24D-243 (14) 61 CRESCENT ST BP-2003-0763
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-243 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0763
Project# JS-2003-1256
Est. Cost: $20000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL HATHAWAY 081793
Lot Size(sq.ft.): Owner: KOE ERNEST
Zoning:URC Applicant: DANIEL HATHAWAY
AT: 61 CRESCENT ST
Applicant Address: Phone: Insurance:
2 OLD GOSHEN RD (413) 268-3135
WILLIAMSBURGMA01096 ISSUED ON:3/25/03 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN FIXTURES
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:
(-7
`I� Final: l' •'�, a/��!Final; /�!/ Jam(/(/-
5 Rough Frame:
as:6 4/14.1 Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: Of( 4—/3 - O 3
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIO .
Certificate of Occupanc —e Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 3/25/03 0:00:00 738 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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61 CRESCENT ST BP-2003-0763
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-243 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0763
Project# 3S-2003-1256
Est.Cost: $20000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL HATHAWAY 081793
Lot Size(sq.ft): Owner: KOE ERNEST
Zoning:URC Applicant: DANIEL HATHAWAY
AT: 61 CRESCENT ST
Applicant Address: Phone: Insurance:
2 OLD GOSHEN RD (413) 268-3135
WILLIAMSBURGMA01096 ISSUED ON:3/25/03 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN FIXTURES
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:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 3/25/03 0:00:00 738 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-0763
APPLICANT/CONTACT PERSON DANIEL HATHAWAY
ADDRESS/PHONE 2 OLD GOSHEN RD (413)268-3135
PROPERTY LOCATION 61 CRESCENT ST
MAP 24D PARCEL 243 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid d-'
Typeof Construction:_REPLACE KITCHEN FIXTURES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 081793
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 Dat
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.
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_City.,of Northampton Sat
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t1 f1`'^ i !!{{(( e�+ �� �crilding Department Cur® P/D vewaV 'e 4" i 5
!►2 \.;/ l=3 4 � <.1 ,y" �,t K
-• � 212 Main Street Sep r' eo tc-A at ab>! t _�
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Room 100 Wa ertWe IxAva ab ty.
MAR 1 8 2003 Northampton, MA 01060 T Set ,ofStr c ti'ral Fran �eY` ' �
phone 413 587 1240 Fax 413 587 1272 Plo;%Sate Plar%s kf
Otner,Spectfyretiv0
APPLICATION-TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: •
60br' e l Map . lot Unit
Notllri po Pr y\J Zone Overlay District
"° Y Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
+<,+ *fat ' 70 Maio c-
Name(Print) Current Mi lin iddress: i o i8i O
Telephone l~(� ��" �v g
Signature h (05/ (0el
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building I�,ODO'�o (a) Building Permit Fee
2. Electrical cV 1000 100 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 1000160 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Q pop Check Number
This Section For Official Use Only
Building Permit Number: b �(p Date Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 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, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 0
Or Doors ❑
Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work:_ 1e ato tftesnN4 .(RU& t 1C'/u et-5
Alteration of existing bedroom Yes %/ No Adding new bedroom Yes ✓ No
Attached Narrative 0 Renovating unfinished basement Yes ✓ No
Plans Attached Roll❑- Sheet❑
sa.3If Neitlibisefatd of d"dition to`existing housing, corn pleteTthe:folloogirig:
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 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
SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize to act on
my behalf, i al matters rel e to work authorized by this b ilding permit application.
Signature of Owner Date
I. , as Owner/Authorized Agent
hereby declare that the statements and jr(?ormation on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:� Not A pplicable 0
Name of License Holder : biCPlie1 ('fj, ,^ -_—--_ C6 0 1 f f 12
License Number
2 at✓19 Gfs N wt W 14,v 0 ►uA 11111 ISOOfr
Address Expirati n Da
414 • 21. b• 3137
Signature Telephone
f9. Registered Home 1mproven ent Contractor "` r % . _Ai Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- 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 ❑
f:
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 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 ,f
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212 Main Street ' Municipal Buildinr-
• Northampton, Mass. 01060 —
WORTCER'S COMPENSATION 1NSUIiA.NC1; AFF[DA.V1.T
n IDS t 1.. 1k 1t Pc+4 r kut
l::niclpal place ei uus!.Iiesslresidellce at.
2 . _Qvl? Crb 14-c; attiM v MS 6124. (p:;c ne ''' _26b' 3135r
do hereby ccrt,: tinier the pains penalties of
( ) I am an employer providing the iollo\vint, .;'o:'.•: : coinpensat..on coverage for my
employees working on this job:
(Insurance Company) (Pclir;':::nbcr) (Ex-pirdon Date)
Ar
4 / m
I am a sole proprietor, ��M 501 'r hc--ieowne: (circle one) and have hired
the contractors listed below to lave t Ie ollowincz 'workers compensation policies:
(Name of Contractor) (Insurancca Cotnpa:I)-/Po:ic;' Number) (Expiration Date)
(Name of Contractor) (Insurance Comra,nvPciicy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanylPe,icy Numb zr) (Ex::ra tIoa Date)
---- --------
(Name of Contractor) (Insurance Company/P,._icy Numb,_r) (Expiration Date)
(att,ch%d!itictoJ sheet ifreccn.r::o in_.bxic i .r ms:ice:p.z taming all a_<:::n r::•)
( I run a sole proprietor and have no one -..vor kip for me.
l ) .I am a home owne:- performing all t!le work ii:•': _.11.
NOTE:please be awe c that'while tc<nco«w_n%rho cc;plcry;rs to:':.ram Sr_unc4 ct,trt rJ4:Yl a tci.ur""6: :.: . cl!i et
not u%o-e than throe unit.%in u{::c1t:he tirouirr rn:t:cs or on t.e thecto ere not Ccrscrally crr%i i rr :o E`
cmploycs under the wo(ktftt ccr4)Glsnum Act(CL152,2ts1(5)),rpF•t:eic::by a homcotroa fora l:ec:u or permit r.:ev c-.: n c th:c
legal%tans of an employer under the Woriccer Compensation Ad.
I underztand that a copy of this state nmt may be forwarded to the f>cpartnn.t of lnduarrial Ao-iL oec Office of!:t:uraro a for the
coverage verification and that failure to toatre covet-age and r section 25A of MOI.152 can Iwt to the imposition of criminal penalties
comisting of a fine of up to S 1.500.00 an for imprisonment of top to cn-yt-r.n civil penalties in the fonts of a Step Work Once and a
fine 0(5100.00 a day against tm.
For dcpattt>eatsl uao only
Permit Numtx:r — — —
Mapf/ Lot ;h
r: Si ate -_-- _. —
rc of Liccd: -tJI'crn ttcc 151Lc' _J
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. 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 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)z
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