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29-016 (10) ' t C j JUL 2 5 2001 DEPT Of BUILDING INSPECTIONS NORTHAMPTON,MA 01060 1 T 2x8 joists 16 O.0 -- -- - 2x10 carrying beam. _ — 4x4 posts all material is pressure treated i., concrete footings are 48"in the �- ground and 8 inches in diameter r-� LIVING AREA :::::: -:.- _:_ = {� _ _ 4 221 sq ft �_. f1 I!L S E ll,7D Jl 2 5 2001 DEPT OF K M INSPECTIONS NCRTI HAMPTON,MA 01060 D, 7 7' 5c) i p ��1iA11 PLO �C e - 8 6 �:saztrf(nsrtta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE ATTEDAWT (licensee/permittee) with a principal place of biisine .residence at: �ti trti� (phone#) _.. (street/ci ty/state/zj p) do hereby certify, under the pains and penalties of perjury, that: (� I am an employer providing the following worker's compensation coverage for my employees wor sing on this job: A (Insurance Company) (Policy umber) Txktion Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compa y/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shod ifnxcsssry to include information pata.iaing to ell ooaracton) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that vihilo homeowmn who employ p=om to do maintcaance coastruaion cr repair work on a dwelling of not more than time units is which the homeowner raids or ou the grounds apputenarrt il,=w are not gcom-illy oomidatd to be ariploycrs undo the wm+ces oompc=tica Act(GL152-"1(5)�application by a homcowncr for a liccase cc permit may evidcnoc tho legs!status of an omployer underthe Workces ConVamation Act I understand data copy of this rutcmcnt may ba forwarded to tho Dcp utax of I.&L t icl A.&.&Quinn of I,_—for tho coverage vaif cation and that failure to secure covaago under section 25A of MOIL 152 can Ind to the imposition of criminal penalties ooasistirsg of a fine'of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Ot and a film of s 100.00 a day against ttx For dcpartm —roll' Permit Number 41eMagi Lot#Signatnre of License&Permi SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ __— Name of License Holder License Number r'� ,mil v_�✓bi v�y'�-',� `';.� ___. +` � � .��_` ��,`�`4'4'' �., `` ,�` Address r 1 Expiration [ to Signature Telephone 9..Re isered.Home lm r`vemen Cori"""ractor ",d uE ' ` aQ Not Applicable El Company Name Registration Nu er Address Expiratio D z TelephoneC 7 SECTION 10 WORKERS' COMPENSATION INSURANCEaAFFIDAVIT',(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 SECTION°5 DESCRIPTION'OF'PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other [ ] Brief Description of Proposed Work: 1,;g X// ' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll D - Sheet❑ 6a,"If New hoitse and or addition`to"eic'istin; "ti0usinfY; complete.the,4611owint�: 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? -? aQ 9 ' d. Proposed Square footage of new construction. / Dimensions a X I 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 OWNERAUTHORIZATION TO BE GOMPLETED WHEN OY11N1=RS AGEIVTOR CONTitgCTOR APPLIES''FOR BUILDING,PERIINI7 �X t L7 as Owner of the subject property hereby authorize to act on my be f, in all matters rela 've to work authorized by this building permit application. Signatu a of ner 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. Signed under the pai s and penalties of Perjury, Print Name Signature of Owner/Agent D to 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 @ © 0 , `� Frontage G Setbacks Front 3 Ab SiA,3 L: R: L: �R: s Rear�{ Building Height Bldg. Square Footage, J % a c) 9'0 o25 Open Space Footage % �7 (Lot area minus bldg&paved arkin l Q� B 7 J �6 g6/O V #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 -A 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: � � �! a R .;f r . ........ .�..�._._..._�. ...,.: .,.,� '4 E I f Northampton Stmt sod=f.. x ; Department curbrDv er- 1 ain Street S„ew rlSep t a>1 JUL 2 5 2001 om 100 a erly' Nor am ton, MA 01060 o SetsofSfc c ure a ,, 7-1240 Fax 413-587-1272 PIotlSitePlans ` DEPT OF BUILDING INSPECTIONS OtherSpec�iy NoRTHAMPTON,MA 01060 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be;completed by of�f►ce 1.1 Property Address: f Map Lo# nit o�fa c r Zone - ' Overla�District _ � f [s,•-,;,7 X11 '�. K`, _ , sp � '. ��i,. v �.r„ y. �,� �� Elm St District _ C' strl,tom SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name int) ,q Current Mailing Address. T gyp. ° e� it t r 6�, �-q 2 Signature 2.2 Authorized Agent: Name(P n Current Mailing Address: Sign re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COS TS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building p (a) Building Permit,Fee lAo 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) OC) OG Check Number i 1, This Section For Official Use Only Building Permit Number:_�iU ' Date Issued: Build,ing`Coiijrnisslo er/Inspector of 8 410]1rrg Die File#BP-2002-0096 APPLICANT/CONTACT PERSON William Rock ADDRESS/PHONE 23 Amherst Rd (413)256-4930 PROPERTY LOCATION 32 HICKORY DR MAP 29 PARCEL 016 001 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 17 X 12 DECK New Construction Non Structural interior renovations Addition to Existiniz Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Denied PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan OR Special Permit and Site Plan Major Project: Site Plan OR Special Permit and 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 Stre Commission 4_5� 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. s` + r a ,� � k lots, �t � �; x , s g, r' '" "` - �a. a I t^ '„`t _5 n `". .,F,.s ,k,, ¢t„ w3{F'. m}rz.��$`x.>'. r r z�,,.'je'�k ".j.: a..,,, ,, "e'+3 '`(jF �.,{k Mx rr >Ya y^,� ',' ¢:3 � %F. *..'f€' '� .:,-'' :s F'' +gr g �''' �2 "Hs a 2" + ,-" y ax 7.x � +,I zr- ;y a� �. +' � z+^ 'adz:,ur ., et r 4 r.�t ' g �t ' ' .�Y' r; v;.� hh„„ t `}'�E�"x"3 �r§' X ra"y MR,4-1 11 if, t 3� `" '�` t �� +�" 'k¢'. hr1 ,.e� T} ��. 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