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36-327 218 CARDINAL WAY BP- 2008 -0927 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 327 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- 2008 -0927 Project # JS- 2008 - 001387 Est. Cost: $0.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PIONEER VALLEY FIBERGLASS POOLS & SPAS LLC 143233 Lot Size(sq. ftaL Owner: VENNE RICHARD W Zoning: SR Applicant: Richard Venne f , AI I� Ae .' X11 L EO`V!1l - �L11id -L Applicant Address: Phone: Insurance: 21S Cardinal Way (413) 584 -3596 () WC FLORENCEMA01062 ISSUED ON :4/29/2008 0:00:00 TO PERFORM THE FOLLOWING WORK CONSTRUCT INGROUND POOL 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: ./ _ ®6/ D gC Rough Frame: Gas: Fire Department Fireplace /Chimney: fi Rough: Oil: Insulation: Final: Smoke: Final: C( _06124 t THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu.anc l�'�✓� Si_ nature: - .. FeeTVpe: Date Paid: Amount: Building 4/29/2008 0:00:00 $50.008441 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo I�u ICls.�u 1N��2 xi- : tr, Proposal Brian Burrows General Contracting & Home Improvement looking to renovate? 95 southampton rd. Westhampton MA 01027 413 - 527 -8920 submited to: Dick Venne address: 218 Cardinal Way Northampton Ma 01060 phone: 413 -584 -3596 date: 4 -15 -09 date of plans: by May 7 09 We hereby submit specifications and estimates for: To build = shed style roof on back of house for shade.The overall size is to be 18' x 24'.We shall cu ( holes in finished concrete pad for footings.Ten inch sona tubes will be installed in holes four eet below grade and filled with concrete.The roof shall be framed with 2 xi8 rafters every sixteen inches on center.The rafter cuts shall sit on three 2 x 12's that create a beam.The beam shall be held up by four white round structual columns.(4 x 4)1/2 cdx plywood will be applied to top of rafters.lce and water barrier shall be applied to entire roof area and where the roof meets the house.A 30 year architectual shingle that matches existing shall cover entire roof.Properly flash against house and repair siding.Both ends shall be framed down one level with rafter tail and one to existing porch roof.End wall with no support will have a white structual round column.A vinyl cedar shake shall be installed on both ends over 1/2 inch sheething.(inside and out)Vinyl cedar will be Cape Cod gray to match existing.A Victorian gray vinyl beadboard ceiling shall be installed to bottom side of rafters.The overhang created by the rafters shall have white vinyl soffit on bottom and white trim metal on face.The beam shall be wrapped in white trim metal.A white gutter shall be installed with one downspout.Job site will be kept clean with trashed removed daily.Costumer will be 100% satisfied upon completion.All work comes with a one year contractor warranty. We propose hereby to furnish material and labor- complete in accordance with above specifications,for the sum of: $10,800.00 Payment to be made as follows: $3,000.00 down and $7,800.00 upon completion. Proposal life: 30 days Authorized signature: Accepting signature: l `� t Cordially, Brian Burrows General Contracting And Home Improvement • • Ba:/dEO63illT dii,✓gtCgoai5i�at`Sifzft License or registration valid for individul use only il?b HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return lo: Board of Buildin g Regulations ulations and Standards Registration: 152935 One Ashburton Place Rm 1301 Expiration: 10/14/2010 Tr# 275093 ,. ✓i Boston, Ma. 02108 Type: DBA BRAIN BURROWS GEN CONTRACTING& HOME IMP BRIAN BURROWS 95 SOUTHAMPTON RD. WESTHAMPTON, MA 01027 Administrator Not valid without signature tinbyr+r',weft t: i . /t!r.:.;rrrfa.;r f' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 092972 Birthdate: 10/09/1973 Expires: 10/09/2009 Tr. no: 92972 Restricted: 00 :3RIA v BURROWS SOUTHAMPTON ROAD WESTHAMPTON. MA 01027 Commissioner 7 VDAC Liberty ISSUING OFFICE 181 � � Mutual., Wod ers Compensation and INFORMATION PAGE Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group /Boston 1 - 369465 0000 LIBERTY MUTUAL INSURANCE CO 15628 POLICY NO TD/ CD SALES OFFICE CODE SALES CODE N/R 1ST WC1 -31S- 369465 -018 XX X WF.,STON 102 REPRESENTATIVE 3000 1 YEAR ASSIGNED 2008 Item 1. Name of BRIAN BURROWS DBA BRIAN BURROWS GENERAL Insured CONTRACTING & HOME IMPROVEMENTS FEIN 01- 2521595 Address 95 SOUTHHAMPTON RD RISK ID 541372 WESTHAMPTON, MA 01027 Status 01 - INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo. Day Year Ma. Day Year [tem 2. Policy Period: From 11 - 21 - 2008 to 11 - 21 - 2009 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE tem 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. Ul information required below is subject to verification and change by audit. Premium Basis Rates LINE 110 Per 5100 Estimated Code Estimated of RE- Annual Classifications No. Total Annual Premiums muneration Premiums ;EE EXTENSION OF INFORMATION PAGE Qinimum Premium $ 500 (MA ) Total Estimated Annual Premium $ 500 nterim adjustment of premium shall be made: ANNUAL 'his policy, including all endorsements issued therewith, is hereby countersigned by Authorized Representative Date 11 -03 -08 oc. Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. H.G. Home State Dividend 11 -03 -08 NR MA NEW O -1030 R1 Copyright 1987 National Council on Compensation Insuranr•.w wr nn nn ni A . \ , Q ...?■1 ,ci e 4 -7 c..., c ,09vk .:" .. „ ) §r l 7 • ,Y1) . ,x \\I:A . 0 4 ) 496 ----- --- - „- N1 K) .> i ! i -‘3 v yk , 1 . ,I..) I 9 \ 1 , V 0 • ___...._____ )•\ • -\, ..._ . --r --- --- r — r ------ o'"" v ---------:-"---- - (, ) , 0191,3 vmS , c 6 cRr+-0 evr!) ! )N er s c ,C,vi 1 cyc 71 1 R: , . , --------- 1 c„, itck _ - _....._—, k 4-- \ V \ k ■C°1t '4442 co< ' . '. --4 ■- 1 4 I\ 21\ .‹...7.------- \ .(_____.------- 1 \ _ /I/ ------r---- k ■ --- --- --- ,-- V. 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 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 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 I, 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 The Commonwealth of Massachusetts Department of Industrial Accidents ri , = 7 Office of Investigations 1- 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/EIectricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): ;cu 13 'tr Ge,nel c ,,,A ,,.ti4c� i, tc Grid, 14c-me imprzy.eele• r Address: qr L ie> ?} City /State /Zip: Phone #: td t 3 - S 7) - ctaa Are you an employer? Check the appropriate box: Type of project (required): 1. ® I am a employer with i 4. n 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 employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. IN Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.E Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.E] Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating 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. Below is the policy and job site information. Insurance Company Name: L; be h'L j4uc.,1 Policy # or Self-ins. Lic. #: WC i 7,1S -36946S-01e Expiration Date: 1 l - 31 -c t Job Site Address: alb Ccwc.Vnc4 wwy City /State /Zip: fler. -}cr. 1 ale6G 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: Date: Ll -16 -a t Phone #: 413- s ci'10 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 Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : I3rt'Od\ R cZro 09 as la License Number G 5 SaQ CLNAp tr. (2-(1, l.,Jesl,ca,,vtp+CY\ MN ok01 10 —q — C Address Expiration Date Li ra 6Xtao Signature Telephone 9. Registered Home Improvement Contractor ,„, :: " ! �.'= Not Applicable ❑ :art t3 �rcr s �2 vtez� C�kt'c r∎r ca,nyl, ft1e '1.4∎• prtme.rtiAl 152/35 Company Name Registration Number 95 5co.Actry twx ( touts N► 7Eo , 1 mI oto '1 ichmito Address Expiration Date ��� Telephone 4i3-5g7 -9? 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 IR, No ❑ 11. = Home Owner zi emption 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, von 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 f Replacement Windows Alteration(s) JJ- Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [ ❑j Decks [D Siding [❑] Other [El] Brief Description of roposed r1 Work: 6v∎1tk a. 51. t -cc,)V 0 Q . k oQ 1-605e tc: Alteration of existing bedroom Yes PC No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes 1X 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: 0 Number of Bathrooms U c. Is there a garage attached? MO d. Proposed Square footage of new construction. ' 3,2_ Dimensions al )( 1 t e. Number of stories? f. Method of heating? Walt_ Fireplaces or Woodstoves Ills+ Number of each 0 g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction opert i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes I No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, !J: C k v'enne , as Owner of the subject proporty hereby authorize Rch`o..rr to act on my behalf, in all matters relative to work authorized by this building permit application. 52e C .,r kr - Signature of Owner -. __ -_ -- - - -_. ___ -- --- _- - - -- -- - -_- -_ -- _ -- Date I, Bttiar\ ilvl,C''('c _ 3 , 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. Print Name I - / -d9 Signature of Owner gent Date See a, a-ki-e.A Pkk Pk 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: .,__ Rear Building Height Bldg. Square Footage % _... Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces —— Fill: _..- .._" -,_. _ - ......._... "..m (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 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 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • s Department�tse Of}[�l Y City of Northampton Statuof s ferrate. Building Department C�rbwaPerms� 212 Main Street Sewerls pt railabilrfy Room 100 Water/WOrAva 4bihty a Northampton, MA 01060 Tvg�tsSfrci uratP(aris ,�� phone 413- 587 -1240 Fax 413- 587 -1272 PJot/Site Plan Otter Sped �4 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A OR TWO FAMILY DWELLING E Udd r SECTION 1 - SITE INFORMATION This section to be complejte y ice - C 1.1 Property Address: J ,_ 1 g r;c4.3.rv). 1 WcNy Map Lot `Unit`__ bOr.l r ipk-N ry( /4- C.3Ip60 Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Or C. k. Ven n< Name (Print) Current Mailing Address: See Cam► f ra-c 1-- Telephone y r 3 - 504 - 359 6 Signature 2.2 Authorized Agent: Br tan 95 ScA. p{ r f2 , w eS1-1- 0,rapkr, M X} O&) Name (Print) Current Mailing Address: Say - 4acia Signatu a —� 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 10 gov 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) $ 10 gem c‘..) Check Number i�p This Section For Official Use Only ° Date Building Permit Number: ./ Issued: e / Signature: Building Commissioner /Inspector of Buildings Date • • 218 CARDINAL WAY BP- 2009 -0856 GIS #: COMMONWEALTH OF MASSACHUSETTS Ma i3lock: 36 - 327 CITY OF NORTHAMPTON Lou; -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BF- 2009 -0856 Project # JS- 2008 - 001387` Est. Cost: $10800.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Gro p_ BRIAN BURROWS I,ot Size( 9 ft.): 1 et 11'Tt - ' 7t _VrNN1;: 1 �1 = RT, 41' „,�,' 11 ivvL;tV�I� djjjthc £'kR ' PL'RROWS AT: 218 CARDINAL WAY apidicanrt Address :_ Phone: Insurance: 95 SOUTHAMPTON RD (413) 527 -8920 .1NCSTHAMPTONMA 44 , ISSUED ON: TO PERFORM THE I'OLLOWING WORK: install shed roof over pation next to pool _ POST THIS CARD SO. IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service; ; . Meter: , �V,�p tt Footings :,(11' [ l Rough: Rough House Foundation: = Driveway Final Final: ��- it) Rough Framer TL 5/ 0 7 Gas: Fire Department Fireplace /Chimney: Routh: Oil: ' ti-t ?n: h'inal: Smoke _ _ l +ivai: Q Z1 I2:`� 6� LC V11 S _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 4/23/2009 0:00:00 fc0.006 i8 212 Maio Street, Phone (413) 587 -1240, Pas: (413) 5 Building Conran ssio.ier - Anthony P,�ti!lo 4 MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton, MA 01060 587 -1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 118 Cardinal Way Lot 3 Inquiry Made By: Ronald Canon 413 -552 -9515 Date of Inquiry: 02 -26 -04 Municipal Water Main Existing service to in Yes: X No: Yes: X No: — site? Front of Location? Size of Water Main: 12" Material: DI Age: 2002 Number of Type of _X_ Single Family Type of _X Private Units: 1 Unit(s): Accessory Apart. Ownership: Condo Multi- family Rental Approximate Static Street 70 Flow Test Conducted : Yes: No: x Pressure: If done attach results Size of Service Connection: 1 " Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. The City of Northampton has not accepted responsibility for the maintenance of the water main and service connections as of this date of inquiry. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department with a minimum of 5 working days notification. All ork shall con to Northampton Water Department specifications. P•a"; ( 4), David Sp Irks, Supe intendent of Water cc: Ned Huntley, ity Engineer ∎, __/ '-. d ` r' tv° ' ...., ( 5 b vf - - op, sq, rfu 4 0.,4%5 1 - A � � �� � -- . a e ' 1.•***--'-- __------ \ Z. jfit . \ 13' - \ ...... ..„......-- • \ - \ - . CA 1 . or ta r ....... -0 * \ . 13 .-eliA t , \ , ''- i te kvirA - ly \ co . op - - 4 r 1 % \ 40.11' 14.3,„, \ . - rj(, ' ,if 1 \ ' ...P. ° afa r' .- _ Z C ,45e- ' t, ? io i (�w�j f ,►/ 1 - 1 \ ■ trA ft* \ - Y ( 1 . i \ \ . r - � . ' \ ■''' \ ii , 11 .1_ ' \ too. se G, a it1Ciji-A ))).- i r _.......... " CITY OF'NORTI-1AMPTON, MASSACHUSETTS 4 ,' I , ,. DEPARTMENT OF PUBLIC WORKS t �•�� � 125 Locust Street �� Northampton, MA 01060 413 -587 -1570 Fax 413 - 587 -1576 Samuel B. Grind's, P.E. • Director, City Engineer Guilford 8. Mooring, P.E. Assistant Director of Public Works BOARD OF PUBLIC WORKS DRIVEWAY PERMIT • GENERAL INSTRUCTIONS AND REGULATIONS 1. A "Driveway Permit" is required in all cases where a new curb cut or an alteration to an • existing curb cut is proposed on a City public way. 2. Driveway pertnits issued by the Board of Public Works (BPW) shall be attached to and become part of the "Building Permit" issued by the Building Inspector. 3. Prior to the issuance of a "Building Permit" the owner of any lot to be serviced by a new driveway shall apply to the BPW for a "Driveway Permit" by completing the pertinent portions of the permit (see attached). Once the location of the driveway is approved by the BPW, a building permit may be issued. • 4. The Building Inspector shall not issue an "Occupancy Permit" unless the driveway to the lot has been approved by the BPW. 5. By the issuance of a driveway permit for the stated location, neither the City of Northampton • nor the Department of Public Works imply that no drainage problems will result with the driveway when constructed. Properties situated or driveways installed in low lying areas in the path of the natural drainage will be subject to water problems. These problems may include water sheeting across roadways adjacent to the driveway. The City and the DPW assume no responsibility for any such drainage problems. The owner of the property is responsible for constructing and maintaining the driveway with adequate provision for natural water runoff situations. • C eetrnuel B Brindis, P.E. Director of Public Works C:\MyFilesT ni\Driveway Permit General Instructions (SUBJECT TO ATTACHED CONDITION 1 & 2) D43 -04 Permit No. Conditions: Driveway Permit In lieu of plan approved by City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. B y : .�.d P *itioner Ronald Canon 413 - 552 - 9515 Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. cc: Building Inspector Permit No. D43 -04 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: February 25, 2004 FEE: $25.00 CHECK #: 1695 THE BOARD OF PUBLIC WORKS The undersigned respectfully petitions your honorable body for: Permission to install a driveway at 218 Cardinal Way Lot 23 Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the existing roadway. Driveway surface to be paved as soon as possible if the grade of the proposed driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City of Northampton in the event of a washout of this driveway. By: , "t_ _ Ronld anon 13 Kylene Circle, Southampton Telephone #: 413 -552 -9515 Proposed Location Inspected By: d S Gravel Base Grade Inspected By: Final Approval THE BOARD OF PUBLIC WORKS voted that petition be granted. George Andrikidis Director of Public Works • MUNICIPAL SEWER ASAILABILITY APPLICATION Northampton Streets Department 125 Locust Street Northampton, MA 01060 587 -1570 A Department of Public Works Trench Permit shall be require prior to any construction or connection activity associated with this application. Location: 218 Cardinal Way Lot 23 Inquiry Made By: Ronald Canon 413 -552 -9515 Date of Inquiry: 02 - - Municipal Sewer Main in Front of Location: Yes X No Municipal Storm Drain Available: Yes No X Size of Sewer Main: 3" Material: PVC(Pressure New in Sewer) Age: 2002 Depth of Sewer Main: 5' Size of Service Connection: 1 1/4 Plastic (Pressure Sewer) Comments: . The City of Northampton has not accepted responsibilty for the maintenance of the sewer main and service connections as of this date of inquiry. A corresponding "sewer entrance fee" shall be paid prior to making any connection to the municipal sewer system. Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. Storm Drain Concurrence / 24 - Joseph Thomas, Su intendent .1 Douglas McDonald, Enviromental Planner Streets Department Engineering Department cc: Ned Huntley, City Engineer Anthony Patillo, Building Inspector v ' �l . �iiasaachaactte 1 � _'- , R'i DEPARTMENT OF BUILDING INSPECTIONS , INSPECTOR 212 Main Street • Municipal Building Northanpton, Mass. 01060 Square Footage Amount Basement @ 15 02.G. //,25 JOZ.GO • 1st Floor @ .4f" �'C7 /, UZS L5102, `0 11 16 2nd Floor @ .2f 30 /, 3 Z1 696,30 Z 6 1/2 Floors, Attic, Garage d - ms s ° g7• - 5g Q — Deck, Porches ..„1,0--/ iigo 7a 43. • t �l> TOTAL 282,70 GvZ (214)0U lnd� � -.17 • Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non - Circulating Runouts Circulating Mains and Runouts Temperature (F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170 -180 0.5 1.0 1.5 2.0 140 -160 0.5 0.5 1.0 1.5 100 -130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range (F) 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201 -250 1.0 1.5 1.5 2.0 Low Temperature 120 -200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40 -55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) leakage must be sealed. [ ] When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L /s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs /ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in- winter side of all non - vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R- values, glazing U- factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non - depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 ° F or chilled fluids below 55 ° F must be insulated to the levels in Table 2. MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lc DATE: 03/24/04 TITLE: Lot23 (218) Cardinal Way Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Trus , R -38.0 cavity insulation Comments: /'nCLIP CCl Wig Pt d -0 6 fr 1 D tart CZ�,✓ day . [ ] 2. Ceiling 2: Cathedral Ceiling (no attic), R- 0.0 cavity + R -8.0 continuous insulation Comments: BO n WS t 8e t5 PO/ Pap''-e" Gee/1r Above -Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R -13.0 cavity insulation Comments: 134t,ffc 1 (mod t [ ] 2. Wall 2: Wood Frame, 16" o.c., R- 13.0 - cavity ins ation Comments: // Windows: [ ] 1. Window 2: Wood Frame, Double Pane with Low -E, U- factor: 0.320 For windows without labeled U- factors, describe features: # Panes Z Frame Type r U ,, f Thermal Break? [X ] Yes [ ] No Comments: -- +t� Doors: [ ] 1. Door 1: Solid, U- factor: 0.270 Comments: [ ] 2. Door 3: Glass, U- factor: 0.300 / # Panes 2 Frame Type 51 e?"/ Thermal Break? [ ✓] Yes [ ] No Comments: [ ] 3. Door 2: Glass, U- factor: 0.300 # Panes Frame Type i✓ooI/UynJThermal Break? [ ✓] Yes [ ] No Comments: Floors: [ ] 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R -19.0 cavity insulation . 7 Comments: Ma ir1 i e' 1S7 [ ] 2. Floor 2: All -Wood Joist/Truss, Over Unconditioned Space, R -30.0 cavity insulation Comments: &i pc a Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 84 AFUE or higher Make and Model Number ccr''i -f f)f r [ ] 2. Air Conditioner 2: Electric Central Air, 10 SEER or higher Make and Model Number Air Leakage: [ 1 Joints, penetrations, and all other such openings in the building envelope that are sources of air • been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lc and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of tlte,design load as specified in Sections 780CMR 1310 and J4.4. r Builder/Designer /"� +r�J -� Date *2-3/, / f 1 ' ? - Permit Number MECcheck Coance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lc Data filename: Untitled TITLE: Lot23 (218) Cardinal Way CITY: Southampton STATE: Massachusetts HDD: 6404 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non - Electric Resistance) DATE: 03/24/04 DATE OF PLANS: 3/23/04 PROJECT INFORMATION: Construct 2story S. F .H. W /att. Garage/Porch/Deck/Fireplace COMPANY INFORMATION: Ronald J. Canon Building Contractor COMPLIANCE: Passes Maximum UA = 442 Your Home = 424 4.1% Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U- Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 911 38.0 0.0 27 Ceiling 2: Cathedral Ceiling (no attic) 375 30.0 8.0 10 Wall 1: Wood Frame, 16" o.c. 1088 13.0 0.0 89 Wall 2: Wood Frame, 16" o.c. 1486 13.0 0.0 80 Window 2: Wood Frame, Double Pane with Low -E 379 0.320 121 Door 1: Solid 19 0.270 5 Door 3: Glass 80 0.300 24 Door 2: Glass 33 0.300 10 Floor 1: All -Wood Joist/Truss, Over Unconditioned Space 1025 19.0 0.0 48 Floor 2: All -Wood Joist/Truss, Over Unconditioned Space 310 30.0 0.0 10 Furnace 1: Forced Hot Air, 84 AFUE Air Conditioner 2: Electric Central Air, 10 SEER COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has — A tf / I 7 V (N.10 d V) ---- , I . ,s1 , 1 1 , , Er I ? ') L P/ , O Gcrso X41 1 : 11 ,i , 1 \ 1 ... . t" \ . i , +• i s C O 1 ., — • i y M /97 CN CN C , �,, . C\ii '11'Z 91,E �� t[) 2 Z /8L •■■•._._ .•JY S zix t( PldP T 'L '63 2L rL. Biz - `a Sn0}.� . • awn. _- Q� � 0 / --- -- M „ .9S / 20 g G 8, i cTtiAMpT SD , 0 ;� e (r xt of N4rf pi11lptitt • L -* = ° _ i . .., 'rya j ASSAC�(riSttt6 rt. ` DEPARTMENT OF BUILDING INSPECTIONS ~ , _ INSPECTOR 212 Main Street • Municipal Building c> Northampton, MA 01060 . e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis /her construction sups:.. sor. 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 any 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 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 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 I, 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 ,.. . ' . -citid-IP2- . filk (cilitiT of , ..N - 1 - friliaillpfoli ,--, • .41•I • if • .._ W Sri - -- - - - -- 7 - ' DEPARTMENT OF BUILDING INSPECTIONS 4 4 ••' 2 -= '.B-- Ir-J,1— 212 Main Street ' Municipal Building -0, =-.::---- Northampton, Mass. 01060 .., ,.)... WORKER'S CONITENSA'ilON INSURANCE AFFIDAVIT I ‘15 Ci 4 k oki. (1 ic-en.s.;:drnittc.f.) with a pan' cipal place of business/residence at: /g 4eich. S4 0/0 73 (pl)onej WS 5 6 . . (street/d ty,':;:ale./7...lp) cio hereby certify, unc;er the pains and penalties of pet r, hat. _.. ( ) 1 am an employer providing the follo:,vinc, ..vorker's compensation cove ,c for Inv employees working on this job: - (lasurancz Company) CPciic Number) CE.orpirztior) Date) (/) I am a sole prourittor, 2.entrai c-onor , :, , i - homeowner (circle one) and have hired the contractors listed below - ,vho have the followini2, worker's compensa'rion bolicles: (Na.me of Contractor) (insurance ComioaayiPolicy Numbcr) (Exp:ration Date) (Name of Contnctor) (1.as Con Nurn'Dcr) (Expiration Date) — • ___. __________ (Name of Contractor) (insurance (2 o m; I ic..-,: N11.113}'Plr) (1 Date) (Name of Contractor) (I Else ranc-z Co mr. oLic-y Number (1-i,rDir Date) (miach ,.-„.:::._....-i- ;:-.- .-.:. ,1; / , 1 ( ) ' C Lin a role proprie0r and have no onc •..,olkirif for inc. - ( ) 1 am a home ovine: r)erforrnilY all th--, 11-..,,--If. Nom piczsz be awast that w;:alc. k , .', - ,o ezrrplcry, -d-cr to eo : o.,:r.---tr,:c. Cr : rpa ir sk.r ,..-:-, .-.. ctv,r.Ili.: c: not Inc- = then throo units in. v..{.1d1 t. v- cx cx; :1 c,-. anvurtzr.1..n.t the-v:0 .t:t n..:.< c.,-1.-...rally o..:.( cznploye--3 ury&c.r the: orki-: c.,-, ,..„c, (C3 Li 52=.1(5)), ?..r.211.-_-;.nor. 1r hcnn,..-owncs for z Lic.c-.....4 cc pts-frnr. :-.1.r.:: legal rt2-tug of an c=tployer ury!..er tho Workers Ock-c-perti.0,c1 /xi- copy of thi, etter....,-..... r.. bo fo,,,,rd...;.1 to LI, 1.),1"...m...-ncre: of Loaystriti Arcie...1TY 015 o., of 1,,r,.:-.5 for ttre cover vL and that f.t.ilurc 10 ttitIrt coNn7r..zn ur.dez r of 1.101., 152 can lead te, Me imposition of anminal pet:AL:es coali o f , f of up to S1,500 an1'or i of up to cr, r.z.; p.: civil peralticz in d,c form of . Ste? `4 On3e.: t nd . iro of 5100.00 t city tgainat me. . - - - - - —1 Fo- ,.. celly (7, Pcrinit Niantnr _ _ _1 _ / __ _ naturc of I .icc..-1 .-,p,:iperurdtcf:. ri.,: .--, ; 1 k _..... SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : t ! Mil 11 V . CA 4 ® 34 75 License Number (3' /C /e,z Soci+ot►'vi I�t�. o1073 S /c./els Address Expiration Date � -Vs-5 5 7 �,�ssz 9s75) Signature Telephone •.'a' . - � Re., eke .rne:,tn' ®r..6uernen .. °ontractor -��, -- , = _ �`�,�� _. 'J,.',_= Not Applicable ❑ i2v) / ` r i ym L' ioft r /7/22_ 3 Company Name Registration Number /3 1e�-e..— S' / 7 6 ,1. P1 v/ 07.-7 6/zsAy Address Expiration Date Telephone SECTION 10 '1NORKERS' 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 f 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 _ SEGTiON a =IDES Y° PTION *OF1 ROPOSED WORK (check all aaalacab1e) � Addition ❑ Replacement Windows New House p Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work:_e04S - 6'' & S r>Z S Fe W ? e ° or - _ /ex; A7 'Less Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6a.,; °F. .ew h uo se"" artif addition t - TaistinW housrnatZti i e el iie flowing: • a. Use of building : One Fam Two Family Other b. Number of rooms in each family unit: e Number of Bathrooms i/e c. Is there a garage attached? _ l d. Proposed Square footage of new construction. � l Dimensions S� k� e. Number of stories? 2 f. Method of heating? - €+-S h'rt At • Fireplaces .r Woodstoves C>GLS Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? efeg h. Type of construction kiadetfy2s &sq i. Is construction within 100 ft. of wetlands? Yes / No. Is construction within 100 yr. floodplain Yes ir Nc j. Depth of basement or cellar floor below finished grade 4 k. Will building conform to the Building and Zoning regulations? A' Yes No , I. Septic Tank City Sewer X Private well City water Supply SECTIOT 7 aWNER AUTHORIZATION TO E B COMPLETED WHEN OWNERS "Agt ORR�CONTRACTOR' FOR B PER(YIIT ,,.. • I, , as Owner of the subject property hereby authorize • to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date om" , 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. Print Name ; (_)46 I (( l ignatur• of •wner /Ag nt / Date f , Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I g,532 f° /6; ai Frontage 00.03' f' co Setbacks Front 4 ✓ Side L: Z R: Z L: R: Rear 78' C Building Height 7 3/ Bldg. Square Footage 2 9 , Open Space Footage (Lot area minus bldg & paved 1t „Sao parking) # of Parking Spaces L Fill: (volume '& Location) A. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO DONT KNOW 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 - 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 NO x 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: . , .., , T . :tom, City of Northampton ,iiE o _' Building Department #' �' pia a ad - z ' i � . . 212 Main Streets �� ;. ° Room 100 F� i ,� ,� Northampton, MA 01060 .�� a '` "� 2 ' pho+ 413 =' $7 -1240 Fax 413 - 587 -1272 - ' 'i APPLICATION TO CONSTRUT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION T hissect�on toib completed by office 1.1 Property Address: / dz l r�3/�21 Lila , g 3 " C N4.Q�t ° , i i " - . 1Jn- „,,, ` Zon ' {3verlay D31�c , . +! ,,� - �{,, C /gyp L 03-District EIm J4 D ' > . CB Di.� L.L ”. ,.. SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZEI AGENT 2.1 Own of Record: , d /d rc / 3 �'y � Cr r �'�� .S , ; 9f( Name (Print) Curr t ilin Address: �) - .',1°)t 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 (10 0 03 (a) Building Permit Fee 2. Electrical + (b) Estimated Totat Cost of Construct from (6) 3. Plumbing 000 Building; Permit Fee 4. Mechanical (HVAC) i 5. Fire Protection ©IS ®o 6. Total = (1 + 2 + 3 + 4 + 5 (34 5 � Check Number /70 ! 4h0702/,6--6 / This Section For Official Use Only Buildin Pe umber: A � � ® Date Issued: Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2004 -0906 APPLICANT /CONTACT PERSON RONALD CANON ADDRESS/PHONE 13 KYLENE CIRCLE SOUTHAMPTON (413) 527 -5766 PROPERTY LOCATION 218 CARDINAL WAY - LOT #23 MAP 36 PARCEL 327 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / / v ( 9 /V/ �/ 5 Fee Paid d i Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE/DECK/PORCH/FIREPLACE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 053675 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 ikn Signature of Building ficial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 7- — . , 13 p goo Yo tad „ ,... /. .-...-,7-7 , I Pe "'" - i f ic) / c ) Li i " '-''' N f 11 --1 P . ,4-r :I i "-. ( 3 I.; I 1 \", Ar). 0 i ' r°4 1 : 1 1 , T "1 j_ y__,0 • 3 5- -eteA-4-c-r-rt.-6 -/---- / J '� p , c , �,`e c f ) ,) iq fle_ , ,2.5 Co44e7--So?..„ - Le .-7- L- p 45C . 2) 6-P6Z /2&Z_ /- 2 ,v/4-ce_____ , 3 l Z4 0 r �r/2 sg� �ZTd2 ./.) 01, ,_____-- c l f':,4 ca,",_e_et to,,,, A ..,,,...._ .44-- l /4 LA -2 4,. ,218 CARDINALMAY ,:. LOT #23 - . BP-2004-0906 GIS #: COMMONWEALTH OF 1VLASE,ACHUSETTS Ma.43113lock: 36 ,. 527 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-2004-0906 Project # JS-2004-1351 Est. Cost: $136500.00 Fee: $1221.55 PERMISSION IS HEREB Y GRANTEP-TO: , Const. Class: Contractor: License: Use Group: RONALD CANON . 053675 Lot Size(sq. ft.): Owner: RONALD CANON Zoning: SR Applicant: RONALD CANON AT: 218 CARDINAL WAY - LOT #23 , Applicant Address: Phone: Insurance: 13 KYLENE CIRCLE (413) 527-5766 SOUTHAMPTONMA01073 ISSUED ON:3/29/04 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 2 STORY SFH W/ATT GARAGE/DECK/PORCH/FIREPLACE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: , Service: Meter: 4 - /4 Footings: Rough /4- ).)L / 7 ou g h 7 . R: ,,„). „, ,,,,,, '.., House # - . Foundation: es , if ' ' 1 - 63 - I 4 , t - ,',' Driveway Final: Finakg- 7„. ( Final: 0017,ft 5:ee,64 Rough Frame: rik v )/3/o4.L i . Gas: Fire Department Fireplace/Chimneyc 2 7' • . _----------a Rough: 00 „- -- -i-..1.1 l t....y ...1_1- Insulation:0 K / _ / ->>. _ . 1 Final SW c:-(1-0 Final: S -Or Smoke: ,ty 0 4-0401 4i . 6 -_ j: 05 IM - PEN6ING:BLEr iv ii- ii, I,_ T PERMIT MAY BE REVOKED BY THE CITY OPNORTH N U , ON VIOLA7 OF ANY OF ITS RULES AND REGULATIONS. ------4 ........„- --. 7 Certificate of Occupancy Sienature: FeeTvpe: Receipt No: Date Paid: check No: Amount: Building , 3/29/04 0:00:00 1709 $1221.55 212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272 Building Commissioner - Anthony Patillo • .