29-219 (2) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: I..AJ
License Number
3 lC t—�a �t N _iy1 to
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractors Not Applicable ❑
)!?2 w \ c)7oo�.
Company Name Registration Number
Address Expiration Date
&YAV AVN\(VIVIY r 4/11A bibb 0 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 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 Icheck all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [[] Siding[[--31 Other[o]
Brief Description of Proposed
Work:n�AA=^ate . /�lA e ltivt �►� L�D!'S`' Y ',i ('JJV-to ;-Cccf{
Alteration of existing bedroom Yes v No Adding new bedroom Yes Y No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existina housing,complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathro ms
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 1 of wetlands? Yes _No. Is construction within 100 yr. floodplain Yes No
j. Depth of base nt or cellar floor below finished grade
k. Will b i ing conform to the Building and Zoning regulations? Yes No.
I. eptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR/CONTRACTOR APPLIES FOR BUILDING PERMIT
C__14� as Owner of the subject
property
hereby authorize
to ac y e alf a m ers relative to work authorized by this building permit applic ion.
�s
Si ature of Owner Date
I � as Owner/Authorized
Agent hereby declare that the sta`d1nbrits 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
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Buildin epartment
Lot Size
Frontage
Setbacks Front
Side L R: �� L: R: VJN
Rear 1 4
o
Building Height u'
A,
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pa
parking)
#of Parkin aces
(volume&Location)
A. Has a Spe,flat Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES
IF YES, date issued:''
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 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 0 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:
E. Will the construction activity disturb(clearing,grading, exa6vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use,I
City of Northampton Status of Permit:
Building Department Curb Cuttl)6oway Permit
vt,/ �U 212 Main Street Sewer/Septic Avellabillty
Room 100 UyaterNifell Availability
.Northampton, MA 01060 Ty�o Sets of Structurai Flans
``phone'413-5$7-1240 Fax 413-587-1272 PiotlSitl Plans ,n
Other Specify W
APPLICATION TO CONSTRUCT,ALTER,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
A-7—TI e D R... a Map Lot Unit
Cam'- ",AA C) i v to 7 Zone Overlay District
Elm St.District CB District
SECTION 2.PROPERTY OWN;RSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
2,` i3ew 6-,e �,Y,-od
Name nt) 1° Current Mailing Address:
Telephone
. —- - hone
:-- p /q
Sign ure
2.2 Authorized Agent: �7
4
Name ri�t)^ �. Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building -2 . (a)Building Permit Fee
2. Electrical U I r, �r►'�`fYL+A c.q (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) �%?c �L � Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0569
APPLICANT/CONTACT PERSON ROBERT WALKER
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 28 BEATTIE DR
MAP 29 PARCEL 219 001 ZONE URA(100)//WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out _
Fee Paid 171�9j P/
Typeof Construction: REMODEL BATHROOM REPLACE KITCH CABINETS,MISC REPAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 034783
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFP�RMATION 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 Delay
04, lVCA f i0 ar
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.
28 BEATTIE DR BP-2009-0569
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mag:Block: 29-219 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: ""WILDING PERMIT
Permit# BP-2009-0569
Proiect# JS-2009-000810
Est. Cost: $27000.00
Fee: $162.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq. ft.): 1533112 Owj,er: VITO MICHAEL 3
zoni ng: URA(100)/AVSP Applicant: ROBERT WALKER
Applicant Address: f ituu. Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTONMAD1060 ISSUED ON:1211112008 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM, REPLACE KITCH
CABINETS,MISC REPAIRS
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:j.-_— House# Foundation:
Driveway Final:
Final:t#— n -h�j UFinal:,;
Rough Frame;
Gas: Fire Department Fireplace/Chimney:
Final: Smoke: Final: j 0 5/ 0n�I S
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. y
Certificate of Occupanc , Siunature: -
FeeType• Date Paid: Amount:
Building 12/11/2008 0:00:00 $162.001355
212 Main Street,Phone(413)587-1240, Fax: (413) 587-1272
Building Coimnissioner-Anthony Patillo