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23D-108 (8) 1. . `ostal ervice CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) 3 BLDG INSP.. 23D - 108 1 Postage $ �]/ 0 ��/ 1 `� Certified Fee i�� Postmark Return Receipt Fee1 ( Here (Endorsement Required) 3 Restricted Delivery Fee 3 (Endorsement Required) � tl`fs, Total Postage&Fees $ �-//;f� Sent To Marlene E Snape Street Apt.No.; 187 Federal St or PO Box No. City scare,ziP+4 Florence MA 01062 I -: C.M'L s COMPLETE THIS SECTION ON DELIVERY • Complete items 1, 2,and 3.Also complete Sig ature item 4 if Restricted Delivery is desired. �- 0 Agent • Print your name and address on the reverse X (�1.i^,� /� ❑Ad, s1see so that we can return the card to you. B. Re,ei ed by(Printed Name) C(((��� to of(DDelirery • Attach this card to the back of the mailpiece, ! I J or on the front if space permits. a.3 P-jog D. Is.elivery address different from item 1? s 1. Article Addressed to: If YES,enter delivery address below: No Marlene E Snape 187 Federal St Florence, MA 01062 4 3. Service Type 0 Certified Mail 0 Express Mail ❑ Registered 0 Return Receipt for Merchandise • hi ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number 7001 1940 0005 1333 3637 (Transfer from ser DS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-25C UNITED STATES POSTAL SERVICE First-Class Mail 111111 Postage& Fees Paid LISPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Building Inspector's 212 Main St Northampton, MA 01060 187 FEDERAL ST BP-2004-0837 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 108 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-2004-0837 Project# 3S-2004-1243 Est.Cost: $2675.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft): 5793.48 Owner: SNAPE MARLENE E Zoning: URB Applicant: SNAPE MARLENE E AT: 187 FEDERAL ST Applicant Address: Phone: Insurance: 50 CHURCH ST (413) 527-3954 () EASTHAMPTONMA01027 ISSUED ON:3/3/04 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM ( NEW TUB & SINK) 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 3/3/04 0:00:00 MO $50.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo • File#BP-2004-0837 /ile'/Mtat cC6C7'J—'7 7 5 J APPLICANT/CONTACT PERSON SNAPE MARLENE E 7 ADDRESS/PHONE 50 CHURCH ST EASTHAMPTON (413) 527-3954() PROPERTY LOCATION 187 FEDERAL ST MAP 23D PARCEL 108 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: REMODEL BATHROOM(NEW TUB&SINK) 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 INFQRMATION 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 ommission �.� J r Signature of 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 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability MAR - 2 2004 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 DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office / 7 J / yvt s' Map 3 ) Lot /4P Unit :2/1 t-M L" J'Yt f /de Zone /4.6 Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / f? t Le C .S -i Name(Print) Current Mailin Address:rc, y Telephone :�..2 7 Signature 2.2 Authorized Agent: bt- ✓ cV f FP,0-eAq L 5'7 Name(Print) Current Mailing Address: C�rr-*,i /r I' c oil e N-, i9 Tl idC Signature Telephone ' i 3 _ S&y - 1751 SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /fs c. (a) Building Permit Fee 2. Electrical � . (b) Estimated Total Cost of -� 5 Construction from (6) 3. Plumbing 6. 0 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total ---- (1 + 2 + 3 + 4 + 5) " 6 7 �' Check Number This Section For Official Use Only Building Permit Number: A/ 7 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 4 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 V 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. Does the 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: 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: qr. • • SECTIONZ DESOR P.TtONgOF PROPOSED WORK -check.all apnlacable) . New House 0 Addition 0 Replacement Windows Alteration(s) C7 Roofing 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: { r"`"0 44 /34174`(601'1 — Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D - Sheet D 67FAM WIff e nidro. addition,it 7e tgting ff6Vt ng co t ple e'<g liabllowing: 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. bimerisions 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 SECT,1l047W-OYYNERtAUTHORfZATION TOBE COMPLETED WHEN OWNErtSf ENT O' t CONTRACTOR APPLIES FOR BUILDING PERMIT I, /71/9/t 4).(/e C .f,�/9/?-4 as Owner of the subject property hereby authorize /C ea/.vefti c to act on my behalf, in all matters relative to work authorized by this building permit application. Signatu of Owner Date I, ./1,11/' e4A,4_ 6 , 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. Printt Na me Sign Date ar, U SECTION 8 CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone PgRe> fstered tinme'li pro emen Contractor- Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone SECTIQN 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 ❑ ' =Uslater jJ= r Il 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 Genera] 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 • Mar�,s�e Crittt of Nttrtljziitt}lfan �, �i nY/t�.,E!�� fiicsaar},rrsrtta' / " r— y$ = 1� lam' � � ' •t�a� = t ;Cr>` DEPARTMENT OP BUILDING INSPECTIONS =f 212 Main Street Municipal Building • =_ Northampton, Macs. 01060 WORKER'S COMPENSATION INSUTZANCE tJ1+1+11)AVIT (liccns_Jl crtnittce) with a principal place of business/residence at: _--- ----- ——_ — — - • ___(phone (stTccueiiy;tatet ip) do hereby certify, under the pains and penalties of perjury, that: - ( ) I am an employer providing the following •.vorkers compensation coverage for my • employees working on this job: • (Inuran=Company) (Folic:Number) (Ex-piradon Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • • (Name of Contractor) (Insurance Comprnv/Po!icy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy' Number) (Exc: r tion Date) (Name of Contractor) (Insurance ,,-,. Coen.,.._, soli Ntlmb^s (Expiration Date) cY ) (easels additive:xi alxet iP::!.'t.na^•:n ir.t art^,+tier:;�._.:art, e1;rate::�<,:•) ( ) I am a sole proprietor and have no one working for me. (rI am a home owner per:orming all the +`:or.. iirsclf NOTE:plc.ac t-' swine that while homeowners wto cnplcy;r1c7-:to 61 t�irtt=ncr;or.:.-maim cr iepav.r-s•ri:co a dwell:rig M. not mere than throes units in which the hoin su-rys rciw c•at rase.g^;,•_:s appurtenant thccto ars net cow-ally eo::id:r od io he employes under the worker's art._:trim/•c (rLi 52rs 1(5)),-r;•li_ation by a homeowner for a license cc rermi:may c.;i'.a-Ke the legal status of an amp toyer under ttto Workoes Comperxution Ao- I on&ataad that a copy of this ctaternce.may be forwardsd to tlra DItSnrtarnt of lr+•4'.+trial Am-idrnt&Oflioo of l:a:wen•for the coverage vcrin=Hoes and that failure to secure coverage tu4cr so:lioa 25A of MOL 152 can lead to the imposition ofc . »• penalties eomisturd of a fun-of up to S 1.500.00 and'r impri:.ontr.rat of up to cr.:year and civil penalties in the firm of a Ste;Wort•• r end a fine of S100.00 a clay against rtr_ . For demitrmsal uac only Permit Ntunbcr __._ ;f Nan;; Lot ----- - 1 Signature of I.tce nr,eJPcrnttttt; icvttofpio ; e C!,ztjr of 'orthaiuphi r 1= __ Vol i jt assachusctfs _i '2 "'' DEPARTMENT OF BUILDING INSPECTIONS ', _4 J: INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 - ,�y 5,��, l HOME OWNER EXEMPTION ACKNOWLEDGEMENT I The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups: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), 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 c I, /��/4 L-c'4,-P 6 ,s-,,-i4/1--- 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 ,`',02 `) 6/ Address of work location / Y 7 F e4' C i`> t C i Fe O.vt eft- c -t ,w,t J49 6 /d 6 -L.