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08-064 Barn - ` j, r� �s �i P -TC- os T R e© s ►Jtz c t0 j "4aOW FRAW c sf 6 tp¢fay F.T - .r ! iv 4 ( 3 t�t�dc 51s4,66a m- 1x& I 1 fIV LAOR(-zi. PA ;ems PIN . !f F� � s , i� ;t AM Ac t P R'F eoms t -tfzoc CENTER-- posse �Qpcov A to ( (��� ' � fir. "WOW FRAME vy-j �St i 65 ,y� � <t9 yet���t� �,�ts�►n€ D- D. RMLEFF!7F LAORIFL EIWN T. Vie's 3tOVAC��- ph, CIO"Is FAce I-T —------7---------- --__y � , ! � } ; '. , � � ' of ���r�� i� � ft t-ivc c PO-T Poe 6 kc, PT ee- RC-PtA > Door jAvv"s PT pLqw D 5- FAIr k "to yy A Tet i kmI UN 'r S LAORSL 33n tom, � D. � 3tOPAO+ q,§[jArAm f i y I E � s t 1 No � ► k 8 z � � E � � � ( Nc»kC, �� �r�� t,A.Sf f ; n Ace P05T , i I cn 'ID Co✓r Ge C a LU i t i i �- —� Co"S'r R,-r T Mew >oM mac, r MA Teti UN IT 0 e g �x� 101 �DrZ�(��111�:t�tTI1 aB �blxsai;rhnsclta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 y WORICER'S COMPENSATION INSURANCE AITMAVIT (licenserJpelmittee) with a principal place of business/residence at: (phone#) (st=UCity/statd2rip) 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-king on this job: (Insu..rance Company) (Policy Number) (Expiration Daze) ( ) 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) r. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (lnSU=ce Company/policy Number) (HxTira,bon Date) (Name of Contractor) ansarance Company/Policy Number) (Expiration Date) (attach additioml slsce ifntocrsry to iodide infortnstioc pertaining to ell ocvhadors) I am a sole proprietor and have no one worldng for me. O I am a home owner performing all the work myself. NOTE:please be aware that while homcowmcra who employ pazom to do mxictr�cocstr=on or repair worSc on a dwelling of not more than th-oo units rn Minch the homeowner r eudcs or oa the g vo appurtcnaA thado arc oo(gcncralty coandcrod to be cmploy,=3 under the worker's oxrrp atioa Act(GL152,"1(5)),application by a homeowner for a license oc peraih may evidcnoc the legil datuz of an omployer under the Wotkoez Compemation Ac(. I understand thsi a copy of this ctatemmt may be forwnnied to tbo Department of I.odustrial Ao6d.&Oflioo of Lnarrrsoca£or tbe cover s verification and that failure to secure coverago undcr sxtion 25A of MOL 152 can lead to tbd imposifion of criminal penall:es ooasie-ing of a fine of up to S1,500.00 and/oc impuis�of up to one year and ava penalties in the focm of a Stop Work Order and a firm of S 100.00 a day a&&iust me For dw-t-a"use Daly Permit Number Lot# Signature of LiccnscdPcrmittce Date m 777777777-777777777� 77q;,7771 SECTION38 CONSTRUCTION SERVICES k 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : �"�ce` uo-��{f C. License Number (<1•1c � � C �� ��>1 CS 07 a�G7 ddress Expiration Date r 04 1' 7 2 Signature Telephone �, arcaras + C' '� ate• '" aW:r- �5 #2eej e Arne= 'ffl ent'Contractor � ,,E„ ,. ., . ,.. .� Not Applicable ❑ Company Name Registration Number I j). 2 01� Address Expiration Date Gy1L1;' 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...... ❑ 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 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 persor 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 �` � 3 rte SECTIONDESCRPTI ck T��OFPROPOSEDih�dRK cfeall'a licatile m tin w�a3 un w, a g ,i �, m 3ia;x a33 s New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] `Other [ ] Brief Description of Proposed Work: Rpoair 6r4pa - Au Y4-,o =(e kcc.CQU.t �N~Va��=r _ .11-1 A]ew co'q 4'A ro s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes a No Plans Attached Roll @K Sheet D sail# TI'ew ho sew id or addition 6!&J'sting housin -, comple e th :fol'I in : a. Use of building : One Family Two Family Other -5'01?ale 6>AiP_a 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? 2 f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction 00 e �pl—C. i. Is construction within 100 ft. of wetlands? Yes J No. Is construction within 100 yr. floodplain Yes j. Depth of basement or cellar floor below finished grade A(vu e.. k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION'7a „OWNERNAUTHO4,RIZATION -TO BE COMPLETED WHEN OVYNl:RS gGEzk OR CQNT#tACT.OR;I PPLI't$ FOR BUILDING PERMIT I ----, , as Owner of the subject prope hereby authorize to ac 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 Signature of Owner/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 as ' Bldg. Square Footage 5�D % 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: 1 L- A 10l ity thampton i DEC 1 � il' partment , 2 Wn Street - DEPT Of BultGi'�� ti NS o 100 s NORTNAh1PTOr, MA 01060 . - phone 413-587.1240 Fax 413-587.1272 s otl-Se P a APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section t A,be'xomlet6b " 1.1 Property Address: �:x d .gt)2t5 L PAfZI 3$� [Nth oeo,16 Zone Ove lay District �� Elm St. District' CB District SECTION:.2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �v 462k 140Waow„rrzr5 � � c. Name( t) Current Mailing Address: Telephone Si nature 2.2 Authorized Agent: krte ( e- W Gil � Na e(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed hv permit aDDIicant 1. Building - �p oa (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 = 0 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building.Permit'-Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2002-0587 APPLICANT/CONTACT PERSON Daniel Drollette ADDRESS/PHONE 49 Masterson Rd (413) 665-4818 PROPERTY LOCATION LAUREL PARK MAP 08 PARCEL 023 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiny,Permit Filled out Fee Paid T_ypeof Construction: REPAIR BARN FROM CAR DAMAGE New Construction Non Structural interior renovations Addition to Existin¢ Accessory Structure Building Plans Included: Owner/Statement or License 072267 3 sets of Plans/Plot Plan THE F LLOWING 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 P "/ Signature of Buildi Official 0 1 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. -,t"" L P ARK BP-2002.0587 CIS#: COMMONWEALTH OF MASSACHUSETTS .` 'lock:08-023 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002.0587 Project# JS-2002-0922 Est. Cost: $3600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Daniel Drollette 072267 Lot Size(sq. ft.): 0.00 Owner: THE HOMEOWNERS AT LAUREL Zoning: SR Applicant: Daniel Drollette AT. LAUREL PARK Applicant Address: Phone: Insurance: 49 Masterson Rd (413) 665-4818 WHATELYMA01093 ISSUED ON:12119101 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAI R BARN FROM CAR DAMAGE 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/19/010:00:00 647 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2002-0587 LAUREL PARK A R COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map:Block: 08- Lot: -001 Permit- Building BUILDING PERMIT Category:.Non structural interior renovations Permit# BP-2002-0587 Project# JS-2002-0922 Est.Cost: $3600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Contractor: License: Const.Class: 072267 Use G roup: Daniel Drollette Lot Siro ft.): 0.00 Owner: THE HOMEOWNERS AT LAUREL Zoning: SR Applicant• Daniel Drollette AT. LAUREL PARK Phone: Insurance: Applicant Address: (41 1) 665-4818 49 Masterson Rd WHATELYMA01093 ISS TED IN.-I '191010:00:0 TO PERFORM THE FOL LOWING WORK.-REPAIR BARN FROM CAR DAMAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. Service: Meter: Underground: Footings: Rough: House# Foundation: Rough: Driveway Final: Final: Final: Rough Frame:('( I-'-K—©a 414V-1 Fireplace/Chimney: Gas: Fire Department Insulation: Rough: Oil: Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. - r nature: Certificate of Occu anc Check No: Amount: Fee Type Recei t No S; . Date Paid: 12/19/010:00:00 647 $50.00 Building 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner- Aqthony Patillo