18D-053 '6, • 5 r • ,0 BP-2006-1410
GIS#: COMMONWEALTH OF MASSACHUSETTS
irMap:Blocki 1gd 2653 CITY OF NORTHAMPTON
Lot: -121
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1410
Project# JS-2006-2077
Est.Cost: $25.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: MATHIEU AMY B
Zoning: GI Applicant: MATHIEU AMY B
AT: 80 DAMON RD #5202
Applicant Address: Phone: Insurance:
80 DAMON RD #5202 (413) 585-1131 ()
NORTHAMPTONMA01060 ISSUED ON:6/26/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS/DOORS
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 6/26/2006 0:00:00 $25.001855
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Department use only
City of Northampton Status of Permit:
`�
l k ! Building Department Curb Cut/Driveway Permit
'—`- \ 212 Main Street Sewer/SepticAvailability
2„0 ( Room 100 Water/Well Availability
Jo 2 66 ` orthampton, MA 01060 Two Sets of Structural Plans
' 1. phoj29 413.587-1240 Fax 413-587-1272 Plot/Site Plans
n.n17 "r,INSPECfIONS 1 Other Specify
p
APPLICATION-TOZONSTRUCT,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: /(/ 7—� 3
o0 Pi07 #5()6 Map / 0 t✓ Lot Unite
Zone (;),,.._Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:I anti 'a (dnhhieU st innr2d = 2O4', ae- x )-1�Yia,
Curre t Mailing Ad-dre : (C)
c*,),€45-110 (-1423- 5—K— /3/
Telephone
ignatur
2.2 Authorized Agent:
XName(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 m a-fel-Ta — 42, Co 0` ov (a)Building Permit Fee
L. i- - (PCB.. r
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) S a (Q(� CDC Check Number / y5�
i
This $•07c
Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
-
~
,
Section 4. ZONING All Information Must ue Completed. Permit Can oe Denied Due ro Incomplete Information
Existing Proposed Required byZoning
This column mbr filled mx'
Building Department
Lot Dico
Frontage
Setbacks Front
Side L| | ------ | | |
�-_-_��t�— � ���===L�!-_--_
!
| �
----
' Rear
Building Height
Bldg. Square Footage | | � � %
Open Space Footage Y6 ----.
(Lot area minus mo mnaved
parking)
#of Parking Spaces
F@:
U i /
(volume uLocation)
|
A. Has aSpecial Perm it/Vahonce/Findi ng ever been issued for/on the site?
NO �� DONT KNOW 0 YES 0
. [
IF YES, date issued:
|
IF YES: Was the permit recorded otthe Registry of Deeds?
'
NO DUN 7 KNOW � YES 0
IF YES: enter Bnok ! i Page i and/or Dncument#�
^ ----
B. Does the site contain a brook, body of water orwat|ands ��� NO �~� vt5
OON7NUOVU ��� �.�
IF YES, has permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained /~~\ Obtained �~� Qm�e Issued: i
�-� k~� ' ' '
�� _&����
C. Do any signs exist un the propo� ��.y? Y[3 NO
-
IF YES, describe size, type and location:
_ - -
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
| -----1
IF YES, describe size, type and location: | !
E. Will the construction activity disturb(clearing,grading, .n,filling)over 1 acre orioh part nfo common plan
that will disturb over 1 acre? YES ��� ) NO
|F YES,then o Northampton Storm Water Management Permit from the DPW inrequired.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House E Addition ❑ ReplacemeNNjndows Alteration(s) n Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [C7] Decks (D Siding[DJ Other[PI
Brief Description of Proposed L(// /
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ba"f]tern do sea �a` tro c iz#n> tiaig g h eio` ow,rtQ:
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
XI, , 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
i I, PAIA - MQ` '( i ,a Own- '�uthorized
Agent here declare that he 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.
z mo l out,
Tint NMe
• ..• V NO US/6 ro
gnat A o Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
. ", " Not Applicable 0
9.Regstered`Home,lriaprovement.Contractor_:, ,�,ate; ,��, :�.�,._v„'`�,.. PP
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
1 k® I me O wner ee utin
1 ,
/ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 Signatur
OaCiVtllpTO
(rii_ of Northampton
a �, fie a . L sicclintr,tn'
DEPARTMENT OP BUILDf7\C INSPECTIONS
212 Main Street ' Municipal Building
NW-
Northampton, Mass. 01060 r` "
WORKER'S COMPENSATION L`1SURATICE A1`FD)A\ 1T
iccnserJperrnttcc)
w1L1 a principal place of busines esiden at:
•
4 tbn-ta"1 �oo2f (!)j'' dvp (phone ) (4:36 6 '—/4-3/
(s> (/city/stak.'ap' U/OoU
do hereby certify, under the pains and penalties of perjury; hat
( ) I am an employer providing the followine worker's compensation coverage for my
employees working on this job:
(Lnsuran= Coopamy) (Policy Number) (1 :•pirstion Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the connactors listed below wbo have the following worker's compensadon pe!icies:
(Name of Coat-acior) (Insuranc (I.\piniuon Datc)
(Name of Contracior) (Insurance CompaayiPoUcv Nunbcr) (La-niration Date)
(Name of Coumaao,) (Tnsurancc Compan}•/P0licy Narebul (Expirdoo Date)
(Name of Contractor) (Insurance Company/Policy Numbrr) (Expiration Datc).
(attsc� Cock)bcaif occa.ry to induce inforta.;on po of to )
•
( ) I am a sole proprietor and bave no one woridng for me.
I am.a home owner performing all the work myself.
NOTE: aw-Ire the.•t:.)c bemeovmers..bo employ pc-Loco to do r, -, cr c,00 c nmav work cm a d'.cl of
not mocc thrc ttnu ter r in u},yeh the botcoowocr rid..=or cc the Ground,spp artcazs3 tbeco c-c pot cocait:1= to be
employe,uncle the..vxt d o - -lion Act(GLI52�1(5))•:pplia000 by•boo fen:lice et permit may etidcooc the
,cs.l ct of as crployer uodcr tbs.Workda Compam>tion Act
I uodcssaad tha>copy of this ontornr.y aa>y b.forA-urd..d to the popan .00¢of 7 5.rr;c1 noodr Orno.of 1npuranc.for tb.
ooverker vetreotoo and th1 L•then to Locum tovcriage trader section 2.5A of M(L 132 MA 1.11 to the; aion of a•iminsl prntivo
coasisi n of a fine of up to S 1_00.00 and/or ,oatnot or up to ooe yc=r and ctil pr.,. ;a the foam of a Stop Work Ord and a
fine of S 100.00 a d_y aE7tinst CDC.
For dcp.rsa+=�1 u.c only
Permit 1`I umbcr
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: "'-- DEPARTMENT OF BUILDING INSPECTIONS , `i�= /_
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060 .
01
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup,:: . 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),
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, l� 3 mre 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 (L 046,
Address of work
location ' kI f,i (5a
af nO oLOcoo