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29-442 • InStar Services Group, L.P. 100 State Strei P 0 Box 609, et Ludlow MA ng 8 01056 -0609 Office 413 -594 -7800 Fax 413 - 594 -7802 FID 61- 1407824 HIC 155878 cal Y � e ry� i f A Y � r k r i $ a A • 8 100209 093 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 15 InStar Services Group, L.P. 100 State Street Building 8 P O Box 60911; udlow, MA 01056 -0609 Office 413 - 594 -7800 Fax 413 - 59 -7802 FID 61- 1407824 HIC 155878 , sg 10/1/2009 7 100209 092 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 14 InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 4 14 4 w 3M k 'mil 4 s 6 100209 091 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 13 InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 3' • O tis ar 5 100209 090 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 12 • InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 - 594 -7802 FID 61- 1407824 HIC 155878 { +s e 1 . p g fiW 4 100209 089 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 11 • InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 , 4 ,a � ° 3 100209 088 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 10 • InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 I3IC 155878 a �a cr r i w9`a "" F 2 100209 087 10/1/2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 9 InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 Ate' �x r , s` �a ofer � r F - 1 100209 086 10/ 1 /2009 Taken By: DIANE SWAYGER, Senior Project Mgr SODERBERG 11/9/2009 Page: 8 InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 CONTINUED - General DESCRIPTION CALC QNTY NOTES: Grand Total Areas: 2,245.33 SF Walls 681.49 SF Ceiling 2,926.83 SF Walls and Ceiling 681.49 SF Floor 75.72 SY Flooring 280.67 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 280.67 LF Ceil. Perimeter 681.49 Floor Area 755.44 Total Area 2,245.33 Interior Wall Area 1,266.67 Exterior Wall Area 158.33 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length SODERBERG 11/9/2009 Page: 7 se InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 CONTINUED - Front Storage DESCRIPTION CALC QNTY 39. R &R Casing - 2 1/4" 17 17.00 LF 40. Stain & finish door slab only (per side) 2 2.00 EA 47. R &R Bifold door set - full louvered - Double 1 1.00 EA 48. Stain & finish bifold door set - slab only - (per side) 2 2.00 EA 41. Stain & finish casing 17 17.00 LF 46. Clean the floor with pressure steam F 143.99 SF NOTES: General PIMIWJYI DESCRIPTION CALC QNTY 49. Content Manipulation charge - per hour 8 8.00 HR 50. Single axle dump truck - per load - including dump fees 1 1.00 EA 51. General clean - up 2 2.00 HR 52. Electrical repairs 1 1.00 EA SODERBERG 11/9/2009 Page: 6 Ad InStar Services Group, L.P. 100 State Street Building 8 P O Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 - 594 -7802 FID 61- 1407824 HIC 155878 DESCRIPTION CALC QNTY 27. R &R Batt insulation - 4" - R13 23 *4 92.00 SF 28. R &R 1/2" drywall - hung, taped, floated, ready for paint .5W 206.00 SF 29. Seal then paint the walls (2 coats) W 412.00 SF 30. R &R Interior door - Colonist - pre -hung unit 2 2.00 EA 31. R &R Casing - 2 1/4" 17 17.00 LF 32. Stain & finish door slab only (per side) 4 4.00 EA 33. Stain & finish casing 17 17.00 LF 34. Paint door or window opening - 2 coats (per side) 1 1.00 EA 45. Clean the floor with pressure steam F 97.50 SF NOTES: 1 g 6 " - I " Front Storage Ceiling Height: 8' T 1711• f 372.00 SF Walls 133.68 SF Ceiling 505.68 SF Walls & Ceiling 133.68 SF Floor 14.85 SY Flooring 46.50 LF Floor Perimeter 1 46.50 LF Ceil. Perimeter 1 13' 4" Subroom 1: Closet Ceiling Height: 8' 3'1 "-1 T _ 2,9 -f-- T 104.00 SF Walls 10.31 SF Ceiling t 114.31 SF Walls & Ceiling 10.31 SF Floor 1 1.15 SY Flooring 13.00 LF Floor Perimeter 13.00 LF Ceil. Perimeter 1-3' 3" -1 DESCRIPTION CALC QNTY 35. R &R Batt insulation - 4" - R13 23 *4 92.00 SF 36. R &R 1/2" drywall - hung, taped, floated, ready for paint .5W 238.00 SF 37. Seal then paint the walls (2 coats) W 476.00 SF 38. R &R Interior door - Colonist - pre -hung unit 1 1.00 EA SODERBERG 11/9/2009 Page: 5 InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 - 594 -7802 FID 61- 1407824 HIC 155878 Subroom 1: Landing Ceiling Height: 8' 1- 3' 4' --r T r-3' -- 101.33 SF Walls 10.00 SF Ceiling � 111.33 SF Walls & Ceiling 10.00 SF Floor Lasdiaa 1.11 SY Flooring 12.67 LF Floor Perimeter 3' z" - 12.67 LF Ceil. Perimeter DESCRIPTION CALC QNTY 23. R &R 1/2" drywall - hung, taped, floated, ready for paint .5W 257.33 SF 24. R &R Casing - 2 1/4" 17 *3 51.00 LF 25. Seal then paint the walls (2 coats) W 514.67 SF 26. Stain & finish casing 51 51.00 LF 44. Clean the floor with pressure steam F 85.00 SF NOTES: 1 i c e' --I Storage Ceiling Height: 8' 304.00 SF Walls 86.25 SF Ceiling 390.25 SF Walls & Ceiling 86.25 SF Floor 9.58 SY Flooring 38.00 LF Floor Perimeter 11,8 38.00 LF Ceil. Perimeter m i Subroom 1: Closet Ceilin g Height: ht: 8' T 108.00 SF Walls 11.25 SF Ceiling 119.25 SF Walls & Ceiling 11.25 SF Floor j 1 a 1.25 SY Flooring 13.50 LF Floor Perimeter 13.50 LF Ceil. Perimeter 1-3' 4' . SODERBERG 11/9/2009 Page: 4 InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 - 594 -7802 FID 61- 1407824 HIC 155878 F � 1 . Laundry Ceiling Height: 8' 10 ' 8 " 1 290.67 SF Walls 80.00 SF Ceiling Weft to 370.67 SF Walls & Ceiling 80.00 SF Floor 1 1 I 8.89 SY Flooring 36.33 LF Floor Perimeter 4 36.33 LF Ceil. Perimeter 10'10• { DESCRIPTION CALC QNTY 21. R &R Batt insulation - 4" - R13 40 40.00 SF 9. R &R 1/2" drywall - hung, taped, floated, ready for paint .5W 145.33 SF 10. Seal then paint the walls (2 coats) W 290.67 SF 11. R &R Vanity 2 2.00 LF 12. R &R Cabinetry - upper (wall) units 2 2.00 LF 13. Detach & Reset Sink - single 1 1.00 EA 14. Detach & Reset Sink faucet - Bathroom 1 1.00 EA 15. Washing machine - Remove & reset 1 1.00 EA 16. Dryer - Remove & reset 1 1.00 EA 17. R &R Interior door - Colonist - pre -hung unit 1 1.00 EA 18. Stain & finish door slab only (per side) 2 2.00 EA 22. Paint door or window opening - 2 coats (per side) 1 1.00 EA 43. Clean the floor with pressure steam F 80.00 SF NOTES: ;', Hall Ceiling Height: 8' T 413.33 SF Walls 75.00 SF Ceiling 488.33 SF Walls & Ceiling 75.00 SF Floor 8.33 SY Flooring 51.67 LF Floor Perimeter NO 51.67 LF Ceil. Perimeter SODERBERG 11/9/2009 Page: 3 InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 SODERBERG Main Level FamilyRm Ceiling Height: 8' • 552.00 SF Walls 275.00 SF Ceiling 827.00 SF Walls & Ceiling 275.00 SF Floor 30.56 SY Flooring 69.00 LF Floor Perimeter 69.00 LF Ceil. Perimeter DESCRIPTION CALC QNTY 1. R &R Suspended ceiling system - 2' x 4' C 275.00 SF 19. R &R Batt insulation - 4" - R13 .25W 138.00 SF 2. R &R 1/2" drywall - hung only (no tape or finish) .5W 276.00 SF 20. R &R Paneling W 552.00 SF 3. R &R Door opening (jamb & casing) - 32 "to36 "wide - paint 1 1.00 EA grade 4. R &R Window trim set 30 30.00 LF 5. R &R Baseboard - 3 1/4" PF 69.00 LF 6. Stain & finish baseboard PF 69.00 LF 7. Paint door or window opening - 2 coats (per side) 4 4.00 EA 8. Clean the floor with pressure steam F 275.00 SF NOTES: SODERBERG 11/9/2009 Page: 2 _ r' InStar Services Group, L.P. 100 State Street Building 8 P 0 Box 609, Ludlow, MA 01056 -0609 Office 413 -594 -7800 Fax 413 -594 -7802 FID 61- 1407824 HIC 155878 Client: Peter & Sandra Soderberg Home: (413) 584 -6887 Property: 66 Ellington Rd Florence, MA 01062 Operator Info: Operator: DSWAYGER Estimator: DIANE SWAYGER, Senior Project Mgr Business: (413) 594 -7800 x 317 Business: 30 Haynes Circle Chicopee, MA 01020 Type of Estimate: Water Damage Date Entered: 10/5/2009 Date Assigned: Price List: MASP5B_OCTO9 Restoration/Service /Remodel Estimate: SODERBERG • HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 buildi depart ment 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- conjunctionto the buildin • permitissued,-- and . 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. Address of work location r . ' The Commonwealth of Massachusetts • Department of Industrial Accidents —midi. _ P Office of Investigations • ' 1; 600 Washington Street 2. - "= Boston, MA 02111 •• -z, . www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information / Please Print Legibly Name ( Business /Organization/IndividuaI): /4S7 ///�. p gi &/ S 0 uPLe Address: , �/1 ' .s : i E. r6 eAI 6 0 q L L IV MMI 0 1 0 6 7 City /State /Zip: Phone. #: 1/43 559 Y 7( O Are y an employer? Check the appropriate box: Type of project (required): i ,. 1. I am a employer with 4. 0 I am a general contractor and I Y 6. 0 New construction employees (full and/or part- time).* have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship'. 11 have. no pioyees These sub - contractors have. 8. ❑ Deniol ion working for me in any employees and have workers' Y act ty # . 9. 0 Building addition jNo workers' comp. insurance comp. nlsurance. . required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I ama- homeowner -dern llwork e -have xercised thei'—l I?lumlialgrepairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 ' • f repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. A Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ; t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1 Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation Insurance Company Name: I ' A n Policy # or Self ins. Lic. #: /lee, ft1 ► / eePenA/ Iv 5 V0 Expiration Date: -0j 7. bo Job Site Address: C ( l0 1 City /State /Zip: * ./ I ._ ,.� %i , u∎ / / Q /060 Attach a copy of the workers' co lion policy declaration page (showing the policy number and • : • iration date). Failure to secure coverage_as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1 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: to advised that a copy of this statement may he forwarded to the OffirP of Investigations of the DIA for insurance coverage verification. I do kereb - ce jj under ; , i / an , d , enalties o perjury that the information provided o _islrue.and_carreet.___ _ 1 I 1 , , /AtAf , ti ,I1 . _ _ 7 .... ignature: �� / � � < Date / _ Phone #: /3d �)d1l (O a 98 I -Of cid/ use only. Do not wale in hits: area, to.. be complefed by city or town officiaL City or Town: Permit/License # - -- - Issuing Authority (circle one): I� Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other s- Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 0/ 7 / ] SSJ e License Number 71/7 /11 Address Expiration Date Signature Telephone 9:. ReniStered" klomeInipioiremeiitGontracfar - y ....... .. Not Applicable ❑ //v1Th i&' �2 � v e Le /5 s S7 $ Company Name Registr tion umber Address Expiration Date Telephone 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 buildid g permit. Signed Affidavit Attached Yes GY No ❑ T_he_current_exemption for "homeowners "was extended to include Owner 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, in 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 o amp on *romances; " a e a - s- General= - laws - Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ri Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [Ea Decks [C] Siding [0] Other Vik Brief Description of Propos� e gAae4744,.. )( •—• Work: kroiW v .C7 Alteration of existing bedroom Yes X No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement -s / '" , Plans Attached Roll - Sheet i , , f / ! ! sa If Nair house and:+ eaiftlitaon ` existing:hoi synch eorno etelhe_fOITo " a: 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 I, / t TO S0,D E/2 65/26 , as Owner of the subject property AST // hereby a -; • - i / v� ' 1 ' V I � � ) / i Nt. S1V . to act • my d f . relay- to work authorized by this building permit application. Signature of 0 ner - Date D ,p I, / ,Te gd c� C O Deg 1 t I€6-- , 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. �...ill e . 0 6 k• gel2 ai l Print ame / 4. Signature owner/Agent Date 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 filled in by Building Department Lot Size_._._ Frontage Setbacks Front Side Rear Building Height Bldg. Square Footage fl % i Open Space Footage % (Lot area minus bldg & paved.. ,. parking) # of Parking Spaces — Fill: (volume & Location) A. Has a Special Permit /Variance /Findin• ever been issued for /on the site? NO 0 DONT KNOW AP YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Bo Page ? and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 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 . NO IF YES, describe size, type and location: D ire t�ieie any proposed changes o or a rtlons o signs Inten ed or le property . YES 0 NO' IF YES, describe size, type and location: E. Will the construction activity disturb {Gearing, grading, ex -vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO �4 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • City of Northampton �at(:ft� �*C f . Building Department rl ut r veutra r e � � a �{ 212 Main Street S � vo r W - �f7 Room 100 a a�, � � ` -� � e ,'r 'kk4A t. G K Northampton, MA 01060 ®t tc�a } s F " - � � r he 413- 587 -1240 Fax 413 - 587 -1272 Pig :S'' « '� - -* : tt,: APPUCATION 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 completed by office L1' (19' C. _ fad Map Lot Unit T X ie c C- , ( ,/ ,, U (0 Z Zon Overlay District • 1/'"1"/T -Elm St District CB District SECTION 2'- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _____ / e/e- S*0,Dgg-te/e___ _ ___ ____ 5 et te I Name nt) /iiirr i 0 Current Mailing Address: _ f of Telephone �� Signature 2.2 Authorized Agent: ])1 Ni i 1 j Pkii-snikiT S - &Lam o Mi4 6 loa-? Name (Prin Current Mailing Address: ,' IA, AtilAk d-v60?t_s Signature ,I Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS L Item Estimated Cost (Dollars) to b Official Only completed by permit applicant 1. Building i1 5 D d (a) Building Permit Fee 2. Electrical 1 (b) Estimated Total Cost of (� D r Construction from (6) 3. Plumbing a-oo -' Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection r - T 6. Total- (1 +2 +3 +4 +5) 1 0(� Check Number '?V._� I SO This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner /Inspector of Buildings Date I t File # BP- 2010 -0519 APPLICANT /CONTACT PERSON INSTAR SERVICES GROUP LP ADDRESS /PHONE 100 STATE ST LUDLOW (413) 594 -7800 PROPERTY LOCATION 66 ELLINGTON RD MAP 29 PARCEL 442 001 ZONE URA(100) / /WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid (g e51020 J 02 Typeof Construction: REPAIR WATER DAMAGED BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 017755 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 Commission Permit DPW Storm Water Management Demolition Delay 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. ` BP- 2010 -0519 GIS #: COMMONWEALTH OF MASSACHUSETTS i B1 ck 19,442 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- 2010 -0519 Proiect # JS- 2010 - 000732 Est. Cost: $11600.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: INSTAR SERVICES GROUP LP 017755 Lot Size(sq. ft.): 13155.12 Owner: SODERBERG PETER E & SANDRA L Zoning: URA(100) / /WSP Applicant: INSTAR SERVICES GROUP LP AT: 66 ELLINGTON RD Applicant Address: Phone: Insurance: 100 STATE ST (413) 594 -7800 Workers Compensation LUDLOWMA01056 ISSUED ON:11/16/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR WATER DAMAGED BASEMENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I?nderground: 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 11/16/2009 0:00:00 $65.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo