18C-099 DELONG CONSTRUCTION
76 BANCROFT ROAD
NORTHAMPTON MA 01060
Maribeth Erb & Mary Finn
19 Gleason Rd.
Northampton, MA 01060
March 12, 2001
Amount Due as per Contract to begin work on Kitchen $8,000.00
A.I.C. LICENSE #105618
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MAR 1 2 2001 U.";)
` DEPT OF BUILDING INSPECTIONS
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n erbf B g Design : 08/181001
All din'anions & size designations This is an original design and must ' tale : maximum
g 8� 9 i Date : 11!24100
given are subject to verification on I not be releasal or copied unless i
job site and adjustment to fit job I , appli.ablefee has been paid or job
condtions. I i order placed. Designer
1
ott/J'1
Olitg Nartt &inpfort
4 �/ ( B la asaclivattta =:v •
— DEPARTMENT OF BUILDING INSPECTIONS _ R i=
• 212 Main Street ' Municipal Building — `=
Northampton, Mass. 01060 r"
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
E-144
(licensee/permittee)
with a principal place of business/residence at:
76 34A/'e" /�e4 �wr� (phone #) 47/5-5 7- a437
(street/city /stalthip) o je‘, a
do hereby certify, under the pains and penalties of perjury, that:
(t.--ri am an employer providing the following worker's compensation coverage for my
employees working on this job:
; r 1 ? L. a re , —y o e , 4 f r . , t c & C - 3 / 3 / / 4 3 ° " ' s d7 /2 7 / o
(Insurance Company) (Policy Number) (Expiration Date)
{ ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ persons to do tnaintm'tine, construction or repair work on a dwelling of
not more than three units in which the homeowner resides or oa the grounds apputtenant thereto are not geeecally considered to be
employers under the worker ration Act (GL152,ss 1(5)), application by a homeowner fora license or permit may evidence the
legal status of an employer under the Wodca's Compensation Ace.
I understand that a copy of this statement may be forveardsd to the Depadtmaje of Industrial Aocidenta Office of Insurance for the
coverage verification sad that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consist of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day aguins! mc.
For departmental use any
lj T Permit Number
- - ��/o � � / m Lot #
Signature of Licensee/Permittee Date
ECTION 8 W CONSTRUCTION SERVICES
flook
J. Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Ed.•Y. , -✓d D. 4 E-vry , H44 C S -- O f/1 S 6
License Number
76 734-✓e ' * 4 . /1q 0/0 3 /2 sic. i-
Address Expiration Date
1 e_ --,,,,P --->. Ye--- 4 1 IT - S b' 7— o c/3 7
Signature Telephone
' : a a �A =� a , x Not Applicable ❑
a , a � s � 9fx
DEZo v- <- Co., ,s- ;eo- 4 - i v.Vd -- . ZX'.,,it,/,447.1( .a le
Company Name Registration Number
76 734,reraor 7/24 /o L
Address Expiration Date
A/0 2r��.45..r1777 . A.14. (3/4:16):.) Telephone 4/13-5-4'7. a 37
SECTION 1O WORKERS' COMPENSATION INSURANCE: AFFIDAVIT (M.G.L. c. 152, § 255C(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.
ned Affidavit Attached Yes fed No ❑
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
rhk
CTJQN D- PECRIPTIQ$.OF PROPOR1;D =WORD (check ill . appllc . ble)
New House ❑ Addition ❑ Replacement�Nindows Alteration(s) MK Roofing ❑
/ Or Doors l�T
Accessory Bldg. ❑ Demolitionll3" New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: 12e,vg -/ E tY;5I-vr- .C A717D ,..e .v , ifs d '' ,,'✓' :rd °'u
c/PT/e4Dt ec f esfeeC41G, 71 4v�6i- r to .4 cc .0- f.27)4 -r c.✓ {c - , - isF.,,
Alteration of existing bedroom Yes 1 / — No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes 'No
Plans Attached Roll ❑ - Sheet ❑
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. Mascheck Energy Compliance form attached?
(Pk. 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
SECTIQN 7e OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I .14 A-e f3e174 ,c- 3
as Owner of the subject property
hereby authorize I d Le -v fri nif to act on
my behalf, in al t matters relati e t work a thorized by this building p r 't applicati n.
ii
A., / J 1 i CCU
Sig i wner Date
I, id Lf''pv 4 A/ , asRvnrter /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.
Es L� -rA
Print Name
Signature of-Ovvner /Agent 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
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
eikk 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
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:
File # BP- 2001 -0719
APPLICANT /CONTACT PERSON ED LENNIHAN
ADDRESS/PHONE 76 BANCROFT RD (413) 587 -0437
PROPERTY LOCATION 19 GLEASON RD
MAP 18C PARCEL 099 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ✓ ���� ,
Fee Paid r f
Typeof Construction: NOVATE KITCHEN, RELACE WINDOWS & ENTRY DOOR & UPGRADE
ELECTRIC & PLUMBING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 042506
3 sets of Plans / Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w /ZONING BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w /ZONING BOARD OF APPEALS
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 Consery • n Commission Permit from CB Architecture Committee
_____:, ,Ovi 2 0
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
` requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
19 GLASON RD BP- 2001 -0719
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map :Bloci‘ 18C - 099 CITY OF NORTHAMPTON
Lot: -C(
Permit: Building
Category: renovation BUILDING PERMIT
Permit # BP -2001 -0719
Project # JS- 2001 -1352
Est. Cost: $31300.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ED LENNIHAN 042506
Lot Size(sq. ft.): 7492.32 Owner: ERB MARIBETH & MARY FINN
Zoning: URB Applicant: ED LENNIHAN
AT: 19 GLEASON RD
Applicant Address: Phone: Insurance:
76 BANCROFT RD (413) 587 -0437 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON :3/12/01 0 :00 :00
TO PERFORM THE FOLLOWING WORK: RENOVATE KITCHEN, RELACE WINDOWS &
ENTRY DOOR & UPGRADE ELECTRIC & PLUMBING
eft' POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
ork
Building 3/12/01 0:00:00 1947 $130.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo