38B-149 SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ' lv tk, D • •OS'S
License Number
36 e.evtc C RO AD , 1J091+WAPTao MA 4 ' Z8' 13
Address Expiration Date
41 • .3 - t2 2- 44'.
Signature Telephone
9. Re 'stared Home Improvement Contractor: Not Applicable ❑
5'rErNEN D. QDSS CONTQAGTQ 15684/
Company Name Registration Number
3fo St✓(Vle LE PoAD, N O9-TO MA 5- 4. 1A.
Address 1 1 Expiration Date
Telephone S84 - 1224
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 1 4 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors [l
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [O] Other [0]
Brief De cription of Proposed
Work: } (21rRt C- Vtic-14E14 4ecelJD VtLooR WILL (zEe- 11RRA.N tMfi-t-PT
Alteration of existing bedroom X Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes )C No
Plans Attached Roll - Sheet
5a. If New house and or addition to existing housing, complete the following:
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
147 `J `v KI , as Owner of the subject
property
here uthorize 5T A ; 20gg GENEp4t_ co,1/4)
to act on y behalf, 'n all , a IMOZEW e to work authorized by this building permit application.
/ / O 2--
Signat a of Owner Date
I, ‘7'1 -\ p t. ( , 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.
N DOSS
Print Name
8.23 - V2-
Signa a of 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 N G14A417L
Frontage N4 C 4AN GE
Setbacks Front
Side L: R: L: R:
Rear PO C
Building Height tiI0 Cii -ANGE.
Bldg. Square Footage % 1)0 6 4AA , G4E
Open Space Footage
(Lot area minus bldg & paved uo i1S t V6E
parking) �1f'W
# of Parking Spaces
(volume No �MGE
(v & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO X44 DON'T KNOW 0 YES 0
IF YES, date issued:
YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW (3 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO j DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 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 0 NO +r4
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 0 NO 4, 4
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit • AUG 23 21111 212 Main Street sewer /Septic Availability
Room 100 Water/Well Availability
L No hampton, MA 01060 Two Sets of Structural Plans
°` . , ;p1ge s 413,.. 587 -1240 Fax 413- 587 -1272 Plot/Site Plans,
Other Specify
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 completed by office
t
cowi‘Alau6 Map Lot Unit
NOO:ct M PTV µ Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
►Liter So. �� �a GpWMP�VS Avg, AlOeTt4AMPT"otJ
ame
(Pri 1 Curr nt Mailing Address:
�t►l3 • 3t3 • 6a84
Telephone
Signature
2.2 Authorized Agent:
e 8.04 3(o C-Te- tea, NoeTNAMPTCA)
Name (Print) Current Mailing Address:
41 3 17-24
gnat a Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building If 3-- UaC (a) Building Permit Fee
2. Electrical 3 G U 6 (b) Estimated Total Cost of
/ Construction from (6)
3. Plumbing C( - c' Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2 +3 +4 +5) O 6 7 3 o . d d Check Number 3S 3 L4
This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0202
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 0
PROPERTY LOCATION 49 COLUMBUS AVE
MAP 38B PARCEL 149 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL KITCHEN & RELOCATE 2ND FLR BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
F 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
D - molition ay
Signature of Building O fcial 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.
49 COLUMBUS AVE BP- 2013 -0202
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 149 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- 2013 -0202
Project # JS- 2013- 000332
Est. Cost: $57300.00
Fee: $343.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 5619.24 Owner: DUNN MARK
Zoning: URB(100)/ Applicant: STEPHEN D ROSS
AT: 49 COLUMBUS AVE
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 -1224 0 WC
NORTHAMPTONMA01060 ISSUED ON:8/24/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN & RELOCATE 2ND FLR
BATH
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 8/24/2012 0:00:00 $343.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner