11A-058 (12) A �
124 HAYDENVILLE RD BP-2007-0487
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: I IA-058 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-2007-0487
Project# JS-2007-000709
Est.Cost: $1000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group C PHILIP ANDRIKIDIS 150673
Lot Size(so. 0.): 616374.00 Owner: BRISSON PIERRE R&SUSAN H
Zoning:URA Applicant: C PHILIP ANDRIKIDIS
AT. 124 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
52 MAIN ST (413) 585-9171
FLORENCEMA01062 ISSUED ON:10/26/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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:
FeeTvpe: Date Paid: Amount:
Building 10/26/20060:00:00 $25.001154
212 Main Street,Phone(413)587-1240,Pax:(413)587-1272
Building Commissioner-Anthony Patilto
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
- phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITEWFORMATION
Thisseetlorzto'6eeomPrteek67Fo[fiee
1.1 ProoarN Address:
� � Ogedap,DzSlelati } -
` seurmar eiFxmr&
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEP.AGENT
21 Owner of Rec
/'�-/ Lt.. 2d C ,Sk'J4/d
Name(Priv[(�/�'�`},{-��y]� ^- ' Current Mailing MY
-)Co 1 Vrt SS crJ Telephone y�S
Signature
2.2 Authorized Agent
Gam( S.-, k sem
Name(PtlnQ Cunent Mailing Addri
Cbz ^ 5- 9
$ 1 � I
Signature TelepShone
SECTIONB-ESTIMATED,CONSTRUCTI0N.CO5T5
Item Estimated Cost(Dollars)to be Official Use Only
completed be it aDDlicant
1. Building /cf)0 0 '(z}Building Permit Fee
2. Eledicai '(by Estimated Total Cost of
Construction.From. 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This.Section.For:Offrcial:Use Only
"Data.-
Building Permit Number. Issued:
Signature:
Building Commissionedinspector of Buildings Data
1
Section 4. ZONING Aa De
Information Must Be Completed.Peenit Can Be Denied We To Incomplete Information
Existing Proposed Required by Zoning
This colunm to be filled m by
Building Dcramnent
Lot Size
Frontage
Setbacks Front -
Side L. R: L! R:L— _
Rear
Building Height —
Bldg. Square Footage %
Open Space Footage %
(Cot area a m.bldg&paved
#ofPanking Spaces —
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:: j
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES
IF YES: enter Book Page., ! and/or Document x,'
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued: !.
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it pad of a common plan
that will disturb over 1 acre? YES O 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 ❑ Atltlitian ❑ Replacement Windows Alterations) Q Roofing O
Or Doors ❑
Accessory Bldg. ❑ Demolidon ❑ New Signs (❑[ Docks [[::I Siding(O] Other[C-1
Brief Description c�Proposed r
Work. �- .A " -+
Alteration of exisfing bedroom_Yes No Adding new bedroom Yes "C No
Attached Narrative Renovating unfinished basement _Yes �' No
Plans Attached Roll -Sheet
1>a �E64� ER 1
a. Use of building:One Family Two Family Other
b. Number of roams 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?
L 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_
SECTION7a-OWNERAUTHORf2ATlON-TO,BECOMPCETEDry9HEN
OW NERS AGENF'OR CONRtACYOIt'APPt1E5%AOkBtlICDING'P.ERNBT
Xtf Tf as Owner of the subject
property
hereby authorize
to act on my behaff,in all elative to work authorized by this building permit application.
Signature of Ownerpp Date
A
-i I d S ,as Owner/Authorized
Agent hereby declare that the statements and Informahon on the foregoing application are true and accurate,to the beat of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature ofSignet..of OvmerlAgemtl Date
i
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Sucervisor. Not Applicable Eb
Name of License Holder'.
License Number
Address Expiration Date
Signature Telephone
4 Ri refs`fdnRieRo'h<liriirT"a "ir7E"'iW Not Applicable ❑
c.� l.� 1� .�vL(4d .� 1�o6T3
Company Name 11 Registration Number
SZ !'(Prate sh )r lai.e.. ».G C.(_ I -
Address Expiration Date
Telephone-S2s--9r�/
SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVIT(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 issuance of the building permit.
Signed Affidavit Attached Yes...... 97 No...... ❑
The current exemption for"homeowners"was extended to include.Owneranxii ied Dwellings of one(I) or two(2)families
and to allow such homeowner o engage an individual for hire who does not possess a license,provided that the owner acts
as supervlsar.CMR 780, Sixth Edition Section 1083.5.1.
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 coustracts more than one hears in a two-vem period shall not be considered a homeowner.
Such"homeowner'shall submit to the Building Official,on a fora acceptable to the Building Official that he/she shall be
resnansible for all such work performed under the hairline 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"homeowne'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
of �,Tol: llultt}stoil _
3s•� .h�.dt. _ _
DEPn TNIEId OP OUr(DrNG INSPECTIONS
212 Mnia Strcct ' Muoicipnl L,ldmg
Northampton, A1nns. 01060
1
t6.OIRICER S COKPENSATTON GN'SURA-NCE Al III)AVIT
(licrnzxlpervulicc)
sau tit a pranalpal place of la sioess/residenac al
(;'none,')
(Sianeee/d ylsale/n p)
do hereby certify, under Lit e.pFuns aad penalties of perjury:; Jsai
I am an employer providing the follo�vine workers comocnsauor covma c for Inv
employees vaor6-ing on tfus job
1
(Innur�e Coocae)q (Pete:Ncabcr) {r�piruor.Dom) ' -
O I am a sole propremr, geoeral coo=n or or homeowner (circle ore) and have hired
the contractors listed below wbo hzve the following workers comae_�uon lie kles.
_ (Fiala: of Co.,rmnor) (Insuranv-. Compall)II c ic( Num,,:) �spi:acea D.ncl
(Name of Coav:noo (Insuamcc aMal=v/PoGer N'umc^.r) (Eip�auon Daze)
(Name of Comano:) (I➢SL ,, Compai)1Poliq NumL�) (F-,pir_uoo Date)
(Name o!Coucanar) Oi ra is Coceauy/Poucy Numbu) (E.xpiraoon Datc)
{CI am a sale proprietor and have no one workaog for me.
( ) I am:a home owner performing all cbe work myself.
NOTE:Plesof
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9
m DEPARTMENT OF BU1ML7'G INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Nurthwnpton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to
act as iris/her construction supe-.-:sor. 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 backfillh
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 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