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35-109 (2) JAN-11-2002 09 :57 AM LEADER HOME CENTER 602 257 7939 P.104 II J i i � II !� it 7� 1 I t� .._. Oy I I I I � I s s I I t ksith h8 t: rttiltvn I+iIFG Meriltat Woodward 2001 Client i View Plan l Scale scale to fit Phons:413 887 0763 ( Door Style:Northport white .,^_.....� Design hamilkton room ROM'-. -� Hlandle Cantinuos 7 Date 1/10/02 _ r 1 4�1iMrPT0 goo °e Crx Df wart[Jaillpf oll a � �iSaiC}l itSf llS m DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE Arl MAVIT (licenSCfJperunttec) with a principal place of business/residence at: _��41t ; A4 � ' , "�� '��•,� �. F (phone#) (strezUci ty/stn-fr�ziP) 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 working on this job: (l s-u.rance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, ge �who h neral contra o�;or homeowner (circle one) and have hired the contractors listed below have--the following worker's compensation policies: �t (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compmy/Pot cy Number) (Expiration Date) (Name of Contractor) (Insurance Comp a ny/Poky Number) (Expiration Date) (attadt addrtio(1il sfxct if naccssary to include wfb mi on pertaining to all oodrnctors) O 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 awaro that while homcowocra who employ pczom to do I A=tcaxn cc�cor�oa or repair work on a dwelling of not more than three units in which the homeowner mides or on the U-oundt appurtenant iherdo arc oot gcnnc ally 000mdacd to be employers under the works comp=s4ca Act(GL152,-1(5)),application by a homeoRVCr for a Lomse or Pcrmd may cvidenoe the legal ctauu of an employor under the Workeez Compao, tj n Act I unders d that a copy of thin rtatcmcUt may bo forwarded to tho Dcpwtnrn of Industrial Aoci&-&Of&oe of in;urinoa for the coverage verification and that failure to secure covecngo under sociioa 25A of MGL 152 can lmd to tho imposition of criminal penalties comisting of a fmc of up to S 1,500.00 and/or imprisoamati of tip to cm year and civil pmaltia in the form of a Stop Work On and a frog of S 100.00 a day against mc. For dgrrrtnr'a use o°ly Permit Number Lot tt -r; ; gnalture of Liocnsec/Petmittee Date , 3 SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: + Not Applicable ❑ Name of License Holder :�� 1 �� License Number Address Expirdtioe Signature Telephone _ , � � � � �r � :: Not Applicable ❑ Re19ISMO `d`Hb mpr uemenE ontrector.; ��� N�a �m,�.._.�� �d�� 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 affic will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ pin' The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act 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 then,° 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 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 SECTIONA'�L? SCRIPTIOI t+IJFflR�OPOSED OR# c06&c,"',", a ` liable . £.WC.'"?3 �•.• _.W3.SiM .,Pk `::1, .3'SA'.'kiai t...:-t:-.i+J' H•a«a)�Nk.wi g.gr�M1lM.,.26v.?..•P M+-,.;Yt 31'f.3fi'v,_d >-V)3.33x: k New House ❑ Addition ❑ Replaceme5t Windows Alteration(s) ❑ Roofing ❑ Or Doors A Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: Wj ' y 5 165 cqt '� �� _� I. �Flo �e x poc Alteration of existing bedroom Yes No Adding n8w bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ G,,a�If�New�ti�bi�ise�andor�a°dd'itton�Fto�eicisttn tousin�,£complete�the�followan : g. 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 j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yep No . I. Septic Tank City Sewer Private well City water Supply SECTION7 OW NERAUTHORIZATION TO-BECOMPLETED WHEN OWNERS APENT<OR CONTRACTOR APPLIES.IbR.113WILDING PERMIT I, CCU �C as Owner of the subject prope hereby authorize \�(' � �X M: �j!` ""� to a�: my b III matte relative to work authorized by this building permit application. Signature of Owner Date I Q( V iL .I �; as Owner/Authorized Agent hereby declare that the tatements 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 J Signat re of Owner/A Ant e D 'J ' 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: ity of Northampton uilding Department 212 Main Street ►"" a Room 100 ----- Nor hampton, MA 01060 UjF! u4 �r "d.�"Ri0.13t� 41 - 87-1240 Fax 413.587-1272 01S�e a Ot er�p�ei� ' APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION r This section to be�complQted by office" . 1.1 Property Address: s, Map Lot° � ` � llrirt zone Overlay Qistrict Elm St. District CB District SECTION 2— PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: N qq(P,,rint)�� Current Mailing Address: Telephone Signature 2.2 Authorized Agent: &1 ��a� i ho � �.7 �al�� Name(Print) Current Mailing Address: SjjKature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building 70 d (a) Building Permit Fee 2. Electrical coo, (b) Estimated Total Cost of oe Construction from 6 3. Plumbing ��,� ©� Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) p2, a� �� Check Number This Section For Official Use Only Building Permit Number: 5 Date Issued: Signature: , Building Commissioner/Inspector of Buildings Date on I File#BP-2002-0652 APPLICANT/CONTACT PERSON KEITH HAMILTON ADDRESS/PHONE 27 CAHILLANE TERR (413)587-0763 PROPERTY LOCATION 23 CAHILLANE TERR MAP 35 PARCEL 109 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Pen-nit Filled out Fee Paid Typeof Construction: INSTALL REPLACEMENT WINDOWS&DOORS NEW DOOR OPENING,REMODEL KITCHEN&BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 074129 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIYATION 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 Signature of BuildQ 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. LLANE TERR BP-2002-0652 G1S#: COMMONWEALTH OF MASSACHUSETTS ,UV-.Block: 35- 109 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0652 Project# JS-2002-1019 Est. Cost: $21500.00 Fee: $85.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH HAMILTON 074129 Lot Size(sq.ft.): 10541.52 Owner: JACOBS PAUL D Zoning: SR Applicant: KEITH HAMILTON AT: 23 CAHILLANE TERR Applicant Address: Phone: Insurance: 27 CAHILLANE TERR (413) 587-0763 FLORENCEMA01062 ISSUED ON:1 115102 0:00:00 TOPERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & DOORS, NEW DOOR OPENING, REMODEL KITCHEN & BATH 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/ SiEnature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/15/02 0:00:00 419 $85.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo