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23D-020 (2) 508 ELM ST BP-2005-0113 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-020 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) OD Category: roofing BUILDING PERMIT Permit# BP-2005-0113 Project# 3S-1999-1707 Est. Cost: $2000.00 Fee: $2500.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 7013.16 Owner: FRENIER OWEN P &GAIL L Zoning: URB FREN FR OWEN P ik GAIL L AT: 508 ELM ST Applicant Address: Phone: Insurance: 510 ELM STREET NORTHAMPTONMA01060 ISSUED ON:7/30/04 0:00:00 TO PERFORM THE FOLLOWING WORK:ROOFING OVER EXISTING SHINGLES , ONE LAYER 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: vii: Insulation: Final: Smoke: Final: ©K '3-, l- 4 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION F ANY OF ITS RULES AND REGULATIONS. Certificate of Occupant L/ Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 7/23/04 0:00:00 MO 6932 $2500.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo a Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability 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 DEMO H O R T}N F IL WELLING JUL 2 3 2004 ,_J SECTION 1 -SITE INFORMATION 1.1 Property Address: This s&c.Uion to be'cot�Rl 4t 9 by office ;yb , ,„> i,,,, T A th..i. s' 'j_ce--,c/d £//'� ,-� Map tot 'Unit NQ ` f'?Pit / /I 4 Zone Overlay District '� Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 6-3 l / rr(fJl ( (/o ei,.7 ,..)-- -- Name(Print) �--� Current Maili ddress: /uA4AP A Telephone Signature 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 ©O (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 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building Permit Number: P-&DO3T 01 I Date Issued: Signature: ./' -�"' :".„,./37 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 `. DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Do site contain a brook, body of water or wetlands? NO DONT KNOW YES - IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: A C. Do any signs exist on the property? YES NO - .a. 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: i• ; w - .SECT Ali -ESCR1P.' 7�b ®PTO iYV© 1 'd , B 6'11 f1 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: ( ccl-`CtJ 7 ' ) E i5)i xi c p N7% /iViR Alteration of existing bedroom Yes No Adding new bedroom Yes No/ Attached Narrative 0 Renovating unfinished basement Yes +1 No Plans Attached Roll 0• Sheet 0 1 Mle-�W t�ouve nci o a`dditron to ex,,isti iid sinvg eample�e l e {lowin:$: a. Use of building: One Family Two Family n Other b. Number of rooms in each family uni Number of Bathrooms / c. Is there a garage attached? (1)0 d. Proposed Square footage of new construction. Dimensions e. Number of stories? 2_ • 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 nd ng regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply' 'SEC T 0 Ei#4%If 1l3RIZATION TO BE COMPLETED WHEN OVI,NEvS ENTO CONTRACTORpAPPLIES FOR BUILDING PERM(T . I, G' r° / FrF Iv ?- ER as Owner of the subject property hereby authorize c-r' /J i F 2 to act on my be alf, in all matter relative to work authorized by this building permit iication. • Signature of Owner Date FI' , 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. G 0-1 l 1=' cLe-vV i P_ 2 Print Name Signature of Owner/Agent ate • SECTION CONSTRUCTIoN•SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone Re •$•e,e z•:Dm •mproyetn'en or tract®r. . t i � ::° P Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone SECTI:V D iWORKERSCOMPENSATION 1NSURANCEYAFFIDAVIT(MnG t: 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 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 Zonin" aws and State of Massachusetts General Laws Annotated. C � '' Homeowner Signature y4,{,(1./ • • -0tAN3'J • • -�� fi 1, t ` ! 1iE (rill). of �t7 tljrtl�l}�fnit _ *=_ t •iert Isssrtrh»srtls =t'-'. —. L)EPARTMLNT OP IIUILDD G INSPECTIONS 212 Main Street ' Municipal Building • --_ Northampton, Mass. 01060 WORKER'S COMPENSATION 1NSUIRA..NCE A t ANrIT • I' (liccns rJrcrrnittce) with a principal place of business/residence at: -------- .— —_ — • (Alone• - - -- (strectici t t kt a te.Jzi p) do hereby certify, uncter the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my • employees worldrig on this job: • • (Lnstuan= Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general conn-actor or homeowner (circle one) and have hired the contactors listed below who have the following workers compensation o!ic:es: • (Name of Contractor) (Insurance Compaq„Policy Number) (Ex.:ratica Date) (Name of Contractor) (Insurance Compa.ly/Policy Number) (Expiration Date) (Name of Contractor) (Tnsurancc Companyri olicy Number) (Expiration Date) (Name of Contractor) (Insurance Comt any/Policy Number) (Expiration Date) (attach sotlitioctal t°:.-ct if r:!r<-�i^ ;�i^.:.1•.v- ( ) I am a sole proprietor and have Iib one -.• orkin^r for me. • (or I am a home owner performing all the myself NOTE:pleaac be awn a the u�iJe hcrcovvir-a.v ea�lcy;rz:. to es):r.taiea_tnc;nor:zruC oQ cr trpav.v••;;:on d'vei!ing cf not more quo throe,units in vvbich the 1:.-c:r.o:rcrs r-::::j oc oct the ate•-r:er-.1r.1 lthWcto era no(Eerrsally ox:::i_:: :o be catploycs ur cr the vv e er'a! y:ati cr Ara.(GLI52,,-t l(5)1,ap;li=:tip n by a hot:tcovv act fora licct::c cc p^rtni:-:a:: legal etatus of nn acaployee undcr tiro Workoeg Co,•taperraticn Act • I undc,tand that a copy of thia ctatcncr4 nay bo forwarded to t o lY_{xirtncnt of Itdu triJ Aceidarti Offrc.e of I:::ur.az for the oovcrusc vcrif rtioo and tha f:.ilurc to r! ue oovcrz o ur3;t_cC.iOn 25A of MGI,152 can letd to the imposition of r.••ain-,1 pee: i1ics °omitting of a fine of up to S 1.SO0.o0 ar..''r ri,,ircancui of up to on,_y-:r art.!civil pcsullia in de form of D.Sic?Work Chime_r,d fire of S t o0.00 t day tgain:.t m:. . For cloparumral u.o only Pcrmit Numb es - -- ,5 - ...... ;Sap:, — l,ot . - -- ISnaturc of I.ics n:;ec/Pcrnr,ttc:, -"?iiii'r'' r ! F otTAMPT 4 'O" *Q(City of Northampton iz = / t $$14_,Y-4,40 fllassachusette =_ 1_ y DEPARTMENT OF BUILDING INSPECTIONS :, _`_== /= INSPECTOR 212 Main Street • Municipal Building �`'o, -S .,ter Northampton,MA 01060 . r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supra.' 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 regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill)1 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 ,A l I, ,,a14 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 - CD 8 — 670 s/pi AJ 0 R--i'htar- per,, PA- CYO 6 6