11A-057 (2) IMP' Ilk
8 VILLONE DR BP-2003-0598
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11A-057 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0598
Project# JS-2003-0992
Est. Cost: $8900.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JESSE MONTGOMERY 134274
Lot Size(sq. ft.): 34194.60 Owner: WARNER EDNA M&DONNA GOLEC
Zoning_URA ,1n.:Vicant! Jesse Montoomerf
AT: 8 VILLONE DR
Applicant Address: Phone: Insurance:
P 0 BOX 329 (413) 585-8482 O
LEEDSMA01053 ISSUED ON:12/27/02 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT BASEMENT WINDOWS &
STORM DOORS - ADD 4/15/02 BUILD NEW WALLS TO BACKUP WASHERS & DRYERS
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:Off(' !-{ - aa?• # 3
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc e Signature:
p Y
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 12/27/02 0:00:00 1579/1581 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
, 4Building Commissioner-Anthony Patillo
File#BP-2003-0598
APPLICANT/CONTACT PERSON Jesse Montgomery
ADDRESS/PHONE P 0 BOX 329 (413)585-8482 O
PROPERTY LOCATION 8 VILLONE DR
MAP 1IA PARCEL 057 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL REPLACEMENT BASEMENT WINDOWS&STORM DOORS-
BUILD NEW WALLS TO BACKUP WASHERS&DRYERS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 134274
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved_ _Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
_____y_tZZG�
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office o�
Planning&Development for more information.
I
1
Versionl.7 Commercial Building Permit May 15,2000
Department use only
Cityo'NorthamptonC Status of Permit:
i
Curb Cut/Driveway Permit
'212 Main Street Sewer/Septic Availability
APR 1 4 2003 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plan_____._
Other Specify
_ate
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: Q
VI1A.OK) D—'-.L Map — Lot Unit
(.cecQ S /1 4- Q l O ,S? Zone '' Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ` / l A
Donna, rere.7Ce c-7 Leeds /i1
Name(Print) Current Mailing Address:
11/ ; 6 � f 7 y-5"
Signature Telephone
2.2 Authorized Agent:
else (1111-1 c.N11e( - {'D. gOY i-ee.ds 4 +.
Name(P ' t) � Current Mailing Address:
L( .- - ,5' a.c-d?c(cP
Sign re Telephone
CTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Sc; Coy' (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 41, el
6. Total =(1 + 2 + 3 +4 + 5) C7e0 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
j
Version1.7 Commercial Building Permit May 15,2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 'Y Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0
❑ 0
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
0 Accessory Building[ ] Repairs [ ]
Fecw -I ' : R- ka ti]C,' ti,,,I -I-e ct kur t J1cr-S i'
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
1
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 ❑ A-2 0 A-3 0 1A I 0
A-4 0 A-5 0 1 B 0
B Business 0 2A 0
-
E Educational 0 2B 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
I Institutional ❑ I-1 0 1.2 0 1-3 0 3B 0
M Mercantile 0 4 ] 0
R Residential 0 R-1 0 R-2 0 R-3 0 _ 5A 0
S Storage ❑ S-1 0 S-2 0 5B I 0
U Utility 0 Specify: r
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE—6 ONLY
Floor Area per Floor(sf) 1st
2nd
1st
3rd
2nd
4th
3rd
4th
Total Area (sf) Total Proposed New Construction (sf)
—
Total Height(ft)
Total Height ft
.
Versionl.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private ❑ Zone: Outside Flood Zone ❑ Municipal 0 On site disposal system ❑
8. NORTHAMPTON ZONING
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/Findingever 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/re any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor p��
l r� L" a-� \` �-L `v�`LvLlt Not Applicable ❑
Company Name:
e-%e 11,01 one'
Responsible In Charge of Construction
Q U. [_3o'( 398 LE-COS ✓i a
Address _
---odki(Pa
Sig ure Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, e,W 1 l( epoier , as Owner/Authorized Agent
Y
hereb declare that the state ts 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.
3e_.s _ A ante/moil_
Print Name
/1 Y V/44/0 .SSignat of Owner/
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: j V i on dhi el ex77z1/ D
`i License Number
`-f 6 °L k S-1- Piorc►'ke f. .!' to
� Jo
Addres Expiration D
Si Telephone
SECTION 13 -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.
I
Signed Affidavit Attached Yes 0 No 0
_dig veat E e 01:i ° NUZfIllt 4IInt ='t=L
B`l tr (1n B lasaacltasctt =0 '
mil_
'Pr.,W DEPARTMENT OP BUILDING INSPECTIONS 4 ={_l`f �I
212 Main Street ' Municipal Building
Northampton, Mass. 01060 um"' .s.
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, '` e f`1vn o)tite
with� a principal place of business/residence at:
`() ak St11 . c 1 t3Pen(C. N. 01 OC,a (phone#) 9/7- e '.S/---e 1 U
(stied/city/stair/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for y
employees working on this job:
(Insurance Company) (Policy Number) (Expiration D )
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have : ed
the contractors listed below who have the following worker's compensation policie :
14
`. (Name of Contractor) (Insurance Company/Policy Number) (Expiration' ate)
S
(Name of Contractor) (Insurance Company/Policy Number) (Expiration T)ate)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration ate)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration ate)
(attach additional sheet if necessary to include information pertaining to all contractors)
(Kam a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do me infra;no-,suction or repair work on a dwelling of
not more than throe units in which the homeowner resides or oa the grounds appurtenant thereto an not generally considered to be
employes!under the weaker's cempensatioa Act(GL152,s3 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employe(under the Worker's Compamation Ad.
I understand that a copy of this statemeari may be forwarded to the Department of Industrial Accidents'Offioo of Insunnoe for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
•
fine of S100.00 a day against tne.
7 For departmental e only
/y Permit Number
map4 Lot#
Si Lure o tier late
PROPOSAL •
PROPOSAL NO.
Jesse C. Montgomery
I
t AP" JCM Home Improvement
46 Oak Street SHEET NO.
r Fibrerico,I`•> f=e IVI fi%
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME,- ADDRESS
ADDRESS
DATE OF PLANS
PHONE NO, ARCHITECT
i1 ' — 6O ,-- e 7 LI
We hereby propose to furnish the materials and perform the labor necessary for the completion of
,a s.'t�
64
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi-
cations submitted for above work and competed in a substantial workmanlike manner for the sum of
a � r ���� Dollars ($ � )
with payments to bp made as follows. i � �"�t S c �✓ r0y
0)e* _be 7r f( 64 '101 OcyQ �_ h� '✓) e4c15i 1 7y - Yea'
Respectfully submitted ! p -f 6d
Any alteration or deviation from above specifications involving extra costs '� (
will be executed only upciwritten order, and will become an extra charge a✓ �.a �� `+'c.r 6,01
over and above the estiriate. All agreements contingent upon strikes, ac-
cidents,or delays beyond ur control. ✓
I Note—This proposal may be withdrawn
by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices; specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be made as outlined above.
Signature
Date Signature
a IN NC 3818-50 I PROPOSAL
MADE IN USA