02-002 (4) .Q! 0
cjt'ifl) tit X ort 11allip!Lill
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212 Main Strek AluniApA BuOhn q
NorthayAmi, Maw 01 CO r10
CON11
i,S All 0 IN INSL1r2kNC F1DAV1T
'j�'4-e wA- 01-o"i 3 Y74-740
do Why COW, ulwu K paw wi plAwn .Amliv, 1V
anj an Cnlp!OYCV PrOVIOng thC A)HOWn-V O&S COHYMMM11 CO``CMnC
I LLm a Solc pyopAup, genual cnnmcn� F Komeowner Me OuQ and Kv Wed,
the contractors Red Mow who hava To :YK A= vwykeb comanswinn whow
(Nanc of CanywoM Q=-
(Name of Conwacml
CNnue of Comma)
I �Iin I home
cxwcc I�C verification and tll--t f--A'Urc tot
C"Wistog ON WX Cup to S 100100 nAwcc MIU&M=070 Oup on 1,)7w W KV1 jwUln" an Env W-1(so:MW a
f"lls of 100'DO (tly
N'U'11 Lx"l
SECTION 8 -,CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: n Not Applicable ❑
c 74 --
Name of License Holder : M?S_ _. _f��SS
- - License Number
�o x A)V . 14A iPitc, WA5' -_p,c(oi r --C>-- oti 70,6 -
Addr s Expiration Date
Signat re Telephone
rwM»rx� '•x. .n� +5 ::.....-+- r,. -CaKU' �,� 'fti c+ q k ' "^m T ie$lk ,; g
9 Ret7►steeRl"14ome f-mprovementtContractor , -, ,k�., max. , ,; g�,�,,...... Not Applicable ❑
Su1L7QS 13b -�^7
Company Name Registration Number
gc'X to 11 MFl W03
Address Expiration Date
Telephone 3-4-79 `3 6 3 cZ 2na tf
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 affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... q No... ❑
e . x� #�� E
11. ome®wnerEgemp`tion
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 fir-which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 �.,iabilit� of[:mploycis to
Employees for injuries not resulting in Death) orthe 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, Citv 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 [ ] Deoli [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: ��R1P4CQDOf �� H 5Y►�QIPS. �n5�a1) atiP uen�o i I
PC)f tkAm P c�A LAV�Gl
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
sa. If Newhouse antl or adtlifiion'to existing hdusin complete the.fol'IOwin ;
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 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�1�, •= - _ , as Owner of the subject property
[hereby authorize JD(Z t3L)I L L)f-✓2_S - to acs on
my behalf, in all matters relative to work authorized by this 'ouilding permit an c
n'� ation-
Signature of Owner Date_
asOwner/Authorized Agent
hereby de re 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 Na
Signatur 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:
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 k YES
IF YES: enter Book Page , and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO X 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
City of Northampton StatusoF'e
Budding Department Cu�rti6CUf�la_
wx
2.12 Main Street SewerlSep.a
Room 100 Water/We 1 Av.. t..
Northampton, MA 01060 Two Sets. rc ralr a s .
p,hc5pii)'j413 587-1240 Fax 413-587-1272 Pi ;81te P.an %R "
OtherS{?eclfy
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
�—
1.1 Prop This section to.be,completed by office
� erty_Address:
Map Lot Unit
Zone Overlay:pistricti
pp PTp�; r}SS. Ell St. District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) C.:r�r�ent ��^ailing Address:
2.2 Authorized A ent: {� i
� JArYie 'b.
Nance Tint) orient isaili ig Address:
'-!-- - ----- - - - - 3.74--75 3 -------------—
�ignat,: -
LSECTI_ N 3 - ESTIMATED CONSTRUCTION COSTS I
Item. Estimated Cost (Dollars) to be
Official Use Only
completed bvQerrnit ari lic�.nt
Pudding (a) Building Permit Fee
74
Sp
- �i ;Hated Total Cost of
-- ----- - ---- - --- Mistruction from 6
Plumbing Building Permit Fee
I�.r.chaiic_! (H VAC
)
- - — — _
` IJt
1 + , + 4 + 5) 1 74-
This Section For Official Use Only
Building Permit Number: Date Issued:-___
STin l tur e --
L Building Cornmissioner/Inspector of Buildings Date
705 NORTH FARMS RD BP-2003-0828
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:02-002 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Categor BUILDING PERMIT
Permit# BP-2003-0828
Project# JS-2003-1353
Est.Cost: $7450.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor. License:
Use Group: JDR BUILDERS 130397
Lot Size(sg.ft.): 52707.60 Owner: LUCE ALICE M&GORDON R LUCE&
Zor.j,mrRR Applicant: JDR BUILDERS
AT. 705 NORTH FARMS RD
Applicant Address: Phone: Insurance:
P 0 BOX 66 (413) 665-7587
WHATELYMA01093-0066 ISSUED ON:413103 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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:&4H A f IA(-0-3
Aiv-
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON N-VWLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu an Si nature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 4/3/03 0:00:00 1399 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo