32A-205 (3) 1
frin S
f P BP-2005-1293
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1293
Project# JS-2005-1725
Est. Cost: $13000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BRETT DODGE 053533
Lot Size(sq.ft.): 6011.28 Owner: GREGORY PATRICK BOLTON&
Zoning:URC Applicant: BRETT DODGE
AT: 36 BUTLER PL
Applicant Address: Phone: Insurance:
42 EAST HAWELEY RD (413) 337-4013
HAWLEYMA01339 ISSUED ON:6/24/05 0:00:00
TO PERFORM THE FOLLOWING WORK:ENCLOSE EXISTING PORCH TO 3 SEASON ROOM
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 Sienature:
FeeType: Date Paid: Amount:
Building 6/24/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2005-1293
APPLICANT/CONTACT PERSON BRETT DODGE
ADDRESS/PHONE 42 EAST HAWELEY RD HAWLEY (413)337-4013
PROPERTY LOCATION 36 BUTLER PL
MAP 32A PARCEL 205 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 6d cet_50
Typeof Construction: ENCLOSE EXISTING PORCH TO 3 SEASON ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 053533
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 C 'ssion
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,Departmetit
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/Septicc 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
APPLICATION TO CONSTRUCT,ALTER, REPAIR,REQ) ,A E#6tt5P R TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION JUN 2 0 2005
1.1 Property Address: This sectio ji to be completed by office
36 4'c17LEe, pi, ci
NO(� Map Lot Unit.
H, l P7o�l
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
P rA T R I C K ' C( C—O a y 3 6 g 1,1 7toz. P/v}cL i1J ere API P 7011/
Name
{{(Printt) Current Mailing Address:
I Q �c'.c/1' C Telephone
Signature (�7 3 ) 4.;
2.2 Authorizehi
nt:
A.
h A., Jew CJ/ 3
Name(Print) Current Mailing Address:
913 737 ro/.�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
/2)000
2. Electrical (b)Estimated Total Cost of
00 Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) 13;MO Check Number 67-
This Section For Official Use Only C!�
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
I
Section 4. ZONING All Informatioh 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
Frontage I
Setbacks Front - L I
Side L:! 1 R: I 'L:I 1 R:1 1 f
Rear i J
Building Height - :_ ___1.._
Bldg.Square Footage i I % 1 1 I I 1
Open Space Footage %
(Lot area minus bldg&paved + i I ( i 1 I i
parking)
#of Parking Spaces i 1- 1
Fill: !
(volume*Location) (i
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A. Has s a S ecial Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page' ' and/or Document# 1
B. Does the site contain a brook, body of water or wetlands? NO er DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? •
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO e
I
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q r NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition El Replacement Windows Alteration(s) V Roofing n
❑ Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [p Siding[❑] Other[❑]
Brief Description of Pppossd l I /4'f 6-1/
Work: /�vtc/ol c- -ajL/3j%�/ e,f t v/ S? 'i ►/Se
Alteration of existing bedroom Yes J /✓No Adding new bedroom Yes fr"/No
Attached Narrative Renovating unfinished basement Yes t/ No
Plans Attached Roll -Sheet
"1+Fr+Y'' .- "t�n�"�43'-- «. . -:,,,..a� °��i 3-, .-..,e-� :,�cv ??F•`�-
sa.If=Nevi-house a aztt A o exist nq ioaim - ompletettiayanQvlrinq:
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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 AGENTOR CONTRACTOR APPLIES FOR BUILDINGPERMIT
I 1-)C, �� f�- C ,as Owner of the subject
property � I y hereby authorize 'Rye. t7od,
1
G1Ps
to act on my behalf,in all matters relative toSkork authorized by this building permit application.
cfO ) (1 (/ c/a.�
Signature of Owner Date
I, G O , as Owner/Authorized
Agent hereby declare th the sta ments 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. AIL
Print Name
4.4"-
Signature of 0 r/Agent D/&)-
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:�'J1 /��/1J I Not Applicable El '
Name of License Holder: /,Jl'v.// /✓4�Lf�-� CJ 3J 2
O License Number
Z;Z-/_S---
Expiratio Date
Address Za4
(i3) -3-37 Ye/7
Signature elephone
9..Registered Home Improvement Contractor Not Applicable ❑
kell , ,4_ % - is 7z- 3 z._
Company Name Regis attf ion Number
7 .£ s 1' , t C4J / )/2 • O173, .--
Address Expiration ate
Telephone 7 Yell, 7 er
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 Q- --' No -'
11. Home Owner Exemption
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
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— DEPAR J ME14T OP nuu_Dri'.0 INSPECTIONS
212 Main Street Municipal Building
Northampton, Mass. 01060 r a
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WORKER'S COiYCPENSA'.I ON ENS CE AFFID ViT
I., _ram?./
(li ccasX/permi floc)
with a principal place of businessfresidence at: — —
L oil.3 y
e T • "La /04. (phone;) y/3, 33 1.-' /O
(sa t/city/ /rip)
do hereby certify, under the pains and penalties of perjury, that
( ) I am an employer providing the following worker's compensation coverage for Iny •
.
etvployces woring on this job:
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(Insu arc Conrad') • (Policy Number) (r:-pinion Daft) •
(M l am a sole proprtet r, general contractor or homeowner (ccie one) and have hired
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the cone actors s elow who have the follolvi.nR worker's compen_sadon policies: •
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l`+nfne Of Contractor) (tnsttranon CorT1oaarryt?ollci Nt1IIt_C7) \1_ti 1tr,luon i)c)
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(Name of Conn-actor) (Insurance Company/Policy Nuinc-r) (L"•inira:iion Date)
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(Name of Connarid ) (insurance Company/Policy Nambc.r) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(&mach:d'fi�oc.d r_',ccif acccaa-v to mdud:inforcoo pert.to.11 ooc=r-_corn)
( I am a sole proprietor and have no one woridng for me.
( ) I am.a home owner performing all the work myself.
NOTE:ptc3c be twat th vi Jc boron vocr3 who coo:ploy pecona to do rcpaa work oo.ds'c.0 ,of
clot toner d=n* c =i;is wets the homeowner rtaed.=of co the pwn6 2.9purtenza=tbc-eo e.c Doe cm.r..11y eecd.--ai to be
cizPloycs us•e the wott;ds r'",-pe-.+ion Aft(GLR s2ss 1(5)),opplinioo by a bome000a for c be:or pe,Jit rnry C'tdco°e tbc
icgsl n_n,,of en.tt toys under dao W oho?.Comp000aLioa Ate
I undertand t6.t a Dopy or tlai.ra m t c' ay!w for.-.rd.d rn tbo pe ms pert a o f 1n .am.l Accidents'o{Ooo of I .r`oo.for 6.
oovernc veifsolioa zoo than L-iltsc to soCtrt bovcrttce• k soaion 25A of mot,152 ern icd to the i•* +«loci of citaioal pcoaltie
coat.itssg of a tux arty to S 130Q.00 and!« of up to one year Lod civil peailtio io the So=of.Stop Work()Pict'tad a
flan of S 100.00 a day aatinA me
For Ad Doty
Permit Number
!! S flop:__ Lot"
Signature LiaTsee/Pet-n.i.ucc - t-e • ll A.
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igi ttAk p1. .
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I�= DEPARTMENT OF BUILDING INSPECTIONS _ � /:
INSPECTOR 212 Main Street • Municipal Building
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 supc: . 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