43-070 (7) 96 DUM"HY DR T�,a��q�ry �* �p '200 -0943
S3i58: CFllrl3T ONWE a;i'J- 'f+t3`, SA
M ,:Block: N
tat:-Qol
permit: - Building ] F
Cetneav:rtroSnQ
k BP-2001 4843
ProieaN JS 2001-1700
6et.:Cost$x500.00
Fe:$25.00 PER ISSIONISHERE HEREOF ,T TO: J`=
('.ter Claw
Contractor: j wr xr * .•,
the Gro ro: Ed Corbett Jr 11�
Lot Sizc(sa tt) 1030.08 :..._.� rwa se as Aft, r:. >' "Y;"�Z P,t:°9 "��a'" x4„�.w'
AT: 96 Dt3NPHY DR
Applicant Adirest: Instwnce:
4 Reed Street (4131_58448_
NORFHAMPTONMA01060 iSBUt D bX. 1/010:00:00
TO PERFORM THE FOLLOWING WURS;SHINQLE ROOF OVER EXISTING (1) LAYER
POST THIS CARII SO IT IS QOM THE SYIWET" .
luupsetor+otftambiag Iaipsdor of Wrung D.P.W. , .. ? ;. -
Undngronod: :. :SinS: Meter:
Pooh: "
-Rong1: Runfl: HouseSt Foundation: =
Frame `S
Gas•
circ DeraAmeat.,
Roo¢:
Find: Smoke: > : i�I�` 7.5- / - -ac
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA f • '.OF
ANY OF ITS RULES AND REGULATIONS.
ars
Cartiiieate eT Occuoancv
Fee Type: ' Receipt Ne: ` Date Paid: t is k
Building 52tre10 0:W .. '' `925.00
zlzl mstrcer,PJmria(413)5$7-t.?�Q0:1°ye. J-1-2'1'1
;sine-
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ia,rat. ret` '` (ttvtK iiiiiI r.4 N,
E At of Northampton
Ctit I Ira . „artment r Ytifn(r ra 4 tf
lir s Street ^rt hl t t +i fl>-r trrs z Tr ,, W
MAY 1 R 00 eta �/af i e rin F rr~''gj
JNQ a .r MA 01062 r C q -' 9Yeso t tart e ,t.g-- r
•
phone 413 587 - Fax 413 587 1272 14,,iti ;_.yq� 'iF, ` ..9.:,.. 7 r` !;r^ .. ^v, I
DEPT OF BUILDING , "r m 44.4Aa;y"''OrItA<,ni r •y 'H'4/'s e'? ". a -i
APPLICw
AlillarER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION I
1 1 Pr{7gerty Ad//dress:\ /
�r T This section to be cISA,'V pleted by office,
lit9
tp .L1Ui✓�`h+77 DW ` Loi t ,. 4
Map y' r ' UnBr -
Zone i Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Reecrd:
Current Maiimg Aied,ess_
Telephone 96- [
,.g-afore —�- L&.n.2
2.2 Authorized Agent:
n r riot) Current Mailing Address.
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Iteri Estimated Cost(Dollars) to be Official Use Only
completed by permit apobr_ant
16,1ding (a)Building Permit Fee
r..ccai (b) Estimated Total Cost of
Construction from (6)
i. °taritArg ( Building Permit Fee
i '%ochanical (HVAC)
e Protection
Tel=( 1h3+4 + 5;-..i 2S-to Check Number
This Section For Official Use Only
Budding Permit Number: Date Issued:
Signature- j
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 to by
Building Deportment
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot arca minus bldg&paved
parking)
F 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
e_ 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:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check a&I aoolicablt)
low Nouse O Addition ❑ Replacement Windows Alteration(s)0 Roofing R 1
Or Doors 0
accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
?ref Description of Proposed Work: ��(` leez °vett . 64—fare ,&i;-
'uterahon of existing bedroom _ Yes No Adding new bedroom Yes No
'etacned Narrative.• Renovating unfinished basement Yes No
flans Attached Ron ,;- Sheet C
5a: ifNevkh'ou'se,'and!-okzf88)tidifttre ItiH_,Kot.it'll` co : etP7ttt-e • towint:
Use of building One Family_ Two Family Other
Number of rooms in each family unit:_ Number of Bathrooms_
s there a garage attached?
7. ?reposed Square footage of new construction. Dimensions
Number of stories?
' Method of heating' Fireplaces or Woodstoves „Number of each
r+-ergy Conservation Compliance. Maschec:k Energy Compliance form attached?
"roe of construction
is, Construction within 100 ftof wetlands? Yes No- Is construction within 100 an floodplain Yes _
Oeppth of basement or cellar Hoer below finished grade
a Will building conform to the Building and Zoning regulations? Yes No .
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
__. _...... ..... _...., as Owner et the submet pvscer.
erehy authorize _ to a_
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner
//��^ DateL,-- _ ------tr: as Owner/Authorized Agent
/66
hereby declare that the statements and information on the foregoing application are true and accurate, to the best et my
dons/edge and helief.
Sgned underndtheeme. s and penalties of perjury.
2/a' �Se�tT'�
Prins Name
/+i
on/ i 2 o/
a
u'e o� Owners/Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8„a,Licensed Construction Supervisor: Not Applicable 0
Sante of License,Bolder
License Number
'drrss Expiration Date
,.miens Telephone
9,Registered H'gmehttio/"Iietil2nCContr�"r' a :°wt..".Eai:r(k,6:„LZ.."- Not Applicable 0
(amu"7— �/ ///oaOi
Coniipanv Name Registration Number
,d
-..zres Expiration Date
5 ii/
Telephone "65-7
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6))
.angers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
:._result in the denial of the issuance of the building permit-
mad Affidavit Attached Ye, 0 No ❑
ilk - Home:Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 hcRhe 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"homeownter"shall submit to the Building Offcial,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)
sou 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.
I lowcuwner Signature
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,Proposer
sitt Corbett Home Improvement
im Northampton. MA 01060
L-Ni- Lilt I (413) 584-6571
/I16 //6 6'6,9 <it ` a;?v5o
,.,.,,A. .IXNEFOI,Tcl E 13,�1cr�/:/ aIlINE ) J1I2 DATE /lit)/ y �20aa
� , .ePhl �C Joo,NA,D
i
.,,.�..Ll CXL) w JUB
DATE OFPLANS JOB PHONE
U r Ina clay animal(specifications and estimates tor: Fr �AJ L
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'V\ ,,propes, hereby to match material and mhor-amiplele m accoulamm wills Mr above speci[ralioro tort the min of
(S 2c—0 o
he made a.Innaw -
Nd /`)w'.vc / A/aver re',✓ C4',,"7 ti,',
a IN permuted INCa....pctilleil. All Work to be completed ma workl'l manner augirtling Authorized �
m dr'.0 . .^ Ay altercations orderv' fromtrom uhwe uruartganiinu involvinge will he Signature -
at p..n iYritten ogler. and willM1 Magi. +hi ihr - All
up, Mc..a.ulens rleluys beyonda . 1 Owe one Note 'Thou p¢pr co may he
.c..uV giuranu,. Our wrkcAre tully.' vcre.I by V,orkirien:form vu I .urau.c v.ithilrawn by mu if not aecpedwlu `Cu),
\cc (Mee of(proposal The.I i v r r. 32-1r4A
Lilt.at�ti I e hereby y - p I. You nr, sisnalmre G.
upeigfieti. Payment will he madetllnnlalx(ve
it ALt epF,n.e 7r—I -00 � —4-/ s e vatua
f