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23D-116 (3) 202 FEDERAL ST BP-2007-0018 GIS#: COMMONWEALTH OF MASSACHUSETTS ,fdap:Block: 23D- 116 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0018 Project# JS-2007-0031 Est. Cost:$2000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME OWNER EXEMPTION Lot Size(sq. ft.): 30056.40 Owner: CARRASQUILLO ANGEL& Zoning:URB Applicant: CARRASQUILLO ANGEL & AT.• 202 FEDERAL ST Applicant Address: Phone: Insurance: 202 FEDERAL ST () 586-9430 () FLORENCEMA01062 ISSUED ON::7/7/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:Roofing 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 7/7/2006 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2007-0018 APPLICANT/CONTACT PERSON CARRASQUILLO ANGEL& ADDRESS/PHONE 202 FEDERAL ST FLORENCE 0 586-9430() PROPERTY LOCATION 202 FEDERAL ST MAP 23D PARCEL 116 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid C..Htiilding Permit Filled out Paid ' Z- •c'O -4' �S b Typeof Construction:_Roofing New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON EIFOXCIATION PRESENTED: Approved 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 Commission /aturee.-4„of7(07/06 Si 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. Department use only i of Northampton Status of Permit C ing Department Curb Cut/Driveway Permit Main Street Sewer/Septic Availability 2001 OOm 100 Water/Well Availability ,ul NorthamplOn, MA 01060 Two Sets of Structural Plans phone 413;0 7-1240 Fax 413-587-1272 Plot/Site Plans 1 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 Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT z.1 Owner of Record: tS 61-n e t - ()A e(Print) tI it Current Mailing Address: O�� � 'T YL?���` ''-L {�� 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 0 G _ (a)Building Permit Fee ..?ono 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 1,con 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number j S‘ ' '' (JO 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 __ ._ — Frontage --- Setbacks Front j Side L:"t� I R:i. L:1-7 R: 1 Rear I-- I Building Height L • Bldg.Square Footage r-- r % • 1 • Open Space Footage % -� (Lot area minus bldg&paved �_' parking) • #of Parking Spaces Fill: 1 (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:I I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and/or Document#; —7-81 B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © Date Issued: C. Do any signs exist on the property? YES ® NO 6 IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES © NO e( IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,a cavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ISECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 1.19 Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [ZI Siding [II] Other[C7] Brief Descriptign f P_r5�p-osed Work: r �.�Y[G'1 1/6-C_L_ r o -(' Alteration of existing bedroom Yes No Adding new bedroom Yes / No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ta.if NewIiouse ana-ot kdition to_existing housina;ftbnipike-thelailbiultict 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 ,a Owner/A thorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the b y knowledge and belief. Signed under the pains and penalties of perjury. Print e s\ .d14°//4("A( ))/( Signatur ofwner/ gent I Date SECTION 8-CONSTRUCTION SERVICES 1 1 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Reaisfete ri-lom6friiiaioveIne null traet6Ea ,. ; 0ar Not Applicable 0 Company Name Registration Number Address Expiration Date 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 11: a 0wi;r � 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, tate and Local Zoning ws and State of assachusetts General Laws Annotated. Homeowner Signature �(� 6 4Qi`� U,/16- C�r B E Lj•Ii Of Yo1;ti?aiiipt0li -~ -- V E .61431.nctlagrlfa' Z ; DEPARTMENT OP BUHLor'C INSPECTIONS 212 Main Street • Municipal Building 1slorlhampton, Mass. 01060 airs { • «WORQ:R'S COMPENSATION .MSURANCE AFFIDAVIT • Diy (19/2 gos(ti permittcc) with a principal place of-business/residence at: • _ (phone#) (scr=1/city/suldzi p) do hereby certify, under the pains and penalties of perjury; th2t ( ) I am an employer providing the following workers comocnsadon coverage for my employees wor ng on this job: I (111sur7z.M=Co (Pelic: Nn_rabcr) (r:-pinion Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the conuactors listed below v-ibo have the fotlowi.nQ worker's coonns eation policies: l - (eruct of Contrtcior) (In uranc; Coinoany/Pout; Numb :) (rxptrduon Dalc) (Name of Coot-lac-tor) (Insuranc:. Comaati•fPolic Nuncrr) (E u-tion Dais) •• (Name of Coan rid,) (I-nstuaacc Compa.o}-IPoticy Nambes) (Expiation Date) . (Name of Contractor) (Insura-n Comczay/Policy Number) (Expiration Date). (ansch:ddi�oc51 bra ifacxziry to etc&inf,- on per-taioiog w.11 rear-s.o:s) ( ) I am a sole proprietor and have no one working for me. (% I am.a home owner performing all the work myself. NOTE:plcx be esrlre bcmeowacra vebo eaplay pc-cooa to do r-s rgair work oa.d••cll_z of ant moon the ` o t it r in which the botatow-ocr readc3 o-oa the :r zppurtca-ri.tbera c c DOC t,..-.11y eeer.Gsd to be crploych a+''c the wui cl.a`. •t;ca Act(GL152-n I(5)).rppticboa by a botacoava fcr a lrcy..a 1 tit zy c-idmcc the real cuss.o(&a¢ploys coder duo Workor.Coop osa ioa Aat l uodctZaod chats.copy of this mtcmnx may be for-s.arda4 to tbo popu'smr of tom•-ricI AccdcsnY Offioo oCinz u koco Car tha eoYCrhtsc vciGt ion a_id t nt L•iiu c to socurc'coverage under roc ion 25A of MOL 1 S2 an real to the iapasitioo of Unica!prn-'+iti.= 000siaiag of a tux orthp to S 1500.00 and/or inaprb.oaan=a of up to one yrsr end aNil pc- do is tic form of Stop Work Ordc and s rim o(S I00.00 s d_y tzx For do;s.rtrr u,c only Pc-rmit Number cam / i,�p __ Lot S i Ptaturc Licz=n_sccfPc rrni t= e - 015t1AMPTOy Cf ify of Nor#lyantp#on DEPARTMENT OF BUILDING INSPECTIONS VO 212 Main Street • Municipal Building INSPECTOR Northampton, MA 01060 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: .i:;or. 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