22B-008 (19) r
130 SPRING ST BP-2002-0933
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma:Block:22B-008 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0933
Project# JS-2002-1510
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KENNETH LYNDS 0013668
Lot Size(sa. ft.): 65775.60 Owner: PEASE THOMAS R&PEGGY-ELLEN
Zoning: GI A-pplicant: KENNETH LYNDS
AT. 130 SPRING ST
Applicant Address: Phone: Insurance:
P O BOX 448 (413) 584-9282
LEEDSMA01053 ISSUED ON:4/26/02 0:00:00
TOPERFORMTHEFOLLOWING WORK.-STRIP, PLY & SHINGLE HOUSE ROOF &
PARTIAL GARAGE ROOF
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 Sionature:
Fee Type• Receipt No• Date Paid: Check No: Amount:
Building 4/26/02 0:00:00 2053 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
T
Department use only
�m
---'City of Northampton Status of Permit:
Bugding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability________
t " r Room 100 Water/Well Availability__—____—
Northamptoh, MA 01060 Two Sets of Structural
�t1 t phone 413-58771240 Fax 413-587-1272 Plot/Site Plans-------------
1 Other 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 comnpleted by office
o
d Z_ Map— _ Lot
r Z--- Unit
---- —
Zone-----6�-Overlay District______________
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: /
4eSignn
�--------------rintCurrent Mailing Address:
Telephone
2.2 Authorized Agent:
Lfe.ear .rs oo4--
Name(Pr Current Mailing Address:
-- -------- ---- '" ---- �3-.S 5�-10—VC
Sint e Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
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 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:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other[ ]
--- ----- ------- --------------------
----------
Brief Description of ProposedJ
Work: 2w,VV-0-. Nom- O�G K-�o�'�t f�►a t F 7A�'�4C vet " �Q.�+T
Alteration of existing bedroom------Yes—.V _ No Adding new bedroom___--Yes ___V-' No
Attached Narrative Renovating unfinished basement ____Yes --✓_No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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.
1. 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
l a �S ✓ .�QJ ____, as Owner of the subject
-- �T ----- -------- --------------------
property
06
hereb authorize ah -------------------------
to ac n my beha , in a Iafters rel i to a �this permit application.
-- ---- --------- - -----------------------
Signature er Date Op�
�_ �/�a. ��----------------____-, as Gwmw/Authorized
Agent hereb declare that the statemer�fs and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under e pains and enalties of perjury.
---------------------------------------------------------------------
Print Name
Signatu Owmer/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor: j Not Applicable ❑
Name of License Holder: -z- U /3 6
License Number
Addres T— Expiration Date
S ture Telephone
9 Registered Home Improvement Contractor Not Applicable ❑
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.
Signed Affidavit Attached Yes....... No...... ❑
11 - Home Owner Exemution
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 buildine permit.
As acting Construction Supervisor,your presence on the fob 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
rpT
�� GGc3ic� Oy
Of '-Nortiluilip toil
.—�-
--
w DEPARTME14T OP DUILDr�\,C INSPeCTION'S {
212 Aloin Strcct ' Municipal DmIdin
G •,
Northampton, Mass. 010GO
A
«'ORtQ;It'S CONVQ'CNSATION MSURA-NCE AFFMAVI-l'
plincipaJ place of busioess/residence at:
. 0� �ox jC�� /15 Ex (phone-') &—SIL
(&T=UCity/statcfzip)
do hereby cerdi ;, under die pains and penalties of pcg'ury, i.hat
( ) I am an employer providing die following worker's comocns:bon covemge for 111�
etuployccs w.orUng on dtis job:
(lnsur-_nom Conrzc}) tPoLic: Nur -- (r
i tm[ion DaLc)
( ) I am a sole proprietor, general contractor or homeowner (circ;e one) and have hired
the contractors Listed below who have the follokving worker's compensation policies:
(Nlaruc ofCon.mCwr) (InRlranc;. Comp vi'ciic; '�`umccr —FEx -
- (NWrnc of Coatraczor) -- (lnstuancc C.omDanY/Pouc-y Ntuac^_r) E."t.Lm ion Date)
(Frame of Coluramor) Onsuranc:. Compan}-/PoOc). Nambzr) (ExpiratJoo Date)
(Nzmc of Contractor) (Lasuran Comcaay/Policy Numbs) 12xpu-atioa D' .
(ea.u� ..ti:::ociJ r_'�cct frac-N i n.to utev �aformaaoo prrcainins to.L oom-ac-.on)
I
am a sole propne-tor and bave no one working for me
I am.a home owner performing all the work myself.
NOTE:plcs:h aw-in th.,4{Jc bca co.mcn.bo cz=pl oy P.-`t to w r.
aot axYe th_n t� cis r� a rAa r-uric oa,d.•c(L of
t�t� n«3ich be bor000 vc r=&=a oa the
miplayc�unr'.c Lhe�.ai:cta oc��.--.., -''�P -r=thcc•.o�-c oc,<�c-�cilty a�tr:dcrctii to t`c
m Act(G L 15 2,sz 1(5)),app lino oa Iry a bomco w�fm n U c=:a perTan rL y a-idcncc trc
IcS11 rt,^,•of as czzploy.r uodr rte Wor4c.r Ad
I uodcrrund thrt a copy of thio cml�ro..y b.rw-,._,,.d to tbo
or lodutriJ Aoodcoi>'Offioo of Ir'...000 for th.
v—6-
--IG—oa a.•sd that L•il=c to eoauc bo w under sccdoa 25A of}.SoL 151 eta Icsd to the Lmpolaioa of crimiail pcaiw
ooaiiau ng ora GDC ortp to 51-500.00 and/or orup to one yc.-v and oil pm.ltia is t5c form ora Stop Work Order and a
rm orSloo.o0 t dty tpinn >x
For dcp+rtm—+J—only
Permit Number
e- Z-r t. 1.zp:t Lot
,tun of Li JPcrrniU