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35-202 (2) 011h) 111 'N>_7r#llaillp f oll — 4_ 6 fllIs2Aclltccclts DEPARTIILNIT OF BUILDING INSPECTIONS 212 Maui Street ' Municipal Duilding Northampton, Mass. 01060 N�'OR LE,R'S COMPENSATION INSURANCE AFFMANIT Rl bt c � Lc�ELS..rJ1Frullttcc) ---- �;rith a principal place, of b1.1S1r1eSS/rcS1dencc at '] d0 he[eby celLllY lln:" I the l7i'.!:1S ;?iiV per;altles of pCrllll�', tIl<`'.i. ell ain an employer providing the. 1o110wim-, "voir:el-'s colilpens tion coves- e for Iny ' I efnployces working on t'lis jcb. hi/�ce,r;i {YID 0.4 ` 3oZ17 914 - G (Insu=lt: Company) (Pclic;Number) Cru-pir tion Datc) ( ) I aril a sole proprietor, s enerai contractor or homeowner (circle one) and Have lured the contractors listed beiovv -,-,'ho hr:v-, the follo-"117"Ing workers col-P pensation oelic:es: (Name of Coritnctor) (LI1SUt�_IlC Coln^811'j:�Oh�f NllSnLcr) (�?:;:ri LCfl D1tC) — t ----.,--._- --��_ r -.. - ^�� /p �.--�— �� ��:.` it:iilOIl Date) (Dune of C OLt:�.CtO;) 7nsu.��nc^ C om:.,.rv, o.lc�' Numh r, (Name of Contractor) (Inszlranrz Companyil'olicy Nuintr--r) Date) (Name of Contractor) (Insi ante Comr�-ly[Pohcy Numlrrr) Date) (ettac3t adliticcaE c::.-ct ifr.ax:zi:-:tc irr_._:.4:�a�t::u'ioc: ,:�.a:n:nt',.;ell i ( I "dill it sole plOpll t0i ilild have [lo oIle %VC)Fklilg for Tile. I a In a 110111e I) ill all isle 1livsCff NOTE::plcaac lac awuc lc kx< u«;r_r3 + o c:ploy r_io:s to :-;;air ,?: not u?orc th n thole units in ct at Lw:p ct:r:s z F.uttcr nt thado c:c r<Ecrrrall V c r.:::i:: :c czIploycs under the woe}xis mn zatim Ac,(GL.I 52 s 1(Sl),TrVI:zaticn by a hoc1eor1,,-,er for a Gccix Icgal ctatui of an employer under,,Lo Weaker.Comq r lion Art I undcr:t>tnd Ihit a copy ollluJ ctatcn»I m.y tx fixwcvci«f to ti»IY.Sxirtsr=si of Iz�iafrial Acci<:cittf OfGoo of I.::ruar>_a for Un covct-agc vcrificalioo and that fzilurc to:-utrc covert ut der erica 25 A of hiaL 152 can Icad to the impos iio of c =.ir 1 pc sit:a coct isting of a frnc of up to 51 500.00 anA'cx i-r:prix,cm r_:rl of up to ore-yr:r a.-tid civil pcnaltica in dY f<xrn c f a stc,t W crk Or,- and a f m of 5100.00 e diy _ Fcr cjg%+tn,,:,j u.c—1y I • � ® Ycrmlt Ntuntx=r ----------___-� --- - Signaturc of I.lcc::•,cJl?crnli• r•c T-) SECTION 8 10N.SERVICES 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number C �'�✓nJ 0.16 S !�6 Address Expiration Date Signature Telephhonp / (� C) -7 a Register�e F(ome m rp ovem`entContractor Not Applicable ❑ 73 -11, 7e S'14 io a Company Name Registration Number 751, lee) Add ess,c� Expiration Date �,f Telephone 5 7 00,51 ,SECTION 10,WORURS';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 o he building permit. Signed Affidavit Attached Yes....... No...... ❑ i i i 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 A$ECTION S DESCRIPTION OF PROPOSED WORK .NN ew H�,:,oteru.Ps.e..r.e ar,`�,.w_�a:.�m*_«.�+'w n"�tw.+C,.n�?v❑ra i`x;s���Avd'kz,w-«d�,��i.t i�aPo.n._�r4 a.. ❑.r. xalt app licabx l Windows r d c x:a 4 A�-! �l terations) ❑ Roofing ❑ Accessory Bldg. ❑ Demolition❑ Decks [ ] Siding ' Other [ ] Brief Description of Proposed Work:_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a If New house nd or addition to existing housing t-Jt6 p`lete the fol"aowMR: 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 SECTLON 7a 'DOWNER AUTJIORIZATION -`TO BE COMPLETED WHEN OWNEaSAGENTORCONTRACTOR,APPLIES FOR BUILDING PERMIT' .r .. ..., J4& e as Owner of the subject property hereby authorize GU 73 e'4'`Q / to act on my behalf, in all matters relative to work authorized by this building permit application. ✓ l2 0 Signature of Owner V Date LEA/? aster/Authorized Agent hereby declare that the statements an 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. �%W n1 2- 13,,e 4,y Print Name Date Signature of QUW/Agent 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: tt City of S atusof�'�r a:• r Y � � Building Department Curb>Cuil=ry yg. Win'Street Se erl}S APR Room 1Q0 loerNorthampt6n, NIA 01060 T Sets of r I phone,413-58 7.1240 ,F. x 413-587-1272 Plot%SlterRl ris e - Other Spt ctf � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Pro Rerty Address: This section,to be completed by office, Map LotUn'it o a L' aJ C L � � © 0 ho.Z Zone � Overlay District �l Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: HA& o 0 Natne(Print) Cur ntt Mailing Address: 0�� --- Signature .y2 /S_/(Pl ----- 2_2 Authorized Agent: Nanie(Print) Current Mailing , ddress: r Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee C)0 2. Ele<.,rical (b) timated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5 Fire Protection 6. Total = (I + 2 + 3 + 4 + 5) /_O, 90,0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2003-0893 G1S #: COMMONWEALTH OF MASSACHUSETTS b2. CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate or o BUILDING PERMIT �. Permit# BP-2003-0893 Project# IS-2003-1438 Est. Cost: $10800.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: B & R Siding 100465 Lot Size(sg.ft.): 48787.20 Owner: HAGUE GERALD C&SUSAN C Zoning: Applicant: B & R Siding AT. 1292 BURTS PIT RD Applicant Address: Phone: Insurance: 781 Bridge Rd. (413)586-4167 Workers Compensation NC,RTHAMPTONMA01060 ISSUED ON:4122103 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SIDING 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 Si nature: Feel e: Receipt No: Date Paid: Check No: Amount: Building 4/22/03 0:00:00 18712 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 0�(1iAMplO Crity of Warthtturptan L z � � �JGtaesAChusctte - s Q-, DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building '`>a 1N S.�y Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as has/her construction sup sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/resident's signXI'ding a requesting exemption) I will call to schedule all required inspections necessary for the building permit issued to me. Date Address of work location 1Lf ti ( Iilr Of �'c71:fllaliipfml 6 h�:sexcllnstfis " • m DLPla2T1.;ENT 01' EUILDING INSPECTIONS 212 Main Street ' Municiptti 13ullcling = Northamp toil, Afass. 01060 N 'OMCER.'S COMI'ENSATTON INSURANCE APFDDAVIT i, n:°c III1ttc^) principal place Of businesslresidencc CIO lleieby CCI�l L'17;1 1" i_I1C pa!r1S '�iiCl pCi] ltiC of pef.11IN itll!i: ( ) I am an employer providing the 10110"vint :Orr_c! S cOIIWCIIsation coves-.e or ]ny elilployces woridrig on t?lis job: j=rain Cotapam') e c,Nu�tfxr) ---- (r�� r ion Date) - i a-m a sole proprietor, y=eneral c::)n�nc`cr lion (oOwner / ; Cie- Oct) and l":ave hired til Contractors listed beioCv "`i,1,0 i1 ih iOL IOri:P-�S Cou:D°II Or1 0, (- amc of Con cto:� (In u-nc Ccn -: ':Toiic; P1urn1• :) CE . ..c- Dat 1 (Nacre of Conte o:) (7llsar_nce Compar;� Pe!ier Nun r; (I :ciratina Date) R"'a lc Of COI1t-,--actor) (Ir1S 3S1C t_p ol:c Iv III]?ff 7) \" -::i10 Dat't.) (Name of Contmctcr) — Jnsuranc:, Comr�y/micv Numb- (I xni-:iin Date)- (^tucll_&d i.lcc.aj no 011e ..'C!"::iii f 0, ?ill a home O%V?ler iiCi:0�1?lli'" 11l i_. J. iI li. NO"ITi: plczisc tr awzrc tltsc not:r ore th n(hreo uai-3 ir,te{ c:'.ploycs u_ti,cr tlr ;-ct(GL. _ (t eta S_.__., );. legal rtat;lc of an cmlloyor under tae Wcvkee. az;crrstion!.ct I undo-it.+.nd Ut,t a copy o(U�crate:s•r_:xy fo faw.vclo-;l to t_'rr Ii;txitt:.�c zt of lndaistrial Ykcci& Its'Ofl,w of for Ux -V=se vcrificzlioc ntld th=t 1-alurc to to uc co`-T-9-0 ut 3: cam,cr 25A cf MOL 152 cw lc--,d to the imposition;f c-=i_.l petisli;= coast3tv-1a of a rur_of up to S 1•.;00.00 of up to cr:y-;r -,j civil xnslticz in y,e timn c•f n Stc `Vni.<h c_r„1.: Lr of S 100.00 a dry tgain:.1 for dq;utn>'atil u.c oily .I Permit Nuultr:r ---- _ Jtt;naLuzc of i. _...._ T, I F S�CT10N 8 CONSTRUCTION SERVICES 77q 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone ., .- =Reg sfere orne =movement Contractor - =91 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS'COMPENSATION INSyURANCE AFFIDAVIT(M.G.L. c. 152, §25,C: .05 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...... ❑ WWO�TIl WN 6 > ? CIO 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"homeoNvner" 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 SECTIONSDESC �IONOF PROPOSED WORK[checlall applicable ! New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other�f rief Description of Proposed Work: t % Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 W f f�f—ew hou d or addit+ion to�ezisting houssng comp's"ete the fol'lowin— 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 7OYVNER/UTHORIZATION "TO BE COMPLETED .WHEN OWNEkS AGENTORCONTRACTOR`'APPLIES" FOR BUILDING PERMIT"! I, 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. Signed under the pains and penalties of perjury. Print Name Si nature o g Owner Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION b Required Existing Proposed Re q y Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear aJr� Building Height i Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) I #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 DONT 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 TOing Department 2 -°-Main Street 'Room 100 AF R 2 C ')CNprthampton, MA 01060 Teat xa " � ° phone 413-587=1240 Fax 413-587-1272 J e� IQ APPLICATION TO CONSTRU TER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: This secfion to be completed by office Zone� � Overlay D�str�ct r �e e7 Elm St.Distract: CB D�sfir3e! SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: ? Telephone i Signature 's _t . to 2.2 Authorized Agent: 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)'Building Permit Fee 3era, d 2. Electrical (b)Estimated-Total Cost of 0, Construction from 6 3. Plumbing Building:Permit Fee 4. Mechanical (HVAC) p 5. Fire Protection 'All n r� 6. Total = (1 + 2+ 3 +4+5) Check Number c�`J This Section For'Official Use Only Building Permit Number: / 0"7J`� . �4 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1021 APPLICANT/CONTACT PERSON HAGUE GERALD C&SUSAN C ADDRESS/PHONE 1292 BURTS PIT RD FLORENCE —.(S/L PROPERTY LOCATION 1292 BURTS PIT RD MAP 35 PARCEL 202 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid o96--- Typeof Construction: REPLACE ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF"MATION 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 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. 1292 BURTS PIT RD BP-2004-1021 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -202 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-2004-1021 Project# JS-2004-1543 Est.Cost: $7450.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 48787.20 Owner: HAGUE GERALD C&SUSAN C Zoning: SR Applicant: HAGUE GERALD C & SUSAN C AT. 1292 BURTS PIT RD Applicant Address: Phone: Insurance: 1292 BURTS PIT RD O 586-1516 O FLORENCEMA01062 ISSUED ON:514104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE ABOVE GROUND POOL 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 Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 5/4/04 0:00:00 2383 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo