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35-018 t s g a � i 1 � B f> r 9 t t� � r.,f• pn�� � cIIAY t �1 4 t Z- Yc'r '.e� -L R fi Crzf� of �a-#Ij&Ill�]fDli 9 B Aasaxchnsctto - d DEPARTMENT OF BUIIDD\IG INSPECTIONS 212 DIain Street ' Municipal Building Northampton, Mass. 01060 WORTCER'S COWENSA`TTON INSURANCE Al FMA-VTT (hccnserJpermittec) with a principal place of business/residence at: S" 1 ��✓>=�s �_/ /` d,n-A rr AZA2. r- 0164� (Phone") (stzr...t/ci ty/stale n p) do hereby certify, under the pains and penalties of perjury, tliat: O I am an employer providing the following worker's compensation cove.,-age for my emplovecs working on this job: (L>Lnl_rance Company) (Polio Nu_rnbcr) (Expirtion Date) O I a-m a sole propl-;etor, general contractor or homeowner (circle one) and have hired the contractors listed below v;'ho have the following worker's compensation policies: (Name of Contactor) (lnsurancc CornpanyiPolicy Numbcr) (Expiration Date) (Name of Contractor) (lasumc-- CompanytPolicy Numi:er) (Expiration Date) (Name of Contractor) (Inure: Compaoy/PoLicy Numb r) (Expiration Date) (Name of Contractor) (L su=ce Compauy/Policy Number) (Expiration Date) (-Hash additioml shoct ifnoocrury to include infocrosrioa pertaimng w all ooat,nc o:s) I am a sole proprietor and'have no one worming for me. O I am a home owner performing all the work myself. NOTE:plcsc be awzm thu wfrilo homcrnvnaa who cmplay pczoni to do moo or rcpaa work on a dwclliag of not morn than tbtno units in wfncr the homoowtxr rc=dc3 a oc the grounds appur�therm tic not gcncrnllY coomdcrmd to be employers under the woes cts axnpcu-tiro Act(GL152,m1(5))�application by a homcowrrr for a bcc We cc per i maY evrdcnoc the JcVl ctnhu of en employe`under dh Woricole Coatpomaitoa Ad I undcrztand tai a copy of this aril—cps may bo forwurdad to tbo Dopartmcaa of Indzi:;rieJ Ana off o of ln,u for tlm covcrugc vcrificsiioo and that f_ilurc to sauce coverage under socuoa 25A of),101,152 can Imd to tha impoufioa of aims-1 pcnalttcs oomiuting of a fine of up to S 1,500.00 and!«imlu i3�of up to one year acid civil pm*ltin io the form of a Stop Work ordcs znd s fin-of S 100.00 s day a gains me Foc dcp:runcoW use only Permit Numlx� _ ® =1 pt Z�OQ 1\t,p I of N Sigiaturc of Licctrs<xJPcrmittcc e •- N SECTION 8—CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: x License Number o0%a/©9 Address �y Expiration Date Signature Telephone .a E �9. Md sf r t! {im lm'"1r "mn. ohtract r� „E',x , ,x�_ Not Applicable ❑ Company Name ® Registration Number Address Expiration n Oate 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...... ❑ 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 s .. SECTION 5 DESCRIPTION OF.PROPOSED WORK check all applicable) New House ❑ Addition ❑ Replacement Windows [Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolitions New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: HMO 1V � v� R ltlati Alteration of existing bedroom Yes >( No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 65 Ifs w e ��oir drlit '"ri o:,.�xis=tin "N rsiri ` com e'tb'V he.follow 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? 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 I, X C t�.:i`T'l c I 1 1 . k� r,f-/41I t as Owner of the subject property hereby authorize ,��- �v �`� �'1 d to act on my behalf, in all matters relative to work authorized by this building permit application. Signat of Owner Date I, Uca ,L® �I C� ��e Y!h a ash/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 under the pains and penalties of perjury. Print Name Signature of Awmer/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 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: -City of Northampton . Building Department 212 Main Street Room 100 Northampton, MA 01062 b phone 413 7587--1-240 Fax 413-587-1272 a APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: This secs#tor► pe�compleied b offCe . -� A :""":'1'7'p fi o � tlr�t 6°.�d y�ch r•ra_rs 0 69�� Zone �A�r�rldyDistr�rct El dSt District , CB Distrret SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 7C y � Name(P"t) Current Mailing}Address: �— ! --- d'-, -5 K z Telephone SignaYure 2.2 Authorized Agent: �1 a=V Z— Name(Print) 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 a (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) ��, ecJ Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0781 APPLICANT/CONTACT PERSON RICHARD DENNO ADDRESS/PHONE 551 FLORENCE RD FLORENCE (413) 584-0852 PROPERTY LOCATION 132 WEST FARMS RD MAP 35 PARCEL 018 001 ZONE SR(100)//WP/WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 7VIC AL Typeof Construction: REBUILD FLOOR IN EXISTING 8 X 14 ADDITION New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 066189 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Delay 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. a� ark �•"°�*r� �`� � '���� "` ��`-�.� �'� .` - �` .. 4w 4�A�ik t t ka 5 � Lc Y w ,�Y �N 132 WEST FARMS RD BP-2009-0781 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35 018 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit:- Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0781 Proiect# JS-2009-001167 Est.Cost: $6200.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor: License: Use Group: RICHARD DENNO 066189 Lot Size(sg. ft.): 23348.16 Owner: KINDAHL CAROLYN J Zoning: SR(100)//WP/WSP II Applicant: RICHARD DEN NO - AT: 13 W EST F I.-Z M 5'R ` Applicant Address: Phone: Insurance: 551 FLORENCE RD (413) 584-0852 FLORENCEMA01062 ISSUED O1y:41212009 0:40:00 TO PERFORM THE FOLLOWING WORK.-REBUILD FLOOR IN EXISTING 8 X 14 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: Rough: Rough: " House# Foundation:QLC S ©� 7-4 9 Driveway Final Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: I?�►�t¢h:_ Oil: Insulation: Final: Smoke: Final: ©#' L4 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL TIONS. -Ced,i ICat@ Of OCCU an Si"nature: FeeTyge: Date aid: Amon,nt: Building 4/2/�9Q9 O:OQ.:00 _ $55.001013 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo