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32C-308 /5 ,. ..// _ guli,,c), /1,2_ a 4 <1 1 (A\ ,) ""e . ". + Ail Ld r' /(t 9 t.„ .,...... r ri c,e 4 re Z_ H e4 7 6. ' /- piy R '4?t 1 i f 2 j , 7(roc f 4 4 ai•ue,7 .. 0,c 'i _______ f SeCo/r o{ FlooL 1i b 3 d101° I ___ _ l'' f i __.. , -<--_ — tat' . 1z ------- ----, Q v /( 7 57- (4 1)CLIA 1( / i \-'\ ------- Y PST ■ ' ' .c. . s e( ') C-_______________________21e -.- fqX s err R y S t1 o,2 T ei 7o'7 _c /1:e4ky 5-1, 404 I2ti.f?:- X I I I Pe,A(2,,„, 01: L.)ils.do`4 ilkid,' i ( I ,,,_ Se co4r \ 7 {/ ---- ---- — -----\ 1/ ---:- ____� sG J� _ II -- — 10111111 1 -'17k 1 ?C WO - ` or = A f4 ; k ' OS' . ,f (11:0°,0ke- \\\N tot 0( i 1 /ix_ 1 Froolliall-f - --/.--.440b,4,c. LoNr ' \ . 11411 s •9- ' 6x/4 e, fo5r V \ _ (o a j � Cao Cie 1 e. ` f 6, l/ San � • Book 683 444 belonging to the said_ _J9i]Il_R. and_ _ Julia_ Dzawlslwaki___and__their heirs and assigns, to their own use and behoof forever; and 1 hereby for _ myself _wad my heirs, executors and administrators, covenant with the grantee 8 and their heirs and assigns. that_ _ L 13721 lawfully seized in fee simple of the granted premises; that they are free from all incumbrancea, Except a mortgage of sixteen hundred dollars to Northampton Cooperative Bank • that__L have good right to sell and convey the same as aforesaid; and that 1 will and___ heirs, executors and administrators shall WARRANT AND DEFEND the same to the grantee_ , and hi8_ heirs and assigns forever, against the lawful claims and demands of all persons, — — And for the consideration aforesaid_ _1, _ Vinc en f_ _J skiewicz _ hushand _ nY_ the _ said _ Annfl._ _ . Juskiewiez do hereby release unto the_81331i_grantee Sand their heirs and assigns all right of or to both nvwas- _ _aurtally and HOMESTEAD in the granted premises, —.Dad- ell - esker- rigkes- and- irrrereets -the eia. • IN WITNESS WHEREOF,_ We_ _ _ _the said_ A/1118... _Juskiewicu _ and_ ineent_ _Juii.e_wiez hereunto set___011x hand 8 and seal8 this__ twentieth day of Ileptemher in the year one thousand nine hundred and twelve. Signed,_ and __sealed in presence of Daniel D.O'Brien Anna Juszkiewicz Beal Vincent Juszkiewicz Seal / COMMONWEALTH OF MASSACHUSETTS Hampshire. _ ss.___ Beptembex_B0 ____19_1 -.___ HAMPSHIRE, ss aSeAtslabJx_ Then personally appeared the above -named n nn _Anna _Juski exile z_ 11_ o'clock 3_0__ minutes,_A.___M. a� astl The foregoing is a true copy of the original. - ,µ;; and acknowledged the foregoing instrument to be her free act and deed, before me, One Attestation, i(ifi ',X e—Ltss;nr _Dan iel_.D..0 !Br i_en_ Justice of the Peace. REGISTER. Book 683 Know all Men by these Presents That 44-R Anna Juszkiewicz ',Anna Juskiewicz of Northampton, in the County of Hampshire and Commonwealth of Massachusetts -, To John R.Szawlowski Julia Szawlowski IN CONSIDERATION OF_ One_ _Dallar_ and_ tither_ _valuab1e_IIonaider_atUons. Hockanum Road, paid by___JChn _aaid_Nor_thamp.tDxi Northampton the receipt whereof is hereby acknowledged. do hereby give. grant. bargain, sell and convey unto the said c i John R. Szawlowski and Julia Szawlowski their heirs and assigns forever: the following described parcel of land situate in said Northampton,bounded BOOK69a5 and described as follows: Beginning at corner of Hockanum Road and Meadow mGERZW Road, running N. 63° E. (206.5) twohundred six and five- tenths feet to a stone bound, thence continuing N. 56° 12' E. (18.8) eighteen and eight - tenths feet to land of Peter Kowalski, thence running South along land of said Kowalski (162.4) one hundred sixty two and four - tenths feet to land of Anna Juskiewicz, thence S. 61° 1' W. (231.2) two hundred thirty one and two tenths feet to an iron pin, thence N. 31° 21' W. (168.4) one hundred sixty -eight and fourth - tenths feet along Hockanum Road to the place of beginning. Being a part of the tract conveyed to this grantor by Louis J.Rogers et al, by deed dated January second 1912,and recorded in Hampshire Registry of Deeds Book 675 Page 42. • TO HAVE AND TO HOLD the granted premises, with all the privileges and appurtenances thereto I A.dtinistration Send Comments *3011 , r0rop 0 4, City of Northampton, Massachusetts City Home Page -------------------------------------------------------------------------------------------------------------------------------------------- - Permit Details More Details: Permit #: BP-2008-0081 View Inspections Tracking #: View Conditions Project Name: REPAIR FOUNDATION Permit Type: Building Street Address: 5 HENRY ST Navigation: Submitted Date: 7/24/2007 12:00:00 AM Back To Last Page Issued Date: 7/30/2007 Permit Expires: Applicant: RONALD MISIARKA Contractor: RONALD MISTARKA Status: SIGNED OFF Approved By: Work Area: Work Description: REPAIR FOUNDATION Map: 32C Block: 308 Lot: 001 Parcel No: 6/50 Database Last Updated on Friday, September 24, 2010 at 7:08:52 AM Version: 9.12-062010 ( . I I Web Copyright© 2010 Des Lauriers Municipal Solutions, Inc. nnti Adm fstx 'Send C.0"nr r-s fir me O 4 • +. City of Northampton, Massachusetts City Horne Page Permit Details More Details: Permit #: BP-2002-1184 View Inspections Tracking #: R View Conditions Project Name: PORCH REPAIR/SIDING Permit Type: Building Street Address: 5 HENRY ST Navigation: Submitted Date: 6/28/2002 12:00:00 AM Back To Last Page Issued Date: 6/28/2002 Permit Expires: Applicant: RONALD MIST ARKA Contractor: RONA! D MIS TARKA Status: APPROVED Approved :y: Work Area: Work Description: REPLACE PORCH DECKING & INSTALL SIDING Map: 32C Block: 308 Lot: 001 Parcel No: 'Jo Database Last pdated on Friday, September 24, 2010 at 7:08:52 AM Version: 9.12-062010 Web Copyright© 2010 Des Lauriers Municipal Solutions, Inc. Akimfmstraton ft.'end Comments Home i Alt: " City of Northampton Massachusetts City Home Page Permit Details More Details: Permit #: BP-2003-0333 View Inspections Tracking #: View Conditions Project Name: PORCH REPAIR/SIDING Permit Type: Building Street Address: 5 HENRY ST Navigation: Submitted Date: 9/27/2002 12:00:00 AM Back To Last Page Issued Date: 9/27/2002 Permit Expires: Applicant RONALD M LS1 AP KA Contractor: RONALD M1S1ARKA Status: APPROVED Approved By Work Area Work Description: NEW WINDOWS & SIDING Map: 32C Block: 308 Lot: 001 Parcel No: Database Last Updated on Friday, September 24, 2010 at 7:08:52 AM Version: 9.12-062010 ( IL '1/4„ Web Copyright() 2010 Des Lauriers Municipal Solutions, Inc. Acreage Type (Other Improvements: 11 Total Value: 15,65011 Street /Roadl Type Acres' Value no no information information Sales Info Permit Info Date !Permit # Price I Purpose Date I Type Price ;`Validity 107/27/20021 1 184 1 15,0001 RENO PORCH 1 101 /02/2002 'Land + Bldg 19,30011 A 0 1 & SIDING 109/27/200211 333 1 16,5001 NEW WINDOWS & S t FCC\ \7 ■ �. ;A t 11 H Nordic :\ 1 \: (:( c1,11 1pl ci m IN Rl'col d ( ._ 11 ,,1 New Search Prgperty Tye C'lassification Code Reference Card 2 of 2 1 Parcel - Location - Zoning - Assessment Map- Block -Lot: 32C 308 - 001 Zoning: 1 Assessment: Location: 5 HENRY ST Neigborhood: 16 Land: 145,010 #Living Units: 6 Deed Book: 6488 Building: 407,290 Class: A Deed Page: 309 Total: 552,300 Building Information Building Sketch Bldg #: 2 Year '. uilt: 1900 # of Units: 4 113 al5, ! A-101013 1 31 Quality Grade: C 112,.- , r ' 12614 B.12 # Efficiencies: 0 . -iiit BB :. : # 1-Bedroom: 2 A,`4 E. 1212 # 2- Bedroom: 2 1 tr 12 # 3- Bedroom: 0 Covered Parking: 0 14 , : 4 Uncovered Parking: 0 ! E 175 41 Total Unadj RCN: 157,630 - Ei, - .25 120 41 Total Unadj RCNLD: 221,340 17 Ill .dy Grade Factor: 1 1 t " 3 ' # Ident Units: 1 _u i" -E - Func /Econ Factor: .9 i2 1212 RNCLD: 199,210 ' ) P., ' =i Attached Improvements Type Meas -1 Meas -2 Meas -3 # Units' RP2 74 0 1 1 Detail Information: RP2 I 88 0 1 1 RP5 I 175 0 1 1 Levels Use'Ext Walls Heat AC % Good Unadj RCN WD1 120 0 1 I 1 - Bl 91 0 16,740 RP2 I 80 0 11 1 1 - 01 11 'Frame HW/Steam 0 67,410 RP7 1 175 0 ( 1 1 - 02 11 'Frame HW /Steam 0 59,720 RP4 80 0 1 1 - Al 86 'Frame 0 13,760 Land Data Outbuilding Info Square Foot Type SQ Utilities Type Feet Value no no information Length Yr Phys Func % Value information Descr Width or Size Quan Built Cond Util Good AB2 1 1200 1 0 Fair Normal 0 15,650 • • (: "it ot NottlidltllThil. ,AJ \ ((imir11,rt'ial }'topcii kLo..iik (' New Search Property Type Classification Code Reference Card 1 of 2 1 2 Parcel - Location - Zoning - Assessment Map -Block -Lot: 32C 308 - 001 Zoning: Assessment: Location: 5 HENRY ST Neigborhood: 16 Land: 145,010 #Living Units: 6 Deed Book: 6488 Building: 407,290 Class: A -1 I 1 Deed Page: 309 Total: 552,300 Building Information Building Sketch Bldg #: 1 Year Built: 1900 1 t u`� u "' a ' ° ` D i rA A t:l tV # of Units: 6 ! 11E12 41 Quality Grade: C P 11111 - 280 # Efficiencies: 0 7 1 # 1-Bedroom: 4 # 2- Bedroom: 2 # 3- Bedroom: 0 501010 ' Covered Parking: 0 ,: 1612 1 _ _ 11 1 Uncovered Parking: 0 , app Total Unadj RCN: 148,560 Total Unadj RCNLD: 172,000 Grade Factor: 1 # Ident Units: 1 — Func /Econ Factor: 1 1 RNCLD: 172,000 i Attached Improvements Detail Information: Type Meas - I Meas - 2 Meas - 3 I# Units RP5 I 272 0 1 I 1 I Levels Use Ext Walls Heat IAC % Good Unadj RCN RP5 I 175 0 1 I 1 - B1 91 I 0 18,380 I RP5 I 72 0 1 I 1 - 01 11 Frame HW /Steam] 0 68,080 RP7 I 272 0 I 1 I 1 - 02 11 Frame HW/Steam 0 62,100 Land Data Outbuilding Info Square Foot Type SQ Utilities Type Feet Value no Length Yr Phys Func % information Descr Width or Size Quan Built Cond Util Good Value Prime 38,600 145,010 Site no information Acreage Type !Street/Road Other Improvements: I Total Value: 0 I Type 'Acres Value I I no ,.., 32 309 u6,.. 7,,...,, to. - . ..., . .:,.., 32C- 308 .; .;.'. 168 .4 1 4 1.:::7,-: 4., ....' 9/0 39,4 -042 - sbo .. 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NI' ,,," _2.-Ds-bie) ----------j- N ' - r P t ,t ,-----T----,g ., 1 e viol q 1 i .._______ 1,1, — 4 ,Jr ,,,,I, _____ Vii'' is- lyi/a ? .1i/t,'/ Cf V-') , ., e ;:i -j , -- 1 -7-- . vclo 1 -)' i "7 iova) d5 .- L --- l 1 v3 r av v "' •-.■...... /\ !I o vt f .,,....._ ' ------ - .- ; I ' l l L V 1 \A 9., AN 1,1 g e'l- jas0 > -',. 7 t N) c iao > \ \-- kp v-tid : Q L. o-P (C) Pre51 12 ' ' - : ) , ,S' a • ' N Q� i j ?5� WS r �. ul� 1 aC°/ " 1 ( - )/ - Z i ' 7 f 2 �W �� --- q07 j a sap _ r -.*. --2//ovo? t-- et 1 -&------- -7 4,9i -------\/ _____V__ ' )0=1=Etj ,1 ±� �7o"s °.L jot/ ; �j011 y►roc ,� v � S � o� Q�� ���� k1V2 j s 1 7 , 7I —poi) 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 regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill) 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 occuoancv 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 Permits in conjunction to the building permit 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 1, 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. Date Address of work location * y 5l • AxQ l y, -�6T ��'!'! ( ' fica ,Le. F % .�.�d ■ r• ' • r "n . The Commonwealth of Massachusetts Pi �, Department of Industrial Accidents - t �_�= t..-. Office ofInvestigations • =.,... � 600 Washington Street Boston, MA 02111 .'■, _ www.mass g /dia 'Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business'Organizationandividn 1) : 6/6'C 4&_ r/ • - Address: /17 ,<r44 sr, . Cit /State/Zip: 645140:i / 4 - , 119, !O 7 Phone. #: Y 3 u2.7 0 90 Are you an employer? Check the appropri box: Type of project (required) : / 1. ❑ I am a employer with 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction 2... I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no enployees These sub - contractors have. . 8. Diii Dersolition working for me m any capacity. employees :and have workers' 9 - Q .Building addition [No workers' comp. i�urance mP• t'rancr ._ 5. We are a corporation and its 10. b� Electrical repairs or additions re R j 3.0 I am a homeowner officers have xercised their 11. Pluinbmg repairs or additions doing all work myself [No workers' comp. nglit of exemption per MGL 12:Q.Roof repairs • insurance required.] f • c. 152, § 1(4), and we have no [No workers' 13.❑ Other • employees. [N comp. insurance required.}. *Any applicant that checks box # must also fill out the section below showing their workers'-compensation policy infommtion: • t Homeowners who submit this affidavit.indium:big they are doing all work and then hire outside contractors must submit anew affidavit indicating such. . tConuactors that check this box ntust.attached an additional sheet showing the name of the sub=contractors and state whether-or not those entities bave employees. If the sub- contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. • . 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 tnider Section'25A 'ofMGL 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 Irvnvestisations of t for iiisurarice covera:e ver`ifica6on: /1/44 hereby certify under the ,airs , • , alties ofperjury that the information provided.above rs.true and_corr•Pr _.__......• Si • .. tune: ��// . . .' _ ,,K,0 . .t �► s at _ . _ de # , Phone #: " t i 3 - 6 ;0- - 01.0 . • • Official use only. Do not write in this area, to be completed by city or town'officiaL City or Town: # Issuing Authority (circle one): .'1. Board of Health 2. Building Department 3. City/Town Clerk . 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: SECTION 8 - CONSTRU SERVI —2 1-1-2 L SA Lic Not Applicable L Name of License Holder : � e4 C' ?� /�' License Number le 4 r 57 - 4,�f�4r Address �/ `� Expiration Date ignature Telephone 9 Rteaistered i'cifveientContractor 7 #g l . jii 'a* Not Applicable ❑ 6 .5 7.14 ....4.4-1/lee) e- Company Name �r /� /� Registr / on Da Num / tie '7 U K1`!�t f 7 f /�.5 ' f � jt 'I i i �"�t Exp ,n Address j/ `�' Telephone 1 f 5 ~. / -' 0 ?0�, SECTION 10- WORKERS COMPENSATION I NSURANCE AFFIDAVIT T (M.G.L C. 152, § 2 &a) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failur t o provide this in the denial of the issuance of the building perm Signed Affidavit Attached Yes ❑ No ,` l r vex 4 ;s, fir;igg The current exemption for "homeowners" was extended to include Owner - s 1 d c allow such for hire license as d e llow s CMR 780 Sixth Edition Section al for hire �) Ur tw Definition of Homeowner: Person (s) who own a rovided tha t he is, or is intended to be, a one or two family Parcel he land a which structures. A e who constructs er» s more one ho re than h e /she oeca re sides ied Dwe or intends lin of to one re side , o Such `home owner" shasuch ll submit to the B re t dwelling attached or detached stru ctures accessory onsibie for ael w >ile In a mo o- ear rY t0 such W an t a uch homeowner to engage an individu who does not possess a ork etrfor g 0 t fficial, res on main eriod shall not As acting u med trader the b a cceptable i b e considered e an completio of the work for which this e C onstruction S rv'sor your n> job former th e n time i a hp llle Als bead Presence on the ' mtt g Official t6 advised that with refe Permit is issued. 1 °b site wi11 re t h elShe Emp loyees for in' rence to Chapter 1 S required fr o �..� you hire to Junes not resulting in De at h fi to ti The unde perform work for ) of 2 {w0 e rs' Co rsigned " you under Com p e nsation) and ' dunj b' and this th Massac hus e tts Gen eral upot Northa me owner " Pe r mit. Ch 1$ Ordinances Law 3 ad • certifies and ass res St at e and Loca/ 2oni s Annot bllit of Homeowner Si gnature ng L aws a nd State t t3' f or coTh d ' ° u ma b i i mpl oyer an ce With a ab le for °f M assachusetts G � tate J S $ • * u L aws Annota �d ode City of i I " o -Se UY ��Ip� gpist�ct- --�'�- C Ist�ct � � ,; go on (t 1 1 �/ � ! i j ORtyED ;4041 \ 1 �� NNERSHi° IAuTH n ti U �d AaacesSR t Mad'm9 � Curren j • r e ' - � 11 A r - A o A' elep v � � � 'ing Addres i � C Mai � � .. ° � • --------- 1elePh p�fia�a \use °I.1\1 /`!� S e U N COSH p°llacsl tO b nt \ \d\n9 pes Fe 1MAT ��NST� E ,orn.\ ke t st �t a• • \►ca (a 6u °i to• d Es f\p eel \ere ° b� Cdhs ?eta F ee: s e•-•' G N�n'bec CI Y, © C)0 ` � tat uge 00 \ O N P�i� , 0 4A- ,��, 5 GG °0 HOC pate 6. ?I�ker,C\Or k � .� 51 pate \ 11k2 k 3 b ey. \E °t at eultd` rg s y � \a \e C 5 `ore1 %\° e�lta \r9' °m�is o��zea \9\ a �t ^ - besk GGUCa tO t fo r - true an d a � P , dbe �°',e ,, ✓r Oah ar � O • dP9en _s SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : E-c/6 " &s2 e 7715041,53" ! 41 «/ ?�i� License Number / 6 57 605 ter.; Pr/73,20/1 Address ( 1 Expiration Date 1 vI c> �'� � ignature Telephone ;Rttissfei4l Hortt+ ln7irovmetifndcf' _ SEinagagi Not Applicable ❑ S amore -, 1 a iee /e_� ice ?„J� /33 V 7 Company Name Registration Number y 6.244 7 5 r i95 7,,,4,,r,i , id 6 Z2 7/2 if Add ress Expiration Date Telephone )/J 7 " 040 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 extended to include Owner - occupied Dwellines 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Wind s Alteration(s) Roofing ❑ Or Doors Lk Accessory Bldg. ❑ Demolition New Signs [0] Decks [I Siding [0] Other [0] Brief Descriptim of Proposed / �' / /� Work: K cs./ /", .VP.QC ildver.5 it, 0 t r. ' / e eel Alteration of existing bedroom v Yes No Adding new bedroom Yes v No Attached Narrative Renovating unfinished basement Yes !/ No Plans Attached Roll - Sheet saA 1i New ol�sedr acd~ct ezis�tirq�sina ,niG�ipttheoilaiflq: 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 Gt f_ LA-7._ z r ..` a t_ , as Owner of the subject property �r �j hereby authorize 616e. L e- L i1-O/7? gi to act on my half, in all matters relative to work authorized by this building permit application. Signature of Owner �� D ate 7 6 7 , 4 119 , aswAvrpep/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. Print Name V 2 //0 Signature ofr /Agent Date - ! . f 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 1 1. t � it t! Frontage { , 1 1 = . Setbacks Front € [ 1 , Side L: i R:i L:i I R:E Rear = - - -- Building Height 1 `I Bldg. Square Footage i mi i 1 % [ = € 1 Open Space Footage % (Lot area minus bldg & paved = I $ _ t parking) # of Parking Spaces "fl 1 ~ Fill: — — r,. r , . ... —. ,� . ...— w_� ,� �. (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW +►��4 YES 0 IF YES, date issued:€ { IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW +V YES 0 IF YES: enter Book I Pagel and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ;rt. DONT KNOW Q 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 0 NO iPI IF YES, describe size, type and location: ° € D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO ir® IF YES, describe size, type and location: s E. WiII 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 1 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , � .=''� ,City of Northampton s *� e \ >— )Building Department g $ )� "' ,.._ r ---- �y 2 Main Street m . a l'..1.51 Q �� ffn . N oom 100 � . Y $� to ampton, MA 01060 _ M ,: " - pftone4 3- 587 -1240 Fax 413- 587 -1272 er g ' r p l APPPCATION 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 S ' 47 57 �c.....s---- ' . Map - Lot Unit A/9011 ®/1 Zone Overl /J�� i E St District C B District x C7 i SECTION 2 - PROPERTY OWNERSHI /AUTHORIZED AGENT 2.1 Owner of Record: _ • • 103 � S I Name (Print) Current Mailing Address ( dLG3� _ ,e,\ -e- 7 A CC -. � 1 ..` " 1 a� ' - elephone { tom I Signature r "I [ - - _L, ci a-Lte 2.2 Authorized Anent: fil)( e 720, ‘V 6ie/9 /7/ ST:: ST A4.y, I! Name Print) __ Current Mailing Address: F Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 0 / e -� (a) Building Permit Fee 2. Electrical 101 — (b) Estimated Total Cost of 0 2 / 000 Construction from (6) 3. Plumbing ei30 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection OZ, 000 6. Total = (1 + 2 + 3 + 4 + 5) �(Q a0 Ch eck Number /( f � / �.- This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date BO "Ea File # BP- 2011 -0282 APPLICANT /CONTACT PERSON EUGENE THOMAS _ ADDRESS/PHONE 49 GRANT ST EASTHAMPTON (413) 529 -0902 1 r Q R.- !-C1 E 1.Z-10 1 PROPERTY LOCATION 5 HENRY ST - UNIT 5C 2ND FLR LEFT f PL t)5 MAP 32C PARCEL 308 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: (f i E CI 9 (30 r to PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /,, Fee Paid �( I� 9w Tvpeof Construction: RESIZE BEDROOMS, REMODEL BATHROOM & KITCHEN New Construction tef,rxl, Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 81882 „Dui) K<(" A f)) p-0 3E 1 EC1 (LS Pt 3 sets of Plans / Plot Plan CIA P—('. Kri CD (.P THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION j • SENTED: Approved r .0 Additional permits required (see below) L i 14 Z CeiloT1 PLANNING BOARD PERMIT REQUIRED UNDER: § 'c, 4 i (-I( tJ (` l ) Intermediate Project: Site Plan AND /OR Special Permit With Site Plan !b z, ivoPfk s IPf Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § I &. Nf►A/' K Finding Special Permit Variance* f t ( Sc' T1t 5 �0( 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 lop IC) 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. 5 HENRY ST - UNIT 5C 2ND FLR LEFT BP- 2011 -0282 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 308 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP-2011-0282 Project # JS- 2011- 000470 Est. Cost: $16000.00 Fee: $96.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: EUGENE THOMAS 81882 Lot Size(sq. ft.): 38594.16 Owner: SZAWLOWSKI REALTY INC Zoning: URC(100)/ Applicant: EUGENE THOMAS AT: 5 HENRY ST - UNIT 5C 2ND FLR LEFT Applicant Address: Phone: Insurance: 49 GRANT ST (413) 529 -0902 EASTHAMPTONMAO1027 ISSUED ON:10 /8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:RESIZE BEDROOMS, REMODEL BATHROOM & KITCHEN - SMOKE & CO DET PER CURRENT CODE 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 10/8/2010 0:00:00 $96.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner