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18C-130 The Commonwealth of Massachusetts t - = , Department of Industrial Accidents =.510 � j_ : E Office of Investigations . • p r y : cur = 600 Washington Street Y�� iw„ _ .. Boston, MA 02111 :.� www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers Applicant Information Please Print Legibly Name ( Business /Organization/Indiviclnai): Address: City /State/Zip: - Phone .#: Are you an employer? Check the appropriate box: Type ofpi -oject (required): / 1.0 I am a employer with 4. 0 I am a general contractor and I 6. 0 New construction employees (full and/or part- time).* have hired the sub-contractors listed on the attached sheet 7. 0 Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub - contractors have. 8. 0 Demolition working for me in any capacity. ei loyees_and have workers' _ 9 Building addition workers comp. insurance re comp. incrma„rP — .. 0 required.] 5. We are a corporation and its 10. Electrical repairs or additions 4 i officers havexercised their . 3. i t I am a homeowner doing all work 11.0 Plumbing repairs or additions ..ysell [No workers' comp. insura right of exemption per MGL 12. Roof repairs r rr e required.] t c. 152, §1(4), and we have no employees. [No 13. Other o workers' comp- insurance_ required}. . *My applicant -that checks box #1 must also fill out the section below showing their workers' compensation policy information: t Homeowners who subcmt this of idavit,indiicatiag they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors 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. I am an employer that 'is providing workers' compensation insurance for my employees. Belo w is the policy and job site information. Insurance Company Name: . • Policy # or Self-ins. Lic. # Expiration Date: Job Site Address: City/StafelZip :r _ Attach a copy of the workers' compensation policy declaration pae'(showing the policy number. and expiration date). Failure to secure covera 'of .. . . ge:as required under Section 25A MGI: c T52can 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 If veiniations of the DIA for insurance coverage verification. _ ...,:... y pains p of perjury that i Ido hereby certi u e ains� d penalties o - at - the tnformationprovufed .above- utrue r riden rrecL —_ . _ ._ Signature: Date _ / /e , Phone #: `/ 5? 6 • Official use only. Do not write in this area, to be completed by city or town official City or Town.: Permit/License # _ - Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical jnspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: ■ SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone Et. . Rep to red )-torrielmproYeinenttoritracti . ........., iiga; .._,. , , ..,. 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 ❑ 11 l , et caner , 'XCD ►' iO il 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 res. • nsibility for compliance with the State Building Code, City of Northampton Ordinances, Sta - • d Local4Min a and State of Massachusetts General Laws Annotated. Homeowner Signature � , . — _ ........1 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) (zi Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [E] Siding [0] Other [0] Brief Description of Proposed t ( /_ f J e 'i C f� �"- walk Work: a Y f Te.x. v lCtt� �?c I� � G19a walk l Alteration of existing bedroom Yes No Adding new bedroom Yes / No S ki-e r Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 64, 'If N`e*' h' c se : 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 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 1 _'1- [ ,C-'' , as Owner /Authorized Agent hereby declare tha e stateme jand inf. ( ation 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 Signature of Owner /Agent Date i 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 I i ._ F .__ i Setbacks Front a 1 -- Side L:L t R: 1 L:= _ R:` __ 1 F L �. Rear .."""i . 1 Building Height Bldg. Square Footage r I % 1-1 r i 1 i L Open Space Footage % (Lot area minus bldg & paved _ 1 parking) # of Parking Spaces „„ ' -- i - pw Fill: --, l =' (volume & Location) -- i N A. Has a S ial Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: enter Book i i Page ! and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued C. Do any signs exist on the property? YES Q NO Q 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 Q IF YES, describe size, type and Location: 1 E. Wiil 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 Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. o • ° n s � ffs City of Northampton x f ' , . &� , 5 Building Department ° � � 5 �� ' � � � � g' ��� 212 Main Street f p= • , e ab , Y Room 100 ° e 3 ., 8,71 _ 9 L010 Northampton, MA 01060 • F phone 41 �3- 587 -1240 Fax 413- 587 -1272 - • y - 4 i T�' . ; , i i i i = -, f d • ; ' d u4 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 • SITE INFORMATION This section to be completed by office 1.1 Property Address: 76 si,61.61zbo nit j\j a Rk.ovic-d--ery.- , �j � Map Lot Unit �`%' Z one ` Overlay Dist 0 fb (90 Elm St District f CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 7�, /.�'�e 4 1--- 4 , L 2- - . >- � 2 - _ / 4,2/4 l� - '/' /Lie.. 7* i ', -i /f ° '/ /)ems Name - / Current Mailing Address: � ���� ,d: i / Telephone / 3 �- . Sign. , / Y13 �� f 'l� r 7 "'-°� , 2. • uthorized Aue -7 .. 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 / D 2. Electrical 15 00 (b) Estimated Total Cost of 1 r Construction from (6) 3. Plumbing -77 O 0 Building Permit Fee f 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7 D 0 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date . 1 File # BP- 2010 -0786 APPLICANT /CONTACT PERSON HEAFEY BRIAN J ADDRESS/PHONE 76 BLACKBERRY LN LEEDS (413) 586 -3269 Q PROPERTY LOCATION 76 BLACKBERRY LN MAP 18C PARCEL 130 001 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 O"� }}. �� e? 5 Typeof Construction: REMODEL BATH,ADD POCKET DOOR,REPLACE TUB W /SHOWER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan = ,1U ,0 /'� • a BE f 6 R e Tf i THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON S < v0 INFQRMATION 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 3)1CliO 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. J } 1 `li ftY LN (< BP- 2010 -0786 GIS #: COMMONWEALTH OF MASSACHUSETTS ap a i 1 : 18C - 130 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 -0786 Project # JS- 2010- 001173 Est. Cost: $6300.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 11020.68 Owner: HEAFEY BRIAN J Zoning: URB(100)/ Applicant: HEAFEY BRIAN J AT: 76 BLACKBERRY LN Applicant Address: Phone: Insurance: 76 BLACKBERRY LN (413) 586 -3269 () LEEDSMA01053 ISSUED ON :3/11/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REMODEL BATH,ADD POCKET DOOR,REPLACE TUB W /SHOWER - INSPECTION REQUIRED BEFORE FRAMING COVERED 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 3/11/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo . . , , v The Commonwealth ofMassachrrsetfs 4 Department oflndrrstrial ' s Office of Investig atioris •i 1 : 600 Washington Street 4R@ i t 5 Boston, ZYIA 0,2 11 www. nrass•gov /dire Workers' Compensation Insurance Affidavit. Bui, Tilers / Contractors /Electr-icians/Plums Applicant Information Please PrintLeaib ber ly Name ( Business /Organization /Individual): /(.4. /4 /f L4 F - I h Z Address: ' ddress: r ` - - / 1 V(cl/0 L� F City /State /Zip: (-) lifer? --)'/C jri, Tv/1.0 ;/ 3U/ Phone #: / . i fi G � ' Are you an employer? Check the ap box: Type of (required): 1 � 4. I am a general c,on[ractor and 1 1. cl I am a emp with 6 / ❑ 6 [j] New Construction employees (full and /or part-time).* have hued the sub contractors 2. ❑ L am a sole proprietor or partner listed on the attached sheeC. , a 7 Remodelin ship and have no employees ees These sub - contractors have, , g 1�eltidltfl 1 P p y . ort working for me in any capacity: employees anti h4vewokeis' 9 a ding addttton [No workers' comp: insurance. comp msur atice f ° f required.] 5, 0 We area corporatkt n an i ts , ' .1.6 r or additions �. ❑ 1 am a homeowner doing all work officers ha1 e e5tercised their, :11 ..; iuoibing repairs ar additions myself. (No workers' comp. right of exetiaptioiiper'1t�10L, , ',122- j IAoofrep s insurance required.] t C. 15 2 §1(4 , an lave�n �, , employeesNo s L`C rs .--, coma •inst ranee 1 egtutx ] .., r_•-. ' a *Any applicant that checks box #1 must also fill out the section below`sho\vmgtlietr works§ LoriipetleatUUn,pc3lie yrrir 1ian Homeowners who submit this atfidas it indicating they are doing all v4'ork aid tJ ett-bi . outside co j Ts rri , ubmrt a ii rlii iaat mdicaim s utb: *Contractors that check this box must,�itacheil an additional sheet showin the.naiii.e bf e Sub c ntr- f_tois and state w`theth -irp`t 6%4tdse ert0tyes`ha ,. employees If the sub - contractors have employees they runt proytde -Piety Wdrk com p:p ij bef �. z_ w , I am an employer that is provi wor co insu rance fot my e)�nployee ,i e as the p r fl tcy a- it= si information. Insurance Company Name: f /r �/ S ll.r r T P- 7 (0 f : Policy # or Self-ins. Lic. #: >%,(_ /�'f c Z Q._ f � . Expiration Date:, 1 , O/- CS7r- lob Site Address: s / C � •� s. n C it y /StaterZ.ip: P I t , •' a G b�0 Attach a copy of the workers' compensation , -olicy declaration page (showin the p.Olity number a rl expiratio1i date)_ Fai to secure coverage as required under Section 25A of MVlGL e 152 can lead to th'e imposition of e iriininal pen alties of i fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form' of a STOP SX ORDI .6-'°4- . a fi ne of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to'the Office o#' Investigations of the DIA for insurance coverage verification. I do hereby cer . • under the pain andpenalties of perjury di at the information- provided above is true and corr Signature. 4 / �L /// 0 ' D a t e: • I • I Phone #: �3 l 7 �- 0 Official use only. Do not write ire this area, to be completed by city .. r town offic City or Town:. Permit /License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk. 4. Electrical Tnspccto'r- 5 Plunaliing.lnspector 6. Other Contact Person: Phone #; , ■ ..i_ 1 SEaTIo eic {S Rta.W10; E S :4y 3� ' 8.1 Licensed Construction Supervisor: � Supervisor:. Not Applicable ❑ Name of License Holder: l / i D )-�k_k - bl 0 ` l t `"c q LO License Number 4 55 NI a i n ' CI cep n eA8 h G . 0 C30 ( ( L Address Expiration Date 0 C � -03 Signatt7l Telephone 641s er " '; d-o m - ' -prove . en t°'6:n - o :_�z s r W . is -- 0' 0 :: Not Applicable ❑ -a, Company Name Registration Number C N1 %tn . Clce -e nQ1A tAG 0136 , ?ti a(4 [ ( 2 Address _ / �, �n Expiratio Date 0 Qom& C, C� f "W� Telephoned ; gl CEa cy, N SID '- R F A '� a3' cc -er- , .e. gA..1. , .,,,x .,fks:,... y"" q waVIM,Y, ..n1.`A, ` -"rtc° � s ,..,.. 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 hd ld No ❑ i N 4 I.VWAs i�: E'er . all 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 ■ , ■ r • SEGlgIbN = tk E afili ri O PAOPOSED W FkRi checkallApg , . -xa 4 js x �rt , z N.. ; s `^ "' L a „ f . `i �„ t a r F'°.� y „ .? ' "�; gs�.�''t fn's ?. y _. „ ,s. '•' ; � . d > ^# �yi 6. T &; �,� S r d r x $o. ' 1a „ y,33:ySV' _ y �l * V 3 v.�.. „ i• -M4zn �. .-... 1. l ry.Y.v�- +..ivr ..- €'- £Yn�.��4Y'.' ;: #? �'o�::. -. .L��,.'S'...,i �� 2...�r�+�"A,.�. o >,....m'"�'�kb - New House 1 1 Addition 1 Replacement Wjfldows Alteration(s) 1 / Roofing 1 1 Or Doors [� Accessory Bldg. [ 1 Demolition 1 1 New Signs [D] Decks [El Siding [El Other [E lj Brief Pes rip ion of P rr .�.os-d , Work: .. L. 1 e.!11 t .11 % hr ' _ • 6) ■..�1 ■ • . 1 '4... ■ 1 fit! •', a . N o` - *AAk . chart y - Alteration of existing bedroom Yes _ ✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes . , No Plans Attached Roll - Sheet € -. .9 ..s 7 ii DT; `d. t I4 fa.JCLS,t;l66'1 © A omp , ::;.T.'. . ° r : -: 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 nee ) d.CQrn o1 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 q,:alyL— Z >„^ .'trCK sct X M a ```ii'tAV 'reZg'Wr-S ..YrX a V i.Y+tf a'"^� _- FL\ E GE�J�[�TS O t S � `1 L 1 074 3 k ? ... g I, V i tc , I 1 I Q geace , as Owner of the subject property "� - 1 hereby authorize ' 6 LL-� -? 6 U L ` ") t 5v C- - to act on m 7.-h, , in all m. I r e to work authorized by this building per pplication. LA _ '�l��v _A ,// Signature of'a •r AMINIMErgar, Date I, D Q V I D 0 H t fl 1 0 ' C LL A Pcz_o b kiLT 1 N t , as Owner /Authorized statements and in on the foregoing application are true a Agent hereby declare that the state accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. I \i l CA 0 i4 .1 ' Print Name __L h j ii & ig ( ( Signature of Owner /Agent Date • l , 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 1 1 1 Frontage 1 1 Setbacks Front 1 1 1 1 Side L: 1 R: 1 L:1 1 R: 1 _ 1 1 1 Rear 1 1 1 1 1 1 Building Height 1 1 1 • 1 1 1 Bldg. Square Footage 1 1 1 1 1 1 1 1 1 Open Space Footage (Lot area minus bldg & paved 1 1 1 1 1 1 1 1 1 parking) # of Parking Spaces 1 1 .1 1 1 1 • Fill: [ (volume & Location) A. Has a Special Permit /Variance /Finding ver 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 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 DONT KNOW 0 YES 0 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 there any proposed changes to or additions of signs intended for the property ? YES 0 NO i IF YES, describe size,_. type and location: 1 E. Will the construction activity disturb (clearing, grading, exc vation, 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. f . • • 76 BLACKBERRY LN BP- 2011 -1045 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 130 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP- 2011 -1045 Project # JS- 2011- 001683 Est. Cost: $4200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 11020.68 Owner: HEAFEY BRIAN J & VIRGINIA B Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 76 BLACKBERRY LN Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:6/13/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOW 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 6/13/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner