29-450 (11) 24 CRESTVIEW DR BP-2000-0868
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-450 CITY OF NORTHAMPTON
Lot:-001
P Buildin
Category: vinyl siding BUILDING PERMIT
Permit# BP-2000-0868
Project# JS-2000-1614
Est.Cost: $4495.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THOMAS BACIS 1 261 16
Lot Size(sq.ft.): 1001 8.80 Owner: SHELDON ERIC D&KAREN G
Zoning:URA Applicant: THOMAS BACIS
AT: 24 CRESTVIEW DR
Applicant Address: Phone: Insurance:
114 LINE ST (413) 529-0801
EASTHAMPTONMAO 1027 ISSUED ON:4/10/00 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 4/10/00 0:00:00 641 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
City of Northampton
Building Department
212 Main Street
Room 100 "
• Northampton, MA 01062
phone 413-587-1240 Fax 413.587-1272 = �
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This section to be completed by office
1.1 Property Address:
o� t( Map Lot Unit
c.,(e57 V+ et4'
l ✓t�►c C /"f Zone. Overlay District
Elm;SI.District . CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
k Gt r{' S R I CJ Or■ SQ Y►'t L
,,Amilame(Print) yi Cur t�Mailip �ress:
Telephone
Signature
2.2 Authorized Agent:
7A ar~.0 s /4. ( Lt S 114' LI\Ic' $ 7 '6T 7Liurip r.
Name(P 'n ) 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 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection �l
6. Total =(1 + 2 + 3 +4 + 5) . Li y q S- Check Number 67
This Section For Official Use Only
Building Permit Number. Date Issued:,
Signature:
Date
Building Commissioner/Inspector of Buildings
• OP
lb
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 ✓ 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 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
IF YES, describe size, type and location:
D. Arp there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
J"w'CTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New Air ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
WRIF
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding* Other [ ]
Brief Description of Proposed Work: v/4 ((// \ 5 e.e€ V /
Alteration of existing bedroom Yes No Adding new bedroom Yes V No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a.,If New house and or addition to existing hauling, 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. Mascheck Energy Compliance form attached?
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, , 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, /116r4 us (aLLj'I , as Owner/Aut
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
,signed u
ir
the pains and penalties of p rjury.
Print Name
7-Z.....1.4., 4, 6 _- c, — 6,0
Signature of Owner/Agent bate
•••
Atiok
#40'
CTION 8-CONSTRUCTION SERVICES
tt.1 Licensed Construction Supervisor: Not Applicable ❑
c
N ense Holder : / '7 Oret f '3 Ct�f Q 7606
t f
a License Number
'V /L-r /1 S '3 -(— G c
Address Expiration Date
%i i , 52-9' -0 b 6 f
Signature Telephone
I :feII tttfi31>ito►e1Ch'tlfifir`, ..<<E. .. ,. '. "., ;. " ` Not Applicable ❑
,k/e 'v fi /av I at"oder,1,19 1 1-6, 1(6
Company Name Registration Number
l f Y t--,V► e c7/ C( Z Z — O
Address Expiration Date
(.t S7/16% ✓ti p 9U■■ / • Telephone 5)-g— Gt /
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.
6'igned Affidavit Attached Yes pit0 No ❑
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
VINO
ofieht
•
.-(1(AJ-!p�,
g N to f ll a-m*1 n
'fin',"tie gasaxchnsclla
000 DEPARTMENT OF BUILDr-NG INSPECTIONS
212 Main Street Municipal Building -11
Northampton, Mass. 01060 IMP'v
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
-7/10w►q J / 1,G L,•S
(li ccnsec/pectin ttec)
with a principal place of business/residence at:
114 L r -c 5 7t lei S 74q -6^
-- -- — — h Ai 6/aLi(phone;-) 5�9 �og61
(strt/ci ty/stab in p)
do hereby certify, under the pains and penalties of perjury, that
( ) I an an employer providing the following wor'ker's compensation coverage for ni
employees working on tins job.
(Lummsnm Company) (Policy Nu= r) (L=xpiraon Dale)
:-.1 I a sole propnnetol, ,eneral contractor or homeowner (circle one) and have 'tared
the coonactors he ielow who have the following worker's compensation policies:
(Name of Contractor) (lnn!rance Company/Pokey Numbc:) (Expirtuon Date)
(Name of Contactor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurancc company/Po Licy Numbu) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additi caoa I risers if nocenary to incluck inform,r;oa pertaining to all ccoh-a..on)
czt I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcsc be aware Chad while homcowocn wbo employ pctoai to do m.iatim c riioo or repair work on a dwelling of
not morn than throe units in which the ho owner resides or ca the Rounds appurtenant thcetn arc not geacrally comp:derrd to be
employers under tho worker's occDp=zsatioa Act(GLI52.,s 1(5)),application by a bomowan:r for liceasc or permit may cvidcoce the
legal ctanu of an.roaployec under tho Worker's Coenpaaaarion Act_
'" t uncicrrtAnd that a copy of this aEat.cmens may bo foewnrd.od to tbo Dcpartmcns of In„Amtiai Anodcncti'°taco of Isar:nco for the
eoventge verificzaioo and that failure to secure coverage under section 25A of MoL 152 can lead to the imposition of criminal pcwdties
oomutiirg of a fine of up to S1,500.00 end/or iroprnnemertt of up to onc year and cavil pera.Ilia in the form of a Stop Work Order and a
fine of 5100.00 a day againA me
For depa.-ax am tLC Daly --- f---
or /�� Permit Number
I� ''-"� 1` 30 Lot n
--------- ------
Si 3cure of Li Mize-
—- —
�` arLScelPcrnuucz
• *OPP
joss
ri
AIN