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29-225 (3) JUL 1 2 20M McCutcheon Cos : ' ;�� _ ¢ - Full Service General Contractors 87 Chestnut Street Florence,MA 01060 (413)584-3352 qq y rQ) 1 1 � 1 t t s �\V` l 2 20M McCutcheon Construction L DEPT OF SUi±D1G iii SPRU!'', Full Service General Contractors 87 Chestnut Street Florence,MA 01060 (413)584-3352 T`v - Vt-- L40 PUAH Grify) of Out[juillp Lill 4 � E ,31.ssACf7atttte w OEPARTMENT OP BUILDRvIG INSPECTIONS 3 � 212 ?(lain Sirect * Municipal Budding Northampton, Mass. 01060 WOJ ICLR'S COi�TPENSA`IION LNSURANCF AFFIDAVIT 01 ccuS:c/perrni ttcc) nth a pi-Mcip�.l plac.° of business/residencc at: cz (s1-Tr:--4/cIty/�s >,c-lzl p) do hereby certify, under tic pains and penalties of perjury, :hat ( ) I -Im an employe" provldln- the follovlgm wo,"Ker'S corm)c1lS ,lOi: Illy cmployccs w01'11-inu ml t-11s job- ( ) I am a sole proprietor general contractor or hameowner (cl c;c ore) end lhavu hued the con factors 11s(e, below who have the foUowi9P vlorle�s co oen��on polictes: (Na-me of Coor:;clot) Qns nancc Como�v1pOlic--,, ) (t�T r .lion D2te) (Name of Coruraclo,) (Inatrancl Comv)an)•/Pot:c-) N11irb:r) i1-�pir [io❑ Datc) (Namc of CO[1tPCiCr) -- (Insuranc-- Com1a13)'/Po11cr Numl�J) ���.�+;ira[ion Da1L) (eaAc1: d1: a:a1 r'o_:dn'---.,.,"n p�tnminr,to ell c�rc oa) A I am a sole propnetor and have no one working for me- O I am a home owner performing all the work myself. 1,'OTE:plea 1Y ea-ue t±'i-,-3c bccrr,)"S -n u{yo employ pc Toni e4 r.D "ori: of ON ancc L:-.n!`ro L-Iiu m tft:boc:YSrAVCr rtvd�oc oa the p�.ua1- n:.t :2-y w tic �—tpicyc ui-x—'tb_ cc:�;.^.:-u on Ac,(GL152-"1(5)�-ppbcation!ry a Lc,, u, fc7 c L --cx Irrniit n-,-v c.,d.'vcc tL�c 1cg1[13'31(of en—TPloy-uod-d,, Wocko(r Cocz§xcnl AcZ I undo-nt d d,-xi a copy of uhf,ctitavmi may bo forv.nrded to tba OfL of lrx��Cor tim ooveise v RG-1100 read ltLl f_dLuc W tccauc covcroj�c under soeUOn 15A of MOL 152 C, Icsd w tha v�-r,-x Oa of c all pe—b- 's coma�of.Crrr or up W S 1.500.00 of up to oix Y,:r zrA 6,i1 pcn,.1',io�9 tx form of.St.a",r Word end a rim of 5100.00 r my rgzLtnA tn_ For r Pcrtnit Number _ C t 01 CC, L --- --- Si( taturL of 1_iari_crJPcrrllittcc- _ 0T46N 8-CONSTRUCTION S,fRYICES d.1 Licensed Construction Supervisor: (� Not Applicable ❑ Name of License Holder: �I l: -i^ OG ZI�_q 4 License Num er ?7 Address 4 a C Expiration Date Signature .Telephone NotApplicable ❑ Company Name Registration Number �- Address Expiration Date Telephone �y r3�5 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. Op"kigned Affidavit Attached Yes....... %L 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 V :10 S- '- SC IP I= POP R Check a a licab New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes x No �LSk Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet- ..; he hk 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 RE COMPI. I ED WHEN QVdN IRS,AOEi�i Q „ ON71*ACTC iR APPLIES FIT UII; I O p i2MlT 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 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. igned under the pains and penalties of per ury. C Print Name Signature of Owner/Ag nt 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 2L CCU �, Z� �� 9(DJ 6-c� Frontage C?C> -1�1 Setbacks Front Side L: &> R: L:JJA R: Rear C) z O Building Height Bldg. Square Footage (p'-1 O L1 —1 /0 1?co L)to Open Space Footage (Lot area minus bldg&paved �7QC-+C? f 64o �v� parking) #of Parking Spaces Z' 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 1� IF YES, describe size, type and location: D. there any proposed changes to or additions of signs intended for the property ?YES NoV IF YES, describe size, type and location: r y Ili Northampton W 1 Bu I Department i'-� � � ain Street R om 100 nFPT OF BUILDING IN ton, MA 01060 F' .= � � 40 Fax 413 587 1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: Als I' rtpleted- off ce �f ! h k f jqq F:71a,ck Ce4n +� �x �ltrict 00- q, �E9 x f1 cD �* 'blsjrll SECTION,; -PROPERTY OWNERSHIP%AUTHORIZED AGENT 2.1 Owner of Record: me(Print) Current Mailing Address: % Telephone Signature 2.2 Authorized A ent: ' Jd{ Name(Print Current Mailing Address: Signature v Telephone SECTION ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building r C-v (a) Building Permit Fee 2. Electrical _ (b) Estimated Total'CDsi of Construction'from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) Check Number This Section For Official Use Only uilding Permit Number: Date Issued: Signature: Bu lding Comm issioner/lnspector.of Buildings Date r File#BP-2001-0037 APPLICANT/CONTACT PERSON Paul McCutcheon ADDRESS/PHONE 87 Chestnut St (413)584-3352 PROPERTY LOCATION 144 ACREBROOK DR MAP 29 PARCEL 225 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 10 X 16 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 062544 3 sets of Plans/Plot Plan THELOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § —w/ZONING BOARD OF APPEALS 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 jL&V4 'A 044 ne:� 7-13D o Signature of Building O cal 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. ak Ns A Woo toy Scy, ATA VA? If ply t� r' r s' � a l f i y C 9 u dt F Win low to NASA ty Hr h L 1 �� S 144 ACREBROOK DR BP-2001-0037 GlS#: COMMONWEALTH OF MASSACHUSETTS Man:Btock:29-225 CITY OF NORTHAMPTON Lot:-001 Permit: Build n Category:leck Adc on BUILDINGPERMIT Permit# &--2001-9937 ` k JS- Q L%c 20o.00 EN:$50.00 PERMISSION IS HEREBY GRANTED TO: `Const.Class: Contractor: Licenses Use Groff Paul McCutcheon 062544 is J2.1): 15153.$8 QMt2gE�r.- BOWER HQLLY 2onin&URA Aaggmt Paul'McCutcheon -AT: 1!L4 ACREORQOK DB Applicant Addresss Pik Insurance: 87+chestnut St (413),584-3352 FL.ORENCEMA01062 ISSUE.0 QN.*1/13/00 P.,00.- t!_ TO PERFORM THE FOLLO VNG WORK.-CONSTRUCT 10 X 16 DECK P ST M&AN S LE IS MI_BM MM.'T)EIE STMT Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter Footings: Rough: Rough: House# Foundation: lye L14 k Final: Final: ''2G!?d � Bough Frame: Gas Eim fteaften t Fireplace/Chimney: Rough: Qil: Insulation: Final: Smoke: - Final:O k -7 9 S D© I&W THIS PERMIT MAYBE REVOKED BY THE CI OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. ..--- Ce i , I S.gnatu Fee : Rece" 't No Date Paid: Check No: A o nt: Building 7/13/00 0:00:00 ; 4574 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-A khony Patillo