31A-027 7 BANCROFT RD BP-2011-0766
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Bloc 31A - 027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP- 2011 -0766
Project# JS- 2011 - 001264
Est. Cost: $20000.00
Fee: $120.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 3179.88 Owner: CORDOVA ELIZABETH
Zoning: URA(100)/ Applicant. CORDOVA ELIZABETH
AT. 7 BANCROFT RD
Applicant Address: Phone: Insurance:
18 VERNON ST (413) 586 -8046 ()
NORTHAMPTONMA01060 ISSUED ON :312512011 0:00:00
TO PERFORM THE FOLLOWING WORK.-FINISH ATTIC FOR STORAGE
SPACE, INSULATE /SHEETROCK,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: Date Paid: Amount:
Building 3/25/2011 0:00:00 $120.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
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City of Northampton 9'
Building Department
R�G ` 212 Main Street
Room 100
N hampton, MA 01060
- 87 -1240 Fax 413 - 587 -1272
V ;IM P P LICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Proaerty Address
This section to be completed by office
7 �a✓t �� o�� Map Lot Unit
�D ✓� l� j iM Zone Overlay District
r:6 5t bistrict , e CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record /� 1
Cj , Za 6 , t6 1 1k D��yd�- Ve ✓ 1 )� 1Vo✓� h'l
Name (Print) Current Mailing Addres
i : 41; 5
Telephone
sigrrdtu
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building f pG (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) a Q O % Check Number
This Section For Official Use Onl
Date
Building Permit Number: Issued
Signature v<
Building Commissioner /Inspectorof Buildings Date
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemen>� ows ' Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [O] Other [L7]
Brief Description of Proposed
vn llf 6 a (c -4-o t - m 15ktd - g i ora WA+c, s galls
Work: x�d von � ,{ a {- o✓�;,t t vo1� ��W ��oyv . ()tw wt ,, d dv�5 Gh
wa Ifs �-a �-) ►�
Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No G oct t/t'v� I 1 ar^
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll - Sheet
6 ,1fAlevr►.�t0(u °s "e ai i lr t d fl f X ��I11ii N1 iE>f ate A "fFit i f i s
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? Eire laces or Woodstoves Number of each
Compliance g. Energy Conservation Compliance. 1 -� M check Energy e form attached?
h. Type of construction
i. Is construction within, ', 00 ft. of wetlands? Yes No. Is constr ion 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 o .
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
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
.. * .'. as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are and dccurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of pedury.
Print Name
Sig atur of Owner /Agent Date
' T
The Commonwealth of Massachusetts
Department oflndustrial Accidents .
Office of Investia ations
600 Washington Street
Boston, MA 02111
,• wwx.massgov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumb.ers
Applicant Information Please Print L i ' Iv
Name ( Business /Organizationandividual): �II `7_G
Address: 7 h at,hc,►ro-��
City /State/Zip: N 610O Phone. #: If 3 — 6$4
Are you an employer ?.Check the appropriate boa: Type of project (required) :
1. Q I am a employer with 4.. Q I am a general contractor and I 6. ❑New construction
employees (full and/or part-time). * have hired the sub- contractors
2.. Q I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
ship and have no employees These sub - contractors have. .8. ❑ Deaolition
working for me in any capacity. �Ioyees and Isaye workers'
9 a aAdition
NO evorkers' comp. nostuance _. comp..ms #
r ecL 5. Q We are a corporation and its 10.E3 Electrical repass or additions
es j officers havexercised their 11. PIumb' 3 I am a homeowner doing all work r Q mg repairs or additions
myself [No workers' comp. right of exemption per MGL 12.Q.Roof repairs
insurance required:] t c. 152 §1(4), and we have no
work='. 13.Q Oilier
..
employees. �o work
comp. insiaance requir=ed j.
'Any applicant -that checks box #1 must also fill out the section below showing theirwori=s'_compensation policy information
t Homeowners who submit this affidavit.indicatmg they are doing all work and then hire outside contractors must submit a new a$davit indicating web.
rConwwtnis that chick this box must. attnched an additional sheet showing the name of the sub - contractors and stn wheiber or not those-entities have
employees. 'If the sub contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers compensation insurance for any employees. Bela_ w is the policy and job site
information
Insurance Company Name: .
Policy # of Self -ins. Lic. #: Expiration Date:
Job S ite Addres City /Sta&Zip:
Attach a copy of the workers' compensation policy declaration page (showiuF the p9licy number a44 ekpiration date).
ifi ` ositioa of penaltes ofa
Failure_ to secure coverage: as regm mfie= rea i Sechori 25A'ofMGL'c: 15z can lead to the '
fine up to $1500.00 and/or one. - year imprisonment, as well as civil penalties in the form of a STOP' WORK_ ORDER and- a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be_forwarded-to the Office of
I ivestis ations of the DIA for'irisurauce coverage vcrifit
1; under o hereby certr the air ; and persaltres of per/ury: that the uiformatian rovidedsrbav�
Si tore: /. ate• . 2 t/
Phone#:
Official use only. Do not write iii this area, to be completed by city or town"ofjlcr_W
City or Town: PdrmitUcense #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk .4. EIectrical Inspector 5. Plumbin Inspector
6. Other
Contact Person: Phone #:
Possible window combination
(i)Anderson 400 Setles 7-0"
by T- 413!16"
V (2)400 Series 7-0 I/Ir by 2 "-4 3/8"
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New Windows West Wall
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Cordova House Attic Plan
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