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interpretation of the general iagra caathedral
HOME DEPOT JUDY LOVITZ
appearance of the floor plan. It is
not meant to be an exact rendition. 20 GLEASON RD
NORRTT HAMPTON, MA
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Note: This drawing is an artistic THE niagra cathedral
interpretation of the general HOME DEPOT JUDY LOVITZ
appearance of the floor plan. It is
20 GLEASON RD
• not meant to be an exact rendition.
NORTHAMPTON, MA
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All dimensions & size designations THE T his is an original design and must 22801655 Scale : maximum Dwg no.
niagra cathedral
given are subject to verification on n ot be released or copied unless Designer
HOME DEPOT JUDY LOVITZ
job site and adjustment to fit job applicable fee has been paid or job DAWN
•
. conditions. order placed. 20 ASON RD Wall /C Line # 1 —
NORT RT HAMPTON, MA
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• All dimensions & size designations This is an original design and must 22801655 Scale : maximum Dwg no.
THE niagra cathedral
given j
iven are subject to verification on n ot be released or copied unless Designer
HOME DEPOT p 20 job site and adjustment to fit job applicable fee has been paid or job DAWN
• conditions. order placed. 20 RT GLEASON RD Wall /C Line # 5
NORTHAMPTON, MA
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installed here. no view in 20/20.
\ 2:do not need drop in
I range cabinet - -g.e appliances
jp350tb /jtpl8wa under counter
oven.
3:use uf6 trim to fit
. mounted horizontally above
under counter oven. see oven
installation info.
T Dwg no
22801655 Scale : maximum Design : 12/06/00
All dimensions & size designations THE This is an original design and must niagra cathedral Date : 03/04/01
• given are subject to verification on not be released or copied unless JUDY LOVITZ
job site and adjustment to fit job HOME DEPOT applicable fee has been paid or job
conditions. order placed. 20 GLEASON RD Designer —
NORTHAMPTON, MA DAWN
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' 0' 1' 2' 3 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14'
0'
1 ' MAR 7 2001 .)
2' DEPT OF BUILDING INSPECTIONS
NORTHAMPTON, MA 01000
3'
5'
6'
7' 0
8'
9'
10'
11'
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'" = DEPARTMENT OF BUILDING INSPECTIONS =
• 212 Main Street • Municipal Building ' =--.1.4. ``
Northampton, Mass. 01060 �'" r'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
. U 4 or 771 0. Zo(I; _r
censeeJpermittee)
with a principal place of business/ esiden at:
V o 6 ?L '6V Z 4-0 A10, T tF' bit,! 1 V4 - 6/ '(phone #) /5— 586; -- 9'4'0 (,)
(street /cit / staid zip)
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:
i
:4 71, (Insurance Company) (Policy Number) (Expiration Date)
p>
I am a sole proprietor, general contractor of homeowner (•; cle one) and have hired
; contractors listed below who have the followlig wor. e s compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
KPt✓
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
I3P 'J
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnecesaary to include infrnmaation pertaining to all oocrtracto s)
( ) 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 dent while homcowncrs who employ persona to do maintenance, construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the groin appurtenant thereto are not generally considered to be
employers undo the worker's compensation Act (GL152,ss 1(5)), application by a homoownir for a license or permit may evidence the
legal 'tams of an employer under the Worker's Compomation Act.
I understand that a copy of this etatemeni may be forwarded to the Department oflnutrial Accidents' Offioe of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting 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
fin of S100.00 a day against me.
For departmental use only
Permit Number
,/ _� 3/7/ Maly# Lot # ,
._:.,. Si J1 . r r of Liccnsee/Permittee Hate
CTION 8 - CONSTRUCTION SERVICES
iesz
,.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
,�� - `, ai A t : :bag' ', Fe.1 „ 4 = 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.
gned Affidavit Attached Yes ❑ No ❑
0
` . t I " , 1-', ,,i 4 Li k 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
No pton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature (-t-Zi (17)-1§--
i''
c riON 5 : DESCRIPTION OF PROPOSED WQR (check all applicable)
ri
New House ❑ Addition ❑ Replacement Windows Alteration(s)X Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ], Decks
[ ] Siding [ ] Other [ ]
Bri
'ef Description of Proposed Work:_, -C LerJ t . 6J-C ' zr ( _c. ),4 ,A ` i
erlJhlSE,,.7-✓
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
x a re a y m # ® **Safi tititiCr - ing ttj° I ° n . h Jolt W1i
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?
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
I, , 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
l;1 VII, 6 , as Owner /Authorized Agent
hereby clare that the statemenm and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
S igned under the pains and penalties of perjury.
TrAot D Lo/
✓Print Nam , A.\:) 1-n-14—
✓Signature o Owner /Agent Date
4
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
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. Ar there any proposed changes to or additions of signs intended for the property ?YES
No f
IF YES, describe size, type and location:
File # BP- 2001 -0714
APPLICANT /CONTACT PERSON LOVITZ JUDITH DARA
ADDRESS/PHONE 20 GLEASON ROAD (413) 586 -9406 Q
PROPERTY LOCATION 20 GLEASON RD
MAP 18C PARCEL 094 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ll77
Fee Paid dtio —
Typeof Construction: REMODEL KITCHEN & BATHROOM, INSTALL SKYLIGHT & SLIDING DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE LLOWING 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 Conservation ission Permit from CB Architecture Committee
L 2 o/
Signature of Building fficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
dipaK requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
20 GLEASON RD BP- 2001 -0714
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C - 094 CT OF NORTHAMPTON
Lot: -001
Permit: Building
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2001 -0714
Project # JS- 2001 -1339
Est. Cost: $ 18037.00
Fee: $80.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 12763.08 Owner: LOVITZ JUDITH DARA
Zoning: URB Applicant : LOVITZ JLIDITH Di.t
AT: 20 GLEASON RD
Applicant Address: Phone: Insurance:
20 GLEASON ROAD (413) 5R - 9406 O
NORTHAMPTONMA01060 ISSUED ON:3/7/01 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL Ki- :'HEN & BATHROOM, INSTALL
SKYLIGHT & SLIDING DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: ay/e/ 11kl'" Meter:
Footings:
Roug o gh: House # Foundation:
Final:
'74-157//' F nal: J
` /` 0 / / i. Rough Frame:
Gas Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: moke: Final: eJ k C.., r O / ,lat+f
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL ION();
ANY OF ITS RULES AND REGULATIONS.
Certificate of / si gnature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/7/01 0:00:00 333 $80.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo