1ast.rouCk Chuo. lithe,
BuildinQC —mrsicre' Assslant Cummisse-er
tf0AI1-. UR N1:I2 I-U-Vtl'I Inn. .A(lkA(flA LEUGF Vtt N I
The State o'Massachusetts allows the homeowner the right under 7800AR 108 3.4 to act as his+her
onnslnudion soperv:sor The state defines 'Homeowner'as 'Per%unlsy who owns a parte'on Mt di
he/she res des or 'tends to be, a one or Iwo family dwelling. attached or detached structures
accessory to such use and.•or farm structures A pe'son who constructs more than one home :n a two-
year penod shag rot be consideree a home owner.'
The hudd:ny depaarnerk for the Gly df Northampton wants any person(%) 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 concealed),insulation inspection (if required)and a final building inspection.
The building department requires these inspections before the work is concealedfailure to secure
these lncpectWns can result In failure t4 Obtain a certmnate 4f occupancy undl the_w4(k_Sa_n_be
inspected.
l'the homeowner hires other trades to perform work electrical plumbing & gas)the homeowner wit 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 inspect ons as requ red can DELAY the protect until such time as the proper permits
v�€ and inspections ate made
PI. understand the above.
i Home owner/resident's signatur uesting exemption i
I w cal! to schedule al: regaled building inspedioris necessary for the budrtny permit issued to me
•
Date 5— IR- 2ot '7 F
Address of work Iecatonb c ) 02 ex) ee
FlowtICe MA
pi v 62
The ConrnwnweuIth of Ilansachuneus
LDepartment oJ'Industrial.dccidents
y� 'i OJ/ice of lnrentigufions
I Congress Street. Suite IGO
Boston. I1-102114-20r
wnnr.tnass.goi'dia
Rbrkcrs' Compensation Insurance %Enda%it: Builders!ContrattorsiElectriciansiPlumbers
Applicant Information Please Print Legible
`A Name u 1 dP ,. :d::
F-`'< lddres:
Cm State:LipPhone
ire toil an empir s t r' ('heck the appropriate hoc Type of project (required/
!. I uu a ;wept- s ilh
4 I .t stn•I J -.I alk : suer I
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-
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:I
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������nnrvnnn1 ra h I t r'i cd their
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❑ P ku,tnu} n.a addCwnn
nrt.Jt ' r ' ker., .o..il.. a r.l-.tempir .. per \K rt u knot rplees
in.uraua -e..vned � It. dint, ase h m'
<.ac .mllnpcs INi, v.orAcr,- l nI>Ihcr
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•1. .Ll i.nl.r.u:.. .d ... uJal I..t .:. a'.IL. .t& I -,d i, i..mal . : 1. Jcnua:.:.
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I am an rmp/ult•r that it prm•ideng wnrdere'campetnalion insurance for int tmpinjcc'. Below Is Mr policy and job vee
in/ormanon.
'woo.aut. ( np.un N.unr.
P.:II.i • t•: 411 ns Lr.. ". Eµ:c ala'n Date
( it. Marc 7ir.
!lath a tops of the workers' compensation polies declaration page(showing the polity number and expiration dale).
Y.into. I ` aee INC: s --r:WC .n rclllur.,l .:^.dzr Sr.rlun ';4 it S lid I'` cm 1:a/:to the :rpna:Ion nt anions d pcn:r:rie.illa
Ins; Irp Lr*I '110 111..rthi of one- ear r prla,mm n . a. a F! u. t l p ,:::'Ic: in 'he Corm ut :I S I OP \1'I}Rh ORD] K aml a 'mr
cl e d.1) : :.n llm .rdateL Ler aduxd that s Lc{•. .d 1111)>lYunun nd. b. I s:udtd !o t61:()ll.tt of
$ Ins a n.m, the DI:A I:,I m>utiiK. t,„Lrr_: .:II'Lull„
1 da hereto.tern/t under the palm andpenaltieso/periurr that the Information provided alum a ie mit and correct
Sr. �_
aVVV l — r9 77
Pllo i3 55; oz
011it:ul me owl)-. Do not nate in this area, n.6r templaned br till or town°Blois/.
Of Mown: Permit:Lkensc a___
Issuing luthnrat (circle ont). � �_ � —_
I. Board of Ileallh 2. Building Department 1.C Its T11%11 Clerk J. Lleclricat Inspector 5, Plumbing Inspector
6.Other
(•,ntaet person: Phone#: