44-007 (4) 459 ROCKY HILL.RD BP-2021-0931
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-007 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ALTERATION BUILDING PERMIT
Permit# BP-2021-0931
Project# JS-2021-001587
Est.Cost: $14100.00
Fee:$91.65 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 11804.76 Owner: Elizabeth Skelley
Zoning: Applicant: Elizabeth Skellev
AT: 459 ROCKY HILL RD
Applicant Address: Phone: Insurance:
459 Rocky Hill Rd. (413) 586-9337 ()
FLORENCEMA01062 ISSUED ON:2/26/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT GARAGE TO LIVING SPACE
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.
I
Certificate of Occupancy Signature{' Y�
FeeType: Date Paid: Amount: b
Building 2/26/2021 0:00:00 $91.65
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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, The Commonwealth of Massachusetts / f
Board of Building Regulations and Standards A 2Q2/ ICI�'ALITY
QV') 7 Fah
Massachusetts State Building Code, 780 C
n; s USE
Building Permit Application To Construct,Repair,Renovate h iseci Mar 2011
One-or Two-Family Dwelling 'ti "'A,� TDNs
�� Q This Section For Official Use Only
Building Permit Number: t7r—a ' / e Applied:
41,0 ' Z5.5 2-25- 20.2.1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
0'7
1.la Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone. Outside Flood Zone?
Public I Private 0 Municipal 0 On site disposal system t�
Check if yeslar
2.1 Owner'of Record:
\,7o„,-eA-►--) St2\\ .0 nCt (itA 0i000 2-
Name(Print) City, State,ZIP)
HST Roc. \Ay;\\ d _ kit 3-3zo-3357 k1.,efIZzeS@C,a-ms• ,nek
No.and Street Telephone Email Address
New Construction 0 Existing Building 0 Owner-Occupied 13 I Repairs(s) 0 Alteration(s) 13'I Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':6//�""a," �.y
G � �li/i i d f j
Estimated Costs:Item (Labor and Materials) Official Use Only
1. Building $ VI k►p 1. Building Permit Fee:$ Indicate how fee is determined:
I 0 Standard City/Town Application Fee
2. Electrical $ 0 Total Project Cost'(Item 6)x multiplier 4100 x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: ,,LL c (,iS
Check No. 'a(/i�Check Amount: 1 I' " Cash Amount:
6.Total Project Cost: $ ., -"uej Iyik000 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address D Demolition
5.2
Registered Home Improvement Contractor(HIC)
N T5 A.Me co ff - T°'"4 K In N c 11(,5 (�.E P A t.d� I- IIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
Lc e4, �on4k(PtSN6Als cttkAiL. Cpt�'�
No
aY a u�1L F M,A b l 03cL Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE 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 0 No -15(dt 6 MR1 t4c
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
; , 5�11{ 1-i Z_ 1171z'� L,
Print Owner's or Authorized Agent's lie(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.IL) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.IL) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
I/ Massachusetts z: r��r`
11 tlW ,
itS4)
y ` DEPARTMENT OF BUILDING INSPECTIONS 7? +r
?^ 212 Main Street • Municipal Building sJ ����1�
. Northa
mpton, MA 01060 �N�
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: \) N u y i4.::t.y0.4bA) ch-S-c"ik.Aetwi 1u), NW-1 W4/410A/ ANA
The debris will be transported by:
Name of Hauler: W c4_ y N,ti\ 5:,,,.
Signature of Applicant: -; Date: V0, i?,2.>Zt
The Commonwealth of Massachusetts
.r Department of lttdtt%tr►al Accidents
=-i►_ .2 Congress Street,Suite 100
t =11= Roston,Al4 02114.201"
wills..Mnf tgoridia
Compesitadon Insurance davit:Buiidert'Contractors Electricians Piw tke a.
MBE MED MTh DIE PERIIMENGAUTHOWIT.
Applicata Isfermatioa lleasaltint laglIstr
Name ► manh:
Address:
City/State/Zip: Phone»:
Are yew so oteplerser,t lac!eke+epprapriwte bra:
xylle of project(requited):
2.Q I au a orepltyer tenth, employes'(tali AM or ppww I• 7., 0 Now tobsoutuan
2 I cote a Mao pepiwr er pry webit aN beer et oopltrvwM sorkief for are is S. 0Remodelint
say cal.wg.(Aitsaa ore tomp.111111111101 aa�eit<l 9- 0 N1ar03liiCn
l Q I art a 10 Building addit ►
l. as serutitr a+itfl 11104111111111111111111111111111,111110
estmt!Mt mouton 11 JJ Electrical repair.;or addition
suparimenhawoullepm 12_0 Plumbing ma's or addling
$.0 I aaa a pteoM comma sod I hac-s beet tit ne►-caaentlere tieaei as r aastdti alma
note mt-coortarrox:lraro mar ari>wr*adore mop issomece 13 o�oaE rapa�irz
saw.ate•calm■misa maim Aker.iaiceemeiw atbeitdehateengritepetVALc 1
152.#l{a).amtsrlemsar amplemo a.pissadns' nt iai l
May pliearrirt&nla1railsowMoMrrtltrttiratalrrelrrtitiiatrrtrlmeenjrmisapeky ir■rrrit►
llanteerne swbsainiribisaaiirrieieiicmiaptlieyarobiota.s aksetareakimmmibcoatimeassrmrtaeiriraaraaaieiriniaiesask
t�aattaettrt that cloth ibis boa wow ser bell as aiiiiarot door Armies it aaeu ado a aei Stan iebrier mate slot.semen bare
SL lk+41 tf tls tteb•towtarts lr.-a arplepore,*ay mist podda*bit osiers'comp-peaky aetrlas.
/aaa an earAplsyfrr Am isprwiilg**ken'ceopensedien inure aear,*r my employees. &law is dye pokey mrdjab slit
infermatiest
Insurance Cesium;Name:
Policy s or Self-ins.Lac.a: &passion Date.
lob Site Addnris .__.._...._._ Grim 'tap:
Attack a copy of the workere comported**policy declaradon page(slowing the poesy member surd aspirations date).
Father*to:ociue cos-wagons rtgiiised sender h1C c. 152.12 to L a csisssiiaal violabompusidlialtla by a fine up to S1.30O00
mutes one-year impriscomant,await as cnil peilbt in the ft* sof a STOP WORK=ER cola a Ike ofrp to S250..00 a
day aft the virhtm.A ropy attlrn ozie eeatmay be tbroarded to the Odioe atimestistiass afie DIA deer tastaanto
co drape`vacation.
beret enrit,r, srmltrsithintairipamieeab jaray that a sats emawll+eet
2 i7 .L1
Mast ones* Dr ssrtiiew is this area,so he e,trtofteeiby thy wawa dada
City or Ulla Permit Yieente
Invite Arthisity+ k R.
1.Booed of 8ed& 2.Saildhelfaparrameat 3.City Torras Clerk 4.ilectrical Impeder f.Plu tbirel lseepeeaer
6.Other
Costae Palos: Posse R•�
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City of Northampton
Massachusetts , ..
: ' Fi DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building , "SC.
Northampton, MA 01060
I, E \' .-N Mart Sk:e\.\ (insert full legal name), born WI ZSI1 g7 (insert
month,day, year), hereby depose and state the folio g:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this 11 day of QC.hruort3 , 20 L I.
(Sig re)