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23D-201 (2) I 118 HINCKLEY ST BP-2005-0051 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-201 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 PERMIT411 Permit# BP-2005-0051 Project# JS-2005-0069 Est.Cost: $8200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DENIS DUGAS CONSTRUCTION 048448 Lot Size(sq.ft.): 32931.36 Owner: JANES ERICH L&MARILYN ?nnir :URs Applicant: DENIS DUGAS CONSTRUCTION AT: 118 HINCKLEY ST Applicant Address: Phone: Insurance: 22 GILBERT RD (413) 527-0494 SOUTHAM PTON MA01073 ISSUED ON:7/14/04 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT FINISH ROOM IN BASEMENT Ill INPOST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Ow Rough: Rough:b/hi c ,,/i11:_ House# Foundation: �'i7 Driveway Final: Final: Final: G4c,r ftip (/T/ Rough Frame0" �--t q`0 N Gas: Fire Department Fireplace/Chimney: /` Rough: Oil: Insulation: K q."--fq,.c9 Li C'� Final: Smoke: Final: 6 K l p,_a p Av �1 THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VIOLATII OF ANY OF ITS RULES AND REGULATIONS. a ----1... el , , Certificate of v Occu anC nature: n �' Si� FeeType: Receipt No: Date Paid: Check No: Amount: Building 7/14104 0:00:00 2597 $50.00 r 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0051 APPLICANT/CONTACT PERSON DENIS DUGAS CONSTRUCTION ADDRESS/PHONE 22 GILBERT RD SOUTHAMPTON (413) 527-0494 PROPERTY LOCATION 118 HINCKLEY ST MAP 23D PARCEL 201 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out y� , Fee Paid C 7 / g4-5 — Typeof Construction: CONSTRUCT FINISH ROOM IN BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 048448 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON • INFO ION PRESENTED: proved 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 'ssion /X°C3Y Signature of BuildingOfficial Dafe g 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, RENOV �iEI LF511A Vel R FAMILY DWELLING \Dd) SECTION 1-SITE INFORMATION `� UL 1 5 2004 This-section q t 'completed by office 1.1 Property Address: // � J et ,� �Ft ,,rr�� / /�/ /./C e la SrMap +=ot t.� / Unit / y { rektCe_ D /O Zone Overlay District Elm St.District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Elf-Lc-. /ha21/yn \ha _s //a ,ui kJ.1y — Name(Print) Current Mailing Address: se& - 3c,C., y Telephone Signature 2.2 Authorized Agent: lJG A S 2- 2- 6i ,t-lt /Id - ;0v-l-A, i ,046.1 Name(Prin Current Mailing Address: 0/07 3 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ZOO (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 1617 05-0-- This Section For Official Use Only Building Permit Number: hc'61 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 Fronta,e 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 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 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: r • SECTIO7NT5-itftSCRIPZT+aON2OF.PROPOSED"WORK(check ail aapl-lcable) i ".^:-^' +...,,-s.-»+-�.-w New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing ❑ Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: coy. '� -�i vA tS lea d r(,t /N r'o ALe �f' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Y., Yes No Plans Attached Roll 0 - Sheet❑ 6ailf _ e illid se4and or;a iblit aria a sting=Mitingr onipie: a the fo di ing: 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 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 aECTION OVYNER AUTHORIZATION TO BE COMPLETED WHEN • OYYNEFS`AGENT OR CONTRACTOR APPLIES FOR'BUILDING PERMIT I, A Cir l I l/ n V OL 1'1 e,� , as Owner of the subject property r hereby authorize b ..,Y► I,� L( q CAS to act on my behalf, in all matters re ative to work authrized by this building permit applicatio . 1 . „ 13 Q Signature of Owner Dat rbENe S LIG4 S , 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. S, -7)064 S Print Na7()_em,), 7- ' Signature of Owner/A ent Date - - o • SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : '2)t' 4 S 0 V Ole c e/8 License Number 2-2- ( / I J £ /Ly' //7ic— 0(0 7 3 /O — /lP — a o o S' Addres T • Expiration Date 41r4 . Sot -ova y Si nature Telephone ;Re_ s e.e® .erne rrp Foueinent'. ont acto a -- A W-A-i4: 4;*I'i.,:N-sr 1, Not Applicable 0 ` ..Q J s /00 g a Company Name Registration Number 2Z �, /k-u /t .L '4/+/`� A ( o/07 3 (o - 3 — doo t� Address Expiration Date —4"4r/) /411r— Telephone -S-1 7_0 Y9 SEC ION10 WOryRKERS' 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 No 0 -Con 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 fo;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 • • o¢11tAmpt •+% �%is'',�/�61asaachnsrfts ^- z.:: .2.2. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal building • Northampton, Mass. 01060 ' \ rORKER'S COMPENSATION INSURANCE A.I1irLDAVIT I bEAvis "--D11G4S (Iiccnsreip rmittcc) —with a principal place of business/residence at: • 2 z G, /b. - AI , a Al. 0/0 73_ (phone'-; Sol, — 44f9 y . • (strc icity!st t ligip) do hereby certify, under the pains and penalties of perjury, that. - ( ) I am an employer providing the followinc v orr:er`s compensation coverage for my elnployces•working on this job: - (Insurance: Company) - (Policy Number) (Expiration 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) (I.nsuranc Company/Policy Number) (Expiration Date) (Name of Contractor) (insurance Companv/Policv Number) (Expiration Date) • (Name of Contractor) (Insurance Companyil'olicy Number) (Exi. ra ton Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiation Date) (MLidh s.d'!itioc:al tins(ifnocc:Ttr :n inchwic.-.:ct:^.::oc. ._._.:::, .,art o:cY_._(>.<) 7 x I am a sole proprietor and have no oneworking forme. ( ) I am a home owner 1)ef7orming all the work mn self. NOTE:plc:se be aware that dire t',ctrcow rs wro employ;ems;:3:n<.)aa:.lt^ssncS arc_r-,;G:m cr::,pate yogi:CC lixn F,e not tnece than throe units in tt1 idt the b,--:k.uv-rr_.;w or o:the g•_:.4_3 aptartcr-sni thcctc arc no(Gmerzlly vr-:itkrtd:a tic cztptoyes under the tvvek ra ect:;=..atico Pat;(G1.152 s 1(5)),application by a hotncotrocs for e liccu cc p'tmi:may r. 'en-e tile legal status of an employer under the Wcvlccla Comper.,ation AcL I unde:tared that a copy of this:tat:meet n'-y be forwertled to the DrI truome of lnrh„trid Accidents'Office of In..vanx for the coverlet vcria=floo and that Eau=to EtCart cov:rs urdc::ecicn 25A of MGL 152 ctn Ir_d to the imposition of c."rir_1 per-allies eoasisting of a flue of up to$1,500.00 arld'cr i-zprivcnrnc.:t of tip to are.yeer ar4 civil penalties in the form e.t.a Stc-2 Work Ord,:and e L'rx of S 100-00 a day agaitra m- . _ For d4=uvttettsl use only _i _ -----._. ---/glAtdie. pCrmit Nuutlx:r ----- ___-� ;Sap, _ I c)t I I I t,JJ .SiGnntuiu of ccnnedlic near; _ , l j:.,:-;. *9�STCo'La =*=u • i s 11..410 fa ASSACI11IStttlf ___DO`_ `mL`" x. DEPARTMENT OF BUILDING INSPECTIONS _ =1 /; INSPECTOR 212 Main Street • Municipal Building 'r%y=S , Northampton, MA 01060 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: ,' :;or. 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 3 N S l I 8 1-4 ) , / cK Lc S P' ,1 ,-- tal L.. ,----(-4- 1 f L------ 1" 1d 1U,..TE�4, iN ., w. e- q ' --i \I) . F _ r ' / --' Y`r tit Fro !I , rt ESL ;-0 1‘ f / //too v^ /, /\\ k) in IN I . I // 1 if / // I /1 , / ., , , �- I 7 I _