23A-093 (9) j - AjIt;x BP-2003-1223
GIS#: COMMONWEALTH OF MASSACHUSETTS
,' 23Jb401 .r CITY OF NORTHAMPTON
Lot: -001
Permit: Building_
Category: BUILDING PERMIT
Permit ft BP-2003-1223
Protect# JS-2003-1894
Est. Cost: $251300
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: John Corbett 104000
Lot Size(sq.ft.): 13242.24 Owner: SHAW MELINDA
zoning: URB Applicant: John Corbett
AT: 17 FAIRFIELD AVE
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:6/30/03 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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: Receipt No: Date Paid: Check No: Amount:
Building 6/30/03 0:00:00 1616 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
•
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APPLICATION TO CONSTRUCT, ALTER. REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address.
Map_ - Lot - Unit
Zone -._. Overlay District
Elm SL District - _ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_)'Y)e-L-s5L9W --- —_ - /71.:..-rre„„La 4ve„-
SY-➢' _FrSo
2.2 Authorized Agent: -�-
ki 4j jegi 36 QINfoCI•- sT Lc -fib.. mit
tS8! '71Z
SECTION 3 - ESTIMATED CONSTRUCTION COSTS f
;=m Estimated Cost (Dollars, t Official Use Only
completed by Deceit aonlsarm
IH 2573
a) f:. Icing Permit Fee
' !ed Total Cost of
-_ - t-t:notion from (6)
Building Permit Fee
I
c. =ncc, Number
�j This Section For Official Use Only _
Building Permit Number' /09(/.,yq z __. Date Issue°'.-
Signature
B-vI!ding commissioner/Inspector of Buildings Data
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House !J Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors-
Accessory Bldg. ❑ Demolition❑ New Signs [ I Decks [ ] Siding [ ] Other I I
Brief Description of Proposed Work.- . . fl LL gellikeseytei GNr u5 _ -
Alteration of existing bedroom Yes No Adding new bedroom Yes _ No
Attached Narrative❑ Renovating snfinished basement Yes _ No
Plans Attached Roll L- Sheet,,
Ga. IFNew,hbuse':and"or addition to existing housing, complete the following:
a Tice of building : One Family Two Fami y- _Other
b. Number of rooms in each family unit- Number of Bathrooms
• Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
• Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each_. _
g. Energy Conservation Compliance. _-. Mascheck Energy Compliance form attached?
h lyp_of construction _
Is construction within 100 IL of wetlands? Yes No. Is construction within 100 yr. floodplain _Yes _Nr
Dern of basement or cellar floor below finished grade
k. Wil suddmg conform to the Building and Zoning regu tat ions' "es - No
I. Sept c 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 of the subject property
hereby authorize to as or
m, wet rd in all matters relative to work author zed oy`h s millbong Remit-application
Signature of Owner Date
I, CSC�h �C't^Set( as Owner - ?.or,zed Ago rt
_ e _ .
hereby �edare that the statements and information on the foregoing application are true and accurate, to the hes : !
knowlesge and belief.
Signed .nder the pains and penalties of perjury
Cr-ST
Print Ne—;.
�e Jsc/o 3
SignSignatureref Own'r�enf Date -
SECTION 8 -:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
T9_ReeisleieitHome°ImproVe'men1Cont`ractor.'c, - Not Applicable ❑
6-.)z a cw Guo to Scoot,
Company Name Registration Number
Address Expiration Date
Mil 0/52C.c!.1, Telephone.QT4 Tn,—
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 Att:davit Attached Yes ❑ No ❑
ome , v em ttun
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2) fami!Ics
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 he 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 persons)
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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