24D-243 (15) 61 CRESCENT ST BP-2003-0999
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-243 CITY OF NORTHAMPTON
Lot: -614
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0999
Project# JS-2003-1600
Est. Cost: $6000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SHAWN ALLEN 069965
Lot Size(sq. ft.): owner: ATLAS RA HAEI.E
Zoning: URC Applicant: SHAWN ALLEN
AT: 61 CRESCENT ST
Applicant Address: Phone: Insurance:
28 LAUREL MT RD (413) 665-1499
WHATELYMA01093 ISSUED ON:5/15/03 0:00:00
TO PERFORM THE FOLLOWING WORK:CARPENTRY & FLASHING REPAIRS TO ROOF
OVERHANG
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: et; ?--q•O 3 .
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIO .
Certificate of Occu anc Si nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 5/15/03 0:00:00 5417 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
61 CRESCENT ST BP-2003-0999
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-243 CITY OF NORTHAMPTON
Lot: -614
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0999
Project# JS-2003-1600
Est. Cost: $6000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SHAWN ALLEN 069965
Lot Size(sq. ft.): Owner: ATLAS RAPHAEL E
Zoning:URC Applicant: SHAWN ALLEN
AT: 61 CRESCENT ST
Applicant Address: Phone: Insurance:
28 LAUREL MT RD (413) 665-1499
WHATELYMA01093 ISSUED ON:5/15/03 0:00:00
TO PERFORM THE FOLLOWING WORK:CARPENTRY & FLASHING REPAIRS TO ROOF
OVERHANG
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 5/15/03 0:00:00 5417 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2003-0999
APPLICANT/CONTACT PERSON SHAWN ALLEN
ADDRESS/PHONE 28 LAUREL MT RD (413)665-1499
PROPERTY LOCATION 61 CRESCENT ST
MAP 24D PARCEL 243 614 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 07-5---
Typeof Construction: CARPENTRY&FLASHING REPAIRS TO ROOF OVERHANG
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 069965
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 Co ' sion
S—///0€L3
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.
•
City of Northampton .Pefr t
lt.
"r ",Building Department curt') c ,, /nriveway. e
r— —_— 212 Main Street Se , pt�c A ailab"ty
Room 100 Wa er 4 ii Ava �� �� �P
MAY 1 2 2003 Northampton, MA 01060 of
p
hone 413-587-1240 Fax 413-587.1272 r 1, ians ,ri r
Other Spect> � ,
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:
lD t GR ESLE/%•1'r Ser. Map Lot V U n i i1/y
Zone t� ' Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
•�r
.teq
\ J PS>tW
Name(Print) Current Mailing Address:
(1,k°l 516-1511
Signature
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 46)
(a) Building Permit Fee
2. Electrical (b) stimated 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 31i/7 �S-
This Section For Official Use Only
Building Permit Number: 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 t ere 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 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other ["Y"
Brief Description of Proposed Work: 44J2}Ej)D2y FU Si4)ut, EA)r2S ?b RooP 0us2144
Alteration of existing bedroom Yes �No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes �No
Plans Attached Roll ❑- Sheet❑
hfN'ewhoiseandor�ad"tlifiontoeXi'stini; housing, cdmphetetri" fS131aGuing:
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, in all matters 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.
Print
Signature of Owner/Agent Date
SEC ',IdN 8=�C�NS fRUC47ION SERVICES
8.1 Licensed Construction Supervisor:_1 Not Applicable//�� ❑
Name of License Holder : •s!-lAWA AL-LEAV Cp`19(p5
License Number
ZS 414inz. z mar. 1Sb. l 2-17-Zaoll
Address Expiration Date
144yDEn1 d!tAZ ,)1,4 • 4/b 39
Signature Telephone
(vlo 5 -P199
el gli . me mp .0 e ent'.•ontractor Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION10 WO,RKERS':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 1J— No 0
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
•
•
SSrTO
.Q
; 4,....
aze of Nor# t7 } ton 1 —
a. ( tl =�
8 "�^ filasaarlinsrlta is= t=
Mifigi
1fi6 DEPARTMENT OP BUILDING INSPECTIONS * —= j-
212 Main Street • Municipal Building _ �Northampton, Mass. 01060 rr'+�
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I,
S�40N 4 L-+� .
(liccnsceJpermittec)
with a principal place of business/residence at:
•
2- l- FTh')7. R 4ybekidiv.& AS.(phonc?o “S—i 9
•
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my •
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( I am o e proprietor general contractohor homeowner (circle one) and have hired
the contractors 1st eiow who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
,r
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comrngy/PoLicy Number) (Expiration Date)
(attach alitioail silent ifneee-sar::o inclia&information pertaining to all cccCraderi)
i
( I am a sole proprietor and have no one :�rorlang for me.
( ) I am a home owner performing all the work myself.
NOTE:picnic be aware that%sink hcxncowsm wbo employ pa-sons to di maintenance,corn-maim Cr trpau we k on'dwelling of
not more than three units in wi::clt the 1somcos renid.=or on the grounds appurter.ni thereto arc not generally ccrtuiered to be
employer t+,vi r the worker.co:pc saticn Act(GL152,n t(5))•applimtion by a homeowner for a license cr permit ritzy r.4noc the
legal status of an employer under the Workers Compomation Act
I understand that a copy of this etatcm at may be forwarded to tbo Department of Industrial Accidents'001oo of be waooa for the
coverage ve iftcatioo and that failure to louvre coverage undx section 25A of MOL 152 can Icad to tho imposition of criminal penalties
oomisting of a fine of up to S I.S00.00 and/or imprisonrncni of up to one year and civil penalties in the forth of a Step Work Order and a
fino of SL00.00 a day avinst tar_
For dcputmars1 use only
43g....
5-7 3 Permit Number ____
maw; Lot
Signature of Licen secdPcrnuttcc r%I'= • 1
0sott Mpg.
� e �If�l ofNorthampton Jz =*_
"ir ,l fldassacliusrtts g — -
'�'ar' DEPARTMENT OF BUILDING INSPECTIONS ', '_ 1— /
'
INSPECTOR 212 Main Street • Municipal Building `014= •ss
Northampton, MA 01060 Imo
`
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups-,-isor. 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)t
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
"2?7: 1
_ .TrsA.wO.rl✓'LAW r.n m - �.,,.
✓fie -omvrrcrn .../d a//iadsac/cudel7a : i
BOARD OF BUILDING REGULATIONS
i(---'re 1‘. License: CONSTRUCTION SUPERVISOR
• 'p'~` 1 Number: CS 069965
„i Birthdate: 12/17/1959
• Expires: 12/17/2004 Tr.no: 5385
Restricted: 00
SHAWN M ALLEN r /
28 LAUREL MNT RD ( - .
HAYDENVILLE, MA 01039 Administrator
•
g2e -69r— ea/,L, okywa4oachuae/4 i
— Board of Building Regulations and Standards
�M=-"
__ � HOME IMPROVEMENT CONTRACTOR
=_" 'b Registration: 123295
R`r Expiration: 01/22/2003
Type: DBA
i
WORKABLE WOODS
titttttii.4kitx 44Kuk L+;�ci:ititiikkgtittttieiik tkk,W 66Scxxkitilst St*i>if-iii#2#iggiKi3tfffti titkg. SHAWN ALLEN kr£'itit:ks£isf$611.t>tit oo
28 LAUREL MN1 RD fir,.,„ t..-' i
HAYDENVILLE,MA 01039 Administrator