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BP-2002-0280
GIS if: COMMONWEALTH OF MASSACHUSETTS
4.4, A o o CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofing BUILDING PERMIT
Permit ft BP-2002-0280
Project# JS-2002-041 6
Est.Cost:$2000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: John Punska 100795
Lot Size(sa. ft.): 18251 .64 Owner: WAGNER ROBERT D&MARY E
Zoning: URB Applicant: John Punska
AT: 32 PARK ST
Applicant Address: Phone: Insurance:
5 Dimock St (413) 584-5533
LEE DSMA01053 ISSUED ON:9/11/01 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 20 X 20
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: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: OI: 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 9/11/01 0:00:00 2809 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
f
City of Northampton h . zs K r
Building Department
212 Main Street *': ^F + r•: ./ •=,<+ <
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: hta z r p<; completed? y office
:7 2 PA'CK sTRgET Map 'nt . Unit
FLORENCE 02A0 )062-(206 Zone u , ba yDisirct
Elm St.1110CI District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Kosgp-r D. &MARL' E. WA &JJeP- �2 PARK ST FGOREPJC ./pA0106 '2-12,9
Jame(Print) / Current Mailing Addrges
*,-€P_m 7 tU -(1 o94�i �/ Telephone
Signature J SC X J36
2.2 Authorized Agent:
Name(Pant)' 1r 2 Current Mailing Address.
Signature I I Telephone
SECTION/3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building c- y, (a) Building Permit Fee
C- Ci
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:
OiSk
Signature:
Building Commissioner/Inspector of Buildings 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
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 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:
OLFCTION 5-DESCRIPTION OF PROPOSED WORK(check all auolicable)
New House 0 Addition 0 Replacement Windows Alteration(s)0 Roofing fH
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: 17,7 t ' t F ' r (, 1,c v Ceti
L'c 5.v• k C'Ititiat cu ,?ccs/ �,
Alteration of existing bedroom Yes ..."No Adding new bedroom Yes V No
Attached Narrative 9 Renovating unfinished basement Yes t ' No
Plans Attached Roll u - Sheet J
Ea,:l... ' iuse: „ • „rk,.x=,.r;a.,e,hollsing.-canoe a f,
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? i -
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?
.^
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
I. ROBES% 1J I- A GA , as Owner of the subject property
herebauthorize t`_. to act on
my `half, in all matters relatiVj to work authorized by this building permit application.
$• (n )
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.
/reigned under the pains and penalties of perjury.
Print Name
a} (,(At.i 1 0 l
Signature of Ower/Agent Date
I SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: - - 0'
Y
License Number
•
'; ef
Address Expiration Date
t
Signature Telephone
kfikaltaldhatitillifinSCSIBtallt v(r<.;... ,. , D'3110;'. Not Applicable 0
Company Name Registration Number
Address Expiration Date
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 affidavit
will result in the denial of the issuance of the building permit.
frinalgned Affidavit Attached Yes 0 No
0
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
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Aro, •.k. U,1Q of Norfliampfoll
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it
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I)EPAR1 i.111,Ti OF BUILDING INSPECTIONS 4
21 2 Maw Street Municipal Building
Northampton, Mass_ 01 060
WORKER'S COMPENSATION INSURANCE AFPLUAVFI
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