23A-301 (3) 154 NONOTUCK ST BP-2004-0415
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-301 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0415
Project# JS-2004-0601
Est. Cost: $4000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JDR BUILDERS 130397
Lot Size(sq. ft.): 19994.04 Owner: CURRAN PATRICK J
?oni„_:LTA Applicant: JDR BUILDERS
AT: 154 NONOTUCK ST
Applicant Address: Phone: Insurance:
P 0 BOX 66 (413) 665-7587
WHATELYMA01093-0066 ISSUED ON:10/10/03 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:eif / -/4 • O3 _a,
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO N I F
ANY OF ITS RULES AND REGULATIONS. 9
Certificate of Occupancy anc Signature:
p
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/10/03 0:00:00 1564 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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154 NONOTUCK ST BP-2004-0415
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-301 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0415
Project# JS-2004-0601
Est. Cost: $4000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JDR BUILDERS 130397
Lot Size(sq. ft.): 19994.04 Owner: CURRAN PATRICK J
Zoning:URB Applicant: JDR BUILDERS
AT: 154 NONOTUCK ST
Applicant Address: Phone: Insurance:
P 0 BOX 66 (413) 665-7587
W HATELYMA01093-0066 ISSUED ON:10/10/03 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:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/10/03 0:00:00 1564 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
154 NONOTUCK ST BP-2004-0415
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-301 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0415
Project# JS-2004-0601
Est. Cost: $4000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JDR BUILDERS 130397
Lot Size(sq.ft.): 19994.04 Owner: CURRAN PATRICK J
Zoning:URB Applicant: JDR BUILDERS
AT: 154 NONOTUCK ST
Applicant Address: Phone: Insurance:
P 0 BOX 66 (413) 665-7587
WHATELYMA01093-0066 ISSUED ON:10/10/03 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:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/10/03 0:00:00 1564 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
U V •1 of Northampton S atus-of Permit .
,� ..
tiding Department Curb Cut/D vewa"s e pit �, '��
OCT 2003 .12 Main Street S w�erl,Sep ic',+al ab .fu-�.`'
Room 100 W�rlwetiv.vai a i .I- " v
., ; �. v. s- v ,...� .4,
orth.I mpton, MA 01060 ;Two Sets',of4St et -at P arks ' 4i`,1"xg #= .,,'
DEpT OF g1li Dl INSPECT() - ,',,.,ti^ s�:� :� ~, .e.,VI-r - ,X r„::`
�' 9 0413- • '-1240 Fax 413.587.1272 -P�Lot/Site Plan "l t," .„ ,-
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NORTrSpe _ - Ikts„
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION ,
1.1 Property Address: This sedtion1to. comp eted+by office
x s
I l O( /{—i CX S Map : Lot ': "� h b nit:— ` n
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Zone : 'Overlay isttr
EImSt1D strict `z CB District"'�.. %' ""
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-
`VA'cGZ%CK CV L'rcA t.) tS L) 0b K)OTvo( S t
me(Print) Current-- Mailing iwac ri, O(OC3
Telephone ssi _ Cr! `g
Signature
2.2 Authorized A t:
larr>�5 D . 45s tg,i1 SD(z gl)1[ 5 IPv 4G `✓4c.1 A rr2A oid3
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Name(Print)n Current Mailing Address: .
(4, ), Z____ 27l 72i?
g P
Signature ,r Telephone
_
SECTION.3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
completed by permit applicant
1. Building f (a) Building Permit Fee
4(66C"
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) '6C ----" Check Number
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 x 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`S- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing ,
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: STi P q' I ZJLcnF 41SQl T-J V v S J.ci 0114 e 69/44/2e4' .ia%L i--
ieiOGf vr,<J7-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll D• Sheet D
61 1f-Ne' Iouse4a rid-or._.:a aiti n. o eCIslin ho n`Z corm te: a he olio Ong:
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 - TORE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ' ;'A\R-1C_K CveG
as Owner of the subject property
hereby authorize JA/n£S '2). /cs S /7gt TO/t ,d/c-of,f-S to acr on
m beha f, in a� atters relative to work authorized by this building permit application.
Signature of Owner , Date
, _ W','-.•ie�.... 1ir-S�lw gy'•:i nJif,'h: taJ
I, - )pri C . . e)-. phi, J /)a 6c:JcI)£.itV , 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.
1-kmrt5 D. &s5
Print Name
/�.�� k-7 03
Signature of ner/Agent Date
SECT1ONi 8 -,CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 42S4- 074/466—
License Number
£e,X 4, No. / T�F ' a Q aa':� 4 -7- of-
Address
Expiration Date
D. 3? - 713
Signature Telephone
Meg ere:.; .orn . mp.oue- en,u.•ontractor ;> � Not Applicable 0
Ji 6 )3a 3?1
Company Name Registration Number
&X 1 G� / f' i9 oi0S3 j- Z- o¢
Address Expiration Date
Telephone -3(7- 74'3f
,SECTION 10„'WORKERS' COMPENSATION INSURANCE-AFFIDAVIT(MG: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 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
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. j DEPARTMENT OP BUILDING INSPECTIONS _^_. =
•
212 Main Street • Municipal Building {_
Northampton, Mass. 01060 or`'•
WORKER'S COMPENSATION INSURANCE A:liYiDAV1T
I, .— �G442f j---..i,--go$5 _ _Pea _ 3-171a 60.1-D As..-_..----___ . .__._
(liccns_Jccrtnittce) _
•
with a principal place of business/residence at:
•
-•--13°X ke f-nJ Y�Z/V-f- n�o9�.----__ ._ _lphone =)._2 7-7G 3f
I:(strc t/cit at:.1p)
do hereby certify, under the pains and penalties of perjury, that: -
( ) I am an employer providing the follow inc worker's compensation coverage for my
employees woridng on this job:
•
- (Inruance Company) (Policy Number) (Expirntion Date)
•
( ) I am a sole proprietor, general cont-actor or homeowner (circle one) and have hired
the contractors listed below who have the foilcwing worker's compensation policies:
(Name of Contractor) (Insurncc CornpaayrfPolicf Nu nbcr) (Expiration Date)
(Name of Contractor) (insu ancc Compa;ly/Policr Number) (Expiration Date)
(Name of Contractor) (Insurance Co:npanvr?olic.•Ntunber) (Exa.ira tion Date)
-
. (Name of Contractor) -- (Insurance Comrr:;y olicy Numbs) (Expiration Date)
(attach additieral s?:eet ifr. -t.-.to irA)x i: -::a:ia: ,_._inin,::eII o:r.-_da:^I
I it1I1 a sole propnetor and have no one workingfor me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that wile hctrcowtr_rs Vri)o C::ip!oy;tees tO c:>r':.name;a:.:-rack-ct or r pair w'ij:•t n dWet!i g cf
not more than throe units in tct:ich the hole+owvc-r=it°-.a-on the •ela a9p.m-ter.n1 theoto tic not G-c-erally Correia::i:a be
employe:s undcr the tvorkre d ttim AL;(GLI 52.,!(5)),application by a homeowner fora Bees=ct per:ni::: e .ti oc the.
legal status of an aztployer under tho Wor!ee's Coroper—aticm Act.
I uadcnstand that a copy of this statement may be for-worded to the Do$artarrrt of Jn,,triJ At+idmt>'Office of IrLsorenoe for the
coverage verif crtioo and that radar=to:metre coveraps urd`::cc:ion 25A of MOL 152 can lead to the imposition of c ttn.I per.1:a
ooasisting of a fine of up to S 1,500.00 em.f r in prisr._rc-. of up to or.:yrzr ar4 civil petu!tics in tho fnrrn of a Ste;,Wed(Ord=and a
. firm o(S100.00 y tgr in.t t t. .
For deputmerral use only -. . __...._.1
, P / )U per mii munb ar ._._._______ _
7a�
.-- is:tn;, got. t
.)1gnaturc(If r —
_ir.•z.:... 'fin----- _.
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g�9 etaetiQ �`$ Cr z#yr of adilttiiip#on 17 /,
9 t, . is r,iICI assachitortts " Ulla
1 DEPARTMENT OF BUILDING INSPECTIONS �,
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INSPECTOR 212 Main Street • Municipal Building _
Northampton, MA 01060 .
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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 supc-Hsor. 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