38C-052 (2) SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: < Not Applicable ❑
Name of License Holder : $ 1 2 " fJ 07 g j 4c2
License Number
34 S'-c ✓;t.t eas.m. 4"0---14 c y /z �� 43
Address Expir tion Date
7 .c,.27 .414- D /G le, e
Signature Telephone
l)y / - 4 (0 — .fit '/ — / 2.Z
9. Registered .Home Improvement Contraptor Not Applicable ❑
S'Ae P.4201/ .,..�,�„ �►, ,�,��. /(3) 8 7
Com a ny Name Registration Number
Address � t 7/ Z
Expi tion Da
Telephone 5194 —12-z 1 /
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 ❑ No ❑
11. - iome 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
/VI .4 all t 5 +T 1 '3
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 : R: L: R:
Rea
Building Heig
Bldg. Square Fo•tage ° o
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding a er been issued for /on the site?
NO 0 DON'T KNOW YES
IF YES, date issued:!
IF YES: Was the permit recorded at the Regis of Deeds?
NO 0 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 er DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES NO �:J
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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exca 'on, 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.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ✓- Roofing E
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I7j Siding [0] Other [0]
Brief
Descfor Proposed ti/a. f
Work: r�' t / /__ .a v 5 . ...c a., r" /�
�
Work: � 1:...,_ � 't�'a..� .-6 .r'
. t--------N--lo
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If ; e o and or addition to existing housing, complete the following:
a. l b ' :One Family Two Family Other
b. Nunf6er 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
D ''t . 1 I I> 2-- I 67 --- , as Owner of the subject
property
hereby authorize 5�"C Lim 126 5 Q
to act on my behalf, in all matteig relative to work authorized by this building permit application.
ll
3/ /13/1 /
Signa Owner Date rr
1, 71-� 4 -c-k.. (2 0s-f' , as Owner /Authorized
Age t hereby &dare 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.
127 ..) ./1 1 i
ft' Owner /Agent Date
87 -1272
DepPermit artment u se ert#
RECEIVED 01; of Northampton Permit:
Bu (ding Department Curb GutlDnveway
iYp I 20 -,. 2 Main Street Sowertse ptic Availability
�!!t< Room 100 W
lorthampton, MA 01060 Tests Sets o ell f Structu Plans
DI , "• r r
NorminM ^1`1 -5 37 -1240
DEPT OF BUIL Fax 41 - 5 Plot/ Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMI D W ELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by offi w7"` I k Map W�
g( So � c— Lot ce Unit
/VII / � y 4,. /11 . o ! U 4 D Zone Overlay District
Elm St. Dist CB • District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2. Owner of Record:
T../,,,\.1 i 0 ►�4tZ►�- (C Z 31 r�.�,,'- i tiit ,w. hK #144
Name . t)
Telephone Current Mailing Address
/ ��� / — ? 2 3 6
Sign ( (.�
2.2 Authorized Agent:
5'4- .� � .{,�„ �drs 3 5-_,.. rv;eK C�H Rd N�,,.._� a job
Name (P t ) Current Mailing Address
yi.l q - /ZZ
Sign ure Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building J /7 _ - � (a) Building Permit Fee
2. Electrical 1 6 v , (b) Estimated Total Cost of
Construction from (6)
3. Plumbing / �D /) Building Per mit Fee
4. Mechanical (HVAC) (/
5. Fire Protection
6. Total= (1 +2 +3 +4 +5 ) Q ? 01 C heck Number `3/3 $ /o1O _e
T his Section For Off Use Only
Permit Number: Date
g Issued:
Building
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2011 -0742
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS /PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 0
PROPERTY LOCATION 31 SOUTH PARK TER
MAP 38C PARCEL 052 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 3/3 I / 02.0 —
Fee Paid 3�i!
Typeof Construction:_REPAIR WATER DAMAGED BATH & BEDROOM
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
Demolition Delay
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.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
31 SOUTH PARK TER B P- 2011 -0742
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C - 052 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP-2011-0742
Project # JS -2011- 001233
Est. Cost: $20200.00
Fee: $120.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 7187.40 Owner: NARKEWICZ DAVID J & YELENA MIKICH
Zoning: URB(i00)/ Applicant: STEPHEN D FOSS
AT: 31 SOUTH PARK TER
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 - 1224 () WC
NORT HAM PTO NMA01060 ISSUED ON:3/23/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR WATER DAMAGED BATH & BEDROOM
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: 4 - 4 -/ / _Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation: //
Final: Smoke: Final: 01 f [ /t--1,
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULAT" -- �f y _
� • �`,CiltrVt!ir�`
i� Gt�e.�s
Certificate of Occupanc, si gnature:
FeeType: Date Paid: Amount:
Building 3/23/2011 0:00:00 $120.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck - Building Commissioner