43-069 (5) BP-2003-0174
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit it BP-2003-0174
Project# JS-2003-0326
Est. Cost: $14500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Gmnn: Larry Paquette 100679
Lot Size(sq. ft.): 15768.72 Owner: THEROUX ANN
Zoning. SR Applicant: Larry Paquette
AT: 88 DUNPHY DR
Applicant Address: Phone: Insurance:
40 East Green Street (413) 527-6375 Workers
Compensation
EASTHAMPTONMA01027 ISSUED ON:8/16/02 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF,INSTALL SIDING &
REPLACEMENT WINDOWS/DOORS
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/16/02 0:00:00 3111 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
,. C \ •�.f Northampton =, r •� -
E - I„ g Department , a ,. , •.
\U ' Main Street , reti7�r
A.\
'Ie I r R,om 100 ,tettan ,xai :V.,./ii, ,I
.A �t Nor am.ton, MA 01060
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�. ,gtfe�gdf2'FN387-1 '40 Fax 413.5871272 i,ttyJt.
f `".re ,. p, tte.- C614rbl F•,
'' APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE-LNFORMATION.
v- 1.1 Property Address: T '''`'; .+ 3„ru17r$(d Se b1t`X> '
8S;
at npl Dr z
M
fioK-Qote //0 0/06 _' {aF Fstero- ' t.
ElruSt:Diitnd `n5 g4-iiU1 - „.i--=1 s .
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
y- 2.1 Owner of Record: p 7�
47/7 Ingle-0 ei y O t 22( 1J2 l Dr it/iximi cc
Name - int) Curr�/MtdlingA dr sss'-_y2
s �4 .. t. __ Tele ne d�
:nature
2.2 Authorized Agent: 7 d)
L AR ( (.4 ° IJe_119 'ME Lk'' /z1 eAsT �.J rec- % 7- crc-d��l°',11°�r
Name(Print) ( (' Current Mailing Address:
J
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item 7 !y Ko co Estimated Cost(Dollars) to be Official Use Only
J completed by permit applicant
1. Building (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
•
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 Flynt
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
Parking) i
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variarrce/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:
`1'Ea *x : .
New House 0 Addition 0 Replacement Windows Alteration(s)0 Roofing t -
Or Doors qJ/
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks
l [ ] Siding[y-' Other[ ]
Brief Description of Proposed Work: Ra. Yca1 .CLQ-� —' -1-�%J S — c Ca 0 N.-
Alteration
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Nr. lative 0 Renovating unfinish"I basement Yes No
Plans Attached Roll D- Sheet 0
ralfiNEWMITMIU:'o'*:=•dditib'S"iti s'Y- f . W ,.oW,inn :
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
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? _
h. 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-TOE3COMPLUED WHEN
,OWNERS AGENT OR�CONTRACTOR APPUIES;F R;BU(LDING'PERMIT
��1y
erd U K , as Owner of the subject property
hereby authorize to act on
my beha 'n all matters relative to work authorized by this building permit aapp lication.
.ChtrAb �v
Signature of Owner _ l/e7
a e
I, , 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.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Not Applicable 0
a°cu {y fb (-4 ti> to6 — F ) 7
Companyj� Name6.101-
� /, y��(/� Registration Number
4 0 t,.�-1 - J' -4 ez. '14'r^1 mv` (C.-. is — o Y
Address Expiration Date
Telephone 5z7-6 3 �S
SACT1O1,$10-WORKERS',COMPENSATION INSURANCE AFFIDAVIT,(M.GA.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 0 No 0
xtil)111•1 kv it,ci?al o"r` ll
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 peal aws and State of Massachusetts General Laws Annotated.
Homeowner Signator
bti Qittg oil Narthantpfon }
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5 �'
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_
DEPARTMENT OP BUILDING INSPECTIONS 5.._'f_
212 Main Street ' Municipal Building
Northampton, Maas. 01060 ini
woman's COMPENSATION (INSURANCE AFFIDAVIT
I, ilc.Ae �? -• 6-4/42h ca `)2e 4_d .
Z t .,J)—C'o't-•-ate'.. (Naase&permittee)
with a principal place./of buciness/residence at:
yy,/4d:-4a
lie Co-�,s�. "°d- C`c-t farnt (phone#} 5-,27'6 & c
(tediraty/stateMp)
do hereby certify, under the pains and penalties of perjwy, that'.
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Cl WI cola Hi c .._ ‘ -4d' — a
(Insu.ance Company (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLey Number) (Expiration Date)
(Name of Conrrictor) -..(insurance CnmpanyRoucv NumLer) ... (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(ouch aOehtteelu'ere ifn.oetvry to teef*&[tftrnsum poetising leen ooeto-non)
() I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:?tee=Lc aware the.while Low wacre uao anploy"as=tom - ^or.mvr_iw err repair tone co e dwt14g of
not mom ton arca units in utich the&,meoxvm video ac 00 Cu&monde apps town tb&do are ler GateraIY mnidaM to be
eaployea necks the workcts co panatim Ace(OL152P1(5)),apptirrion by a Lommwaa for a Uc me or ps°met cyidma dee
lepl etww of an=ploy.,un rurdu Wo,4.Ye `..sup. .tion Act
(uedeswnd theta owof Oil ceitmcretrosy be£aexudsei to do Doe all .mill AA'nt OF5ce of laxrnm+for the
ww.bc wrUHodoo tad tint Gilacto an,r,t covin&o tmix soetioo25A ofMOL 152 on lad to the imposition of ca m',l penalties
°"utni of fine of up to T1.500.00 mVutimpthoomcm ne aid of up to oyr acivil rennin in thee of a CO'Woh Ott and a '"
ca
fin of StD0.n0 a thy.rind me
e . Far dcp.z`netd use msy
r `oPermit Number
• `�'�-$-�o�.. map& Lot 1,
.
Signature . LiccoJpeimitthe l.Hte {