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24A-127 (3) ---? pac/r 1, 124 a,A .A0a,J Jor ----) , r . .._______t-----7,5 1- ,--\.... i ,171- _ ililkIl■■■____ CA �� PA vas vd000f M ON r dNA o.,r ic ,--, 4 d i . ,Co,�ol c.i. t 0 per' -gy ass ' f Li t, jO q ✓1 <W V. CI 5 t t 0 1 °nowa8 . M O t' +a w ,"10 co:4 L t 01 � � � a � ��Sp`�ol /7 u mil„"° � �, ° 1V - /1 It all 442144 12v Q� RO 1 -e a w 3,1\V d D9d5Q { HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and _regulations The inspection process quires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper — --------- perts-in- conj unctionto_the_ ' issued,_ and_ that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location 3: t The Commonwealth of Massachusetts �; / Department of Industrial Accidents =►� • Office of Investigations • ' f�ll a � , 600 Washington Street =Ilifj- _ " -� _. _._ Boston, MA 02111 www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers Applicant Information Please Print Legibly Name ( 3usiness /Organization/Indivirina1) No ).e,,,,,, l 4- 14..4..61,_ Address: lrf t^ 1 a..;l s 7 c. r=„44,,, NrA- 61 ( City/State/Zip: Phone. #: "I / 3 - 2 So - )0 Are you an employer? Check the appropriate box: Type of project (required): / 1. I am a employer with 4.. 0 I am a general contractor and I 6. 0 New constmction loyees (full and/or part time).* have hired the sub- contractors 2. I am a sole proprietor or partner- listed on the attached sheet 7. 'Remodelmnu ship and have no employees These sub - contractors have. g. 0 Demol on for me in any capacity. employees and have workers' working Y P ty 9 0 Building addition [No workers' comp. insurance comp. msurance_$ required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I- am- a- homeowaer-deingall- work __offic_e_zsbav . xer d their _ lumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0. Roof repairs insurance required:] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.]. *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and stag whether or not those entities have employees. If the sub-contactors have employees, they must provide their workers' comp - policy number - I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. Insurance Company Name: - Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /State/Zip:' • Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator: 13e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do_hereby certify under the pai : and penalties ofperjury that the information provided _above .is_true .and.carreCL __ ___ Sia..ture: / Date, 3f4.1 <0 Phone #: '/l 3 - c SO - 3d o f - Official use only. DO not tv ten this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - y Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : N +k con c s. / 44, t d_o 71 License Number C 5 �r1 S -flra. x`44 0160 � d u1�1 Address Expir Lion Date ` (3 a sv - 3acf-2 Signature Telephone 9 : Home: -lmnrovementC ntcaeta ..a&Z ,... �.. , 8 _,. , ..tom .. ;g; > Not Applicable ❑ At 4 k or a-/ 11 -14.4. & . - t ' 1- W16g Company Name Registration Number mA- 0 l al 7 3/ 07 Address Expiration Date Telephone f /)- 1 $'v_349 _ SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M. G. L. c. 152, § 25C(6)) J 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 ❑ 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 "o amp on • r i tnances;' a e' . -, • . .1 General -Laws- Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing El Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[J Siding [O] Other [0] Brief Description of Proposed Work: W: L. 10✓ otaal ✓ os.dp - Alteration of existing bedroom Yes No Adding new bedroom Yes l No Attached Narrative Renovating unfinished basement Yes / No Plans Attached Roll - Sheet a °I1f I kEffaf11. , and'& ddrtton a tcstincf 'ousrieiaint feete tfi+ f flbwinq: 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 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 I, k , 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. ideii- Itarioe j Al rw2 /441.... Print Name //oit * 3 o /c Signature of Owner /Agent Date . . 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 _..._._.m, ___ . Frontage 1 i _. _ ' Setbacks Front F"` I ; ^ Side L L ' R:t, 1 L:' _ § R: Rear _..........._I Building Height ; j Bldg. Square Footage t t% j i ra 1 '._ Open Space Footage _ „ % (Lot area minus bldg & paved , , _ . parking) # of Parking Spaces . . Fill: i._ 11 _ 3 (volume & Location) -- -- •---- _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ©/ DONT KNOW 0 YES 0 IF YES: enter Book d Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 cy IF YES, describe size, type and location: D. gore any proposed c - anges o or a. 'Mons o signs into ed for the property ? YES 0 NO e IF YES, describe size, type and location: g E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 i$ she �a v° � p � • e , � � �': City of Northampton Building Department iN - J 212 Main Street 0 0 Room 100 , :R 21 a! N�,� 2 `' ,Northampton, MA 01060 �` phone 413- 587 -1240 Fax 413- 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMA N � 1.1 Property Address: / This section to be completed by office (,/q Map Lot Unit ` 1 Pro5 Ave A`oo 44„ ..0k . �4 Ol 0 6 - 0 Zone Overlay District EIm St. District CB District SECTION 2.- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Ave Name (P nt) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Nositianiie Alm r l(‘ Easar..? Mtn' d) 00 Name (Print) Current Mailing Address: _ 4 //3 - . Sv - 3 v0 - 7 Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building COO (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection i 6. Total = (1 + 2 + 3 + 4 + 5) . )OOO ----- Check Number cg #/. . This Section For Official se Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 49 PROSPECT AVE BP- 2010 -0820 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 127 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0820 Project # JS- 2010 - 001212 Est. Cost: $17000.00 Fee: $102.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NATHANAEL ALMEKINDER 102079 Lot Size(sq. ft.): 6621.12 Owner: MARDAS MARGARET B Zoning: URA(100)/ Applicant: NATHANAEL ALMEKINDER AT: 49 PROSPECT AVE Applicant Address: Phone: Insurance: 66 CLARK ST (413) 250 -3007 EASTHAMPTONMA01027 ISSUED ON:3/19/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL BATH, INSTALL FRONT & REAR RAMPS, 3 /30 /10- WINDOW,SUBFLR,RAMP (DECK TO GRADE) 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 3/19/2010 0:00:00 $102.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0820 APPLICANT /CONTACT PERSON NATHANAEL ALMEKINDER ADDRESS /PHONE 66 CLARK ST EASTHAMPTON (413) 250 -3007 PROPERTY LOCAT ICALALPROE4PECT AVE !MAP 24A PARCEL 127 001 ZONE umomr, THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �/ Fee Paid Ot. St Construction: REMODEL BATH, INSTALL FRONT & REAR RAMPS, !3Q /10- ' T® • P, New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102079 3 sets of Plans / Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I FO 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 Demolition Delay 3/36/6 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. Y± 49 1' r. 4q109 17;r--; ..o A ( ( k 1.1 The Commonwealth of Massachusetts 4 C41 i Department of Industrial Accidents ATIP Office et Investigations 600 Washington Street, 7' Floor � h Boston, Mass. 02111 - Workers' Compensation Insurance Affidavit: Building/Plumbing /Electrical Contractors Applicant information: /J Please PRINT legibly name: f k t O Ao„ r� c l /I / rtl e kt vtr,de address: 66 C in " city Go' `f" ljc 'J state: ��l zip: 013, 7 phone # i 1 25 - 3Ou'7 work site location (full address): ❑ I am a homeowner performing all work myself. Project Type: ❑ New Construction Eltemodel ®--I am a sole proprietor and have no one working in any capacity. ❑ Building Addition ❑ I am an employer providing workers' compensation for my employees working on this job. company name: address: city: phone #: insurance co. policy # El 1 am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone #: insurance co. policy # company name: address: city: phone #: insurance co. policy # Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct Signature 0,64-77% -e—e �-C� Date 3// tJ/ /() Print name //cc( Phone # 713 - s'ci - ..1i7 official use only do not write in this area to be completed by city or town official city or town: permit/license # (]Building Department ❑Licensing Board 0 check if immediate response is required ['Selectmen's Office ['Health Department contact person: phone #; ['Other (revised Sept. 2003) SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder : 1 �r o_ [7 a ire / A-1 wt e k i key e,.. (C) c) Q 7 9 License Number 6 1ln,- k ki rs (/ 01 3 � o t ;— Address Ex pi Y/30-0 tion ate `l - �Sv- - 3t) w-7 Signature Telephone 9. Resist / ered Home Improvement ( Contractor: Not Applicable ❑ I YC► 't ha 1,1 ei (2 I /41 1,i e h, h cl Pr x y Company Name Registration Number 4 C1 e - /e f"7/ n ( Q Y7 ,3700 j Address Expiration Date Telephone 1 1/3-dS'"0 -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. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 buildiine 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors CI Accessory Bldg. ❑ Demolition ❑ New Signs [Cl] Decks [p Siding [O] Other [fil Brief Description of Proposed (..1/1/071,741/12-4._ Work: r a vn o c]od r S 4- - ! . 4 1( c..`f Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes __2 Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT M.AiQO ,q fae-1 irvI A k61 , as Owner of the subject property hereby authorize (\I R ' 1+4 Ari Ai -M6Ki ) ,DE-Z to act on my behalf, in all matters relative to work authorized by this building permit application. Z 1 ,i �j 3 )/ 7/1t Signature of Own Date I, N ti±k (fro e / ,1 m e /(c „ dp,. -_ , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of i krraV rd an3belief. Signed under the pains and penalties of perjury. No+i ahUe/ l�( w<0. 4 ind Pv Print Name 3 ((c Signature of Owner /Agent Date 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 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 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained I© , 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: E. WiII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department 212 Main Street Curb Cut/Driveway Permit Sewer /Septic Availability Roo 100 Northampton, MA 01060 Wat er/Well Availability '7", � y A r ` '; 0 010 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office L 9 Pr ( 5/0P_c - AFL Map Lot Unit AL 0,"41-, n r 'i- ilk 61660 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 1 . NI C r dczS q. c( PftSred Au : NI cif- rt,at-U D 1-n Name (Print) J Current Mailing Addrg T 'y �' r :.,a!l� ss: SKy 427 2)141- 43 . l . iLl Telephone Signature 2. Authorized Aaennt: 14 / / / L C`�Li iael - I meI:,Ad .V C' L[C�"r^i 5� -t-7-14.4- tnn n PO o )J Name (Print) Current Mailing Address: 1 9 - ign.ture Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee /3 000 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing 00,3 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection + 340 019,122 6. Total = 1 + 2 + 3 + 4 + 5 ) IS Co d 0_ Check Number This Section For Official Use Only Permit Number: Date Building Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0820 APPLICANT /CONTACT PERSON NATHANAEL ALMEKINDER ADDRESS/PHONE 66 CLARK ST EASTHAMPTON (413) 250 -3007 PROPERTY LOCATION 49 PROSPECT AVE MAP 24A PARCEL 127 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��q Fee Paid dd Typeof Construction:_REMODEL BATH, INSTALL FRONT & REAR RAMPS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102079 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Demolition Delay cy-r,ce—t- Sti7(1 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. 49 PROSPECT AVE BP- 2010 -0820 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 127 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate,gory: BUILDING PERMIT Permit # BP- 2010 -0820 Project # JS- 2010 - 001212 Est. Cost: $17000.00 Fee: $102.00 PERMISSION IS HERESY GRANTED TO: Const. Class: Contractor: License: Use Group: NATHANAEL ALMEKINDER 102079 Lot Size(sq. ft.): 6621.12 Owner: MARDAS MARGARET B Zoning: URA(100)/ Applicant: NATHANAEL ALMEKINDER AT: 49 PROSPECT AVE Applicant Address: Phone: Insurance: 66 CLARK ST (413) 250 -3007 EASTHAMPTONMAO1027 ISSUED ON:3/19/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL BATH, INSTALL FRONT & REAR RAMPS, 3 /30 /10- WINDOW,SUBFLR,RAMP (DECK TO GRADE) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Met Footings: Rough:.'- s / o Rough: Hi Foundation: Drive . I al: Final:.4-1-671 o r " - Final: q3q SS Frame: 621:'< i ] Gas: Fire Departmefit fireplace /Chimney: Rough: Oil: ✓ Insulation: Final: Smoke: Final: 01 5119 / le THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: CA' ' FeeTvpe: Date Paid: Amount: Building 3/19/2010 0:00:00 $102.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo t o. 7 .1 04A2 i/evy y /_, fr e 9 7 „ Ill 17 c.iqj & tog, / 49 PROSPECT AVE BP- 2010 -0820 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A -127 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0820 Project # JS- 2010 - 001212 Est. Cost: $15000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NATHANAEL ALMEKINDER 102079 Lot Size(sq. ft.): 6621.12 Owner: MARDAS MARGARET B Zoning: URA(100)/ Applicant: NATHANAEL ALMEKINDER A T: 49 PROSPECT AVE_ Applicant Address: Phone: Insurance: 66 CLARK ST (413) 250 -3007 EASTHAMPTONMA01027 ISSUED ON:3/19/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL BATH, INSTALL FRONT & REAR RAMPS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: ,*Rou Rough: 3 - ,� `f - Il 1. f „,Rough: 4 ,W House # Foundation: Driveway Final: Final: Final: 67/2// Rough Frame: sh Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK 511940 tes.( S THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupanc //?._ Signature: FeeType: Date Paid: Amount: Building 3/19/2010 0:00:00 $90.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo