24C-075 � *0 'N)'ee ( Hla'4 'T' t-'iv re--- 36 MASSASOIT ST
BP- 2012 -0048
GIS #: COMMONWEALTH OF MASSACHUSETTS
Ma :Bloc 24C - 075 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING PERMIT
Permit # BP- 2012 -0048
Project # JS- 2012 - 000071
Est. Cost: $18200.00
Fee: $109.20 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER
Lot Size(sq. ft.): 15768.72 Owner: HIRSCH EILEEN B
Zonine: URB(100)/ Applicant. ROBERT WALKER
AT: 36 MASSASOIT ST
Applicant Address: Phone: Insurance:
36 Service Center (413) 584 -1224
NORTHAMPTONMA01060 ISSUED ON :7115120110:00:00
TO PERFORM THE FOLLOWING WORK.- Screen enclosure on existing deck
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 7/15/20110:00:00 $109.20
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2012 -0048
APPLICANT /CONTACT PERSON ROBERT WALKER /J
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584 -1224 e
PROPERTY LOCATION 36 MASSASOIT ST PAAA
MAP 24C PARCEL 075 001 ZONE URB(100)/ S �+
d� I
THIS SECTION FOR OFFICIAL USE ONLY: �,,,�
PERMIT APPLICATION CHECKLIST V _
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
VBuilding Permit Filled out
LA� Paid y . 7 0
Typeof Construction: Screen enclosure on existing deck
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Buildine Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOA&IATION 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 Permit DPW Storm Water Management
Demolition Delay
,7 1 J ( l
Signa re of Building TDfficial 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.
bepar eott use onl y
City of Northampton Status of Permit:
Building Department Curb C Driveway Permit „... Q_.
way
212 Mai Street
-- -_ werlSept Availab ity s
€i
E40 ElVE.- 1lyater/Woll Ava
�
No rt D Two Sets ' Structural Plan
phone 413 - 5 413 - 1272 plot/Site puns
Z Other Specify APPLICATION TO CONSTR i s F4TqyAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
NORTHAMP
SECTION 1 - SITE INFORMATION
1.1 Property Address
This section to be completed by office`
2j Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
t-A �j (c ll/l+c��SA S��fi ST ►.� crz t v ,
Name (Print) Current Mailing Address:
`�— Telephone 7
Signature
2.2 Authorized Agent: `?
Name (Print) Current Mailing Address:
V fit- _ a'Z
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building - (a) Building Permit Fee
l �C�u,
2. Electrical (b) Estimated Total Cost of
vO Construction from 6
3. Plumbing Building Permit Fee Q r�
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) tk �U - Check Number
This Section For Official Use Onl
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
_. ...�
; a�+��
z
Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fill n by
Building Departm
Lot Size
Frontage
Setbacks Front
v
Side L: R:Q L: R�
Rear 7 � `
Cl 1D
Building Height Ks
Bldg. Square Footage % M, ,
Open Space Footage . '
(Lot area minus bldg & paved
p arkin g)
# of Parkin aces
F.
volume & Location
A. Has a Sp ial Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES Q
IF YES: enter Book Page nd /or Document #!'
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , 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:
E. Will the construction activity disturb (clearing, grading, exc ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House [] Addition Replacement Windows Alteration(s) Roofing ❑
Or Doors C]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [CJ Siding [0] Other [
Brief Description of Proposed
Work: v�� S �c� 42{vZ1iC� v �� STlE� 6 �—
Alteration of existing bedroom s �o Adding new bedroom Yes �No
Attached Narrative Renovating unfinished basement Yes
Plans Attached Roll Sheet
6a. if New house and or addition to existing housing. complete the foliowlng:
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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 Zt P ¢� �!VV L, as Owner of the subject
property rc I
hereby authorize
to act on my behalf, all matters relative to work authorized by this building permit application.
� pa IZ- It
Signature of Owner Date
I _., �� V..►��- 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.
Print Name
L
Signature of Owner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Sue 'sor: Not Applicable ❑
Name of License Holder VSV LAJ �� J [ -
License Number
tr.v C - t v 1 t 11
Addre Expiration Date
Sign Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
(p Vo
Company Name Registration Number
Address Expiration Date
n / 7
Telephone S I
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....... ❑ 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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