22B-008 (13) 130 SPRING ST BP-2004-0434
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22B-008 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2004-0434
Project# JS-2004-0632
Est. Cost: $2500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID J RUSSELL 009938
Lot Size(sq. ft.): 65775.60 Owner: PEASE THOMAS R&PEGGY-ELLEN
Zoning: GI Applicant: DAVID J RUSSELL
AT. 130 SPRING ST
Applicant Address: Phone: Insurance:
148 RYAN RD (413) 586-0428 Workers
Compensation
FLORENCEMA01062 ISSUED ON:10/16/03 0:00:00
TO PERFORM THE FOLLOWING WORK.-NEW BATH FLOOR, SHEETROCK WALLS &
CEILING
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 SiEnature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/16/03 0:00:00 1308 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2004-0434
APPLICANT/CONTACT PERSON DAVID J RUSSELL
ADDRESS/PHONE 148 RYAN RD (413)586-0428
PROPERTY LOCATION 130 SPRING ST
MAP 22B PARCEL 008 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
r
73�40-
Typeof Construction: NEW BATH FLOOR SHEETROCK WALLS&CEILING
New Construction
Non Structural interior renovations
Addition to Existing
Accesses Structure
Building Plans Included:
Owner/Statement or License 009938
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 ssion
Signature of Building Official 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.
at
of Northampton S u sof P r i -
r—:�� ding Department rbCuf% fve
2 Main Street S er-7Sr�
ocl 4 2003 Room 100 wNt
N rtha pton, MA 01060vvets`0ft. o ra{Pa
-58 -1240 Fax 413-587.1272
pEP10F B s�: ON,MA 01060wa
D erpet;l
e *;r
PPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be�comple#19, Y office
1.1 Property Address: '
ap
OveyD�s#r �
� � w
Elm•Stpistrict Cg Distric# •, ..- .
SECTION 2 - PROPERTY OWNERSHIP./AUTHORIZED AGENT
2.1 w n e r of Recor
L/` �h0/I1S E'Q S�-
Na rint) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTfON3.- ESTIMATED CONSTRl1CTIO4C0"STS
Item Estimated Cost (Dollars) to be Official Use-Only
completed by permit applicant
1. Building �S (a) Building Permit Fee
2. Elec.rical (b) :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 ,3a _
This Section For Official Use Only
Building Permit-Number: Date Issued:
Signatures
Building Commissioner/inspector.of'BDate
uildings
T
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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, des6ribe size, type and location:
..._.. .............
f
I SECTII�f �� -S R P,�TIONOF�PROPOSED 4110RK fcheck�.all applicab, le),
u q
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ',v � ped'),
— a �� G✓ �,�
Alteration of existing bedroom Yes_ No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes _ No
Plans Attached Roll 0 - Sheet 0
M-e h—ou e" a"n o "" clition to eX-isUhTJ ousmgg MW MUM 6'&-fo-HVWM:
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. 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 Nc
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
S�ECaIYNEFt AU'(HORIZATION TO BE COMPLETED WHEN
OW,Nff{S GENT`OR CONTRACTOR APPLIES FOR BUILDING PERMIT
v I, Cfl101n CCS /L \ �C'QS�.
�T as Owner of the subject property
hereby authorize to ac; or
my b alf, in s relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/.Authorized Agent
hereby declare 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.
T k S's lt/
Print Na
Signature of Owner/Age Date
SECTION B: i ONS',T�RUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder : / L X77 ,l
License Number
Addre Expiration Date
Signature Telephone
e e s om. Not Applicable ❑
Company Name / Registration Number
/16 &A4A (,F-- ti �(G%K�ZLf C-Q �� 7— Z Z - Z 4Z',Y
Address Expiration Date
Telephone
SECTI,0 TD 'WORKERS' COMPENSATION INS;U.RANCE:AFFIDAVIT(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....... ❑ 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 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 homeowner.
Such"homeowner" shall submit to the Building Official, on a form acccptable 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
t tt/Nl�T
(rxftr of lt7rtl�i7711}7foII _
6 ��134 ACh I,S rtl4 -.
m DEPARnfENT OP I=UILDD�G INSPECTIONS
212 Main Street ' Municipal Building _
Northampton, Mass. 01060
WORKER'S COiYT ENSAT'ION INSURANCE A, i I AVIT
I, a),v
(11 CCP.S_^/�;ri II11ttC^)
N+.ritil a principal place of business/residencte at:
pllone'=;.__���e
(strc:ticity s-t?.tch7 P) d
do hereby certify, under the pains and penaitiesof perjury, that.
( ) I
am an erTlployer providing the 1,01lowinc ••�:Orkcr's compensation coverage for Iny
employees wor drig on tllis job:
(Insurance Company) (Polic:Number) (Expiration Date)
( ) I
ani a sole proprietor, general aontracCor or homeowner (circle one) and have hired
the contractors listed below-,-,?ho ila':e the workers compensation pollc'.es:
(Name of Contractor) (Insumnoc Comc;:a,/Folief Number) Y ii..1r�,_,.: u;or. Dart..)
t.
(Name of Contactor) (11-lsu.ralICC Comp-ana'dPolio,• Number) (I:xpir,:tion Date)
(Name of Contractor) (Insurance Comraayil)olic. Niuuhu) - (-xcoa Date)
(Name of Contractor) (Inst' race Comp=y!Policy Numkr) (Expi-:tion Date)
-l1
i
I iuTl it ,Ole pi-U1)r]CiOi' and 1]Clvc I10 one `.�:vrkliio t01• :Ile.
( ) I '1111 21 110r11e OWr]Cr t)CI?or1111I1g all th . +:C: t; ii1yscIf.
NOTE:plc:u be caste ilii:rile lx<-,c0Htr_r3+ryon to c:>�ar1.^�ncS ccr.r: ,n += cr:rpair ,ni:+ s dwtlli:3 c
not mete than throe uai+s in%%-t ch Lhe F i r.+ir_ r=ic:=or 0nzpu r ec rat theree--:texx cartally vr: :rd:a be
c�tployc3 u.--"=thr_%%-,, cs a ar.P:+ion Aa(Ui.151=1(5)),ztpti_t;io:;iry a hot:acow ner for a licca or pY:ri:r tin
legal rtanu of an employer auader tbo Woricclt w=pa_Yation AcL
I uade-staad that a copy of th1,rtatrnxr3 easy bo foru•nreted to tl:e D,%t rt.•ncrat of Indlaslriel Aclzi4cwy ofrcv of l:::urar.:*for the
covense verMealioa and that faihuc to!<_irc eovcrtp„under sc�,iM 25A of MOL 152 can Icad to the imposition of a inial pcnaL:u
Nasuting of a run_of up to S I,500.00 er."Jcr i^pris tr-,ar of up to }:::rr.i civil xrultin in d+c fc;crn cf n Sic-,,Wcrx O:tir a;,d a
f m of S1 t0.00 a day IgAirW m
For cSa;uuaYstal uic«ily i
perm t
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DEPARTMENT OF BUILDING INSPECTIONS
ain Street • Municipal Building
INSPECTOR 212 M
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to
act as his/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 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 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, I o In a-S Qs 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 /0 -1,41- 03
Address of work
location
��o"ell CC_
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