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38B-121 (10) „L NM04 QNn03 3dld N0�11 „l CD z Z a w w w J � Q z U U Sn9w0'1� Z O U ONIISIX3 M„L NIISIX3 J a JAI Ja '118 ap OD __j SNoIlIQQb w,...; �43SOdOdd > Z N N -- N �1 ` >1lVM 'ON00 X .� t w / N J N r /, 3snOH / ►� ONUSIX3 .�; U N O CD z 0:8SN � �A��` 11 1 xldM :118 ..L S SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable /❑ Name of License Holder: License -3 v- en--t- C 2 772 i 0// 7 Address Expiration Date Signature Telephone !/ !r 5.Re ai red Home,Improvement Contractor: Not Applicable ❑ �'-- b i2ao�S C4'u�r-c/� (� C Gc� T L�4'+� / 5-0 97 `7 Com nv Name Registration Number 34, S,V'Vi C-� Cw�'^> �r?� �f1��•X10 , . �'3� �4_ S` GI Lt° Address Expirati n Date /z— Telephone S-F'/ 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....... ❑ No...... ❑ 11. - Home Owner ExempItion 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 Ef Replacement Windows Alterations) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [M Siding[❑] Other[❑] Brief Description of Proposed / / Work: ,e-� ►rc;0 a/C)i ✓+r L{� G(ter'.", Alteration of existing bedroom Yes No Adding new bedroom Yes No� Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet $a. If New house and or additlonAgrexistina housing, com lete the followin 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? n y d. Proposed Square footage of new construction. 1/6 q Dimensions e. Number of stories? t f. Method of heating? /7JJ©� � ��� Fireplaces or Woodstoves"— Number of each G g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 4117 ' fir'.-° i. Is construction within 100 ft. of wetlands? Yes No. Is Tristruction within 100 yr. floodplain Yes L- No j. Depth of basement or cellar floor below finished grade CV-4 �L1 k. Will building conform to the Building and ning regulations? V 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 25 as Owner of the subject property Q h e uthorize t o y behalf, in all tt tive to work authorized by this building permit application. Signature of Owner to as Owner/Authorized Agent hereby Oclare that the statements and infortfation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. �- -p- (ZO -5 Print am Zzs- Signatur/of Owner/Agent Date ---Cl lyet 101 Z�� � 2: /*1 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: 2 R: Rear y U 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 Q DONT KNOW 0 YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 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 0 Obtained Q , 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 Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc ation, 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 Permit from the DPW is required. yED Department use only City of Northampton Status,of P�tmit: Building Department Gub Cut/C?t'" eway Permit LOO�F Z ( 2415 212 Main Street S0w4r/,SaptieAvaif lydy Room 100 Wate*Vell Avaiiabiiity'. WINGINSPE 0Na orthampton, MA 01060 Two Setss of Structural Plans PTO MA0 3-587-1240 Fax 413-587-1272 Plot/Site Plans' 0ther 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 /_ u. �✓-�'�T Map Lot Unit Zone Overlay District Elm St.District ' CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5'e�^ Nam Pri Current Mailing Address: Telephone rs G, f"Sel Signature Zl 2.2 Authorized A Name(P nt) Current Mailing Address: Sign re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (lV �� (a) Building Permit Fee 2. Electrical UU v uv (b) Estimated Total Cost of Construction from 6 3. Plumbing Gib© v� Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection (>UU 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-2016-0550 61C APPLICANT/CONTACT PERSON STEPHEN D ROSS ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON01060(413)584-1224 Q PROPERTY LOCATION 160 SOUTH ST MAP 38B PARCEL 121 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin¢Permit Filled out Fee Paid Ty_peof Construction: DEMO PORCH&CONSTRUCT 16 X 19 FAMILY RM/KITCHEN ADDITION/RENOVATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 079160 LV C eG�jed�< C 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 Permit DPW Storm Water Management el y Sig re of Buil g 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. 160 SOUTH ST BP-2016-0550 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B- 121 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2016-0550 Project# JS-2016-000907 Est.Cost: $119500.00 Fee: $776.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEPHEN D ROSS 079160 Lot Size(sq.ft.): 8276.40 Owner: SHEARER ALICE M Zoning: URB(100) Applicant. STEPHEN D ROSS AT. 160 SOUTH ST Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413) 584-1224 O WC NORTHAMPTONMA01060 ISSUED ON:1012612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO PORCH & CONSTRUCT 16 X 19 FAMILY RM/KITCHEN ADDITION/RENOVATION 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: FeeTVpe: Date Paid: Amount: Building 10/26/2015 0:00:00 $776.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner