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16B-032 (2) BP- 2010 -0521 GIs #: COMMONWEALTH OF MASSACHUSETTS 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- 2010 -0521 Project # JS- 2010 - 000735 Est. Cost: $8000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa. ft.): 19602.00 Owner: PATRICIA NOLAN Loninw UPB(100)/ Applicant: PATRICIA NOLAN AT. 58 FERN ST Applicant Address: Phone: Insurance: 776 WESTFIELD ST (413) 786 -5047 WEST SPRINGFIELDMA01089 ISSUED ON. 1111312009 0:00:00 TO PERFORM THE FOLLOWING WORK :STRIP & SHINGLE ROOF & INSTALL VINYLE SIDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Linderground: 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 11/13/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo . City of Northampton f Perms n Building Department�areernl 212 Main Street 3tcAvailrl� i Room 100 �WE Northampton, MA 01060 Tsae��oi� phone 413- 587 -1240 Fax 413 - 587 -1272 a.'Pr.. . 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 completed by office k Map Lot Unit Zbiie Overlay District EIm.St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 O wner of Record: J%o L L C Name (Print) Current ing Address: 0 w Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit 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 id 6. Total= 1 +2+3+4 Check Number J!" This Section For Official Use Onl Date Building Permit Number. Issued: Signature: _ Building Commissioner /Inspectorof Buildings - Date 1 � � Section 4. ZONING All 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 Rear Building Height Bldg. Square Footage % s Open Space Footage (Lot area minus bldg & paved p arking) # of Parking Spaces ?. -- •.,...,= — . Fill: j (volume & Location)- -. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book ? Page! and /or Document B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: -+ � ' - -- - U Xr there any proposed changes .- t-6 or aaaition f signs intended for t property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 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 f Or Doors / Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [0 Siding Other [p] Brief Description of-Proposed /+ Work: ✓I N7 L . S / D/r- -S 'F� �✓��, r / - �f�/ f Q �-� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa_.If New pause an?cF ©Tcdrt�o`Yto ezisfifn " fiou�ir� co ( "ete "le..foTFornin 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? _ / V 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - T.0 BE COMPLETED; WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDINGPERMIT 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 Owner Date I, ( N " as Owner /Authorized Agent hereby d lare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pairs and penalties of perjury. Print Nam _ Signature of wner /Agent Date a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone w . 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...... ❑ . _. The-current-exemption for _ "homeowners" was ext ended t o include Owner-occupied Dwellings of one (1) or two(2) families hi and to allow such homeowner to engage an individual for re who does not possess a license, provided that the owner acts as supervisor. CAM 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" ce es d assumes responsibility for compliance with the State Building Code, City of o "ampton r mances; a tts General Laws-Annotated. Homeowner Signature / J The Commonwealth of Massachusetts Department of Industrial,4ccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumb.ers Applicant Information Please Print L ' i embly Name ( Business /Organization/Individual): Address: 0) f J City /State /Zip: ('7, & ZV Phone. #: v Are you an employer? Check the appro riate box: Type of project (required): ^ 1. Q I am a employer with 4.. E] I am a general contractor and I 6. New construction employees (full and/or part-time). * have hired the sub- contractors 2. El am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have. no employees These sub - contractors have. 8. ❑ Demolition working for me in any capacity. employees and' have workers' 9. Q Building addition [No workers' comp. insurance _ comp. ins re uired 5. We are a corporation and its 10.0 Electrical repairs or additions S. I -am -a- homeo - wner -dsin, all-work - - - - --- ' ,th�'ir —L �g.�.ingrepairs or additions myself. [No workers' comp. right of exemption per MGL 12.E Roof repairs insurance required.] t c. 152, §1(4), and we have no . 13.❑ Other employees. [No workers' con3p. msiirance required.}. *Any applicant that checks box #1 trust also fin out the section beiowshowing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub = contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. lam an employer that isproWil ng worker' compensation insurance for my employees. Below is the policy and joh site _ in ormation. Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /State/Zip Attach a copy of the workers" compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section-25A of MGL c. 132 can lead to the imposition of criminal penalties of a fne up to $1,500.00 and/or one. -'year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. j3e advised that a copy of this statement maybe forwarded to the Office of Investizations of the DIA for insurance coveraee verification I do hereb certi u e _ fy pains and penaltces ofperjury that the information provided- above L"rue arrdcorrect__ _ _ Si mature: ate: Phone #: - L6.Ot al rise only_ Do not write un this area — to be ceted by city or town official r Town: Permit/License # g Authority (circle one): rd of Health 2. Building_Diepartment 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector ct Person: Phone #: s HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and -regulation-, The , ection n" c�quues that the building department be calle to inspect work at various stages, which include foundation /footings (before backfilb, sonotube holes (before pour) a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing: & gas) the homeowner will be responsible to make sure that the trades hired secure their proper ___p is in_conj. unction _to_the_buildingTermit.issued, and that they get their required inspections. Failure of the individual trades to secure. the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made L understand the above. .(Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location ' FE,S'' ` BP- 2010 -1197 GIs #: COMMONWEALTH OF MASSACHUSETTS :Bl ck: 16B -,032, 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- 2010 -1197 Proiect # JS- 2010- 001731 Est. Cost: $1689.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: IDEAL HOME IMPROVEMENT INC 091207 Lot Size(sq. ft.): 19602.00 Owner: AMATO CHRISTOPHER Zoning. URB(100) Applicant. IDEAL HOME IMPROVEMENT INC AT: 58 FERN ST Applicant Address: Phone: Insurance: 142 BOYLE RD (413 ) 863 -2128 GILLMA01354 ISSUED ON :6129/2010 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL BASEMENT & ATTIC INSULATION 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 Sianature: FeeType: Date Paid: Amount: Building 6/29/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -1197 APPLICANT /CONTACT PERSON IDEAL HOME IMPROVEMENT INC ADDRESS/PHONE 142 BOYLE RD GILL (413) 863 -2128 PROPERTY LOCATION 58 FERN ST MAP 16B PARCEL 032 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: INSTALL BASEMENT & ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included• Owner/ Statement or License 091207 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INl?O 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 Permit DPW Storm Water Management Demolition Delay 4il� 6 /2 41,9 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 of Planning & Development for more information. ` Department use only City, of Northampton Status of Permit: Budding Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 -587 -1272 Plot/Sfte Plans 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 completed by office Map Lot Unit G i Zone Overlay District �� ®►' r) C' e 1 X 1 4 CSI() Elm St District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record• .� rl S a M CC. O'Ci /Y1CS r Name (Print) Current Mailing Address: Ole Telephone Signal 2.2 �6_ 'zed Agent: c a e (Print) ) Current Mailing Address: �gn lure Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by rmit applicant 1. Building / �/, (a) Building Permit Fee 2. Electrical i � (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2+3+4+5) Check Number This Section For Official Use Onl Building Permit Number. sued: Signature: Building Commissionertinspector of Buildings Date Section 4. ZONING All 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: Rear Building Height Bldg. Square Footage Open Space Footage _ % (Lot area minus bldg & paved p arking) # of Parkin Spaces Fill: ; (volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW � YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW C) YES C) IF YES: enter Book Page and /or Document #` B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES f IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , 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: E. Will the construction activity disturb (clearing, grading, excavation, 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 Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ED Demolition ❑ New Signs [CM s S - ding J Other [ Brief Des n of Pro ed I W ork: DM.64 '4- 'c'oC i r6u- �G( f7 -i SO lE "' �(c�F,Q ✓e /12 17 r 1`i Alteration of existing bedroom Yes - --' No Adding new bedroom Yes -- No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. 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. 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 rl,_S as Owner of the subject property hereby authorize to act on my be f, n all matters relative to rk authorized by this building permit application. " L L 0 Signatur f er Date 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. -3 Gl 4 Printm e i r /O of Owner /Agent tie SECTION 8 - CONSTRUCTION SERVICES " 8.1 Licensed Cons truetion S / ervisor. (l [` � ` Not Applicable ❑ Name of License Haider : �/� rn 42 � ! t 6 11 ao License Number i M A Ada r �j!Af 1 o� I t* ( C) Si ature Telephone 9 . tared kamompaigContractor Not Applicable ❑ I VC k t-- V i " ► (.; CCy�l` n� E , .Lt C._ t Lj- (eLt -() .� Company Name Registration Number Address r Expiration Date Telephone � i 3 ` U�3 - 3 1 i� SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6)) Workers Compensation insurance attktavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building pemrit. Signed Affidavit Attached Yes- ...... 0 --' No...... ❑ 11. Dome Owner Exemption The current exemption for " homeowners" was extended to include Owner- occupied DweRh mn 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 10835.1. 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 dwel ling, attached or detached structwes 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 belsbe shall be responsible for ail such work performed under the buldine pen it 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 The Commonwealth ofMassachuseft Department oflndus&W Accidena Offue of Investigations 600 Washington Street Boston, MA 02111 www.rnass gouldia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Leidbly Name ( Bushms/organizatiodlndividual) ` I 6�e—aL Address: ��}-�, �� {��►- City /State/Zip: t^ �� 1, r 1 Phone #: q-, 3 - � 0 3 ' Are you an employer? Check the appropriate lox: Type of proles (rapired)= 1. 0 am a employer with 7 4. Q I am a general contractor and I 6. Q New conshucdon employees (full and/or part time).: have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7- Q Remodeling ship and have no employees Tie sub- contractors have 8. Q Demolition working for me in any capacity_ employees and have workers' 9. Q Building addition [No workers' comp. insurance comp' insurance. required.] 5. Q 10. We are a corporation and its ❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I 1 _Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Q Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.Q Other employees. [No workers' comp_ insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensxiion policy information. t Homeowners who subunit tbis affidavit indicating they are doing all work and then hire outside contzactots most submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet slowing the name of the sub- couliaCtas and she why or not those comes have employees_ If the sub - contractors have erpdoyem they most provide their workers' comp. policy number. I mn an et r1ai er that is provridi con fmsa6bn hauradce for my enyffoyeex Below is tee policy mrd job site infornodom Insurance Company Name: / ,�1 { U� Policy # or Self -ins. Lic. #.- qL , `fLj -7c Expiration Date: Job Site Address: 5 2 y -- r &. Ciiy /State/Zip: PloY Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $ 1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy under the mud penaMa ofperjury that the infornotibn provided above is true and correct Phone #: Offrcial use only. Do not write in taus area, to be complesed by city or town o City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Budding Department 3. Cityrfown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: i iaiuiui6 cuiu c�uuutr, -uvatu rippituauull rage 1 ai 1 ds Pl-aritlirlg and Zoning Bo O wner First Name *Owner Last Name OR Business Name E state of Kimberly Pytel * Owner Address T C/o Christopher C. Johnson, Esq., 776 Westfield Street * City * State * Zip West Springfield Massachusetts D1089 Applic First Name * Applicant L ast Name Business (if applicable): l Ann — e e la Shartrand * Applicant Street Address 121 Bridge Road *C * Stat * Zip Florence Massachusetts 01062 * Phone * E - Mail '413 -586 - 7584 ashartrand @gmail.com * Assessors' Map (s) and Parcel ID(s) _ * Parcel Deed Book and Page } } 4338 -155 Probate No. HS09P0040EA * Work Location *W Location Post Office *Zoning/ Overlay District ,` Florence 01062 * What PERMITS or AMENDMENTS are you applying for ?,' PLANNING Special Permit w/ INTERMEDIATE Site Plan ($200, except flag lots $1,000) PLANNING Special Permit w /MAJOR Site Plan ($1,000 plus, unless this is an amendment, $0.05 /sq ft of proposed new building) U PLANNING Intermediate Site Plan ($200) 01 PLANNING Major Site Plan Approval ($1,000 plus, unless this is an amendment, $0.05 /sq ft of proposed new building) APPROVAL NOT REQUIRED Surveys ($250 /plan page) [..-.I PRELIMINARY SUBDIVISION ($1,000 -Type H or $600 -Type I PLUS $75 per unit) 0 DEFINITIVE SUBDIVISION (Greater of $3,000 OR $10 /linear foot of new roadway; $4,600 OR $14 /foot if no preliminary; $400 PLUS $10 /foot for one lot minor subdivisions; $500 for Amendments) L2 ZONING BOARD Special Permit ($200) f ZONING FINDING ($200) D APPEAL OF BUILDING COMMISSIONER- Zoning ($200) COMPREHENSIVE 40B PERMIT ($500 plus $0.05 /sq ft of proposed new building) �{ VARIANCE ($1,000 plus $0.05 /sq ft of proposed new building) . _ 43D Permit (Any Planned Village commercial project) * Relevant sections of zoning and subdivision regulations {; 350b httn: / /fsl2.formsite.com/fsl2 app/FormSite 9/24/2009 Luutll� 1CLi 1i1J1J111 GLlU11, 1JLJ 1VV 1 Md.VG L110 Pktgu U11L11 1L PrIJILJ:: ! rage 1 of L .Fe3d }<s/ i iitt "t1I1 <` . ]14'i.It1c�)Ye Do this kal.11[ it prints!!! Owner: Estate of Kimberly Pytel Address: c/o Christopher C. Johnson, Esq., 776 Westfield Street, West Springfield, 7 l Massachusetts 01089 Applicant: Angela Shartrand /[pipe: 75] Address: 121 Bridge Road, Florence, Massachusetts 01062 413 -586 -7584, ashartrand @gmail.com I represent under the pains and penalties of perjury that: 1. The information in this application is correct 2. Two copies of the application (EXCEPT for ANR plans) have already been delivered to DPW. 3. I have ALREADY posted the required sign on the property. 4. The OWNER has authorized the City to inspect this roperty Applicant signatur ,it 9 i , ,a � ner Signature: C- Work Location: 58 Fern Street, Florence 01062 Map ID: 16B-032-001, Deed: 4338 -155 Probate No. HS09P0040EA, Zoning: URB Permit(s) Requested: APPROVAL NOT REQUIRED Surveys ($250 /plan page) Regulations: 350b Project: Divide property to create existing house lot and new building lot. PERMIT CRITERIA (IGNORE "pipe," it refers to permits you have not applied for.) Finding criteria [pipe: 245] [pipe: 246] Appeal of Building Commissioner [pipe: 2521 [pipe: 118] Comprehensive 40B Permit [pipe: 197] [pipe: 196] Variance Application: [pipe: 2491 [pipe: 251] Special Permit and Site Plan Criteria: [pipe: 253]: [pipe: 82] [pipe: 254]: [pipe: 87] [pipe: 255]: [pipe: 91] [pipe: 257]: [pipe: 96] [pipe: 256]: [pipe: 102] [pipe: 258]: [pipe: 105] [pipe: 259]: [pipe: 100] [pipe: 156] [pipe: 261] [pipe: 198] [pipe: 1991 �_,_ httn- / /fsl _fnrmsi .,co f 12 app/ForrnSite 9/24/2009 r L VIIIIIyI rYcuuuii6 rAyP►ICaUCII. Ilu 1NU I icave Lim pago tului IL prlms: ; : rage L oI L Requested Site Plan Waivers: [pipe: 210] [pipe: 185] CITY CLERK USE. SnGmilluJ.• _1_109 Dai k,,A L /09 Application must include fee and (except for ANRs) $40 check made to "Daily H pshire e e" INSTRUCTIONS to file your application View Results htti):Hfsl2.formsite.com/fsl2 app/F'ormSite 9/24/2009 Zoning/Planning Application: Do NOT leave this page until it prints!!! file; //f Users /angela/ Library/ Mail %20Downloads /58 %2OFem%20... Zoning /Planning Application: Do NOT leave this page until it printsM Owner: Charles & Clara Bode Address: 407 Driftwood Drive, Gibsonville, North Carolina 27249 Applicant: Angela Sharaand /N /A Address: 121 Bridge Road, Florence, Massachusetts 01062 413-586-7584, I represent under the pains and penalties of perjury that: 1. The information in this application is correct 2. Two copies of the application (EXCEPT for ANR plans) have already been delivered to DPW. 3.1 have ALREADY posted the required sign on the property, 4. The OWNER has a orized the City to inspect this property Applicant signatur : wner Signature: Work Location: 58 Fern leet, Florence, Florence 01062 Map ID: 16B-032-001, Deed: Bk 4338 Pg 155, also Bk 527 Pg 210 & 211, Zoning: UR13 Permit(s) Requested: APPROVAL NOT REQUIRED Surveys ($250 /plan page) Regulations: ANR Project: Creation of one new lot. PERMIT CRITERIA (IGNORE "pipe," it refers to permits you have not applied for.) Finding criteria [pipe: 245] [pipe: 246] Appeal of Building Commissioner [pipe: 252] [pipe: 118] Comprehensive 40B Permit [pipe: 197] [pipe: 196] Variance Application: [pipe: 249] [pipe; 251] Special Permit and Site Plan Criteria: [pipe: 253]: [pipe: 82] [pipe: 254]: [pipe: 87] [pipe: 255]: [pipe: 91] [pipe: 257]: [pipe: 96] [pipe: 2561: [pipe: 102] [pipe: 258]: [pipe: 105] [pipe: 259]: [pipe: 100] [pipe: 156] [pipe: 261] [pipe: 198] . I of 2 9/24109 1:54 PM Commonwealth of Massachusetts The Trial Court Hampshire Division Probate and Family Court Department Docket No. HS09P0040EA At a Probate and Family Court held at Northampton in and for said County of Hampshire on the twenty- second day of September in tkfe of auftord.two'thousand nine On the petition of Kathy Anne Northcutt Administratrix of the estate of Kimberly Pytel late of 58 F Street, Northampton MA 01060 in said County, deceased, intestate praying for authority to sell certain real estate of said deceased described in said petition at private sale, in accordance with the offer named in said petition or for a larger sum, if she shall think best so to do; all persons interested having assented and no person objecting thereto, it appearing that said offer is an advantageous one and that the interest of all parties concerned will be best promoted by an acceptance of said offer. It is expedient to sell real estate of said deceased. IT IS DECREED that the petitioner be authorized to sell and convey at private sale, upon the following terms: for the sum of Two hundred fifty thousand and 001100 ($250,000.00) dollars in accordance with said offer or for a larger sum, if she shall think best so to do, the real estate of said deceased described as follows: A certain tract or parcel of land with the buildings thereon, situate on tha Southerly side of Fern Street in Florence in Northampton, County of Hampshire, Commonwealth of Massachusetts, more particularly hounded and described as follows: Beginning at an iron pin on the Southerly side of said Fern Street, the same being the Northeasterly corner of Lot 665 as shown on "Plan of Oakland Park, Northampton, Wass." racordad in Hampshire County Registry of Deeds., Book 527 - Pages 210 and 211; thence Easterly along said Fern Street, one hundred seventy -five (175) feet to a pin at the center of Lot 669 at land of John J. Gustavis et ux; thence Southerly, through the center of Lot 669, one hundred fifteen (115) feet, more or less, to an iron pin; thence Westerly one hundred seventy -five (175) feet to the Southeasterly corner of said Lot 065F thence Northerly one hundred nine and two- tenths (109.2) feet, more or less, along said Lot 665 to the point of beginning. , Meaning and intending to convey Lots Nos. 66, 67, 68 and the Westerly one -half of Lot 669, as shown on said Plan of Oakland Park, recorded in Hampshire County Registry of Deeds, Book 527, Pages 210 and 211. E)1�ffi8 The estate tax lien has been released in accordance with the provisions of General Laws Chapter 65C, Section 14(a) ... Justice of the Probate and Fariiiy Court 58 FERN ST BP- 2009 -1062 GIs #: COMMONWEALTH OF MASSACHUSETTS Map-.Bloc 16B - 032 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: renovation BUILDING PERMIT Permit # BP- 2009 -1062 Protect # JS- 2009 - 001473 Est. Cost: $6000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: - Use Group: PATRICIA NOLAN 49104 Lot Size(sa. ft.): 19602.00 Owner: NORCOT KATHY Zoning: U RB(100) Applicant: PATRICIA NOLAN Applicant Address: Phone: Insurance: 364 SOUTH ST (413) 786 -5047 AGAWAMMA01 - 001 ISSUED ON. 612412009 0 :00 :00 TO PERFORM THE FOLLOWING WORK :INSTALL KITCH CABINETS, FLOORING,BATH FLOOR & TUB SURROUND - 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: F Driveway Final: Final io— r '��1 J_. Final �' Rough Frame: Gas: Fire Department Fireplace /Chimney: Insulation: • fI� 2�2 /�� IS I O �rL 3 U1(.piNC� OK No Final: Smoke: LS�� .� � Final: Cam' P6N�� �`t w�°d 1W DErECPo l24 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupanc g s zna6r"e: FeeType: Date Paid: Amount: Bui ?ding 6/24/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo