18C-062 (4) w
BP-2005-0285
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0285
Project# JS-2005-0371
Est. Cost: $3000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: B & R Siding 100465
Lot Size(sq. ft.): 10672.20 Owner: CAHILLANE MICHAEL T&FLORENCE
Zoning:URB Applicant: B & R Siding
AT: 157 PROSPECT AVE
Applicant Address: Phone: Insurance:
781 Bridge Rd. (413) 586-4167 Workers
Compensation
NORTHAM PTON MA01060 ISSUED ON:9/9/04 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 9/9/04 0:00:00 19505 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Department use only
City of Northampton Status of Permit:
^^^------��� Department Curb Cut/Driveway Permit
O
ain Street Sewer/Septic Availability
om 100 Water/Well Availability
In
Northa ton, MA 01060 Two Sets of Structural Plans
! SEP p�or �13 1240 Fax 413 587 1272 Plot/Site Plans
Other Specify
AP LItAti fi'MO�'t . T2UCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
uf_"N5U t,. A
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
/�o4tO c i 4 i Map Lot Unit
Ya M Zone Overlay District
A ?elf
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of /
Record:��t '
/°�/ri//�4I f�1i/hi iiC /<s" 7 .2ds LCo /9GL
Name(P' t) Curr�r Mailir Addres i- \ m A-
G/ � / /Y61P�/"I �9 7v/
�� �� Telephone p " )3/o�Signature O / y��
2.2 Authorized Agent: ,,� n i 4—
Nam (Print) Current Mailing Address:
i//7
Signature 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) `f
5. Fire Protection
6. Total =(1 +2+3+4+5) < dry/ Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Informatioh 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
Frontage
Setbacks Front i I i I.
Side L:'—J R:I L:1 R:!. ( I
Rear
i I I 1
Building Height _ __ .
I r
I i I i___
Bldg.Square Footage 1 I I I % ( I I I
Open Space Footage %
(Lot area minus bldg&paved i I i ! i I
parking)
#of Parking Spaces ��
Fill: r I 1I !1 1
II(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued: I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book 1 Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW O YES O
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 Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO O
,
IF YES, describe size, type and location: j I
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 Q r NO Q
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ' Addition ] Replacement Wihdows Alteration(s) n Roofing
Or Doors [:1
Accessory Bldg. 1 1 Demolition I I New Signs [El] Decks [Q Siding[DI Other[0]
Brief Description of Proposed
Work:
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 addition'toY existinq-housiriq;complete the ftowiriaj:
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 JCONTRACTOR API ,�
APPLIES FOR BUILDING PERMIT
I, /�1 C�/!9/9c� / ��/j,d/1 �Z , as Owner of the subject
property J
hereby authorize G��dee4,!r ) L. 73,e,4
to act on my behalf, in all matters relative to work authorized by thisuiilding permit application.
/ Vd/ C
Signature of wner Date
E-1.01 rJ / 24/� , as(lesser/Authorized
Agent hereby declare that the statements and informatio on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
L_ JS'le,►9r
Print Na e /
Signature of Q r/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 4, 13 Roy
License Number
/2 el,. 4-, lo„e-74 yag
Address Expiration Date
Signature Telephone Q)..-c, 7 a6'S4
9.Registered Home Improvement Contractor. Not Applicable ❑
bJ h & v • 1J*i
Company Name
l Registration Number
,F) /34') def2i /66%/
Address Expiration Date
Al6 lei I. h1,# 0 MA9-- Telephone 51 g 7 ooa
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 ❑
11. Home Owner Exemption
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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F, E (yif of �arfl alit foil• —_--
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Q— DEPARTMENT OP nUlflwri c INSPECTIONS el
212 Main Strcct ' Municipal Buildin0 "� •
Northampton, Mass. 01060 r''
WORKER'S COMTENSATION L`ISURANCE AI<1."1.1)A.Vfl'
I, --6(v� 6-hp) ti-_' S D,%�,)c_--
iccns&pc mittee)
with a principal place of businessfresidence at: -
g, /3i i cY i)de7?/a k i 77/ ✓0' (phone;')LC. ‘✓ */6 7
(stt/bi ty/statcra p)
do hereby certify, under hc.pains and penalties of perjury, that
( I am an employer providing the following.wworker's cotnocnsanon cove mge for lily
employees woring on this job:
•-.�e1 rz1t /�0T 41 ,-1� s kic,�-s/67-�3a 17R ) os� ado S .,
( an Cogcanv) (Policy Nut-Aber) (Expiator Dam) .
( ) "I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's campen_tadon policies: .
(Name of Co„mctor) (In uranc: Company/Policy Numix7) (Y':pirduori Date)
•
(Name of Contractor) (lnsv-anec. Company/Policy Number) (L»ir,:tion Dale)
(Name of Coamacto,-) (Insuranc Company/Pol,cy Nambc.r) (EXpiraen Date)
•
(Name of Contractor) (Lasuranca Comcauy/Policy Number) (Expirtion Date).
(aasch aelditiocil Mcaifncc=ary to inclucic tafor>usoa pertaining to.11 mil--snri)
( ) I am a sole proprietor and have no one worming for me.
( ) I atn.a home owner performing all the work myself.
NOTE:plcsc be aw-arc t4, .w{ )c bcmcow•ocrs wbo omplay peons to do -•+:r--,..n —:taoo C-tcpo.0 work on a d..cn_g of
Da mote th:a ee trj in tvbith tbc homeowner raid.=or on the grounC,z,port-c thc-eo'--c we cm.:.11y xerdzol to be
cnploy-s tt,,,-.—the wot1 r^'*"X--.*ioa Act(GLi152.n I(5)),=pplintioa by.bomrrsaaa far a lies_a permit r>_y nidtmcc tbc
IcQJ runic of as rsploy.c under dto Worker's C,ompem+lion Ad
I uss.cicrsuzni that a copy oCChia mtsmmi tsvy b.for-c.nrd..d to tb.Dop.ctmcat or1•a.t•.Yri4 A.c.s.a>'pis..of 4uucooe for the
covcri-gc nTiretina and th 1 L•iltnc to some'covcruzc under=aion 25 A of MOL In ma lad to tbc i o it i of c toim! n•l:tat
oomi.izg of a Ern of up to S 1300-00 andlor imprii.ocon=1 oC up to ooc yc-.r r_od civil pcoaltia in t5c form of.Stop Watt Order sod a
fin of S 100.00 a d_y q z.iast me
For dcp.ns�uac only
L14 -
f Permit Number
� hap:—_ Lot
Signature of Ltaariscc/Pcriniucc LCe ... -J
sci viva
" ti Crx# of Northampton tptnxt �.• it
i�A IJ �I�1$ ,f •
; ►••..�-ilt••rrt 4 a aciluSetts
vr4
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§:1 DEPARTMENT OF BUILDING INSPECTIONS / i%
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 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 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 i egulations. 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
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