42-008 . I
�' Diu ► BP- 2011 -0334
GIS #: COMMONWEALTH OF MASSACHUSETTS :2 oos CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0334
Project # JS- 2011- 000549
Est. Cost: $17450.00
Fee: $104.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq. ft.): 50965.20 Owner: SHAPIRO LYNNE R
Zoning: RR(8) /SR(93) //WSP II Applicant: ROBERT WALKER
AT: 987 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584 -1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:10/14/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL 1ST FLR BATHROOM
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: Date Paid: Amount:
Building 10/14/2010 0:00:00 $104.40
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0334
APPLICANT /CONTACT PERSON ROBERT WALKER
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584 -1224
PROPERTY LOCATION 987 WESTHAMPTON RD
MAP 42 PARCEL 008 001 ZONE RR(8) /SR(93) //WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICAATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 40 e ? ce /1 ti / r"
Fee Paid per` �"�� w
Typeof Construction: REMODEL 1ST FLR BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 034783
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFMATION 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
Pen from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
/0/191
Signature of Building O ficial 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 of
Planning & Development for more information.
Department use '
City of Northampton ent /Driveway
Status of Permit:
Bu Departm Cur
21 Main ild Street Sewer / ptcAvailabi r .,.,
( Room 100 14fater/WeH 4varlabi t y
3 Northampton, MA 01060
Plot/5ite Two Sets Structural � s
,v,
p h one 4 ;13 -587 -124 Fax 413 587 - 1272 Plan
Other Specify
Y DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
12_t7 • Map Lot Unit
1 E)73
Zone Overlay
Elm St. District CB District District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
of Record:
2.1 Owner (, vice‘,......„...
°‘-' tJ i�+-P t \Z- 0 S' �.' k- .��? rp r-s C
Name (Print) €, % s: S
/liu�/ / � Telephone
Addres v
Signature � ���
2.2 Authorized A gent: ' ` i y _
Name (Print) Cu rrent Mailing Address:
Signature Telephone
SECTION 3 - EST CONSTRUCTIO COSTS
Item Estim ated Cost (Dollars) to be Official Use Only
co mpleted by permit applicant
1. Building (a) Buildi Permit Fee
2. Electrical I et) (b) Building Permit Fee
4. Mechanical (HVAC)
5 . Fire Protection "�� 6. Total = (1 + 2 + 3 + 4 + 5) i 7 °() . Check Number$*6&
This Sectipn For Use Only
Building Permit Number: Date
Official
Issued:
Signature:
Building Commissioner /Inspecto of Buildings ' Date
Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 Spe ial Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date I ued:
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 Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excav Lion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors EI
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [E] Siding [D] Other [CO
Brief Description of Proposed 0 ....e. �• - {l �.- tz- � ?.."24-,--T-1-1 S V .f : ✓S CE
Work: . - i iS t - Nc ;
Alteration of existing bedroom Yes No Adding new bedroom Yes 1 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 t , -
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. Masscheck 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 - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, L. yi1v6 R SYt c1;/ , as Owner of the subject
property / P � � hereby authorize b &KY- !141kev
to act on my behalf, in all m hers relatve to work authorized by this building permit a plication.
1K
Sign ur of Owner 1 Date
I, V 1?°'-121i- V V " -k -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 p s and penalties of per•u
Print Name O
Signature of Owner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 1 / 6ra J Loll' A /t 5 4 - 78 Z 7
License Number
Address Expiration Date
Signature Telephone
9. Reaaistered Home Improvement Contractor , Not Applicable ❑
Company Name Registration Number
36 014 I 1 ( 2 . 2 I 7.0
Address / Expiration Date
Telephone J ' 4 Z24
SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed ani1 submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildi permit. 67—A, (
Signed Affidavit Attached Yes No ❑
11. - Home Owner Exemption
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 Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature