Loading...
36-019 (2) • SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : J� - - -- e.oe.ietrc License Number Address Expiration Date Signature Telephone 9 KReQis Bred, ibriiar OiiTtigNit 767iiric ZillAWC21.1%4 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION10- WORKERS' COMPENSATION NSURANCE .AFFIDAVIT (1VI. 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 ❑ bk 4 : ®O @ wnenExernption 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 nd Local Zoning and State of Massachusetts General Laws Annotated. e owner Signature - e� Homeowner 6 Gi /� • SECTION 5= "DESCRIPTION OF PROPOSED WORK .(check all applicable) , New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [►] Siding [O] Other [0] Brief Work: Description of Proposed n � �^ pOO /5 t X,36 D-c k Car I" I 1a /5 Alteration of existing bedroom - Yes x No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll - Sheet FM, . ew.house and or:ac�cl�t onto" existing, housinq,tcompletethenfollow�ng: 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 ?.OWNERSAGENT OR CONTRACTOR APPLIES FOR BU ILDING PERMIT 1, , 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 , 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 e ature of Owner/ en Date Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information l Existing Proposed Required byLoning This column to PC filled in fiti t* Building Deparent l ,. r � _ e ti Lot Size 1 le 35" i i / .,6 r . Frontage Setbacks Front =; Side L: ' R: L:/4 R: 1 i 0 Rear Building Height - t 4 Bldg. Square Footage ` j % } i .I Open Space Footage (Lot area minus bldg & paved [ I 1 parking) I I , # of Parking Spaces Fill: i s I _�_..�___� (volume & Location) I i A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES . IF YES, date issued:, ,,/, i 3 g IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book I Page; 1 and /or Document #1 1 B. Does the site contain a brook, body of water or wetlands? NO 1 1 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 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: 1 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 ation, 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. j E � „ ©epartrnemt: u oni , Ed City of Northampton to us� i Rerni£ °a Building Department �� 4 �� rtzti �� ,� APR 4 212 Main Street Beaker• I G al » Ilr� W �° Room 100 Se el^ at I - 41 t f:. � � " iii 1.'oFeuq_oiNG INSPECri Northampton, MA 01060 ® � ' a� � . N MAO" "N+ ot� • INSPECTIONS -13- 587 -1240 Fax 413 - 587 -1272 P ; � is p '^ -a 0,- ' ;i �V " '.� Other 5pecl ' 4 r 6 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: r This section #o be completed by office . I � �r Q ST &I ):1 r . 4 € Ma i # ' Lntr tss yy z Unit ` � I /D r Q• 1. rhA 4 ma x." 3 u m 1 . -+aP a '43 `' .e � WI l D /D (, Zone . ` ' Ovelrlay Di str i ct -Elm st [ st CB Disttict SECTION 2 - .PRO PERTY OWNERSHIP /AUTHORIZED AG 2.1 Owner of Record: ) I" Ots 6J. �ar •col -rS e( J I t. s� G /�� 1D r . Na Print) G e.....„ s/` Telephone Current Mailing Address: W3-6- 3 6 ,/ 9 6 ature 7 • 2.2 Authorized Agent:, Name (Print) Current Mailing Address: Signature Telephone SECTION 3 r ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use .Only 4 . completed by permit applicant 1. Building / / tJ ? �-� (a) Building Permit Fee 2. Electrical (b) Est Total Cost of 'Constn from (6) .? . 3. Plumbing Butldmg Permr} Fee 4. Mechanical (HVAC) 5. Fire Protection s ' 6. Total= (1 +2 +3 +4 +5) Check Number This Section For Official Use Only- - Buildin Permit' Number - Date g . .. Issued. •. '�� Signature Building Commissioner /Inspector of Bui ldings Date • ©k RA 0 Rvi£w File # BP- 2012 -0861 APPLICANT /CONTACT PERSON BARANOWSKI CHARLES W JR & DIANA L BARANOWSKI ADDRESS /PHONE 17 FOREST GLEN DR FLORENCE (413) 636 -1489 Q PROPERTY LOCATION 17 FOREST GLEN DR MAP 36 PARCEL 019 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out n� Fee Paid f "/ Typeof Construction:_CONSTRUCT 12 X 15 DECK & 15 X 30 ABOVE GROUND POOL 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Peliuit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management t emo • • . Delay . .4Ar 2----- 7-- --/- _ 1 ature of Buil, -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. 17 FOREST GLEN DR BP- 2012 -0861 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 019 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Above ground pool BUILDING PERMIT Permit # BP- 2012 -0861 Project # JS-2012-001515 Est. Cost: $14300.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14679.72 Owner: BARANOWSKI CHARLES W JR & DIANA L BARANOWSKI Zoning: Applicant: BARANOWSKI CHARLES W JR & DIANA L BARANOWSKI AT: 17 FOREST GLEN DR Applicant Address: Phone: Insurance: 17 FOREST GLEN DR (413) 636 -1489 () FLORENCEMA01062 ISSUED ON:4/9/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 12 X 15 DECK & 15 X 30 ABOVE GROUND POOL 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 4/9/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner