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01-001 (3)
juN 1 62000 � Y HEARTWOOD CONSTRUCTION �C�. p� 5 I i Cz� i� 413 - 268 - 0371 P.O. Box 993 - WILLIAMSBURG - MA. - 01096 MASS. LICENSE CS 043443 6,P+....o...�ld gl..�(aaoeG.�.rct NOME AR — COMTRACT0R Re9Istrition 100056 O�� R E (-11i�) of �'Iorfljalliptoil 9 " E �Zc�enrhncrtla = - `t DEPARTME1JT OP BUILDING INSPECTIONS 212 Alain Strect ' Municipal Duilding Northampton, ATass. 01060 \N'O R1C E R'S C O NT EN S A'M N LN S URA-N CE A FFM A VIT (Ii ccvs:r/pcnl>;flee) .- \31rith a principal place of busines Jresidenec at. ticN3cf(j,none .?)a6_�- 371 do hereby cer- f):, under the pains a,Dd penalties of perjury, �.h ai ( ) I am an employer providing the following workers colnocns_:uon coverage for im, etuplovccs wor�jrlg on this job= (Pel1c; i U--air_r) ---- ( xpiruor Dztc) ( ) I am z sole propr,etor, general contractor or homeovmcr (cucie one) zrtd have hired the contractors lister below who have the foUo%vinQ work=er's c)DD. nsaaon pckies: (Name of Co�f::�eto�l _ � (In�ranc�. Comoanyii'c�c, NurnLYr) �(I_��irat:on I�:+te) (Maine of Couuacior) (Insuranc:. Comoauy/-Poticy Numicrr) (Expi -non Date) (Name of Contractor) (Insw-dnc: Compan)•/Pokc) Numb'-r) (Expi-Mbon Date) (Name of Contractor) (Insurance Compztry/Poticy Numbs) Date) (anad�:.d!i�oc:al c.'x<t tf nc'�a.^:to a�.�ruc�in(on-ir..ioc t:_:n�nF to-13 ( am a sole propnctor and have no one vworking for me ( ) I am a home owner perforTnisig all the work myself. NOTE:prcx Lx n r tb, u't:Jc hcarA.;m-n't�curiloy t_ ont w cis c-�-i:.tc�vz� =="..cam �:rc,av•�oric oa a u..clL.�of nrx a rt th-n t`r«I=Yj in«",v�tb:.t"tnoa -r"i&o ex CO the rn be c >4oycs unG.-tlx oc c ticc Act(GL152-"1(5)x-pptics cn try a hotncoax fcr c l:c-,--:a P—I rz_y c.id�cY Lbc legal et"^«of na azprovor under El- Co�n/.d I—&---Tt—d Ilya>copy of thi,a>t®eri—y tx(orvnud.od to tbo De,Vutmana � dam'Off oa of tea.i000 for 0h mvcnSc vmr icmLoo rcW U>s Lli urc w PccL c covcr�ur�d sect on 25A of MGL 152 an lad to he -g>.d oa of criminal P—Ihl- 00a=is zls of a FMC of up to S 1 500.00 nridlcx unpri ow';j oCuP to one yt.c r-0'1 avil Pc rj- L,r.5c form of n Stop Word Order e�d a no 0(S100.p0.d:y aPatnsl m= I K aril y Permit Number Lot --- ._,nzutm of 1-,i �scrJl'crntittcc � � __ laTla>�83 PION STRIJCTN©N SERVIC6 o.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: "� � 6"4 3 If Li-3 License Number ro Add ess l z Expiration Date n Signature N Telephone Is% Not A plicable ❑ 6-0 s ©a5� Company Name Regis ration Number Address � Expiration Date Telephone �$� S',ECTI 11Q--,W 3RKERS'G NIPENSATIONI INSURANCE AFFIDAVIT{M.G.L.c.:1S2,§2 C 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. ned Affidavit Attached Yes....... No...... ❑ 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 'r I New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes / No Attached Narrative F] m/ Renovating unfinished basement 1/ Yes No Plans Attached Roll 13 W - Sheet T 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 elk Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodpiain 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 SEC 'IQPI 7a i3WNER=AUTHCFtI2AT10N -TOE GOM #'Lfxt , WHEN ( YN T�ACTO A PLIES ..RBJl`LDl4G PE RM17 as Owner of the subject property hereby authorize .-� S Ll/ G'` to act on my behalf, in all matter's relative to work authorized by this building permit application. Signature of Owner Date as QmmsO/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. 'gned under the pains and penalties of perjury. �� Print Na e 4� Signature o ./Agen 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 R: L: Rear Building Height Bldg. Square Footage Open Space Footage % 1t (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 V 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 V 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: ti a City of Northampton uilding Department 212 Main Street Room 100 .. v) o hampton, MA 01060 87-1240 Fax 413.587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 5ECT10N 1 1TE INfORMATII©N. 1.1 Property Address: f F in r"I"7717-011 ot it n SECTION 2 PROPERTY OWNERSNJP/AUTHORIZED AGENT 2.1 Owner of Record: pp , omo me(Print) Current Mailing Address: 'r 1 Telephone Signature 2.2 Authorized Agent: Name G Current Mailing Address: X69 ©�7i Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION"'COSTS Item Estimated Cost(Dollars)to be Oicial Use Only completed by ermit applicant 1. Building 01 (a)'BuildingPerrnit'Pee 2. Electrical (b) Estimated Total Cost of Constructi©n"from i*- , 3. Plumbing Budding=Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) 1 Ch4ck,Niffter r Setnn;far Official.Use Onl uillding Permit Numbeir: bate Issued: Signature: Building, ommisA loner/lnspe tor,df Sulldi gs Date File#BP-2000-1147 APPLICANT/CONTACT PERSON Heartwood Construction ADDRESS/PHONE P O Box 993 (413)268-0371 PROPERTY LOCATION 710 NORTH FARMS RD MAP 01 PARCEL 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled o t Fee Paid d'- Typeof Construction: FINISH BASEMENT BEDROOM.BATHROOM&LIVING RM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 043443 3 sets of Plans/Plot Plan THE�LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § —w/ZONING BOARD OF APPEALS 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 �/ Laoa l/ 2..0 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. 710 NORTH FARMS RD BP-2000-1147 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 01 -001 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: renovation BUILDING PERMIT Permit# BP-2000-1147 Project# JS-2000-2026 Est.Cost: $9000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Heartwood Construction 043443 Lot Size(sq. ft.): 871 20.00 Owner: BATES ROBERT E Zoning:RR Applicant. Heartwood Construction AT: 710 NORTH FARiy1S FiD Applicant Address: Phone: Insurance: P O Box 993 (413) 268-0371 WILLIAMSBURGMA01096 ISSUED ON:6120100 0:00:00 TO PERFORM THE FOLLOWING WORK:FINISH BASEM ENT,BEDRO0M,BATH RO0M & LIVING RM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: _ Footings: Rough: Rough: �o�2 6�a �I" House# Foundation: Final: /AI--fl CO-? Final: 12'2$IM A&*- Rough Frame: ()FC C .2 G-C"6 Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:Olf' 1-3-01-16z4v THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc si nature: C Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/20/00 0:00:00 1644 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo