24C-083 (8) w w
1i * BP-2006-0551
GIS#: COMMONWEALTH OF MASSACHUSETTS
' CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0551
Project# JS-2006-0810
Est. Cost: $5085.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WESTERN MASS MASONS 133234
Lot Size(sq. ft.): 7492.32 Owner: RADKE MARY BETH
Zoning:URB Applicant: WESTERN MASS MASONS
AT: 15 MASSASOIT ST
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) 540-1959 WC
SOUTHAMPTONMA01073 ISSUED ON:11/15/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD CHIMNEY/INSTALL LINER
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: Date Paid: Amount:
Building 11/15/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
.
Department use only
tity\of Northampton Status of Permit:
C }
� _.--' Building Department Curb Cut/Driveway Permit
J! 212 Main Street Sewer/Septic Availability
Cf Room 100 Water/Well Availability
NOV 1 5 Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
AP -b k 1 -,/ Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�a rs z r� j�G(!t c
Name(Print)( � Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
D4,,, a,' 74/ 2 w(c_ f)-(- - 50' 4.
Name 'nt)/Al c..„ \ Current Mailinng Address:
Sig ure ,5-44
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 7
6. Total=(1 +2+3+4+5) j�yJ-S ci �/ Check Number 0 3(9
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size '
Ii i
Frontage
Setbacks Front !!
Side L: R:i i L:' R:r^
r
Rear
Building Height f— f--- . -- 1_
Bldg.Square Footage 1 i1 % I I i
7-1
Open Space Footage ,______1 %
(Lot area minus bldg&paved ; 1 i I 1
parking)
#of Parking Spaces
Fill: I
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book I Page i and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
• Needs to be obtained Q Obtained ® Date Issued: _
C. Do any signs exist on the property? YES 0 NO 0
r
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location: I j
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® ,. NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
r.•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑_; Replacement Windows Alteration(s) n Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding[CI] Other[ID]
Brief Description of Proposed ' / -
Work: G�a , t✓l G4 ,.....r� /(.+_)/4 l( /, sv e p
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New house'and or od oor o xtstInci ;ioc slnct-,-:complete th`oiJo winrq:
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. Masscheck 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
l 75 '-C't lJ 05 c e c lc , , 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.
yD , .6 os1e`c .
Print Name `
Signatur Owner/Agent Date
4
SECTION 8-CONSTRUCTION SERVICES•
8.1 Licensed Construction Supervisor: � ) ` Not Applicable/ [� 0 /�
Name of License Holder: C/ i U`S/ �� /l V V ! -' ) `�
License Number
Address Expiration Date
2/
Si tune Telephone
9-3teqls iere `.`m'ffmpoem.a Tt eonfra ,., R Not Applicable 0
e s/ e f,,4' T J . ,., rcl h i /3,3 3
Company Name Registration'Nu ber
Address Expiration Date
Ste_ 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 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 f6r 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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It
R tE (�i1 ral �Cflf11F3111]Jfo11
Avgw4 .I E �It�aRrEtatrtla'• �
p- DEPARTMENT OP nu1wr/\C 7NspecriO1.'S
212 Main Street ' Municipal Building
Northampton, Mass. 01060 r'
WO°RIcER'S COKPENSATION ON tSUIZANCE A AVIT
(1i C`nsetlpc Tmi ttee)
v„rita a principal place of business/residence at:
• (phoney')
do hereby certify, under the pains and penalties of per-jury, at
I asn an employer providing the following';worker's compensation coverage for my
em owes worldng on this job:
•
•
(insuin= Company) (Policy Number) (-pimtior. Data)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below wbo have the following worker's compen_adon policies:
CNaimc of CoF'_!Icto") (Insurance Coroany/PoLic Nt.un=cr) -- (ri;pird=2^n Datc)
(Name of Conn cior) (Ins sane CompanwPoiic Nur.1c_r) (LaPiriion Due)
(Name of Contractor) anstiran cc Company/Policy Number) (txnir.:rion Date)
•
(Name of Contractor a
`
{ ) (Innuan� Company/Policy Number) (Expirian Dam).
(nc h:d1oc J rt.oeilno••--.•%.to a>cvc.infortruoc pclaia as to.11 Doc-tors)
( ) I am a sole proprietor and bave no one worng for me.
( ) I ama home owner performing all the work myself.
NOTE:pI .e be exyc tfi-•,*mac hemco rcrs wbo employ pc-om to ct,r-.;--+- ',-• c-sar.aco a rcpaa work on a d..c1L^a of
not Chore lb_a t.1•o_tmfj is wh ctt the bomoo+wc rcnde or co the trouo6 a,7purtra_•7 tbeao err_ot�r.11y coedrod to be
e:d:PIcyc-s a„�'c the.., ..---te—"taco Act(GUI 52 31(5))•opplir+,ioo by a boaar»Qaa fc c bi=ne cc pctnrt ts=y e,idcoce the
lop]r-^'-ora.a cpley.c uoder dae Woe'Cde Coesaematioa Ad
I coder-Lod Eh&a Dopy of Chia c:aramc o may bo foeo,ordod to tba Depanmooa of low, ,id Acodaaj woe of tooce for tbo
cot eao^c.•cif ectroe rad the L-iltac to z.o arc tovcr a,-c trade 10C.ion 25A of MOL 152 eta 1=4 to the .-•aSo t of eimia+l pav isia
cocrds.i is of a fiat of up to S 1300.00 andice izarrisocanca of up to Doc yr_r e.ad a vil p,-”,tia io ex form or.Slop Work Or-de'ad a
fstr of 5100.40 a day tztiaa tat
For 6op.rtm=:.-+1 vc oaJy .
Pcrnait Numb
Mnp^__ Lot " I.
Si&naturrofLic r-/Prr,,;rt.-, rbi'.s
I
¢,taCStp1. =#=L
two , ,(1±t a# itrffj&illptan
$=� ,, "r.�4
Ail asaacftasetti 1_
DEPARTMENT OF BUILDING INSPECTIONS 1:
,
INSPECTOR 212 Main Street • Municipal Building %
Northampton,MA 01060 .
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::.' 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 lot th-e City ofNorthampton 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, 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
WESTERN MASS MASONS
ammi74"
LICENSED 11111111.11.11 INSURED
147 Middle Road
Southampton,MA 01073
(413) 540-1959
WWW.WESTERNMASSMASONS.COM
QUOTE DATE 8-01-05
QUOTE# 674298
TO: MARY BETH RADKE
15 MASSASOIT ST.
NORTHAMPTON MA.
1. REPOINT EX I'LRIOR OF FOUNDATION AS NEEDED AND
RELAY SOME BRICKS AS NEEDED. RED DYE WILL BE USED
IN THE MORTAR.
TOTAL$ 625.00
2. FRONT CHIMNEY ON HOME MUST BE TAKEN DOWN TO
THE ATTIC FLOOR AND REBUILT BECAUSE OF WA TER
DAMAGE AND MORTAR JOINTS ARE FAILING WHICH
COULD LEAK FUMES.
THE CHIMNEY WILL BE REBUILT WITH BLOCK IN THE
ATTIC. AT THE ROOFLINE NEW LEAD FLASHING WILL BE
ADDED AND BRICKS WILL BE USED TO EX"I'END THE
CHIMNEY 2" PAST THE PEEK OF THE HOUSE.
THE CHIMNEY WILL ALSO BE LINED WITH A STAINLESS
STEEL LINER AND CONNECTED INTO THE FURNACE IN THE
BASEMENT. THE CHIMNEY IN THE BASEMENT WILL HAVE
TWO COATS OF STUCCO ADDED TO IT, TO FILL ANY GAPS.