35-242 (2) __ __ __ __ __ __ __ __ __ __ __ __ _
10, 01
jp
ITION
OFFICE
ROUGHOUT
NEW DOO
1�7— R
OFFICE
RADON, door to remain
UP INDIREDTW,H,
install new oil line to boiler.
UTILITY
SCHROEDER BASEMENT
REMODEL
:WASTE LINE �
PUMP../FILL
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I II
II II
II II
BULKHEAD TO BE RELOCATED
II I ,
I II
I II
II II
II II
II I !
access panel to crawl space L
APROX LOCATION OF NEW I C REC, REMOVE PART
BULKHEAD
I i NE
HI LITE STORM THI
DOOR
x � i J
I _READY FOR OWNERS CARPET
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1 add microlam and sheetrocklbeam/ SEP ZONE FHW HEAT
remove one lolly . V�'o;�f L�11ly �oCry-7�i•�
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FRAME FOR FUTURE BATH ceramc
REUSE DOUBLE DOORS CUT FLOOR;'0
I verify AND EJECTOR
WITH PEA ST01
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ELECT PANEL I I
I
OIL TANK WASTE LINE
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SECTION 8-CONSTRUCTION SERVICES If]
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
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1 f L lt4r,0--)
License Number G
1 f't
Addre Expiration Date
� l
gnatur Telephone
au ,.^r.,as_.nr— --:i' "'2,n dr"' v-.:v "' ,,'y" ,-
9 Rea�sfered Homemprovement Contracar_ �; °; Not Applicable ❑
Company Name r Registration Rum ✓rr - -" -"
17
Address Expiration Date
YJA Telephone ti/.7i
SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVIT(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...... ❑
IT
�'�-
11 r :Homer Owsne>r emption
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-vear 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 pen-nit.
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
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SECTION 5 DESCRIPTION OF PROPOSED WORK(check-all applicable)
New House [] Addition [] Replacement Windows Alterations) Roofing
Or boors �
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[0]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If-New houseandorad"dition.toexisfing houslng,:complete.theoficiwlng:
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. Masscheck 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-
as Owner of the subject
property
hereby autho ze Q
to ik myl ha matters relative to work authorized by this building permit application.
-7-
Sign ture of O n Date
�1_?4' (4n J1p f 7 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.
Pri ame
—:
gnature of O gent Date
.
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Section 4. ZONING All Informati6h Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front r
Rear
. Building Height .
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(voluniel&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/nnthe site?
y_� ��
NO �~�~� \^�� DON7 KNOW v�s ^~�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry u[Deeds?
NO �� D0NTKNOVV YES�� z�_
| '---------
IF YES: enter Book
Page� and/or Document#L�
——
�� ��
B. Does the site contain u brook, body ufxvaterorwetlands? NO ^���� DON7KNOVV \_� YE3 �_�
IF YES, has permit been or need toba obtained from the Conservation Commission?
-
Needs tobaobtained x�\ Obtoined /—� Date
� |
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C. Du any signs exist on the pruport �� ��y? 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 0
IF YES, describe size, type and location: '
E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orinh part o[o common plan
that will disturb over 1 acre? YES ��� ) , NO < }
/ `_�
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
J
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City of Northampton
Building Department
212 Main Street
S Room 100
Northamp on; MA 01060 -W r, ara. ta ,�A
phone 41.3-5 7-12}0 Fax 413-587-1272 Pao f an
OFte pect x � ..
-APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: wJ a This section,tobe completed by office
Map Lot Llntt
/� Zone'-, i '" � + ?=Overlay`D►str�cf.
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record_:
Nam Current Mail'n Addre s:
Telephone
Sign ure
2.2 Authorized Agent:
me(Print Current Mailing Address:
LJr ` �r r7 —
nature 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
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) QJ� Check Number
This'Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0210
APPLICANT/CONTACT PERSON KEITH HAMILTON
ADDRESS/PHONE 17 ORCHARD ST EASTHAMPTON (413) 587-0763 Q
PROPERTY LOCATION 39 LADYSLIPPER LANE
MAP 35 PARCEL 242 001 ZONE SR
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 BASEMENT FULL 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 /Me
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.
BP-2009-0210
GIS# I44 COMMONWEALTH OF MASSACHUSETTS
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-2009-0210
Project# JS-2009-000277
Est. Cost: $10000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin KEITH HAMILTON 074129
Lot Size(sq.ft.): 60984.00 Owner: SCHROEDER ROBERT&CAROL
Zoning-: SR Applicant: KEITH HAMILTON
AT: 39 LADYSLIPPER LANE
Applicant Address: Phone: Insurance:
17 ORCHARD ST (413) 587-0763 O WC
EASTHAMPTONMA01027 ISSUED ON:812912008 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT BASEMENT FULL 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 Signature:
FeeType: Date Paid: Amount:
Building 8/29/2008 0:00:00 $60.007489
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo