25A-022 1
SECTION 8 - CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor Not Applicable 0
Name of licanse Holder
License Number
Address Expfietion Date
signature Yeiephone
9, Registered Horne Improvement Cootractor Not Aoo lable
Company Name Registration Number
Af.,.reSS Expiration Date
Telephone I
SECTION 10- WORKERS COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C45))
Workers Compensation Insurance affidavit must be completed and submitted with this appllcation Faiture to provide this affidavit will result
in the denial of the issuance of the building permIt
Signed Affidavit Attached Yes.... 0 No..
11. - Home 1 • ner Exemption
The current exemption for - homeowners - was cNtended to include Chl ;ler-occupied Dwellings of one (1) or ti?..) families
and to alloy. such homeovner t' eni.t.age an individual for hire \sho does not possess a license provided that the owner acts
zs rvisor. CM R 780, Sixth Edition Section 108.3.5.1.
ncflailtiort of Homeowner: Person (s) who own a par,:el of land or, vhih he she resides or intends to residei on which there
is. or is intended w be. a one or two Camily dwelling, attached or detached structu. ac,....essor!. to sh use and :or farm
structures. A person wbo constructs more than one home in a ho eatrliecn-41 a hezr...--orztler.
Such - harnwwne' shall ..;u( to the 1 Official. on a form ac,:xptabk to the Buildina Official, that he/she shall be
orvino".•--44.. ;se rw.edl 'der the building permit.
As actin Construction Siruerkitior 1=oui-pri..-sc7ncie AN1 the job site ■kill hc required from time to urrit. during and upon
completion of the work for which this
Also be advised that with reference to Chapter 152 (WorLers Compensation) and Chapter 153 (Liabilit) of Employers to
Employees for Mjurirs not resulting in Death} of the Massachusetts General 1.,a‘v,Annotated, you may he liable for ptrsontsi
au hire 10 perform work for you under this permit.
The undersigned "homeowner" certifies and tessuirrit:s respoTtsihlity fOr eorrOttrt with the Stutz Roil C o4k. City of
Northampton Ordinances. State,and Sta
Homeowner Signature d:f.'.14/"/
SECTION 6- DESCRIPTION OF PROPOSED WORK (check all applicable)
I
i
New House Addition [11 I 1
Replacement Windows I Alteration(s) 7 : Roofing Ec
Or Doors Mi
Accessory Bldg Demolition ED New Signs 101 Decks f Siding [DI Other [M]
ac Desunply,)n of Propse, 1 i i
Work
/ /,'
AlteratRwl of existing Oedroom Yes Nc Addir new be-arcom 'Yes Nu
Attacr,ed Narrative Renovating unfinished basement Yes No
Pians Attached Roll - Sheet
6a. 11 New house and car addition to existing housing, complete the followMg
a, Use of building One Family Two Family Other
b Number of rooms in each family unit Number of Bathrooms
c is there a oare atfacfled2
a ProposKi Souare footage of new 0 Eamension.F. ,
e, Number of stories?
f Method of heating? Fireplaces or Woodstoves Number of each ..
c, Energy Conservation Compliance Masscheck Energy Compliance form attached? ,
h Type of construction
I I
i. Is construction within 100 ft of wetlands"' Yes No Is struction within 100 yr floodplain Yes Nc
i. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning reguiations? Yes Nc
I
I. Septic Tank City Sewer Private City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I
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
__----,_.-- 1 1 7 .
I, t J 41 I r\c-s.... i,) __.
,----
i s OwnerlAuthorized
Agent h reby dect#re that the statements an information on the foregoing application are true and accurate , to iffe my knowledge
and belief.
Signed under the pains and penalties of luny.
P f . ert 1 J T. l Kt, ±=•., i
Print Name ,.._ ,,,,„; ; , .
1 i
1
St g iatureyOwnerlAgent Date
,_.
Section 4, ZONING Al', Infrmaton must Be Comete.t.1 Pe.7r Can Be Gamed Due. T ncpmpiete ;nforrnat:cT
t\Ifl P., 0.;
1-Z.u-qu;red Zonifv:.=
1. ..2(qui-17 10 fqht,1
1,0t Si4c:
S'idz
13(ig ‘y,11.1are
p •*pace Focyulg:
f k AIL
i` arkinz
i Fill:
murrie & !,oenloy1,
A. Has a Special PermitiVarian:e.'Finding ever been iss for ion the site?
NO tift DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
N° 0 DONT KNOW 0 YES 0
IF YES: enter Book Page andfor Document t
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
0 , Date issued:
C. Do any signs exist on the property' YES 0 NO (i)
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 W111 the construction activity disturb (blearing, grading, exbavation, or filling) over 1 acre or is it part of a common p
that will disturb over 1 acre YES 0 NO 1 41
IF YES, then a Nol.hampton Sto-m Water Management Permit from the DP',/ s ebuired.
r —
Department use only
City of Northampton Status of Perrnit
RECEI\I Et) Building Department .
Curb Gut/Driveway Permit
212 Main Street . —
'Sevier/Septic Availability
9 ItA2• Room 100
WaterAfilell
erthampion, MA 01062 Availability , ,
Tv Sets of Struural Plans
....,:.o.... 41 - 587 - 1240 Fax 413 FloffSite Plans ,
me% NsP
. ..,... . of 811 rim, 0106
Other Specify
APPLiCATION TO CONSTRUCT, ALTER REPAIR. RENOVATE OP DEMOLISH A ONE OR TWO FANHLY DWELLING
SRCTION 1 SITE INFORMATION
This section to be completed by office I
1,1 Property AdrIss .„, 1
i ill 4 r ;14i 1 -- e ff-1 data Lot Unit
f
Ai tl r 4 trfp i rt i p , 4,-,-- Zone Overlay District 1
Etill St District CB District . I
SECTION 2- PROPERTY OWNERSHIPJAUTHORIZED AGENT
F 1
T 1 Owner of Record: . , —
'* -, ,
- - , 7 — 4 .. i ,/ ,,,,„ „ e „ r ,.,
, , , o 1 i ..
Name ,,,,,„, A - -4 7/ Current Maarig Adaress" .ei -, "< , 6 , z 7 i .6 i
JiT fil
Teleptrine .
1 Signature 1 /
12 Authorized Apent:
Name (Print) Current Mathrig Address'
SIgnature Telephone .
„ I
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Rem Estimated Cost (Dollars) to be Official Use Only
completed by permit appliwnt
1 Building is} Building Permit Fee
2 Electrical (b) Estimated Total Cost of
Construction from (e)
' a Plumbing Building Permit Fee
4 Mechanical .(fildAC)
5. Fire Protection 1
6, Total = (1 + 2 -+ 3 + 4 + 5) , i
n _ k...- / 010017
Check Number 0 VD / / ' Ai It
I This Section For giticial Use Only
Date
Building Permit Number. Issued
Signature
.
1 Building Corrimissionernrispector of &likings Date ,
File # BP- 2012 -0804
APPLICANT /CONTACT PERSON FILKOSKI JOHN J & SOPHIE A & FILKOSKI HENRY
ADDRESS /PHONE P 0 BOX 933 HADLEY
PROPERTY LOCATION 51 MARSHALL ST
MAP 25A PARCEL 022 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT -' 16
Fee Paid
'1 c
Building Permit Filled out 3 q # " ( -- 41 , e7 � ,7 t
Fee Paid J � 1
Tvpeof Construction: INSTALL NEW WINDOWS & ROOF a t7
New Construction ) e k � � 1
Non Struct interior renovations ' J
Addition to r)
Accessory Structure
e ,,
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F 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 Permit DPW Storm Water Management
ie �o't • ela �`'
<*/ 0
2 r� i ,,,
. , />
,_, ,,----
Signature of Bui din O 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.
51 MARSHALL ST BP- 2012 -0804
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A - 022 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOFING /REPLACE WINDOWS BUILDING PERMIT
Permit # BP- 2012 -0804
Project # JS- 2012- 001409
Est. Cost:
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6621.12 Owner: FILKOSKI JOHN J & SOPHIE A & FILKOSKI HENRY
Zoning: URB(100)/ Applicant: FILKOSKI JOHN J & SOPHIE A & FILKOSKI HENRY
AT: 51 MARSHALL ST
Applicant Address: Phone: Insurance:
P 0 BOX 933 (239) 793 -7100 0
HADLEYMA01035 - 0933 ISSUED ON:3/20/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW WINDOWS & ROOF - ENERGY
STAR WINDOWS REQUIRED,LEAVE STICKERS FOR INSPECTION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
•
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/20/2012 0:00:00 $70.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner