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FIRST FLOOR PLAN
l
SIEGFRIED PORTH ARCHITECT
/ 116 Pleasant Street
Suite 3404
l Easthampton, MA 01027
k Phone: 1-413-529-9434 MR. AND MRS. LLOYD
Fax: 1-413-529-9434
8 FOURTH AVENUE
NORTHAMPTON, MA
FIRST FLOOR PLAN
Residential_passive.pdf http://www.northamptonma.gov/building/uploads/listWidget/2599/R...
SECTION 8-CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor: Not Applicable.
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9,Reaistered Home Improvement Contractor: Not Applicable.
Company Name Registration Number
Address Expiration Date
Telephone
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 Z. rws and State of Massachusetts General Laws Annotated.
��!G�►��ffi��
Homeowner Signature ► •1 •
4 of 4 4/7/13 10:09 AM
Residential_passi ve.pdf http://www.northamptonma.gov/building/uploads/listWidget/2599/R...
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable)
New House Addition Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed
Work: lb ADD Pow KO— fit/Z-1" f t-W A --
Alteration of existing bedroom Yes V No Adding new bedroom Yes `r No
Attached Narrative Renovating unfinished basement Yes V No
Plans Attached Roll Sheet
6a.If New house and or additiofyto existing housing. comoiete 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 V 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 P an oning regulations? v Yes No .
I. Septic Tank City Sewer ' Private well City water Supply V
SECTION Ta-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
I, t( fl_! D. (A,O\-(D , a Owner uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
C2. t
3 ct 4ignature of Owner/Agent Date 4/7/13 10:09 ff■
Residential_passive.pdf http://www.northamptonma.gov/building/uploads/listWidget/2599/R...
Section 4. ZONING Ail Information Mist 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 L: R: L: R:
Rear
Building Height v `� —
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. -s a S)ecial 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. Doesthe site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES has a permit been or need to be obtained from the nservation Commission?
Needs to be obtained Obtained , 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, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
2 of 4 4/7/13 10:09 AM
Residential_passive.pdf http://www.northamptonma.gov/building/uploads/listWidget/2599/R...
City of Northampton
eft.
Building Department t "bt �Vlylrit
212 Main Street Earl
f 4s
Room 100 Wait A
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 ►Plan ,» ,
Ott*Ms_s -""" �. E
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A OhE OR TWO FAMILY D E ING
ill 2 2013
SECTION 1 -SITE INFORMATION
1.1 Property Address: This sectio , ffl
NORTHAMPTON,MA 01060
FoU2T* Ave Map e Lot Unit
(1,-r .o.w�fa'c-cs s4 wt .
r 81660 Zone Overlay District
Elm St.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/2- cL-af1 6J Fot►f AVS. No tiT H-4Vt PTO
Name(Print) Current LM.I i Addrgs5 5, 1 Z3
Telephone
Signature
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 permit applicant
1. Building e , L t O 8 p -- (a) Building Permit Fee
2. Electrical zi j o o (b)Estimated Total Cost of
Construction from(6)
3. Plumbing 5 a d .� Building Permit Fee
4. Mechanical(HVAC) ,Ld 0
5. Fire Protection ,) 77
6. Total=(1 +2+3+4+5) $ 2 , too Check Number
This Section For Official Use Only
Building Permit Number: Date
g Issued:
Signature: - 9//2//
Building Commissioner/Inspector of Buildings Date
1 of 4 4/7/13 10:09 AM
8 FOURTH AVE BP-2013-0976
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 140 CITY OF NORTHAMPTON
Lot: -001 PERSONS CON I'RACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2013-0976
Project# JS-2013-001623
Est. Cost: $2100.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 5924.16 Owner: LLOYD RICHARD D&BINDA C COLEBROOK
Zoning:URB(100)/ Applicant: LLOYD RICHARD D & BINDA C COLEBROOK
AT: 8 FOURTH AVE
Applicant Address: Phone: Insurance:
8 FOURTH AVE
NORTHAMPTONMA01060 ISSUED ON:4/23/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD 1ST FLR POWDER ROOM
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 4/23/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner