23D-157 tD HINCKLEY S'l : BP-2007-0582
GIS COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 157 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-2007-0582
Project# JS-2007-000857
Est. Cost: $1500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: C & T Construction
Lot Size(sq. ft.): 26920.08 Owner: KELLOGG MICHAEL C
Zoning: URB Applicant: C & T Construction
AT: 60 HINCKLEY ST
Applicant Address: Phone: Insurance:
15 Fairway Drive (413) 586-4965
FLORENCEMA01062 ISSUED ON:11/22/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:Replace windows and front door
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 11/22/2006 0:00:00 $25.003628
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2007-0582
APPLICANT/CONTACT PERSON C&T Construction
ADDRESS/PHONE 15 Fairway Drive FLORENCE (413)586-4965
PROPERTY LOCATION 60 HINCKLEY ST
MAP 23D PARCEL 157 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
✓l�uildi Permit Filled out !ACu U3�
L.-Fee Paid `t
Typeof Construction: Replace windows and front door
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
INFMATION PRESENTED:
l!//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
/ Z2 /U
Signature of Building Official Date ( l
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
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
This section to be completed by office
1.1 Property Address:
Map Lot Unit
/ /(C E 7 r Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/1i (Ae/ /Ldgf 61(9 hid i / $/ / , 2 1'►14:
Name(Print) Current Maifing Address:
ik_q_11)15( Telephone
Signature
2.2 Authorized Agent:
n _K-gegg9 l6 Faiv- . Or /-/dveice ad6(
Na ri Current Mailing Address:
i re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building , S/� (a)Building Permit Fee
s
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) ql<-7 S CO
5. Fire Protection It"3
6. Total = (1 +2+3 +4+5) S�, Check Number
This Section For Official Use Only
Building Permit Number. Date
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 i . i
Frontage = ii
Setbacks Front
z
•
Side L:! t R:I i L:' R: • I
Rear `
Building Height
Bldg. Square Footage ' % i — ��
I
Open Space Footage %(Lot area minus bldg&paved •
parking)
#of Parking Spaces 1
Fill: ',, j
(volume&Location) i `i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: . enter Book Page and/or Document# I
B. Does the site contain a brook, body of water or wetlands? NO ( DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained Q Obtained Q Date Issued: ;'
C. Do any signs exist on the property? YES Q NO I
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 Ey-
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, ex ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
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 n Addition ❑ Replacement Win s Alteration(s) n Roofing El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[E]
Brief Description of Proposedfdd11-s/t 754
' /� �� r` wS Y ff�i' r.Work:
Alteration of existing bedroom Yes 1- No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes .I— No
Plans Attached Roll -Sheet
;, ..: r...'. ��zY.;. r.�.G{;...' . 'ss,-'�„ _'�'�" .kx�`«. .�T' "=�'.ati,�:- "°�';,i�.t xE:.a'�`a.�`..�'.;
6a.tF,ke-i,hoase g d t ad"tti8Tial llgf id}Wsln ompte #rMifaWnq:
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.
1. Septic Tank • City Sewer Private well City water Supply
SECTION-7a--OWNER.AUTHORIZATION-TO BE COMPLETED-WHEN
OWNERS AGENT:OR"CONTRACTORAPPLIES FOR>BUILDING PERMIT
I, miff i ""7 k7+7as Owner of the subject
property
hereby authorize (y L,* s / •1 q
to act on my behalf, in all matters relative to work auti ri ed by this building permit application.
v ', c \''-Q l �./
-Q
Signature of Owner Date 2.8 (?
1, Yl c' /4 ,as Owner/Authorized
Agent here eclare that the statenpand information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under th ain and penalties of perjury.
k S
67/
Print Name
Date (720/6
Signature of Own r/A
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:s�/ / ��� Not Applicablep❑
Name of License Holder: f ,"�S l�y�'"w77 062r� 0 7
License Number
1S �ctI`tday �7r, ll/04/ /Ark )'Gr/2 ie01/d7
Address Expirat n Date
Signature Telephone
Ct elit tela ome lmpr6V.emen ratecto TM ,. m Not Applicable ❑
Company Name Re istration Number
Adds / V may" /OK/4VX24 f /// ' 0/�'Z /7c/orj -��/jExpirafDate
Telephone��o
SECTION 10-'WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M.GL.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 ofland 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
•
•
•
�1.7snrETnLrlls' _
DEPARTMEIJT OP BUILDING INSPECTION'S 411
212 Main Street Municipal Building \zit
Northampton, Mass. 01060
WORKER'S COMrTENSATION -L\NSURANCh_ AITU)AVIT
•
Kerr
ccn_s.:cipermitics)
with a principal place of business/residence at:
are 4 hone') ���(�—1‘7IS"---
(sit/ci t• sutLlap)
do hereby certify, under the pains and penalties of perjury, that
( ) I am an employer providing the following, worker's comoensabon coverage for my •
employees wor±ng on this job:
(lnsuncc Connacy) (Policy Number) ( :pinion Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors Listed below wbo have the following worker's coonensanon pebcies:
( Name of Co^.r::'.cior) (lr1Rlrance Company/Pobc, Nurni:c:) (t-xnirat:on Date)
(Name of Contractor) (insuranc:. ComoaayPo!.ic Nuobcr) (EXviraion Date)
(-Name of Contactor) (Insurl_nee. Company/Policy Number) (Expiration Date)
(Name of Contractor) (I franca Company/Policy Numty.r) (Expiration Dale) .
(.o oediticcail LScc,if occom.:p to-Inc-.& oc per.. to.11 o -r-or;)
P.
( am 'a sole proprietor and bave no one work ng for me.
( ) I alma home owner performing all the work myself.
NOTE:plcx be carat[tfi•1 wt k 6cmwwncri wbo roxploy pool to do r-•r - -,:cucc c'rcgaa work on r d..<11_E.of
act loge theo 'tsv t=itais wbicia the bo 000v oc raido cc cc ciao rounco z.7purtccc s tbeax c.-c co(g -J1y ccor:d.--o1 to be
enploy ,i'f t c s",:e4 t * Y *icc Ant(GL152sa I(5)).=pplintion by.bomwavc for:lie=_cc permit rz y e idmoe the
logo!rts.'uc of en exployor under tiro Woricol.Compoca.iion Act
[uadeniad th t a copy of thu mtemem ooiy be torte-o-do4 to t .o pe+p.irLmmt of Aeart`"*-e'+'OJLoo of(rz�.+(.om for the
oovcasc vcif c1tioc Uz_t tiltac to acatrc tovcrnsc, idr--rxtioo 25A of MOL 152 an led to the i ioa of aimia.l pca ltio
mn^f*i-t;y or a Goo of up to S 1„SWOP.ttdtor¢tt{rriaoottx-n of up to ono ycor e.od ciil pm.Yic.io dac form of.Stop Work Ord and
fm of S I o0.00 c thy cp(iQA ex_
For rr.i.e- —�`�u,c only
� �� Permit 1`i t1IDlX1
��
pc Lot
e J .
Si tuzr of Li ct'rxLi
o1:i ttAM p2O
t o ar
$ Olify of Nora �ampto t . . 2
�i;
%W may" " lleassacltusrtts
1.W10I1-11a1't111._ -
' "4"� DEPARTMENT OF BUILDING INSPECTIONS •
``
INSPECTOR 212 Main Street • Municipal Building 7, —
Northampton, MA 01060
e'
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;: •".nor. 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