Loading...
37-022 PROPO or-CO fir, -0(np rovem cn+- cu / �q. Date SOS d2 �r1C Tai 1 C /'I�i� 0/0 S� . ?.f I, Oil 3)a9L e,Ep -. 2002 \1\1, �C+ Sheet No, (5.x$ ®(2'7059 t4-rG#r 3 4 �� Proposal Submitted To: W _ _ ;;al.;, orme' At: r i BUltY' i60 Name Thar I-F-010171_ Csp i)01 l _---^-�i `r( ✓ Street a it-in Street City R©re/Ze/ State m2- City State Phone CY/•3) ,57( -4f,050 Date of Plans Architect � f TWe hereby propose to furnish the materials and perform the labor necessary for the completion of /t;x'/ S Son (c)vv Yy-\ e k. S / wr'1C re 71-e 3 et& , r e Lie,-/or cot re. h[,)S C-S 1c//ray (O/ j- L writ /ri -t--e r it n y '7 e(I st-m en-t- e/ncio w,s al4ci cc. j ' op v lv t lU'1 S-i-a.i rS . i4f+r,or wolf hOuc & Cathedra-I Cc' lorry /21Shcd ‘U, be&c11xr'1 3 e+r posed .-6eci m s , 130 fi-z) m. ivat l s wt/( C'ode'ine c/ Col c a4c-h i ny addboavd ; J! fr 71-rtyn CtJI/1 p/r/7c , tuctt S e ny t7J (ie.///i(� i/IS V/1cC EA; r r Q CS . r l,( rtt-Je xTe V-1 o r C OCi r ry1S i � � i i lc l ( f t CQ 6Th : 9/1/4, Co"‘ ;?...o. ._cc2 All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial. workmanlike manner for the sum of C,9 k1+-CCY\ trouscQ rlG/ TWO hordYC'L, a d16l %Ci'l17( `f-1'")Y�?ff Dollars [$ iFf av"3 with pay Tents to be made as follows: /SpGcy/?' 111-1 $d L j09(7. 3 ?o1G payincrj-,� ' &I 6‘14..f.? a r1 3 g pa y Knen.)- 4 b,tit/ , 3.3 Any alteratior or deviation from above spec'°.canons v eola,ng extra costs. will be executed only upon vyrtfec craccc voi!I become.ao Respectfully submitted extra charge over and above the estusate agreements centirgent upon strikes accIdents or delays beyond I car,v fire tornado other necessary I',ur , Per men s Can pe sario and Puts ,tlandit, _c be taken out h.+; Note This proposal may he ^:.L' i[nAqr iry _r ` not accepted within days ACCEPTANCE OF PROPOSAL The above prtres, speclfi at'on 9 t „. tetds • sfaccory anti are i rein lc> >.'tt 'b "t.,a '-; "t ,t Payment vvill be made as outlined Signatoi AO 4' Hate /7G') .966 Signature G� � ,. ORIGINAL i , . . 1_ 1 LI S E , ,o.1 i . , -r- 1 , j'') - 4 L Wt.- ! I . DEPT OF Pi ii i r.i NG INSPECT!OS N27-.Y,so.i;='70N ro A n;050 Z v p• ■,,, 0 ,.. Z ' 0 r-: , r•-. -----* i' .• N. 1 -f- „ % '‘ _ ..,...._. --- r- (--,\ .4... -t. - • , -Is- . icitiANp2. 'o . r . �.xf of Northampton ='t=$ CJ'�'%,"4h'►•'tasaachnsctts --Mt `= s d�• -_�_ �aa DEPARTMENT OP BUILDING INSPECTIONS =1_I 212 Main Street ' Municipal Building Northampton, Mass. 01060 to"s` WORKER'S COMPENSATION INSURANCE AF1'I_DAVIT 1, (l►censee/permittee) with a principal place of business/residence at: • (phone/0 (s t reet/ci ty/sta teia p) do hereby certify, under the pains and penalties of penury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees worming on this job: - (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifnccerary to include information pertaining to all occtracion) (4))/1--am a sole proprietor and have no one working for me. ( ) I am a home owner perfoltuing all the work myself. NOTE:pie,r,,be as that while homeowners who employ persons to do maintenance,cor uc.ico or repair work on a dwelling of not more than three units in which the bocseowt or resides or oa the grounds appurtenant thereto arc cot gcrerally oeeridacd to be employers under the worker's ccmpe.sabers Act(GL152,ss 1(5)),application by n homeowner for a License or permit may evidence the legal stanu of an employer under the Worker's Compensation Act I understand that a.copy of the ctatemcat may be Forwarded to the Dqi rtnxo2 of Industrial Accibeats'Office of Is+uwce for the coverage verification and that failure to secure coverage under section 25A of MC1L 152 can lead to the imposition of-criminal penalties comuti of of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Ordc and a fine of 5100.00 a day against me • For depart a °-t uao only / Permit Number • - its c'�:�--� 5-l'i --5 a"�... Map%1 Lot 4 . igaature of Liccnscclpermittce Cate- SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ /l f Name of License Holder : L' ///Q an E. co( A,jJ 1�' C Q License Number Po, 5og 9.5 /Ai- de571-ey t- e(64 /� '1H. a1 bF3 zt e /a5/0 -3 Address Expiration Date 1/ 5 9 G -6 i cQ ce signature Telephone r R gistered-THbme Mmpr0vement`Co tractor " i` ' ,... Not Applicable ❑ / 3 4Lgs�� Company Name Registration Number 1��,22 `vZ //S/ v71 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 ❑ 1 fie; �1� � H.oiine,OwnerExeinption 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 IV-- Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ]t Other [ ] Brief Description of Proposed Work: BLit f( 3 Sec;56 44 i crn► OA/ e>< Alteration of existing bedroom Yes No Adding new bedroom Yes Z./No Attached Narrative❑ Renovating unfinished basement Yes 1-- No Plans Attached Roll ❑ - Sheet❑ sa -:lf New fious"e and'or add►tion°to ezist�ng ousing;.completeTthe°followihg: 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? Al 0 d. Proposed Square footage of new construction. lyt F Dimensions e. Number of stories? I f. Method of heating? JJUil: Fireplaces or Woodstoves U Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction c,Vi�oct 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? G�'� 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 , 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 l Li,/V/ /a c-,)Ce 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 Signa ure of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 1,j 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. Does the site contain a brook, body of water or wetlands? NO 1,7- -----DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO L./ 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: r y z� hsx �� m r4.P A � 9 d "`" -r .,' ' ;.. Qi ► Northampton 5 F. S B . •_ Department ., /� 3� i '1u.'—‘' ���i 2��2 am Street • r • A. �, SEP '.om 100 "a - d . N N. am. on, MA 01060 et �` � �, �' ���Of 6th i�� e�S$E X87 1.40 Fax 413-587-1 272 Palo#'/Slte Pins« ' 1. : , OtierSpect � i �«.:Mme, .� � -��, �� �_� rte_NORIHA APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completetl by office .; 1.1 Property Address: r r 4 � ' Lea 'rY C .i, 1 /666 lore ee (e Map " , Lots=` . F� f Lln� (.e a+��Jf CIE Zone Overlay°District Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Currenpt Mailing Address: Telephone Signature 2.2 Authorized Agent: _ �` ( �(i m �v S /?().6c))` itii c 5 ✓fte xr1'IA °ice,/ 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 Lr� -1 , '1 0 - p (a) Building Permit Fee 2. Electrical 5—"' c,c) (b` Estimated Total Cost of �r t °�6 " Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) / 'Section�' Check Number 1999 eY55v _- This Section For Official Use Only Building Permit Number: �� 3 � � Date Issued:. Signature: Building Commissioner/Inspector of Buildings Date 1 File#BP-2003-0229 APPLICANT/CONTACT PERSON WILLIAM SORENSEN ADDRESS/PHONE P 0 BOX 25 (413)296-0129 PROPERTY LOCATION#4 MT LAUREL PATH-600 FLORENCE RD MAP 37 PARCEL 022 004 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out d T/A Fee Paid ,---- Typeof Construction: CONSTRUCT 16 X 14 3 SEASON ROOM ON EXISTING FOUNDATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 067059 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOP1ATION 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 :mmission , 6 / z— 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. t ".,. F WIW16CERD"¢ BP-2003-0229 GIS#: COMMONWEALTH OF MASSACHUSETTS 7- CITY OF NORTHAMPTON Lot: -004 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0229 Project# JS-2003-0408 Est.Cost: $18283.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WILLIAM SORENSEN 067059 Lot Size(sq.ft.): Owner: ESPINOLA MARTY&DIANE Zoning: SR Applicant: WILLIAM SORENSEN AT: #4 MT LAUREL PATH - 600 FLORENCE RD Applicant Address: Phone: Insurance: P 0 BOX 25 (413) 296-0129 WEST CHESTERFIELDMA01084 ISSUED ON:9/10/02 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 14 3 SEASON ROOM ON EXISTING FOUNDATION 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 9/10/02 0:00:00 8999 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo