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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
-------------------------------------------------
---------------------
License Number
-------------------------------------------------------------- -- ----------------------
Address Expiration Date
------------------------------------------------------------
Signature Telephone
9.Registered 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 nat 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
a
y
ay.
ao'
31'
C ��
SECTION 5'-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alteration(s) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[0] Other[
� Pool
Brief Description of Proposed
Work: �11YxC 'b 1'� t�C1C Q 1 I�lf' t a-41)(/1 ?�oLro AbK Gamd
1&trt yrN'�/
Alteration of existing bedroom -----Yes b_('No Adding new bedroom_—____Yes o Y,x�c
Attached Narrative Renovating unfinished basement —__ es —No
Plans Attached Roll -Sheet
6a. If New and or addition to existing housing, 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. Masscheck Energy Compliance form attached?
h. 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
�'A Q `!�3—�M A-TT—_ —_ — ,as Owner of the subject
property
- - --------------------
hereby authorize
to act o my behalf,in all matters relative to work authorized by this building permit application.
----- --- 1A;(�lw----------------------LiP 3 JQY----------------------------------
Signature f Owner Date
I, as t!1 _� � _ _ _ _ _ __—___,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 nder the pains and penalties oJaerjury.
lwk r I
Print Na
Signature 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 5
Frontage S I
Setbacks Front .5j 1
30
Side L: 3$ RAS L: R:
Rear '.1�t 30
Building Height 3a
3s �
Bldg.Square Footage 91 %
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 bL DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO C/� DONT 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:
i
Department use.only
City of Northampton Status of Permit:
77!1�wl r Department Curb t/Drivpway Perm(f lta lS 1 41�/lain Street SewariSeptic Availability
bom 100 Water/Well Availability,
'� 5 20 71
{)ton, MA 01060 TwoS'ets of Structural Plans
phone 413- -1 40 Fax 413-587-1272 I?lot/Site Plans
Other Specify
A RtIC*TIONi;TOAQON$TRUCT, LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
734 1 '�v9 ,'� Map---_ -- Lot__ 13s --Unit___---
T`loc'em-f- , VIM a b(Q a Zone_ —Overlay District_---__--_
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-----------------S mcs cun.d__,Deb ( --3N
Name(Print) Cur nt Mailin Address:
--� ��-� -------
�t±-� '//_'��_Jf� _ _--�� _---___— Telephone
�j�$$$ignature ff
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 bX permit applicant
1. Building aI (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
6. Total=(1 +2+3+4+5) '-1 w_-0. cs-L-7, 0 1 Check Number �U d
This Section For Official Use Only
Building Permit Number: t/ Date
? ` ----- Issued:
Issued:____________
Signature: ------------------- ----------------
Building Commissioner/Inspector of Buildings Date
File#BP-2004-1327
APPLICANT/CONTACT PERSON MOFFETT DEBORAH K&JAMES
ADDRESS/PHONE 341 RYAN RD FLORENCE Q 585-5844 Q
PROPERTY LOCATION 341 RYAN RD
MAP 29 PARCEL 135 001 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 u —
T_ypeof Construction:_CONSTRUCT 16 X 18 DECK W/24'ABOVE GROUND POOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
i
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
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.
3
File#BP-2004-1327
APPLICANT/CONTACT PERSON MOFFETT DEBORAH K&JAMES
ADDRESS/PHONE 341 RYAN RD FLORENCE O 585-5844 O
PROPERTY LOCATION 341 RYAN RD
MAP 29 PARCEL 135 001 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
Typeof Construction: CONSTRUCT 16 X 18 DECK W/24'ABOVE GROUND POOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING 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* �' G 197-e
Received&Recorded at Registry of Deeds Proof Enclosed NA } �
Other Permits Required: 0lVAe—
Curb Cut from DPW Water Availability Sewer Availabih y� f �
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Co ion
�ea6
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.
341 RYAN RD BP-2004-1327
G1S#: COMMONWEALTH OF MASSACHUSETTS
"-My.gl k: t CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-1327
Protect# JS-2004-1993
Est. Cost: $7000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 21780.00 Owner: MOFFETT DEBORAH K&JAMES
Zoning:URA Applicant: MOFFETT DEBORAH K & JAMES
AT. 341 RYAN RD
Applicant Address: Phone: Insurance:
341 RYAN RD O 585-5844-0
FLORENCEMA01062 ISSUED ON:51412006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 18 DECK W/24' ABOVE
GROUND POOL
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 5/4/2006 0:00:00 $50.001504
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo