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36-321 ✓lie - 6omianoiuvea i or✓G/aavac4aaelfa BOARD OF BUILDING REGULATIONS icenst CONSTRUCTION SUPERVISOR Number: GS 071808 Birthdate: - 05114 /1961 Expires: 05/1412005 Tr. no 12169 z Restricted: 00 CHARLES K JAHN / 158 GREYSTONE AVE ' ..., 0 — 4 W SPRINGFIELD, MA 01089 Administrator • • e 4 (., `....e 7 2 12.--)- , (--- /,.-- ,,_,-- z., ,...-_- ---(-> ,..-3be <- ,.,—, k ) , \ --- , ) ----, . e ../ --- ------. .._.....1 __.. 0 . \ (--) 1 7 ---, , . /4._---)// (,-,___„ .•.- ,...4 ...,--------- -.,---, (." ... . , , , .„ _, (.../ (.._,,' c...„' (.7:- ii-,,5 (5 -- t,----._ / 1R L- / (-Ls-14,r , .--- i „, ,4. . , ,;\ 2- t ) ,,.,/, , , i , 0 i /./ ° i __. I . 1 ,- I ? I / S' __--,-..=, ;� (!I xt of Ntwt1iampton ). — ,�1�_ /, t w� _ (, J assacl�nsctt I_ � DEPARTMENT OF BUILDING INSPECTIONS ,, =4 -j _ /_ INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 ----.==--.-- ,. y e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supc.' 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 Y- 3) C.1 r c"i%G1Cr / oQ L 1 C '7C. A.i , . .. lb. , . - °4- 4 4 ,..., 6i,„ of NI-1 - 17t Ilainp to n 'i-- 6„ 161, t fit% ; tj41 " etjt,f fili"R,}1"cu5. • .......-...,.. _ 'Ir... - DEPARTMENT OP EUILDD,ZG INSPECTIONS , •=s..Z. — : 212 Main Street • Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AileIADAVIT , . I, 4_c_s r Zc-'-. . ( . ,.-27 77, — (Ii ,ns.scipermittec) with a principal place of business/residence an /— k • _ --- (strecticit do hereby certify, unc;::-_.r the pains and ponaitics of periury, that ..... ( ) I am an employer providing the follovvinc: . .,.orker's compensation coverace for my employees working on this job: - (Lasuranc.:.- Company) (Pciic Number) (E.>: til'on Date) ( ) I am a sole proprietor, general COD=C or homeowner (circle one) and have hired the con listed below who have the folio; v compensataon polle:es: (Name of Contractor) ansur,ance, Cc,ru Numbcr) (Expirntaon Date) (Name of Contractor) (Insurance Co=ariv/Policy Number) (Expiration Dare) -------- — - ---------- - (Name of Contractor) (I Ilat rallCfZ CO 'CZ, T. ally/P 0 I i cy Narnl-flr) xi Date) _ - ------------- (Name of Contractor) (Insurance Comt;a1 Number) (1 Date) (i..a...,th -..,4:litic,-,..1 ! irr,,,,-,..-.- .:, ,-_-i.,..- •••:--,:.::-, -;------:-:.,::: ni; i.. , t .1 airl a sole proprietor and have no one V.:01 for rne. ( ) I am a home owner pc:rforn all the wo: myself — NcYFF 1 2 L'. 8 7 1 - 1 ,'` 111 tic l " c'nP kr/ P)===c 'a) e.): ceiraruc•-:oci es ir.pair ,, , - - 7., I L ri- mccc tu th roe units in ‘rizdi Lbe 1::: raai:!..:_a cq- 06 t.:',.: , aor.. alc tact ccr_rally cx to ca u, - the vecz c !-ca (Gi...152,.ma 1(5)). a.r-.)..:ion by a. homoola for z Lcct tt ct - p7. : ths legal rtatuo of an <cap' oyov under ill," Workeet Cocnpor-.....idaori Aci- I unckrattacl th.e. A copy of thil rutcri-tan a:Ay bo forwitrd.ci to t.l.:ea l),-.1),..t..-Dcrli of Indalltrial Accid...-itY Offloo of :.:..1,.oco for tire c ' pv tr 1 3 vceintioel and that failurc to s cov.^:nagr, ur.d.:-.- r.-cctict: 251 of MOL.- 152 czut 1=1 to the intpositim of er'- ND-a-Li e- oxtti of a r ° f ut ., to 51.500.00 no.'c yir of:17 to cr.:. yrzr ar.i civil pc. in ti fix of it Stc \v cot Ord.= o-,d t f:r of S100.00 a city ti. For cicp.tme2rt.1ti.c cell y 1 Si 42, k 1. 1? V•V ,:, :tt (urc of 1 .icc:r;c.'l ! .-/M'S" . . " ..-- 1ilF.T;- SECTlON 8 .CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : a- - 7/ ( , * t1/) 02 / ova License Number ? e/ x 2 / 7 , &rear .S ��� �,��. � -1y Address ✓ Expiration Date ( I?- . 7l Signature Telephone 4 tie bin = :: m 1' v'.eContractor � �: �"' ,.: .,,, � -" Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECT1ON10 1N0RKERS' 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 o the building permit. Signed Affidavit Attached Yes No ❑ 'I I Q t l 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 fu: 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 SECTIOIS SCR P,ATION OFPPROP 4 SEDNWORK (check all apalica le)mat New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ Brief Description of Proposed Work: /5 1z 1 S C i' 1 F't? /c? !`{ f �°� ` T• ^ 1 Alteration of existing bedroom Yes No Adding new bedroom Yes o Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6a ,.e ou drop" .cliti li to; ezistirigkhoutlr fr�cOmple�e lie olloyv-rng: 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. bimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 50T):917 7 TED ,NEAUI1-IORIZAT1ON - TO BE MPL COETED WHEN OWNFtSA CONTRACTQR APPLIES FOR BUILDING _PERMIT , as Owner of the subject property hereby authorize _ _ to ac; on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name j Signature of Owner /Agent Date or A S ection 4. 1 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 Frontage Setbacks Front Side L: R L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces 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 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: ■ A sv - x City o f Northampton �� �� � �� � � ° �: i _ 1 << riiding Department �� 12'12 Main Street - ' 4 }p - . ! Room 100 -, � f�f t,R 2 9 LC04 Nort 8mpton, MA 01060 � 4 phone 413;587-4240 Fax 413 - 587 -1272 - � , "� � :, ';':;i''''211--- ''` e t a.° '' " - ` ,.. ` ..�;' APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 .- SITE INFO RMATION 1.1 Property Address: k T to be coi»pletM by office Ma � " '"1: 7 � ^ re k n t i Y�' 4 a v. x'" nit �� f-& /1"--t`'/ / r� � w � o ne ' ' 4 . * y Ovecla D �strr c z` EIm Sty District . , a 3 w GB SECTION. 2 .' PROPERTY OWNERSHIP /AUTHORIZED.AGENT 2.1 Owner of Record: [JA r cvn (Gi� �� Name (Print) Current Mailing Address: Telephone 1 >.)_-- , z 7 9 / - - / i , Signature 2.2 Authorized Agent: Name (Print) =� Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION C OSTS &/,'"',..t.....L. ---- Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /‘, �� (a) ;Building Permit Fee 2. Electrical (b) Estimated Total of Construction from Cost '(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 5. � �y "- r p This Section For Official Use Only Building Permit Number: f F I / °1---- Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2004 -0912 APPLICANT /CONTACT PERSON CHARLES K JAHN ADDRESS /PHONE P 0 BOX 1317 WEST SPRINGFIELD (413) 478 -0718 PROPERTY LOCATION 231 CARDINAL WAY MAP 36 PARCEL 321 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 736 ! Fee Paid Typeof Construction:_FINISH BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 071808 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: v 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 y141? -3 2q ( O _/ Signature of Building Offi al 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. 231 CARDINAL WAY BP- 2004 -0912 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 21 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 -0912 Project # 3S- 2004 -1362 Est. Cost: $16800.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHARLES K JAHN 071808 Lot Size(sq. ft.): Owner: PO LORENVER Zoning: SR Applicant: CHARLES K JAHN AT: 231 CARDINAL WAY Applicant Address: Phone: Insurance: P O BOX 1317 (413) 478 -0718 WEST SPRINGFIELDMA01089 ISSUED ON:3/30/04 0:00:00 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT 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: Receipt No: Date Paid: Check No: Amount: Building 3/30/04 0:00:00 736 $84.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo p ` y L , (C ,..� c 1 -nr Ya- �, _l am- F j % � ?_ _ .4i .. gs3aciptsct'_s i - _"" = o DEPARTMENT �TMENT ' INSPECTIONS ^ cc A OP BUILDING I ° ° ; INSPECTOR 212 Main Strut • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION N ACKNOWLEDGEMENT FMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction su p.^: . 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_" y The building = department for the City of Northampton wants any person(s) who seek to use the homeowner 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 reunited) and_aJinal buildiina 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 ran -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 !Ylassachusetts T. Department of Industrial Accidents Office of Investigations ( . '& 600 N%ashinoton Street 4 =^ %r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /EIectricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/lndividuaI): /, i- , // 7 Address: V 4 Xi y , City /State /Zip: ij'7 H' Phone #: '/ 14 / e5.13 O Are you an employer? Check the appropriate box: Type of project (required): I 1_ N:f I am a employer with 1 4. Ed I am a genera l contractor and I have hired the sub-contractors 6- ❑ New construction employees (foil and/or part - time). ' 7 i 3 r'i a sole proprietor or paT 1CI- I- '-shed on the attached sheet 7. ❑ R e^m' odelin o- shin and have no enloyees These sub - contactors have g ❑ Lemo;i ion employees and have workers i working for me in any capacity. 9. ❑ Buildias addition I fNo workers' comp. insurance comp. insurance.: requii.ed] 5. El T� e are a corporation and its 10.❑ Elecu cal repairs or additions 3. ❑ I am a homeowner doino all work officers have exercised Theo 1 I.❑ Plumbing. repairs or additions myself o works' ca right of exemption per MGL mP 12.n Roof repairs insurance required.] t c. 152, §I (4), and we have no employees. [No workers' 13.0 Other como. insurance required.] - 'any applicant mat cn=ia vox T-I must aso nil out the secnon oe.ow snowing then workers' coropensanon policy mformatioa I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Cann actors that check this box mustatached an additional sheet showing the name of the sub-contractots 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. .r^ Tsurance Company Name: ,7i7 Fib /c_ y 1,.✓y' / Policy n or Self -ins. Lic. 4: /1- (20 0 $ WCQ 1. Expiration Date: .j4/1 Job Sire Address: ,,l3/ ( e...4;! City/State /Zip: A.anic.✓4 ,/1 _eleiiriZ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required trader 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 �Investinations of the DL4. for insurance coverane verification_ I do hereby certify under the pains / d f ' ' =' es of perjury that the information provided above is true and correct. -- -- - - O- _-- _ _ --- �mafure: r 541/ Date: G /d ) — Phone 4: j /.3 ._ l e7 I)-3G OfJiciai use only. Do not write in this area, to be completed by city or town official City or To P- ermit/License Issuing Authority (circle one): I. 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 : / //LL. , i/G�,c/ ( 6 /0eg License Number y? r , e- i` 3/,1.5'7 7 Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: 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 , pF No ❑ 11. - Home Owner Exemption 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing Q Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [DJ Decks [Q Siding [D] Other [D] Brief Descriptiori,of Proposed Work: /'C.) X4 (K, ,c .r i-'K ,- 14/`77 7ZOE if47"/fic1D Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes „/ No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a -- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 .40g 41k . Po , as Owner of the subject property hereby authorize . 1 f )A / to act on my behalf, in all m tt rs relative to work authorized by this building permit application. Signature of Owner Date � Y ),✓,C/ , as Owner /Authorizer! ` 19en_t 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 Signature of Owner //Agent Date Section 4. ZONING Alt 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 Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q Date Issued: C. Do any signs exist on the property? YES Q NO T 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: 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit Building Department Curb Gut/Driveway Permit 212 Main Street Sewer/Septic Availability \ \ Room 100 Water/Well Availability y v f�ortharppton, MA 01060 Two Sets of Structural Plans phone Fax 413 - 587 -1272 Plot/Site Plans Other Specify 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: 7 � C4 rLP l.fAt wAY Map Lot Unit PLO M Cf MX (71G6 Z Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Pv .231 chttpt N/AL NA 0106,2_ Name (Print) Current Mailin Address: 2 H3 5�G i I'i Telephone Signature 2.2 Authorized Agent_ / /,L n1( / ✓h 4'J �_ ; y / /1,,/ Name (Print) Current Mailing Address: t6-7 —0 o 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 C/O O.�:� 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ��`J 0. Tula! - (1 i 2 3 5) �)OCx.) cU ('hark Niimha if / ! This Section For Offic Use Only Building Permit Number: Date g Issued: Signature: Building Commissioner/Inspector ofBuildings Date BP- 2008 -0401 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: - 001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2008 -0401 Project # JS- 2008 - 000587 Est. Cost: $2000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIMOTHY SENEY 127364 Lot Size(sq. ft.): Owner: PO LORENVER & CHERRIE CHUA Zoning: SR Applicant: TIMOTHY SENEY AT: 231 CARDINAL WAY Applicant Address: Phone: Insurance: 43 COUNTY RD (413) 667 -0230 HUNTINGTONMA01050 ISSUED ON:10/16/2007 0:00:00 TO PERFORM THE FOLLOWING WORK: ROOFING 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 10/16/2007 0:00:00 $25.001147 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo No te f 1.,/°C4cA 1 4 64 1 7 . II a j _ O ° t 1 4, --. 'C\ - '0 u' ; 1 l -- . v- LIN 45%-- .... •%/, , 7,0 - 'c'AN ---- # ,,,.........._ _ t \ 4 - 1 1- c TA. • \ , c$144 7- Z 1 ‘ / GP s /447 —, I . N . i T!'. -- / Q , .% . -;.,,, LJZIA....=., / 1 tt; \ tp A*. . ' / X 1 .., / all (13 1 � v ...., • \ ..:‘ ....4 .4.7. ' ' ' P 1 \-3 - 0) *- t.) \ i PrI)---- Li P -1 / 7,- .4\ . , , '■ 0 ,,-\ „," .p. / , . 1 r .....- , \ c it\e. r F 1 . ' — -.- —____./ ....."- '� . . • . • a ' ti i Permit No. D42 -03 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. By: Petitioner David Lep' e, Building Contractor 413 -527- 975 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. • 4 Permit No. D42 -03 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: May 9, 2003 FEE: $25.00 CHECK #: 5753 THE BOARD OF PUBLIC WORKS The undersigned respectfully petitions your honorable body for: Permission to install a driveway at 231 Cardinal Way Lot #17 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 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: / David Lepi• , Building Contractor 262 East reet, Easthampton, MA 01027 Telephone #: 413- 527 -3975 Proposed Location Inspected By: l - Gravel Base Grade Inspected By: Final Approval THE BOARD OF PUBLIC WORKS voted that petition be granted. George Andrikidis Director of Public Works (SUBJECT TO ATTACHED CONDITION 1 & 2) cc: Building Inspector 11 r,n4 MUNICIPAL SEWER AVAILABILITY L, A), Northampton Streets Department • 125 Locust Street Northampton, MA 01060 587 -1570 Location: 231 Cardinal Way Lot 1/ 17 Inquiry Made By: Dave Lepine, 413 -527 -3975 Date of Inquiry: May 9, 2003 Municipal Sewer Main in Front of Location: Yes g No Size of Sewer Main: 2" Material: PVC Age: 2002 Depth of Sewer Main: 5' Size of Service Connection: 1 -1 PVC Comments: The City of Northampton has not accepted responsibility for the maintenance of the sewer main and service connections as of this date of i nqu i ry _ 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, specifications. Joseph T �onlas, Superintendent Streets Department cc: Ned Huntley, Asst. City Engineer Anthony Patillo, Building Inspector cc; ' I' MUNICIPAL WATER AVAILABILITY Northampton Water Department 237 Prospect St. Northampton, MA 01060 587 -1098 Location: 231 Cardinal Way Lot # 17 Inquiry Made By: Dave Lepine, 413 - 527 -3975 Date of Inquiry: May 9, 2003 Municipal Water Main in Front of Location: Yes x No Size of Water Main: 12" Material: DI Age: 2002 Approximate Street Pressure: 72 PSI Size of Service Connection: 1" copper 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 work shall conform to Northampton Water Department specifications. Charles Borowski, Superintendent of Water cc: Ned Huntley, Asst. City Engineer Anthony Patillo, Building Inspector 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) 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 and glazing U- values 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 3.2 Release la DATE: 05/08/03 TITLE: Lot 17 Cardnal Way Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R -38.0 cavity insulation Comments: Above -Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R -19.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Wood Frame, Double Pane with Low -E, U- factor: 0.350 For windows without labeled U- factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: [ ] 1. Door 1: Solid, U- factor: 0.350 Comments: Floors: [ ] 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R -19.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 78 AFUE or higher Make and Model Number [ ] 2. Air Conditioner 1: Electric Central Air, 10 SEER or higher Make and Model Number Air Leakage: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air 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. ■ Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release la Checked By/Date TITLE: Lot 17 Cardnal Way CITY: Northampton STATE: Massachusetts HDD: 6404 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non - Electric Resistance) DATE: 05 /08/03 DATE OF PLANS: 5 -8 -03 PROJECT INFORMATION: Plantation At West Farms , F, ✓ COMPANY INFORMATION: Dave Lepine Building Contractor COMPLIANCE: Passes Maximum UA = 451 Your Home = 374 17.1% 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 1448 38.0 0.0 43 Wall 1: Wood Frame, 16" o.c. 3024 19.0 0.0 161 Window 1: Wood Frame, Double Pane with Low -E 288 0.350 101 Door 1: Solid 56 0.350 20 Floor 1: All -Wood Joist/Truss, Over Unconditioned Space 1040 19.0 0.0 49 Furnace 1: Forced Hot Air, 78 AFUE Air Conditioner 1: 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 been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la. 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% o the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designe Date 5-4'0-3 J. IN, b 49- id 1.... r ------ \ , , 7 c:)4j 1 . • i ------- _ Ct \ -____ 's \ . . -------.N.,___ I -.--- \ '-\ , • gil'-) el, 4 Ni....., ' ti 4 „.?_ . ' IN- ' % .0 . )5 \ \1\. , I i ' .. ic tg << )5 ' • \ C2 . 0 \e/11P , k , ' NIIII -a0"' VC) 1 . ■ I 1 \ V alf : . Ii • .s- /to/ 4--7_ --c l'`' N 0 __, . ..:5\ 1</ e ,f<, \ # - .,‘ 1 . - 4 ` _______ _otvoqp, ! ZriN cf ,Ncrfilb.1111ptcr, ri I u pelp<C_ 4c,„, r 4 2-7---jr-7 , g t 2.• OE: PARTM ENT OP 13 u'c 1N5pEc-noNs • !q5PECTOP 212 Main Street. ' Municipa! Btaing r:)rt.1)arl1) ton, Mils: 0100C Sciu r e Foot a c..; Amount: 3aseme,7t @ .10 Atliee Acsipx Isieirco 1 @ 40 jrajg, i4n-t VigS) 45/S- DO 2nd Floor @ .20 4g0NROL.161, 1/2 Floors, Attic, Garag,i .10 S 7( 600 Deck, Porches ,9 5 • (,,o TOTAL /Or /0 YO ,;:2 ha f 6 /4/4y , • /4.th t spy � � °� (Eyxt x f 3rcrilia tpttrn 1,.. * — t d q , �rf 6 .fassarilnstlta % DEPARTMENT OF BUILDING INSPECTIONS � = 212 Main Street. ' Municipal Building • Northampton, Mass. 01060 M' WORKER'S COMPENSATION INSURANCE AFI.WAVIT Avie, A 4. , (licenstc /permitter) with a principal place of business/residence at: • t2i .E79 4% 5T#4 'o ,144 (phone #) 41/3 - 7 - 35'7S' • (s*aleet /city / sta te/zi p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job; - (Insurance Company) (Policy Number) (Expiration Date) I am a so - proprietor, eneral contractor or homeowner (circle ohe) and have hired the contractors listed below who have the following worker's compensation policies: .4i# -4 M (truck •-. f 4Z Coki,5411K WI`IZ 8 00j S' - 0(0 - - 03 (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ` f • ,�9 hectic ,4SS. r? K c 5 r J Craze r-C. ;.uc5 S' 3 -. y 6 = G 3 (Name of Contractor) fiance Company /Policy Number) (Expiration Dare) 641 o k# i'/ i..s . ,Sra /(r, /4, .r / - „? ©-CJ �/ _____ N ame of Contractor) (Insurance Company/Policy Number) (Expiration Date) i e Pl LA)C 7 ! 3 g `7 - /-0 (Name Contractor) (Insurance Company/Policy Number) (Expiration Date) � (attach addiarml sheet if necessary to include information too ill =tractors) ' / t''‘, /fey GO.J.S /70/ ";�/14l1P/l7s 1 `7 „ Kvas -s. - k7Y�'y 3 ” aY t) I am a sole proprietor and have no one working for me. • ( ) I am a home owner performing all the work myself. NOTE: plesae be aware that whine bomeowvers who employ p~svm to do m=ints• , consraciien or impair work oa a dwelling of cot more than three units is which the bomeouver resides a on the }founds appurtenant thereto are trot gcoeraily considered to be employers under the workers .nom cation Act (OL152,s3 1(5)). application by a hotneowaa fora Gave a permit may evidence the legal Etatts; of an eraploy.r under the Wockeet Compensation Aei I understand that a copy of thu suteeoeut may be forwarded to the Depectmec of Industrial Accidents' Office of Iax canoe for the avers a vsxif calico had that failure to vxure coverabe t» -t section 15A of MOL 152 CIA lead to the' imposition of aimiosl penallim . • consisting of a fine of up to S1,500.00 ar ita imprisonment of up to cm year and civil penalties in the forest of a Stop Wodc Order and a fine of S100.00 a day against me. Fee departnatoal use only - z - gcrmit Number _ (3 —2 , - e3 - Mai► Lot # Sigzaiurt of Li •• • ctxztittcc --- & , :'. ♦- • •.O SECTION 8 .,,CONSTRUCTION SERVICES $.1.1- leensed Construction Supervssgr: Not Applicable C Name a( License._ Holder :'ftvi tO k - Q 'VW License Number ?6,a 5 sr T 1 PkA4 ti Er- .2 c' t Addres Expiration Date 93 gd7- 3575 — Signature Telephone ingtEEMMEMBIBMEarie � � � �r s.� � -�, Not Applicable 0 r � ra e„- 'fin ,�.i�.a -�, Company Name Registration Number Address Expiration Date Telephone S>rG1'l �1 lb WI RKI+RS' CO MP ENSATION INSURANCg.AFFIDAVIT (M,G t. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavi` will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No 0 VOil a 1.01, 4? -1 a+ v < ale a , 0;j • The current exemption for "homeowners" was extended to include Owner- occupied Dweilin2s 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(: 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 • . CTIONI ¢ESCRtPTtON OF PROPOSED WORK (check all applicable) - New House jQ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding [ ] Other ( Brief Description of Proposed Work: CD/05110e Rcao f cvue 5 51A-1/ - 4334/6 /10/44e, Alteration of existing bedroom Yes No Adding new bedroom Yes - No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll ❑ • Sheet 0 Ba lf4N v+ ATIV cir add ti OM to exis'ting , co rnplet th'e fo1`I5Wi;ng: a. Use of building : One Family X Two Family Other - b. Number of rooms in each family unit: /b Number of Bathrooms c. Is there a garage attached? (it d Proposed Square footage of new construction._ g (ogY Dimensions 4,a x Y e. Number of stories? a 1ft C k w x e. f. Method of heating? q kor q1r'� /!�( _ Fireplaces or Woodstoves / Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached ? h. Type of construction 64, 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 (0 k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer X Private well City water Supply SECTION 1 1;0,iVkitt AUTHORIZATION - TO BE COMPLETED WHEN 0, .S A0 Trr RIPO ITRACTOR 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 I, --- -90f13 V'4, h / M Authorized Agent hereby declare that the stateme4its and information on the foregoing application are true and ac • .. Tto the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Na S ignature of Owner/ • ; - nt Date 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 .—(51 S' , �/�"'t�, I 0e) Frontage 1537 j Eso Setbacks Front a ' YO Side L: 1 S R: / 5 L: 16 R: a c / s Rear a I r � 0 r Building Height 30 f Bldg. Square Footage % aapti 5rtt�" Open Space Footage , /� )5--/Z (Lot area minus bldg & paved 7 I t� 7 r P` I # of Parking Spaces Fill: (volume & Location) _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW YES , IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW _ YES _l _ IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 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: 40. • City of Northampton . Building Department arifitS .zt;. 212 Main Street Room 100 a e Northampton, MA 01060 „ _‘ phone 413.587-1240 Fax 413-587-1272 P.1'61/Sitee,P,krik":2;i:,.: - . •-• _ , othej'ystsfatre APPLICATION TO CONSTRUCT, ALTER, REPAIR, REi4DVATE-00 DEMOLISH A ONE OR TWO FAMILY DWELLING MAY 1 4 2003 SECTION - SITE INFORMATION 1.1 Property Address: ThissecticintAO'itiCcorniilWipititigfickij • ' A , Map C..) .". /t Zone - Elm St. District , . ',CS? DAtt4Ott , , SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -- P4010 , c 7/'? .4-5 r .geY5r7/470/0„..) frt/i. Nam- rint) Current Maiiing Address: 7 - 357_5 T elephone 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. Buildihg a - (a) Building Permit Fee et/ 96. 0 • 2. Elerical (b) Estimated Total Cost of Oot) cis 0 Construction from (6) 3. Plumbing //.. 000 00 Building Permit Fee 4. Mechanics? (HVAC) /y 5. Fire Protection c;?4, 0 0 c..) 6. Total (1 + 2 + 3+ 4 + 5)I 4 178'. mo.. ni) Check Number S75,9-- Ja_54, This Section For Official Use Only • Building Permit Nu der: I bl� Date Issued: . A ep/ Signature: Building Commissioner/Inspector of Buildings Date ■ 0 File # BP- 2003 -1020 APPLICANT /CONTACT PERSON DAVID LEPINE ADDRESS/PHONE 262 EAST STREET (413) 527 -3975 PROPERTY LOCATION 231 CARDINAL WAY MAP 36 PARCEL 321 001 ZONE SR alt /7 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 59 Sol 15 D,�, VID Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE /DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 04418 3 sets of Plans / Plot Plan /7 /� THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INy9ZVIATION 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 Co ssion ., L 2 Signature of Building Official D. e 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. 231 CARDINAL WAY - LOT #17 BP -2003 -1020 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 321 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PER NIIT Permit # BP- 2003 -1020 Project # JS- 2003 -1628 Est. Cost: $178000.00 Fee: $1058.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor: License: Use Group: R4 DAVID LEPINE 044188 Lot Size(sq. ft.): Owner: DAVID LEPINE Zoning: SR Applicant: DAVID LEPINE AT: 231 CARDINAL WAY - LOT #17 Applicant Address: Phone: Insurance: 262 EAST STREET (413) 527 -3975 Workers Compensation EASTHAMPTONMAO1027 ISSUED ON :5/29/03 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH WATT GARAGE /DECK 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: 9 y / Rough: House # Foundation: " �� Driveway Final: ©A 7 2 - Final: Z — .,o, , Final: /LP / ®y „, 4,' Rough Frame: q- /q, Gas: Fire Department CO 1✓�;�- g , . Fireplace /Chimney: Rough: Oil: Insulation: k q l ` Final: / -7-04 k Smoke: ,s Final: D K - 0 4r THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy - Signature: FeeType: Receipt No: Date Paid: Check No: Amount: * TEMPORARY OCCUPANCY — EXPIRES 4 /28/04 Building 5/29/03 0:00:00 5752 $1058.40 212 Main Street, Phone (413) 587 - 1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo