08-009 (7) 844 NORTH KING ST BP-2005-0349
GIS#: COMMONVV L: ""J_CH OF MASSACHUSETTS
Map:Block:08-009 CITE) '..)F NORTHAMPTON
Lot:-001 PERSONS CONTRACTI`: 1TII UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0349
Project# JS-2005-0462
Est. Cost: $32000.00
Fee:$110.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Tristram W Metcalfe
Lot Size(sq. ft.): 392040.00 Owner: PATEL KEN
Zoning:HB Applicant: Tristram Metcalfe
AT: 844 NORTH KING ST
Applicant Address: Phone: Insurance:
142 Main St. (413) 586-5775 Q
NORTHAMPTONMA01060 ISSUED ON:9/30/04 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 1ST FLR BATH,ENTRANCE, 2ND FLR
EGRESS, REMODEL LIVING ROOM
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Metcr:
Footings:
Rough:. — _d (f" R ugh: House# Foundation:
Driveway Final:
I
Final: !j%(,�� pj Final: ` a/O> �t
ro4h.4/ - o i'BR1 Rough Frame:
/
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:04C
Final: Smoke: Final:Qf f 6,- 3 -cos
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 9/30/04 0:00:00 4984 $110.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
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File II BP-2005-0349
APPLICANT/CONTAC'T PERSON Tris Metcalf
ADDRESS/PHONE 142 Main Street NORTHAMPTON 51/e...5-7 Z 5-
PROPERTY
PROPERTY LOCATION 844 NORTH KING ST
MAP 08 PARCEL 009 001 ZONE AB
THIS SECTION FOR OFFICIAL USE ONLL
PERM_ APPLI A.ION CJHECK.LIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,fit
Fee Paid 7 �� 7 oz/V
---
Typed Construction: ADDISL'PLR HATILENTRANCE,2ND FLR EGRESS,REMODEL LIVING ROOM
New Construction
Non Structural interior renovations
ddition to Existing
Accessory Structure
B_ilding.Pians Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved__Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR _Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Corral `.,nn
'rl j'7//10
0
Signature of Building Of icial Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
s
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Ci1y ac Northampton ; ""s'" an " ;:'0} t i
(/ Bufl. gDepartment 2 - a ,,1, ,, 4 4
�-� n 5 ; , 12 Main Street a as ," :* -
�`, �° . ; Ram 100 `�w v i� -� r« ,
1 ,. 1tortham n, MA 01060 <z $ 1+ -t"' ` " s " -
✓pholie W 1240 Fax 413-587-1272 1w
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1Property Address: This section to be completed by office
EZrq I1 . tr--t arCim Map F lot `, Unik
miv„dit......,..,c4—___ trr
Zone itp Overlay District
Elm St.Distdct - CU District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�N vriwr 1(1 o,.2 $7 .
Name(Print) Current Mailing Address:
/
4v 15 bo
Signature r
2.2 Authorized Agent. ! ,7 .,
"tr,54-rot u.. VU 4-ea i.L L4-z- AAA. 5-4-.
Name(Print) dd ��"" Current Mailing Address:
Signa ore Telephone
ON A -E TED CONSTRUCTION CO
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
poo
2. Electrical (b).Estimated Total Cost of
"91O Construction from(6)
3. Plumbing �. o Building Permit Fee
ao
4. Mechanical(HVAC)
5. Fire Protection Z('`"'Ao
6. Total=(1 + 2+ 3+4+ 5) 2121 oaa I Check Number 1/99Vjr rfra ""-
r. This Section For Official Use Only
Building Permit Number; i '.'0 - y Date Issued:
Signature:
&skiing Commissoner/IIrspectorr of Buld'aigs 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 io be filkd in by
Building Department
Lot Size Z 1 0 K Z A
Frontage 250 f 2 Sat _
Setbacks Front 6542 5�
Side L: 3i R: 110 L: Si R; h40
Rear 77 C3 3Sat
Building Height 301
Bldg. Square Footage 11,01-0 Sf- % � a- if
Open Space Footage ,a
(to(arca minus bldg&paved
parking)
11 of Parking Spaces 4 4
Fill:
(volume k Location) VL, oe• ✓Nw(
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 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 if
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:
SECTION 5-DESCRIPTION OF PRQPOSED WORK(check all andicable)
New House 0 Addition 0 Replacement Alteration(s) c Roofing 0
Windows Or Doors ❑
Accessory Bldg. 0 Demolition New Signs [ ] [ ] Sid' g [f. Other[ ]
f5f�°�° siwl fr,,;; _- _ ..r r _ . —
Brief Description of Proposed
Work: ✓ e- !ct-4••t/-t*Lei- 01.44e, .aliWO
Alterationuedetni /1't
of existing bedroom ' Yes No Adding new bedroom Yes No
Attached Narrative- Renovating unfinished basement _ Yes ‘ri"-- No
Plans Attached Roll I-Sheet
6a:: �7E W1tOUSOftin(::Bdd ir:ties: 2ListIna:1lOUsRaa;:rotttbtet ,'thtt%PQWina•
a. Use of building :One Family , Ts. amity Other
b. Number of rooms in each family unit. ign Number of Bathrooms I
2
c. Is there a garage attached? %H
d. Proposed Square footage of new construction. Dimensions
a Number of stories?
f. Method of heating? 0Il-. 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 LGty Sewer Private well City water Supply
SECTION la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, l'--`^''� L 't+c \ as Owner of the subject
Property ^f
hereby authorize . I r t S I,,y`•i� ( tc
act on my behalf, in -r, atters relative to work authorized by this building permit application.
4$ 8 2Z � o
Signature of()wee Date
, — as Owner/Authorized Agent
hereby d-s are the star a . ormation on the foregoing application are true and accurate,to the best of my knowledge and
belief,
Signed under e pains and penalties of perjury.
l '5 Ykti44.e
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su. ervisor:{� }} Not Applicable 0
Name of License Holder: M lam' 8a,ff`mss' q 0 ] So e)
License Number
�`7Z OH GUS %CC . 'I-„(' rr•I' p4 11' li C/ 30 /oc
Address r Expiration Date
V �yr 7/7 761 5 / ib
Signature Telephone
9.Registered Home Ynprovemerittonl actpr: ;.�' _ Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,g 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.
Signed Affidavit Attached Yes lr1r- No ❑
IL:5;S:lionielOWiteriEnniption
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 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 homeow0er.
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 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
--e r1;
(Clip ofdorhamptong ,e _
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9t , n, fib,.. h,..n. _
a kit
ine DEPARTMENT OF BUILDING INSPECTIONS t —a -- i,SN
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i.is/her construction sup; .'sot- 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 backfill,
sonotube holes (before pour)ta 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
.1
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DEPARTMENT OP BUILDING WSPE@I ;
ONS (xx
Yom
212 Main Strcet ' Muvicipal Building
Northampton, Mass. 01060
4VORKSCIfS COMPENSATION GNSUTZANCE A ITPTDAVia
1, ti/IC 1S-rilli'eg.:at'i" 8.r1t_.._GnrtrkwY -iso.
(iccosatfperlmcc)
with a plmdpai plats ofbusiness/residence 2t.
(5y$ ce-Pike, 6t{-ff 0r2.�(etthf WILL- (?(+.17011 (p:hone;') )f7 7&( St`i o
(frrr-A/city/siamIzi p)
do hereby certify, under die pains and penalties of perjury, tha:
(XI am an employer providing the followine worker's compens:son coverage for toy
employees working on this job
VrificSiTer- ,. 4cLIk7*G£ 4:74s. pl000 000�jo11 'tt ) ( 3•) f as •
(losw-aoc Cactiray/ (Pelic:Nu trr) (:..::pinion 02>_)
( ) 1 ain a sole proprietor, general consacior or homeowner ((MC'e one) and have hued
the coon-actors listed below who have We following worker's com1„lenstion policies.
{pio,i-o;"Co^iracoa1 Ouanacr. CoreparyrPcvc,'dl:mta:) ics„n_cv. Dale;
Cn ioc of Con frzaor) ansarancs CoompaayPor�y NtwaPrO (E om on Dare)
(Name of Coonactoo (insurance Company/Po/Ica Nan*xj) (Espiruen Date)
(Name of Coonactor) ...... (Lesuranc Company/Policy Nuni&s) (Lwuzoon Datc)
(.tlu4 ati:iwat].Matroeuaa.n,in me'u&iofc- zio p nthiac u.11 m..-Cool
( ) I am a sole proprietor and have no one wor}dng for me
( ) I am a home owner performing all We work myself
HOU:Scoot.;t.;tout ax'iiia btv<o,ancn uSo en',lay p m to vU c,va.-..nom,c-== a renau„ort no,dothoE of
not moo thea Sv V.V./w..'.nd the bmax.nvr wan cc oe Lb:Erout ' 2pWr4:run theta or m'.a L—'ellv oed+m u tc
coploya au.^c Sc..e4e3 t .'vm Aa(G L152aI(5)1=wlicoiw by boavossm(c:ll:...-=a mon rt.,coo_coe the
1,-84 o.....ou of to y"Ioi'x uo&r to Wo&e,C 'a . ,' ea At
I uWoaund rho x copy of this moon=at y b.fx+vd.d[n the Dcw. . of kaur.id.wuc,Oni.,isLsv'. fu Vb.
mucX6<"a+Gctioa c+dttn+(Oijmc cowman b,vcrayc%nada%caioo 25A of MOL 152 t o lad w the v^Mza m o(aim,nd prndtio
n grog o(a Gor,of tip to SI}O0.goraga mgauaoryvy o(up boa yw and 6'- Imtoa re s farm ori.Sm Wo'tOrta vac.
(m o((SIQQ OO a erg tcaio t too
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