Loading...
32A-008 OWNER AUTHORIZATION FORM 4- l/\- (Owner's ame) owner of the property located at D JUN' f t J (Property Address) (Property Address) hereby authori , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date doi � �($usitioalladtS�. a. 99.4r.v nm. 4 +_� I: n a ;xtai�l rot+ti toi�anc r Y AID to ees frill aaalcrr-. die �� ���.ue_the su"v-cori�ac�is _- -- �• �' ?mod ih: e armed sheet : 7'I icniadeiing 2: t aom�a sole prop�%eaar-orb slti )kd ci�4"10 ecnplo3[�es : : esesub nZacnrs=:��e r,qn { Idng.Sor M*m:. aalsar{ty '-.sii c s= _ � � O,b�.tudm�sc�d�F i Sti iark�e m 'nsttraisce r�tz L. .= ti ? - zlty 3. : "sil`. Yatt?l: srs... `- tBDitii'S.`�.S • -,� :.•.�-►L'�:�i�f)T$Et47i.8ffi!i![� #� - s—. _ - - t ,tc .ha-�e sx ci r ! I I: �:'tWIT re in i n 3 Lama-iicizrreav�rtar dgI>3ror 1 a r r. ;ILM .�4j a��c aa�hii regtdre&I comp- Isummee- ssiY gtiomc'4t cl+dc�s bue�r sau5t also iiii oeA Useseai;ois 3Mioli s,wuu�.-i it 'won por�v.isi�psm i«i: t---. .. . • -i�aesmots-wSo.sobm�tlnsia�ris t�geset[a�.sllti ine�lim�icie�xsitl ecorttrac`icnsriaietsv'araitaa�amda��iadica�°.:ax`..•:: _ •.. .. =Cefitias.tL'eteLeo�c$i�bmcuiust�attaal�daiiadditiouetgfreet.•sltow�sasa_nt�eof .�smien�tnEr_.diraciic�se -�- F. •:iOIpQ:OQ.riCY7Ri1I�2 _. --. . - .;-�ru��s�es�u=� '�iat��••-`: wo. Sri �ts�rii+ice�� � l�ee�:- 'arev�s�Ce c-::�s� `- - .. instttaany }. ._ PhIicy or SetF ins.Lic. �� ebb Sr�e tlddr8ss.. � CrZ Q f l It F_; 1) C' l [et�" amp . ra$ifsie tti ' ssetlttueit wader S�c#io �fz��a3L c.lh?dirt ieaii id 4he. : asi a€�antniasi .was a=& ite ttp to:.1 s 60:a csr o>a3+ ariaetit>. s4lei= c��t• n fses is tie =of a STOP i0:21 It _ 'sisd= - . - '. : of�ptQ�iE0.00.t=dad a�ainsf�vie��ai: ,i3�asi��sez�rsr�:gin;oii#ds staff-ut$�1>r s�r+?mdeci.�tie TA,' . -polio-. Etna: -44b&eeL ol city NJ City` Clam Ct�aes>Pe : , SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: \ Not Applicable ❑ Name of License Holder: a- Gam" I License Nu ber Address Expiration date 44, LA-f-) r-)a, ' A1 Signature . Telephone JL' 9.Re�istere` Home Im rovement Contractor: w Not Applicable ❑ i�lDmc- i �-Vquds Cotinpany Name Registration Num er fYl� D � 0 Ce )`201 S Address 33 Expiration Date Telephone -3U 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 buil 'ng permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) � Rooting Or Doors El I Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[C� Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes N Attached Narrative Renovating unfinished basement Yes ---'--No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building: One Family Two Family Other b. er of rooms in each unit: Number of Bathrooms c. Is ere a garage attached? d. Proposed Square footage of new constr tion. 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 0 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 I, as Owner of the subject property hereby authorize to act on my behalf, in all matte re ive to work authorized by this building permit application. Signature of Owner Date I, as Owner/Authorized Agent hereby decla 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 pe Ities of perjury. Print Name gLlo),Z%D Signatur,, Date Section 4. ZONING All Information 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 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 0 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 I& 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: E. Will the construction activity disturb(clearing, gradin a vation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management ermit from the DPW is required. ?� Department use only 0\5 I of Northampton Status of Permit: B g Department Curb Cut/Driveway Permit J �i�gP 2. Main Street Sewer/Septic Availability Room 100 Water/WellAvailability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay istrict pr h�, 11A ©louo y Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cl c aT e 0.1 e ago u-i & d I A D Name(Print) Current Mailing Address: (li Telephone i !� Ll Z o- Signature `-'� V 2.2 Authorized A ent: in Name(Print) Current Mailing A ss: SignaturdF77 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 0 do (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) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1371 APPLICANT/CONTACT PERSON JAY BOLAND ADDRESS/PHONE 12 PISGAH RD HUNTINGTON01050(413)214-2414 PROPERTY LOCATION 35 WALNUT ST MAP 32A PARCEL 008 001 ZONE URC(100)/ 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: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 101880 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 sPermit DPW Storm Water Management De Si re 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. 35 WALNUT ST BP-2015-1371 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2015-1371 Project# JS-2015-002496 Est. Cost: $1000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAY BOLAND 101880 Lot Size(sq.ft.): 4617.36 Owner: DOUAIHY MARGOT Zoning. URC(100)/ Applicant: JAY BOLAND AT. 35 WALNUT ST Applicant Address: Phone: Insurance: 12 PISGAH RD (413)214-2414 WC HUNTINGTONMA01050 ISSUED ON.71212015 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION 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 7/2/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner