39A-059 (3) BP-2022-0234
57 LYMAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
39A-059-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0234 PERMISSION'S HEREBY GRANTED TO:
Project# RENOVATION Contractor: License:
Est. Cost: 10000 ROBERT SPELMAN 082172
Const.Class: Exp.Date:09/07/2023
Use Group: Owner: TRUSTEES BAROCAS JACK &SUSAN J
Lot Size (sq.ft.)
Zoning: URB Applicant: ROBERT SPELMAN
Applicant Address Phone: Insurance:
71 NASH HILL RD 4135755703
WILLIAMSBURG, MA 01096
ISSUED ON:03/15/2022
TO PERFORM THE FOLLOWING WORK:
NEW WINDOWS,DOOR, NEW SHEETROCK
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i y .
0 • 'tank. )2 .
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
�i ce,
City of Northamp.on $ atus of"�P t'�:rj- " '. ':"�! !; 1,`:
Building De rtmient Cur Csutl D f`era ff 0s u;t
212 Main treOt MAR ®9 2022se e /S '1:'':;L allab
Room 00 L W ter/Well,ova a® IF 4„�y` ^ k=
Northampton, MAI 0E? ---,..._,.,J o Setsio , d. _- 4` _''''
phone 413-587.1240 Fax-4. ? , 272Pecri /Site,,Plan" `; ; , . � ,.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address �j
f Map !4 Lot Unit
6-7 1. 7&w >
Zone Overlay District_
Elm St. District CD District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
j v s HN 36311Q0ei6 57 L1m.9-Ai 72-49
Name(Pr t) Current Mailing Address: A/lOreiMePPLI d7,61
440.2...40_e_ _____ Telep hone_ cy
g /�
Sin lure - l itO — 6 �$U
2.2 Authorized Agent:
SPc ZJ 2 -7! A/4Sr/ hi41_ P-
Name(Print Current Mailing Address:
Signature Telephone 11l 3 575" — S -703
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building , G, (a) Building Permit Fee
2. Electrical ZJ
1 / CILv (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
-0(96 4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)_ i&l"Pc) Check Number , I
a ( his Section For Official Use Only
Building Permit Number: ' .32-1f J Date Issued:
Signature: � /% -3-/y-Zo2
a
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO V DON'T 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 �r
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:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition 0 Replacement}Vtndows Alteration(s) ❑ Roofing 0
Or Doors fY
Accessory Bldg. ❑ DemolitionD New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: 11./5P 4_ Wit/ kiiIA/Oai - t �JW� noU- 3 rderGi4Gcr� T
w T,2L -'- rah') w//Wo1v.!
Alteration of existing bedroom Yes . ' No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑ F14CTO2 . 2:7
romtfINevvlhot—iferairdviTindition to existing housing, complete the following:
a. Use of building : One Family Two Family ✓ Other
b. Number of rooms in each family unit: U Number of Batbroerrf l
c. Is there a garage attached? t\D
d. Proposed Square footage of new construction._ Dimensions
e. Number of stories?
f. Method of heating? L�1 G on (mire_ 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
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
5 cJ S ry ^J -6 g c> c , 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.
3 oZ/2 )��---
Signatup• of Owner Date!
1306 4 Pc7 '' , as_8wrrer/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.
/3
Print Name 1
3 /��zz
Signature of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable' ❑
Name of License Holder : ge25 ����� '� (_S U v 2/ 7 Z
License Number
lAiKH )11 t-c_ lzj // / 3
Address Expiration Date
W1 tb/4 as4uW-6-/ /HA
Signature Telephone
y/' 5703
: Regis eredTNome`i'Improvement`Contractor Not Applicable ❑
4pa.mm'u �034S
Company Name Registration Number
?/ /t4/I n/l ti V'/ / s rb- M19 //15;./zz
Address Expiration Date
Telephone L//� -575 _5 703
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 Et No ❑
•
ome Owricr =empti n
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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DEPARTMENT OP BUILDI7tG INSPECTIONS 4 =_=
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212 Main Street ' Municipal Building —=_
Northampton, Mass. 01060 '•,
r
WORKERS COMPENSATION 1NSURA.NCIL AFFIDAVIT -
•
I, - �"� 7�� - -- -.----
(li ccnsec/pertni flee)
with a principal place of business/residence at:
11 �[ vl1-- -— �it�tu�� Ylr -_ ,_(phone ) LJ/3 : �J S 7a3
(strcetici tv/siateJzi p)
do hereby certify, under the pains and penalties of perjury, that: ,
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (Insurance Company) (Policy Number) (Expiration Date)
• (Vf/rarniiii±prriGIA3I general contractor or homeowner (circle one) and have hired
the contractors is eiow who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) -- (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) , (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifncrc_nar to incl•scic tifortna:ioc:pateinin, ell ochradr,r.)
i
( I ant a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
NOTE:plc sac be aware that while be r oKtm aa'uo employ pascm to d)cair en nce.ooc r c:ect Cr tepau".oik's dwciliy of
not more than three units in which the homeowner maid.=or net Ilse voutnscts apFeutcr_ant thereto are not generally arsid:red:o be
employers under the worker's o mpalsaticn Act(GLI52,7-a 1(5)),application by a homeowner fora license cc perry":may e.>;?,_nce On
legal status of an employer under the Woritoes Compensation Act,
I understand that a copy of this statement may be forwarded to the Dopertamr of rnduatrial Aocidenta OfLoo of Ina ru>x for the
coverage verification and that failure to!cane coverago uvdcs section 25A of MOL.152 can lead to the imposition of criminal penalties
oomittmg of a!Inc of up to S 1,500.00 and/or in prisocunc n of up to one ytar and civil pauIlia in the form of a Step Work Orde and a
firm o(5100.00 I day against ttr
For dcpartmrscal uao only
"'""_�,_..____. Permit Ntlmtxr —
31 lii Map;, Lot
Si�tture of Liccn:,ctlPcrmittce ? 1 t4..
O.4 ct{AMp1
� ' "� Crz ni Northampton • . L -_ _
•+���!! 11t•
•t jyl ..I4:(! Massachusetts - -:�
454.1 ' '—� DEPARTMENT OF BUILDING INSPECTIONS Ilk - p
INSPECTOR 212 Main Street • Municipal Building `
Northampton, MA 01060 ,~ mo e ' '
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 supc .isor. 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
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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: Cl 44-) fit iii
The debris will be transported by: 'P'brU''-1' -)
The debris will be received by: MV-6-1
Building permit number:
Name of Permit Applicant 3 4g ,mriL___
Pecyvt--/-
Date Signature of Permit Applicant