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24A-016 (2) 99 PROSPECT AVE BP-2004-0761 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-016 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0761 Project# JS-2004-1111 Est. Cost: $9495.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: QUENNEVILLE'S SON'S ROOFING 111880 Lot Size(sq. ft.): 18905.04 Owner: FLYNN NICHOLAS D&KATHRYN K Zoning:URA Applicant: QUENNEVILLE'S SON'S ROOFING AT: 99 PROSPECT AVE Applicant Address: Phone: Insurance: 151 ABBEY ST (413) 536-6630 SOUTH HADLEYMA01075 ISSUED ON:1/22/04 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 1/22/04 0:00:00 13351 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ip •. - T ieem a� La e- �; 1 x -,3.:.. City of Building NDepartment Gri'ept'� e!:• T $j ,' 212 Main Street = r Se �Y , 1 s` , �� Room 100 a er elt� *. s ; Northampton MA 01060 ,f-o Setts`ofi5t ell a- a �'; , I phone 413-587-1240 Fax 413-587.1272 Ptot/S,te-Plansc„ e- ` C..ther Specif,�!,-- �.. �- 4 ., APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING • SECTION 1'-SITE INFORMATION , This secfionxto:be-completed by office 1.1 Property Addre s:qg , pp r d en-/- A U q Map Lot Unit 1O f 7Lh /j q rni6f-d�� V/4- ©�� one Overlay District ElmStLDistrict CB District SECTION 2 -`PROPERTY OWNERSHIP/AUTHORIZED-AGENT 2.1 Owner of Record: 44 r-s; k ett,/ FLy nvV 9' q Ptoope7t 4 v c . Name(Print) Curr t M i !ng Addres Telephone 1.. " Signature 2.2 Authorized Agent: v ie h h e v, !l e S®i s fiq q 15 ok e Sf i_o. , Name(Print Currb,pt/Mailing Address: / (ri-(3) S'3 4 --- ‘6. 3 a Signature Telephone 'SECTONN-3 -(ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use'Only mpleted by perm75it applicant 1. Building 6 �� (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) I -L e( q� Check Number This Section For Official Use Only Building Permit Number: Date Issued: ignature` Building,Commissioner/inspector of Buildings Date or I 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 ,C 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 DON'T KNOW X 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 _X_ IF-YES, describe size, type and location: t •M SECTIONfS1 D: TIONI ,1 PROPOS'ED'WORK(checkall applicable) New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing K Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: N`Pi I/✓ t 06 ,i>fV I 2 h f/� / Alteration of existing bedroom Yes No Adding new bedroom Yes No✓✓ Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a ,i;. ew.• Doses nd oridddEr to..existin rho fgri tliWiete lie fa ow=i"ng: 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 eta toy " SECT 0,1411,4a OWNER AU F]ORIZATION -TO BE COMPLETED WHEN OWNERS GENTOR CONTRACTOR APPLIES FOR BUILDING;PERMIT vela � -, et thx I, tC F l n as Owner of the property YsubjectP P Y hereby authorize a 1J e fl/2 e 1/ (�11 .6 (Son .I S l?o0�'/ +Yj j to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date herebyn N f✓' V l s d� c.3 fiftr / �i , as Owner/Authorized Agent declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. SigAdunder the pains an enal 'es of perjury. Print .. . , 6""""'------------ I // QUO Signature of Owner/Agent Date s► v. SECT1ONB CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: Not Ap licable ❑ Name of License Holder : ✓ ✓.5` License Number 3), #417. Addr /^� © Expiration Date Signature Telephone (/ Re: e am trirtNrai ;® ':er<nen - en r c .,s Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION`10 WORKERS COMPENSATION INSURANCE:AFFIDAVIT(MG: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 ^'"5✓�k. g7''a .s*,r s_3'1r 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 Signature if • . 4 • *Fits,'?11 c �_y • I. (! ±t rift A '-, \�tTl 11ci11T�1tt1i1 - $ ,.Zqtelt IaaaarFlttsrtla -=—et '= ^� a�:j DEPARTMENT OP BUILDING INSPECTIONS 4' ' P 212 Main Street ' Municipal building _ Northampton, Mass. 01060 \t'l or'+ • WORKER'S COMPENSATION INSURANCE AVIT I ' 6t ti; Ork.le, ljaV 1 ./I. 3 an, i Z' 9.(Iiccnsre{:crmittec) with a principal lace of business/residence at: ((Cr_ _ _ __ _ t /5t� _ V (� --(phone�': 5ry6IUl4t�(� __ - - - (Strca/city!saat.d ip) 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: - (Irssranc Company) (Policy Number) (Ex-pirdon Date) e/' I anz a sole proprietor, general contra or or homeowner (circle one)) and have hired /�' contractors listed below who have the following workers compensation policies: (Name of Contractor) (Insurance Compan r,Policy Number) (Exp:ration Date) (Name of Contractor) Onsu ancc. Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Coln;anyfPolicy Number) (Exr, ration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (r.tLtch additional sc.-d ifnentri.ry to in,^_l'xic i.a:•r:r..■:ia: ,:ez._.ninE-..-s11 o:c:--c'_c,:•) i f;.< I am a sole proprietor and have no one '.t:orking for me. ( ) I am a home owner performing all the .'r01.: iliys lt. NOTE:plc:ac be aggro that ilc homeowner:v.i;o an—,boy,r,.z:.-a to(:) .air trance,corr tracim a tcpa4."."6'2 a dwC14n3 CI not tneee than throe units in Na-bidithe 1:;,;x;:ty read=or on the is apr.:rter m thccto e.-e not carnally considered to be employers under the wcriu's oomp=ation rant(G1..152:11(5)),z{;•;icatien by a homeowner for a Loci cc rani::.r•_r f.-.4.kricclin legal rtarus of an employer under the Woricor's cortiorr—ation Ad- . 1 ui+dc^statsd that a copy of thus tcn m may bo forwarded to 115,3 1ytiortnaeni oflnAn,strial Actiidmts•Oftioe of l:uvanoe for Me oovezxge vrxi[ctioo and that f:ilttre to rcatre cot:r_go under:cairn 25A of IAGL 152 can lead to the imposition Of criminal pcta1ii:u consisting of a fox of up to S 1.500.00 aty"Jcr in pry x.mccm of tip to cot ycsr r.r4 civil penalties in dye form of a Ste.;Work Ord=and a rim of S100.00 a day ageing ttr . • _ - For dq a)ul ortal tax;only Permit Number _____ _____ - Map„__ —Lot r _..._ Sif:nature r,f I r,.......,...�t)..-.,......, r„ ., ccOIAM pi, 'a, �" Tit of Noi#Ipinpttw )z = i _+r, sill JiGI9SSRC)J liSttt4 :tsar '_ -..�"a l.too:: m.,.. '4►"= DEPARTMENT OF BUILDING INSPECTIONS -': _� /� INSPECTOR 212 Main Street • Municipal Building `p 5,.�' Northampton,MA 01060 . 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