Loading...
29-135 (2) III_ fps, 0 F `E IJT��7 of Portliallip toll 1= y �ltsenc{lncctla DEPARTMEIJT OP BUILDING INSPPCT)O1dS 212 Main Strect ' IJunicipal Building Northampton, Mass. 01060 «'OIUCEWS CON[PENSATION MSURA.NCE AI FUMVIT C-, U (licizuscc/perniittcc) \).rith a principal place of busioess/resideocc at f, ( ci tylstalc/2]p) do hereby certify, under the pains and penalties of perjury, ?11:11 V Z1 -M an employer providin^ tic following worker's cotnocns<:L)o, covc:2^c or illy etuplovccs worP'Ing on ulis job /r3cr�T� v i UPI/ ..��5 �a lv�, i•-3��`,�.i?1/ ��0 1�bbl �,a o � Corr m�) (PoL c-, IN,unai,--r) p I r-,Lion,b 2t°) ( ) I am a sole proprietor, general contractor or homeorY-ner (cu c,e one) and have hued the contractors listed below v.,,Lo lizve the foHo%vwQ worker's comnensaiion policies: (1`lIIri]^. 01- cont::lao-) (lllRlr:111C:: COinoan�'/hGUC-f ��lilTl!'<:) .(!:>:)Iri;:]Oil I��IC) (Name of Contractor) Ras-uiancc. Comoan`•/Po!ie; \tmcrr) (Ex�2ir:tion Date) (Name of Contractor) (Insurance ComPany/PoL-c Numb�f) Date) (Name of Contactor) 0-aal any Compan),[Policy Numbs) T��irltion Dato) (cca�h adJ::;ocz1 c'.ac:ilnc�e:.r� co c.�;!uci-inlcrL�z:iea p�tzin;ns to ell o�a'r.-Gq::) ( ) I am a sole proprietor and have no one worLing for nle ( ) I am a home owner perfomimD all the work myseff. iJOTE:plus be-w re the:1U-c hcG�-n.,b-0 CIMplay j>crtOC to rrnv.ork m.d.• c1L':Z of writ ruccc L.-.a t_`7c=r=aitr in u'b�cb the b7ri� 10"-DC r--'d�or oo tb<p-a.�r`s z;7purt nir_ttrr.D�- c,:,<C- :Ily occnd-cd to Lti cn,loycs u-ry'w tlx-o.-t:ds _lice Acl(GLI 52ss 1(5)�-VgGntioo try a ho-,nwa-Dcr far c l:cca!<oc pnr=rr_y c-r&mcc Lti IcgJ ctaau of cn c ploye undcc tiw Wo,jr-o c Compccnalioa A,,_ I undc-sand c4v¢a Dopy of thiz _y bo forxnni.ed to tbo D,1�,xry of 1ncSwiJ Ac d_[Y O(L oo of It>;rr. ror a_ oovcnsc vvit]Cliow a d t1w f_ilrarc to'--rc cove under soctioo 25A of MCL 152 can tud to tb-.u-9 ositioo of czivi0A pcw',W- ooasirins of z fin-_or up to S 1500.00.r,d"crr{n i Doak n of up to o,=ye:r ar�l 6�i)pm P'.io Li dx form of a Stop Work Order cod a rim of S 100.00 r d-.y agAjwJ t>x roc oily PcrULt I`Lanbcs N'Llp" Lot - SiP-Iaturc of LiccJlsCCIPCrtlti �Ce ���C`�I�1N g CfJN5Tf�UC7`IL1N SlER11I��S _, 7.1 Licensed Construction Supervisor: l Not Applicable ❑ Name of License Holder License Number 7R/ Ge i � b/9O Cdr}Git2 Address Expiration Date CAP- m4e t) Signature V Telephone —7 V , Not Applicable ❑ 100 Vg Company Name Registration Number EIQ4/4�� 0 6,/,9—�-Qo�)-- Address l Expiration Date //O- tecTIA Yr, 7-05 Telephone SEC' IE #. WO>7KERS"CCtMPIs?I�15ATItN`1NII.IFtANCE AFIbA1C1T(M.G.L.,c:152,§ tr �r. . 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....... O'� 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 tf .,.. New House ❑ Addition ❑ Replacement Windows Alterations)❑ Roofing 0 Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding K Other[ ] Brief Description of Proposed Work: °'— ,TV-5 TA/I 1/1 A) S!D, n► 99 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet❑ 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 SEC fl[17a OWNI I ,+ 1JtHt)�21 AT14N•T BE'G01YillrLETIFD WHEN ar>fCI RS AG T©R GONTI2ACT,O� APPLIES aR WiI! G Pt,RM I'T I, vflrrJ 5 mG { .kaw4i My t as Owner of the subject property hereby authorize m , /3 R"4--J - to act on my bebalf, in all matt s relative t wor a thorized by this building permit application. Signature of Owner V Date 1, '0 1, , A aster/Authorized Agent hereby declare that the statements and ififormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 401,J l I /79�J Print Name Signature of Owner/Agent Date s J� 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. Are there any proposed changes to or additions of signs intended for the property ?YES_ No IF YES, describe size, type and location: Clt�f Northampton 4 6 2000 B' iYding Department ' SEP 2 kl +. 21 Main Street ' 1�NS oom 100 ton, MA 01060 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING GTION 1-:SITE INFORI, ATION 4 1.1 Property Address:` 3-el) sJ , 0,190 f' ECTIOI!12 PROP 0W(xII:R { PAiJ7'Hf�RIZR.AIENT 2.1 Owner of Record: �5 Nam int) Curr,gn Mailn Addrepzs: ok" aj Telephone_ Signature s cS 2.2 Authorized Agentjo;e, z5 iv, ,JILf�Oz� '�S/ T�3sa� �Ofgl�_ f A�,,pTO ' ' Name(Print) Current Mailing Address: Signature Telephone v s IQ T ATED ONSTRUCTION 005T5 Item Estimated Cost(Dollars)to be Ofdia1lls ,4rly completed by ermit applicant 1. Building (a)Building Permltfee= 2. Electrical (b) Estimated Total Cost"of Cons truction''from,, 3. Plumbing Building Permit t:e" 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) ' d a °.-= Check Number 173W r ` This Serf h For Official Use Olily Budding Per Nrriber: bate IssuerL Bullcting Ct rr►mt lgner�In: pector oaf EU c lags Date' 341 RYAN RD BP-2001-0318 GIS#: COMMONWEALTH OF MASSACHUSETTS a :Block:29- 135 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:vinyl siding BUILDING PERMIT Permit# BP-2001-0318 Project# JS-2001-0523 Est.Cost: $3400.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sq.ft.): 21 780.00 Owner: MOFFETT JAMES&DEBORAH Zoning:URA Applicant. B & R Siding AT. 341 RYAN RD Applicant Address: Phone: Insurance: 781 Bridge Rd (413) 586-4167 Workers Compensation FLORENCEMA01062 ISSUED ON.9/26/00 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 9/26/00 0:00:00 17286 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ow