29-540 f
�o oy
R .E (riff of ��rrz-�lf�111}�f011 -
lf3f tr11ncrlta =
. 3 DEPAA T MENT OP BUILDrNC INSPECTION'S �=,
212 slain Street ' Municipal BuildinE
Northampton, Mass. 01060
WO>uCER'S COi1IPENSATION INSVnA.NCE AFMAVIT
�;�t1s�p�rrr„ttcc>
\%Ilth a principal place of business residence at:
- 6 TZ v ,6 C (p on YfJ j7T,/-
(sac--U6 ty/siaic./zi p)
do hereby certify, under the pens and penalties oil peg(ry, hal
(�(I 2m an ernployer providing the Iollo\vin�-, workers coinncns L,on cove:-^c for In)-
eluplovees worming on this job
(Las-u c-- Company) (Pc6c-. NtL-,ib--r) (1=;pirtaon Datc)
( ) I am a sole proprietor, general contractor or homeovL-Def (circle one) a D d have hired
the contractors listed below vybo hzve the follo%,vUq, -worker's comen--,2tion pchcies:
_ (Name of Con!,mao-) — - (Insurane Compaq}ri'eue, ?�'um .) �i=xp;,I::or. I��tc)
- (Name of Contractor) - (Inslr2ncc CoIDDazy/Polic)' Nunlccr) (Expo :lion Date)
(Name of Conn-actor) cnnlfancc C-0MT=)•/P0UC) N:unb J) (Expir000 Date)
(Name of Contractor) (Lasuranc-- Compamy/PoLcy Numb) (--xpu-noon Darr)
(�ca�] r::oc�l c'xa itnc �n to ai ud-- infon=-a600 perts.iain.s to.0 ooa-r..co-3)
( ) I am a sole proprietor and have no one working for oic.
( ) I am a home owner perfor7wug all the -work myself.
NOTE:pl—b<ewzre t±ja: 1,Jc bccr�nen ubc mplay pezow w d& c —rk m
not Mocc Lb--n-L—`—c—ua?j in ubich the tw;mo-aver r-&=or oa the p-ouDCb z,7p.:rtcn:r�jbe- ��nx Gene-Uy occ:r6--ci to be
ctpleyc-3 une—the..o-4—o Eoo Act(GLI 52-,-z 1(5)�ap Uc bc-c try a bomoo Qaer fm ce permit rn:y—,de trc
I<5l.l nnn,c of n —PIOYK under da Wortida cocap �^,d
I LLO&C Lad dw i copy of llw eatery W y bo forwnrdnd to Lt,DCV6('t,,cd of j,4,Ltlel&mdc &otroo of lr��for tb-
covmsc ,a-itcx;oo and t1v L•ilta<w cocurc covvrA�&r tmdcr iocxioa 25A of}JOL 152 cw Icad to Ll o i,x>=ji3m of criminal pcazLWc3
oo MLVLc fi of a rine of ilp In S 1,300.00 frlNcx,c=Tz i3�of up to ooc year e'd 6N.11 pmtl'�o o ff�focm or a Stop Worf Ordu and a
rite o(S 100.00 t cLy tEz=tnc
Fo dc" oily
Pmt N�� (—
__ _ 1 p:;---- I of
SiE;natun of Licxri5cc/I'cnniticc —�3�e
� r
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable 13 Name of License Holder: " L` t ✓t � `���`� '0 3,i v73
License Number
�6 f'E C-&-J �� _ a 9 - IS - 01
Address Expiration Date
Signature Telephone
y�1 - Spy - f ZZ
9.Registered Home Improvement Contractor: Not Applicable ❑
/d 7-rz,?
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8))
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 Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
R
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
x':11 J It 19 L yXt-ib,r— '��/ �7�rt.t�r+f 1 j-j This column to be filled in by
�
LA.F—, it Building Department
Lot Size
Frontage P`'
Setbacks Front
Side L:W R: Z? L: ZQ R: 12,
u
Rear l 2fl
Building Height ZJ�'' S
Bldg. Square Footage /o
o /J
Open Space Footage %
(Lot area minus bldg&paved '120
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 0 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 Book Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO � DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained l 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 NO
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 Q9
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
03x'2612008 09:47 FAX 4133847340 [6002/002
{
SFLTIQN'tr ne$CRIPTIQK-"OF'''RR 'W,QM. 1cb&k 4-bj T#gAh .
New Noutm Addition ] Replacement Windows AlteWdoni El
Or Door* 17
Ac*Mory Sldo, ❑ Demolition Q New Signs [p] Decft [Cj 81ding[o] pater[p}
BrIef work,pescriptiorr of Proposed 141& T W"d
Alteration of existing bedroom_____Yes No Adding new bedroom ' Yes No
Attached NnrraW Renovating unflnished basement —�j es ✓ No
Plane AitachttfRall -Sheet
a, Use of building:One Family Two Family Other
h- Number of rooms in eao t family unit: number of Bathrooms_
o. Is them a garage atta0hed?
d, Proposed Square footage of now construction.. Olmensiona
01
e. Numberofatorlse?
f, Method of heating?_ Fireplaces or Woodetoves Number or ea0h
G. Energy Conservation Compliance. Masechack E=nergy Compliance form attachad7
h. Type of constructlon
1. Is wnstruction within 100 fl.of wetlands? Yes No. is oonstructlon within 100 yr, floodpiain_YeB_No
j, Depth of basement or cellar floor below finished grade
k, Will building conform too the Building ana Zoping regulations? —Yes—No.
I, Septlo Tank City Sewer Private well _ trlty water Supply
U0M- H 7a,r OWNKFi AUTl;*�A't'IgN-TO aE COMPLISTED-WHEN
.C(WI3KE[6 A0ENTIOR'CANYRIICT(6 ''APpLIEB F4R>B[11R�1,1`Klfi I�MIT
I 6/#1014 op,!)f as Owner of the subject
property
hereby author'
oe
to ad on my beha , I matte relati a to work riuthofted by this buikimg permit pllc Ion.
Signature of Owns Date
r
as Owner/Authorized
Agent henry declare that the sb►tements and information on the foregoing eppliostlon are true end accurate,to the beat of my knowledge
and WINE,
Signed under zt,-;ne and penatt wf penury.d re-l.-:
Print Name
Signature of OwnOq ent
03/26/2008 09:47 FAX 4135847340 001/002
w f
I
n I =fhamption
Rartment
212 M06 Street
Room 100
t Ivwk 2 I�ampWK, MA 01060
phone 413-687-1?40 Fix 413-587-1272
.._
'S
A�PPU'4T�,�6kTO REPAIR,RENOVATE OR DEMOLISH A ON OIL TWO FAMILY DWELLING
5EC'OOI'1 $ITE'iJ IP01rMIA7tON'
1.1 p'�t�eRvAOdraee; �tleF'�a�qA,+tp'bdcbfliipt!'b�!oAlt=e; ,'
em aria yu--• Lot Whit
Zone
' lo>CrIDt;
$EC;--n 2-PROPERF1r;OMERSI4IR6AIJTkiORUEO'AOF-N7 �-
2.1 Owner of 4{gmrd;
Name(Print)( CuMknt Milling AgdrM: �
Wotan Tbiepiwnrr 6- 6331
rl _ f
1�► JE►� f .2 J i lk✓►C f!- 7.1S' 1 / /AviJ
Name(Prtnq CuITent Meiling AddIgC,S:
'pry - ,zzy
VMQN 5lpnalure Tel Hone
8-EmgAftco NG
Item Estimated cost(Dollars)to be Ofmcial,Use;Omly,
Completed hV perrNt&Rficant
1. Building (e),Buliding-J'ermit.Fee
2. Elect6cal (ti),Estimaterl;"r II .. of
Can tr btlart; to
3. Plumbing 861414 N0rxkF4E'
4, McChenlcal(HVAC)
5. Flrp Pratectlan '�
6. Total m 1 +2+3+4+5)
ChroOk'hlUrriber'
Date
TIiIs•8eeddn For'Qfltclal tJsaOrtl ,
Building Permit,Number: tetSU Issu
- --- ed:
Slpnatum-
t3ullg tomrnlpaldr�err7riripeci�or t3uUtllnos Dew.
f
M
• Fi4l&#BW2008-0831
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584-1224
PROPERTY LOCATION 48 INDIAN HILL Z 37-_32Q5_C C'GC
MAP 29 PARCEL 540 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 7T55 P
Typeof Construction: CONSTRUCT 16 X 24 MSTR BEDROOM ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessor Structure
Building Plans Included: '
4.✓
Owner/Statement or License 039073
3 sets of Plans/Plot Plan
THE F LOWING 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 lay
Signature of Building Offici I 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.
I
i
j)
JJ Y
r T R T,4; f Y
IV
RPMv.
' a}ed p
joloodsul
pu-
p
138tH N01103dSNl Wawa
F
" Q uojdwe4PON }o 43
t
t:, 4
Mb # k :� # � t '�5 s r# -��oYtbk.�w3° �;,.�..s+ �h��.?�`�l•.
ale ,
oha l dsul " .
d a{
O IA
1'3 BVl dWeu�o
UO\
U
I .t
t
1
3
48 INDIAN HILL BP-2008-0831
GIS #: CO?YlMONINEALTH OF MASSACHUSETTS
Map:Block:29-540 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit:` Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0831
Proiect# JS-2008-001269
Est. Cost: 819.2.00
Fee: S 192.00 PERMISSION IS HEREII Y GRANTED TO:
Const. Class: Contractor: License:
Use Grggp Oliver Iselin 039073
Lot Sizc(sq. tt.): 11151 .36 Owner: WILLS CYNTHIA J &JOHN 13
-r_,,,, ,,..- �)'RA Applicant: Oliver Iselin
AT- 48 INDIAN HILL
Applirani Address: Phone: Insurance:
36 Service Center _ (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:411,12008 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 24 MSTR BEDROOM
ADDITION
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; 3 fb house# Foundation:
.Driveway Final.
�3 CD
Final J�'—� ✓6 ll I( Final: ' 7 7
Rough Frame:
Gas: Fire Department Fireplace/Chiniuey:
R;)ugh: Oil: Insulation: I,/_ Z�
Final: Smoke: Final:QX 6 —//-OF
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIOh' 1_!I'
ANY OF ITS RULES AND REGU IO
Si natw•e:
Certificate of •ccu any i _
FeeTvpe: Date Paid: Amount:
Building 4/11/2008 0:00:00 $191001533
212 Main Street,Phone(413)587-1240, Fax: (413) 587-1272
Building Couunissioner-Anthony Patillo