29-421 r .. s •
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) r7 Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [Q Siding [O] Other 16
Brief Description of Proposed Pe,ni, G 0 V e f i ` vim K . p p pi
Work: J
Alteration of existing bedroom Yes No Adding new bedroom Yes 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. 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
r et rg are-i /0 s h , 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, m a 4 Q r L f / S i N , as Owner /Authorized
Agent hereby dec(e 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 erjury.
1110.54 rG It, a Sh
=. tName
/n
Signature of 0 , Agent Date
• . ^
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To lncom 'tele Inform:don
Existing Proposed Require y Zoning
colu to be filled in by
Building eparlitent
Lot Size
_
Frontage ------
Setbacks Front
Side L:- VL--- L: R: L__�
Rear _______
Building Height F---1 /----� �---
6
_ __�
Bldg. Squar Footage �--- r---- �� > � r ---- �---
Open Space Footage _ %
r ----
(Lot mruminus muoavm',m [---� --
parking)
# of Parking Spaces '--- �---� �---
Fill: |--------------'--��----------------!�--- - ---------'
(volume aLocation) L------ � --'
A. Hasa Special Permit/Variance/Finding ever been issued for/on the site?
0 0 ��
NO �_� DONT KNOW �~� YES «`~�
.
, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT YES ��
v�� u/,/ m.u,, �=
IF YES: enter Book | Page | and/or Document #
�� ��
��
B. Does the site contain a brook, body of water or wettands? NO �_� DONT 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 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES x~� NO �~�
�� ��
IF YES, describe size, type and location:
E. Will the construction activity disturb ( ring, gradingexcavation, nr filling) over 1 acre orinit part ofa common plan
that will disturb over 1 acre? YES � NO K�
�� ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
p d. ? "f o Pc// /f
Department use only
° City of Northampton Status of'errnit �°
Building Department
t � 9 P Irur#�OutlDnyea�ray Perrot#
r 2.‘
20,` 212 Main Street �yer!Sepc abilit
Room 100 Water/Weil Availabiltf ;. .
• N. • _ mpton, MA 01060 Two Sets`t� .Str ctur #
-`' -13- 587 -1240 Fax 413 - 587 -1272 PtotlSite Plans "
dF 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
!� a., 01 t 4/ n I/ � I Map Lot Unit
f ) Ov (ti c , e m, 0/ 12, Zone Overlay District
Elm St.:District CB District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
J J Ai S C S -b
war
Name (Print) d Current Mailin A dress:
`
C 4 13 �� S 7 6
/ " r lti 1 )/) 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 permit applicant
1. Building (a) Building Permit Fee 0
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 /911
This Section For Official Use Only
Building Permit Number: Issue
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
.
.
31 GOLDEN DR BP- 2012 -0377
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 421 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit # BP- 2012 -0377
Project # JS- 2012- 000600
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13721.40 Owner: NASH PHILLIP A & MARGARET J
Zoning: URA(100) //WSP Applicant: NASH PHILLIP A & MARGARET J
AT: 31 GOLDEN DR
Applicant Address: Phone: Insurance:
31 GOLDEN DR
FLORENCEMA01062 ISSUED ON:10/13/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL PELLET STOVE
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 10/13/2011 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner