31B-028 (5) 51 SUMMER ST BP-2004-0881
GIS#: COMMONWEALTH OF MASSACHUSETTS
4" 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-2004-0881
Project# 3S-2004-1316
Est. Cost: $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Edward P Hamel 020695
Lot Size(sq. ft.): 4007.52 Owner: ROSZKO STEVEN R&KATHRYN K
Zoning:URC Applicant: Edward P Hamel
AT: 51 SUMMER ST
Applicant Address: Phone: Insurance:
155 Glendale Rd (413) 527-6843
SOUTHAMPTONMA01073 ISSUED ON:3/22/04 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR/REPLACE EXISTING FRONT PORCH &
STAIR
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 3/22/04 0:00:00 1786 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2004-0881
APPLICANT/CONTACT PERSON Edward P Hamel
ADDRESS/PHONE 155 Glendale Rd SOUTHAMPTON (413)527-6843
PROPERTY LOCATION 51 SUMMER ST
MAP 31B PARCEL 028 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Fee Paid 1 'b —
Typeof Construction: REPAIR/REPLACE EXISTING FRONT PORCH&STAIR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 020695
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,RMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
3 8y
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
U
f in. k o
of Northampton S atu
�� .;.!$uilding Department
wJ — �` 212 Main Street 'ran S i Sep +ar a`os '
.��`'�� �� ;Room 100 a e � ettr va �
, 5 20 Northampton, MA 01060 t e kt-.6 `�^AR
phone 413.587. 240 Fax 413-587.1272 PtotlS,te-a-ians -�
APPLICATION 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 cofri ete"dby office
_ Unit_
`J l SU9viyC� � Map Lot r:
Zone Overlay District
Elm,St:_District CB Distrist_.
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 20 Sz KZ)
7Ci/6 4- /64 71-k Y49 /C 5 f S Urvl C4 5/ ,
Name(P int) Current Mailing Address:
;'2409
Telephone
Sign- ure
2.2 Authorized Agent:
E.cL,a,�D /)/3n1CL- ' EL), s v71/44lP70Ai 1P1
Name, rant) Q 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 (a) Building Permit Fee
OGc'�:trU
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) 5 ODD c)Z) Check Number /2/ 0 v
This Section For Official Use Only
Building Permit Number: 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 r/
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 1/
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T 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 1/ DON'T 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 1.7
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 ❑ Addition ❑ Replacement Windows Alteration(s) f Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ,e6 1/11 A t-P? e_,Y 74 f,€ 'Jf /,eC/f 7 s7:4/A_
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
6 1 7e otwe ndior adtlitiori'to:dintin -hiSLISrng c011111 Efe'' tfie i OWit
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
Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
1. 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
/ I, .c qyl� (2-0SZ.k0 , as Owner of the subject property
hereby authorize) CAk'A , /1,/I'1 C Z to act or
my behalf in all matters relative to work authorized by this building permit application.
Signa ur o Ow Date
I, GD4'1'1 P my, E-e._ , 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.
E044i P ' -
Print e
L� ��✓ 3 10 o 9
Signature of Owner/Agent �a
I.
•
SECTION 8: CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 'J Not Applicable ❑
Name of License Holder : �Q�i/�g LP, //4t 7 - 0 2O4 95
License Number
l S c a Lr-N so /)/1-4i f Tv yi z/o
Addr7s Expiran D to
L64',f, 1/44-", 4// 3 52 7 k 3
Signature Telephone
• Re: ere.- 'orn m7r:verrier hCon racto. n' _ _ �� ' : . Not Applicable 0
E0 h).4,e1 P /b141 Ct.— / t v.v 1kAc-on /3 ? G 7 3
Company Name Registration Number
I G-LEaU p4LC De 4 cov7-Atvl p 1 d ►) iz 1 i f'b y
Address r Expirati n D to
Telephone ` ) 5-d 7'bV
SECTION lO '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 ❑ No 0
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinzs 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 acccptable 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
.
•
i. � �RrttAMl2-.O
�
.*(�ifh �ft� tlJ� i } fnlA �€—
6 f• s1,1laatlinsrtla =v *�
II—
m DEPARTMENT OP BUILDING INSPECTIONS * _-_t`
212 Main Street ' Municipal Building =_
,,
Northampton, Mass. 01060 " sr t'
•
WORKER'S COMPENSATION INSURANCE APFIDAV1T
I, ' e,OL✓4g o..__._ A 1_-1� �-- -.---_-_--_...__...--------- . .__._
(l i cent Jpermittcc)
with a principal place of business/residence at:
•
/56— CLeiV01L 26_ i SOUTrnt,Tih) _(Phone=)`'L3 5Z_ ' (,,Sy 3
(strcct/cit /State ip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the followinc worker's compensation coverage for t y •
employees working on this job:
- (Lnsurance Company) (Policy Number) (Expiration D. )
I am a sole proprietor, general contractor or homeowner (circle one) and have • ed
e contactors listed below who have, the following worker's compensation policies
(' tr
(Name of Contractor) (Insurance Company1Policy Number) (Expiration s.te)
•
(Name of Contractor) (Insurance Companv(Policv Number) (Expiration D te)
(Name of Contractor) (Insurance Cornpanvii'olic-y Number) (Exs. r eon ate)
•
(Name of Contractor) (Insurance Comex"yfPolicy Number) (Expiration sate)
(attach addiJartal tic if teestsr to it-A-utic.. :'s::ooc p :a:..ir., .ell o:P_..a..-.)
i
I am a sole proprietor and have no one Working for me.
( ) I am a home owner performing all the work myself.
NOTE:please he aNV-ArC that while homeowucea'who cerrp!Oy peso s to d)tr-aintemanec,cv::sr'c Cl-it-pair Wnai:o n e ds% llim:,of
not more than three units in which the ho,.>1:e o res::es oc on the crou::s a,7pU ters.rd thccto et not gcsrsally considered to.
employe undies theworker's ecrrTaesetia l,'.c:(GL152,.e.11(5)),application by a homeowner for a liecr:.c cc permit r.lay tr.r.c •Cc tire
legal status of xn employee under the Worker's Co.nsp r ation Act-
1 unde•staad that a copy of this statement cnay be forvmrtlod to tbo D.:O rtaxz,1 of Ireb,•triel Maiden 'Ofic o of iearr.n o f• the
coverage vrsif r...tioo end that failure to scat=cot:-r_go tu-4-,-section 25A of I(OL 152 can lead to the imposition of cri.•aia:l . -.ilia
comisting of a fine orup to S 1.500.00 ar-,ror i prisr•tsa7 of up to err year end Civil penalties in de form of a Sic;)Work , and a
f rir of S 100.00 a day a gainu m:. . •
•
Foxq>u dtrr�rsl use only
Permit Ni . ______-__-____
--_ -- - .._.-....._ Iti la-�;i .of --"--
S
Signature of I.iccm:eJPermittc Ti:i'.-''
t
dKl{AMPi
O
�� Git r of Naztl &mptan )^1- _*__� — i
4' i �•�'r:i! al :�
.... .� vllISSSAC}t 118[ttb - �—
: SIT
—_
'�`��""- DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building 7. -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 sups:,. 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