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23D-173 (6) 1111111.1111111 BP-2005-0032 GIS#: COMMONWEALTH OF MASSACHUSETTS 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-2005-0032 Project# 3S-2005-0039 Est.Cost: $450.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NORMAN YOUNG 025262 Lot Size(sq.ft.): 11804.76 Owner: MOLAGHAN TIMOTHY J&GERALDINE Zoning:URB Applicant: NORMAN YOUNG AT: 36 BAKER HILL RD Applicant Address: Phone: Insurance: 75 SOUTH MILL RIVER RD (413) 665-4265 WC SOUTH DEERFIELDMA01373-9733 ISSUED ON:7/8/04 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR CORNER OF GARAGE, REPLACE BREEZEWAY DOOR, EXT DOORS & WINDOWS 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 7/8/04 0:00:00 1504 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0032 APPLICANT/CONTACT PERSON NORMAN YOUNG ADDRESS/PHONE 75 SOUTH MILL RIVER RD SOUTH DEERFIELD (413)665-4265 PROPERTY LOCATION 36 BAKER HILL RD MAP 23D PARCEL 173 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �/ Fee Paid /�D`7 ��— Typeof Construction: REPAIR CORNER OF GARAGE,REPLACE BREEZEWAY DOOR,EXT DOORS& WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 025262 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Co sion 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 �n of rtmon Status of Permit: V ildingNo Department Curb Cut/Driveway Permit t12 Main Street Sewer/Septic Availability fil JUL - $ 2004 ' H Room 100 Water/Well Availability ampton, MA 01060 Two Sets of Structural Plans h 13-587-1240 Fax 413-587-1272 Plot/Site Plans PE'"Or FIIIII `ING INSPECTIONS Other.Specify s z � Z4 '� PLICATION 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 ... 6 cm-e. ' illLL. i b Map 0317 Lot J73 Unit F7 d IiL-�U 6,C Zone Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 771)7 aeee 1 /I7oJ, ,/ / Lq4 egeEF y/L /) 'e-vr- Name(Print) Current Mailing Address: r Telephone Signature 2.2 Authorized Agent: 15 o©u r,1.4__ i�i ' NO ern.41‘) YO q 1.1a c.:5-6,zinv vS E .--IFF-/ -i..-2 . /nig 0/,6 --.\3 Name(Print) AA Current Mailing Address: /J 4/S Co�o e- 4/c;; lob Signature 9 Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by permit applicant 1. Building \6 DO (a) Building Permit Fee 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) Check Number / 4// A,/5 �} This Section For Official Use Only Building Permit Number: Pe �3dZT Date Issued: Signature: 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 °ro (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 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: SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0 Or Doors Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding Other [ ] Brief Description of Proposed Work: f?F_fri °Rrrz R d F G fl (i is/t w J ' 8R�r ZEv a y ' x7po � G7i,4 Alteration of existing bedroom Yes No Adding new bedroom Yes Note Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6 MIEW T60-6 and Eirbn to ez,ic ing=#iouS,ngwcornpletett a feilli flit 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. 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 Nc 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 V � , as Owner of the subject property hereby authorize /02/Fin p /Vea to act or my behalf, in all matters relative to work authorized by this building permit .pplication. Were,-)111.,,,) 7 66(-( ignatur e of Owner Dat( .Sys':..X f -nY'( ,y.�� oYK•; MN�{.R5 .�P ti v@�ii. r I, , 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. Print Name Signature of Owner/Agent Date SECTIONS CONSTRUCTION;SERVICES a3 8.1 Licensed Construction Supervisor: e5 6/6 Not Applicable 0 Name of License Holder : /JO14YY) 1 E y6,4 cr a 5 (p oLJ License Number c cs in,I/ t ?v17f �t 50'a 6/U 4. Addr O'5 9 Expirati Date 1 / &6 y es Sig ature Telephone w -e: . -fe, t, .i a �._r :, �. Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone__ ySECTION 30 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 y 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 _ • . t. ,.____ is..YitANPTO I r .S� 20 i=_ s' (1-Ifu t1f xar .ill}Iftin _ *` �•.:�� 3�6 S1 ass acting tits' L.. El �_ ` ��i_ DEPARTMENT OP DultprNG INSPECTIONS 4 VII 212 Main Street ' Municipal Building t_ Northampton, Macs. 01060 am" WORKER'S COMPENSATION INSURANCE A1+14'11)AVIT I, ,Ailg'infigi - OUAIG_____________...________._ .. __ _ ___ (hecns_dr. rrnittcc) with a principal place of business/residence at: 715_Alithil_leliEicf__ ______..a046_A (PhoneJ ).lig 44____-- 6 —.-- (strcct/city!:>,at:zJp) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the followine worker's compensation coverage for my employees worlang on this job: ((Rq-njjy Ci-fir"--) f9,nEY iC.& Jr"N 2-A)S' CO p•o a i d 38a O/7 /&y 7------ ViTio.6-5r t~ C.ol an}�) li o c.Number) ("ram raonte) I�17�'7r /JR /2bb--� i ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the follow.;sag worker's cornpensa ion policies: (Name of Contractor) (Lnsuranc:Compan sPoticy Number) (Expiration Date) (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance CompanvrPolier Number) (Exi.iratioa Date) (Name of Contractor) (1n uranc Come-,yiPolicy Number) (Expiration Date) (r.n_ch additional et:--et ifntces,^•:n s,cFx'.r i ;t:-:.:ioc:,:_:_.:int;tc ell a<:-:Wit,:•) ( ) I am a sole proprietor and have no one working for ine. ( ) I am a home owner performing all tilt ..or , iinySclf NOTE:plc-.se be awzrc that whi)e homeowners w'ao employ;r ice::o c:).^aer•.tact az:-s-•% er it:pair.•,:i:en n dwelling es not more than throe unit,in v.-Lich the Ii.:e vtr..o ra:;;o CPC oo the :_:.ii;,, •_rtcr_nt t c-rto are not cow lly eons :o be catptoye s un cr the%Yorker'mi.4.•_.antic Act(OL152-e 1(5)).erpi:_a:ioo by s hat:uo..r)cs for a L•trtue cc p-rani::' , ..:n'c the legal claws of an employec unur Ilia Woricele Coropemation Act I understand that a copy of this ctatare t may be fotwnrtied to t—a Detiortamt of la+dzutrieJ An:iEexts'OMoo of I:e unr'x for the coverage vcrif caiioo and that failure to tear cover_;.,urd.:r rcotion 25A of 1.101.152 ein Ica to the imposition of roiel pera1ii:es coos Stang of a fine of up to S 1.500.00 an+!rc in:prinntn-;of up to en::year rr.5 civil pestaltia in the farm of a Stop Work Order e::d a firer of S 100.00 a day tgains1 re . . • For dg,utnsracal uao only Permit Numb.:, __-_-.._.____---_-^__I Lot�: 7 Asap,. I : ^3 3_t�..._ gn. curt of I teee^ ,mine. .__._ /6./.4- 1r ---- 1 r• O.51tAMP2. itb _C ii (rzt r of N>xrtllampthn • I= _*- 1, . t -�� '0 4, JeA33ACltIT3[ttb t_ "' : '=— DEPARTMENT OF BUILDING INSPECTIONS _,a = /; INSPECTOR 212 Main Street • Municipal Building o,�� s, Northampton, MA 01060 . ei 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:.H 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, 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