24C-029 (2) OFFICIAL CHECK
Ezi Bank 30363006-3
52-0133
112
RE:
DATE:
JOHN J FERPTTER 09/01/2010
*COMMONWEALTH OF MASSACHUSETTS** $100.00
o cc .
One Hundred AND 00/100 )sr;
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DRAWER: TD 13 • NA.
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AUTHORIZE ..IGNAT -
H" 30 36 3006 30 1:0 la 20 g 265009 30 30
OFFICIAL CHECK
TO Bank 30363005 -2
- - 52 -0133
RE: 112
DATE:
JOHN J FFRPITFP 09/01/2010
O
PAY TO THE
ORDER Off` ` COMMONWEALTH TH OF MASSACHUSETTS 150.00
Q P uB HEq,
o One Hundred Fifty AND 00/100
DRAWER: TD BA `r
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AUT ^'ZED
"30363005 20 1:0 L L 20 L335I: 6 26 5009 30 30
IMPORTANT FEE NOTICE: CHANGEINLAWABOLISHESCSL's HIC REGISTRATION FEE
EXEMPTION. As a result of a recent change in the law (Section 80 of Chapter 27 of the Acts of 2009), the holders
of Construction Supervisors Licenses are no longer exempt from the HIC Registration fee. CONSEQUENTLY. ALL
CONTRACTORS,INCLUDINGCSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A
REGISTRATION FEE OF 8150.00, AND A GUARANTY FUND FEE. (See instructions for Guaranty Fund
fee schedule.)
16. REGISTRATION FEE ENCLOSED:S L5� GUARANTY FUND FEE ENCLOSED: Icp
PLEASE INCLUDE TWO (2) SEPARATE CERTIFIED CHECKS OR MONEY ORDERS. ONE MARKED
"REGISTRATION FEE" AND ONE MARKED "GUARANTY FUND." MAKE BOTH CHECKS PAYABLE TO
"COMM ONWEALTH OF MASSACHUSETTS."
1 hereby swear, under the pains and penalties of per jury, that all information set forth on this
application and submitted in support hereof is true and accurate to the best of my knowledge.
Further, I certify under G.L. c. 62C, §49A, that l am in compliance with all laws of the
Commonwealth relating to taxes, reporting of employees and contractors, and withholding
a d remitting of child support.
i3 10
Air
Sign , ture of Applicant If a corporation or partnership, position held. ate
INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR REGISTRATION AS A HOME IMPROVEMENT
CONTRACTOR OR SUBCONTRACTOR
Please refer to the following instructions for assistance in completing the Application for Registration as a Home Improvement Contractor or
Subcontractor. NOTE: NOT ALL ITEMS ARE LISTED AS THEY ARE SELF - EXPLANATORY.
ITEM #:
1. Name: The name on the application must be the legal name of the applicant, not a DBA of other fictitious name under
which you are doing business. If you are renewing a previous registration, the name cannot be a different name than used
for the previous registration. If you wish to register using a different name you must file a new registration application and
pay the initial registration fee as well as pay the required Guaranty Fund amount.
2. Number of Employees: The number of employees must include all construction - related employees who worked 20+
hours or more on the payroll in the weekly pay period prior to the filing of this renewal form. Businesses that are renewing a
registration and have increased the number of employees since the previous registration may need to pay an additional
amount into the Guaranty Fund pursuant to M.G.L. c. 142A, § 11.
3. Applicant type: For all applicants doing business under a name other than their legal name, a copy of the fictitious
name certificate filed with the city or town clerk must be included with your application.
4. Federal Tax ID: Applicant partnerships and corporations must submit a Federal Tax I.D. number. Even if the applicant is
an individual, he or she must submit a Federal Tax I.D. number if they have employees in addition to the owner.
8. Responsible individual: If the Applicant is a corporation or partnership, M.G.L. c. 142A, §9(c) requires an individual to be
designated as the person who will be responsible for the corporation's or partnership's work. The identifying information
applicable to that designated person must be entered here.
9. Company name: An applicant doing business under a name other than the applicant's legal name must submit a business
certificate issued by the city or town.
11. Corporate and Partnership Information: Corporations or partnerships listing partners, owners, etc. must provide an
official document that lists the information entered here. The document may be any one of the following: pertinent
sections of the Articles of Organization, a current annual report; or registration with the Secretary of State as a foreign
corporation. (Information on these documents can be found on www.sec.state.ma.us.) Organizations other than
corporations must submit copies of a business certificate filed in the city or town where the business is located, pursuant to
M.G.L. c. 110, §5.
13. Prior Affiliations: Applicants must provide the name(s) of any businesses registered pursuant to M.G.L. chapter 142A
and 780 CMR R6 in which the applicant was an officer, partner, or co- venturer. Attach additional sheets as necessary.
14. Prior D isciplinary Action: Applicants must provide the name(s) of any businesses against which disciplinary action was
taken by the Department of Public Safety or the Office of Consumer Affairs and Business Regulation that the applicant is
currently or was once employed by. Attach additional sheets as necessary.
16. FeBS: CHANGE IN LAW ABOLISHED CSL'S MC REGISTRATION EXEMPTION. ALL CONTRACTORS
APPLYING FOR A HIC REGISTRATION MUST PAY A REGISTRATION FEE OF $150.00. Enclose a certified
check or money order for the Registration Fee and a separate certified check or money order for the Guaranty
Fund Fee in the amount indicated below. Make both checks and money orders payable to the "Commonwealth of
Massachusetts."
Registration Fee: $150.00 -- Valid for two (2) years from date of issuance.
Guaranty Fund Fee: Applicants must pay the amount that corresponds with the number of their employees:
Zero to three (3) employees: $100.00
Four (4) to ten (10) employees: $200.00
Eleven (11) to thirty (30) employees: $300.00
More than thirty (30) employees: $500.00
Completed applications, Registration Fees, and Guaranty Fund payments should be mailed to:
OCABR- -Home Improvement Registration Program
10 Park Plaza, Suite 5170
Boston, MA 02116
11. LIST ALL PARTNERS, TRUSTEES, OFFICERS, DIRECTORS, AND MAJOR OWNERS (10% OR GREATER OF
OWNERSHIP) OF AN APPLICANT PARTNERSHIP OR CORPORATION, BELOW. USE ADDITIONAL PAPER IF
NECESSARY AND INCLUDE NEEDED PAPERWORK (SEE INSTRUCTIONS). PLEASE INDICATE BY AN "X" IN THE
LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D.
CARDS. USE ADDITIONAL SHEETS IF NECESSARY.
I FULL NAME TITLE % OWNER ADDRESS SUPP. CARD
12. (a) HAVE YOU BEEN REGISTERED PREVIOUSLY AS A HOME IMPROVEMENT CONTRACTOR? YES NO
(b) IF YES, PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER UNDER WHICH YOU WERE
PREVIOUSLY REGISTERED:
NAME: HIC REGISTRATION #:
13. (a) ARE YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER, PARTNER, OR CO- VENTURER OF AN
APPLICANT WHO PREVIOUSLYLIED FOR OR HELD A HOME IMPROVEMENT CONTRACTOR
REGISTRATION? YES V No
(b) IF YES, PLEASE PROVIDE THE NAME OF THE APPLICANT /REGISTRANT AND THE REGISTRATION
NUMBER:
NAME: HIC REGISTRATION #:
14. (a) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT
FOR REGIST TION AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN?
YES v No
(b) IF YES, PLEASE PROVIDE THE NAME OF THE APPLICANT /REGISTRANT AND THE REGISTRATION
NUMBER:
NAME: HIC REGISTRATION #:
15. (a) HAVE THERE EVER BEEN ANY FORMAL COMPLAINTS AGAINST YOU WHERE DISCIPLINARY ACTION WAS
TAKEN BY TH DEPT. OF PUBLIC SAFETY OR CONSUMER AFFAIRS, OR ANY COURT JUDGMENTS OR
ARBITRATI N AWARDS ISSUED AGAINST YOU?
YES NO
(b) DO YOU 0 MONEY TO THE GUARANTY FUND?
YES NO
IF YES TO EITHER, PLEASE IDENTIFY BY DATE, CASE NUMBER, OR DOCKET NUMBER:
THE COMMONWEALTH OF MASSACHUSETTS For OCABR Use Only.
OFFICE OF CONSUMER AFFAIRS AND
BUSINESS REGULATION Registration No:
'' 10 Park Plaza, Suite 5170
as} Boston, M A 0 2 1 1 6 Effective Date:
Application for Registration as a Home Improvement
?Y Contractor or Sub- Contractor Expiration Date:
'�tz (M G L c. 142A; 780 CM R 110R6)
1. NAME OF APPLICANT: °
(MUST BE EITHER AN INDIVIDUAL, CORPORATION, LLC, LIP, TRUST, OR OTHER LEGAL ENTITY)
2. NUMBER OF EMPLOYEES ` (�
3. APPLICANT TYPEVINDIVI DUAL -_ CORPORATION _ PARTNERSHIP TRUST
(CHECK ONE — MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN #1)
4. SOCIALSECURITY NO.D 3 ) O . 3� FEDERAL TAX ID NO.:
5. APPLICANT PHONE #: l a5 CkD'O APPLICANT EMAIL ADDRESS:
6. MAILING ADDRESS: 2,74 $t. • KIT-j 43'\vt1Ojbk.3 (A C (06D
STREET CITY STATE ZIP
7. PERMANENT ADDRESS: Si ti--
STREET CITY STATE ZIP
PLEASE NOTE THAT A P.O. BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS
8. IF THE APPPLICANT ISA CORPORATION OR A PARTNERSHIP, PLEASE PROVIDE THE NAME, ADDRESS, SOCIAL
SECURITY # AND TITLE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S T H E
TRUST'S OR THE PARTNERSHIP'S WORK (Please review the Instructions before answering this question):
LAST FIRST SOCIAL SECURITY# TITLE
9. IF APPLICANT IS DOING BUSINESS UNDER A D /B /A, PLEASE STATE THAT D /B /A, AND ATTACH A COPY OF THE
FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK:
DBA NAME:
10. (a) DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL f 0 ANY OTHER CONSTRUCTION- RELATED STATE,
CITY OR TOWN LICENSES OR REGISTRATIONS? YES NO
(b) IF YES, PLEASE FILL IN INFORMATION BELOW. ATTACH ADDITIONAL SHEETS IF NECESSARY.
LICENSE TYPE ISSUED BY LICENSE/REG.# EXP. DATE LICENSEE NAME
. loo < < u J
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 requires 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.
lithe 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
jermits in conjunction to the building permit 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.
Date
Address of work
location
• ..
The Commonwealth of _Massachusetts
Department of Industrial Accidents
- ,..„ ,.......: Office of Investigations
600 Washington
.8 oston,
3fAo 2lil
---1 '"
€ "IFityil g7
www.mass.gov/dia
.
--gm
-Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legiblv
Name (Business/Organization/Individ.no: r j 0 ROTer_14kATER,
_
Address: Z./ 59-06 SV. l'. KAA. 01060
Phone.#: -(1- sre.D.c-(b5-cD
City/State/Zip: -
.-
Are you an employer? Check the appropriate box: Type of project (required): /
1.0 I . . mployer with 4• 0 I am a general contractor and I
0
-..loyees (full and/or part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet. 7. 0 Remodeling
• 2.. 0 I am a sole proprietor or partner-
These sub-contractors have, shin' and have, no employees 8. 0 Demolition •
working for me in any capacity employees and have workers _. — B __
9 u uildmg aerittion
_ comp. insrTwnr T.:
[No workers' comp. insurance
10.0 Electrical repairs or additions 5. El We are a corporation and its
3. 0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
I
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
13
employees. [No workers' .0 Other
comp. insurance required.]
*Any applicant-that checks box gl must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1 Contractors that check this box must attached an additional sheet shcrwing the name of the sub-contractors and state whether or not those entities have
employees If the sub-contractors have employees they must provide their workers' comp policy number.
J am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
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 bfIVIGL c 152 can lead to the inipositiOn of crimiril penalties of a
fine up to $1300.00 and/or one-year imprisonment, as well as civil penalties in the form of ; STOP WORK ORDER and a tine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
feitiiiiions Of ,. P IA for insurance coverage verification. - ' - - - - - - ------ - - - -
_and_co
.Ido hereby e ■.1 , , der the paws and penalties ofperjrnythat the information provided ve rrert _
/
.
- )
Signature: / Date: e ;1 I CD
Phone #: 4. 13* 6t6 * qi,ex_D - - •
Official use only. Do not write in this area, to be completed by city or town official
City or Town: ' • Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical,bypector 5. Plumbing Inspector
6. Other ,
Contact Person: Phone #:
F
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ..,(k{ t-+ 1 �H`-.0 r-
License Number
Z? L { 6 (5*.1 . ,I -39 h
Address Expiration Date
MA • 0 106 0
Signat N � 1 Telephone
tA 11
16.1 G60
8: ° etostelredl Haivi lmprvueifiiri ort ctaw, € Pi l Applicable �,,, Not A hcable ❑
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.
Signed Affidavit Attached Yes ❑ No ❑
> t 9 er mpho
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
•
SECTION 5- DESCRIPTION! OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition El New Signs [0] Decks [p Siding [0] Other [0]
Brief Description of Proposed 17,. _ �- �
Work: F—�u�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a ttS81t 'dl SL1� XiS�itlt "I1 f Slut , ;�itif Ue the' :fair6v ttt :
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
I, Or; 0 "✓ ykytaa--- , as Owner of the subject
property
here by authorize
to act on my behalf, in a I matters lative to work authorized by this building permit application.
A I A ..!'_ � *r /11
Sign. ure of Ow 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 Name
Signature of Owner /Agent Date
I M,
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 i
Frontage
l
Setbacks Front r J
Side L: ` R:l L: > R:! _
Rear
Building Height r 1 ( 7 € i
Bldg. Square Footage = [ l % F I
Open Space Footage
(Lot area minus bldg & paved ,
parking)
# of Parking Spaces '
Fill: r
(volume & Location) r , i.
A. Has a Special Permit /Variance /Finding ev r been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:; I
IF YES: Was the permit recorded at the Regi of Deeds?
NO 0 DONT KNOW (3' YES
IF YES: enter Book 1 € Pager I and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q 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 Q , Date Issued
C. Do any signs exist on the property? YES 0 NO
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, ex vation, 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.
0 "
e et1 ie ,i,
City of Northampton
t.
Building Department s' .. : � e . * � , , ,
.) 2 Main Street -
1 `' oom 100
'Jo ampton, MA 01060 �A
phone 413- 587 -1240 Fax 413- 587 -1272 m Y-
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
�i5 A) 012 ttv% ‘.-1.-' Map Lot Unif
' V Zone Overlay District
iQCXZ iikt2TV N W.
t Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: G,
11 >, it t.•. L... . /� -
- e (Print) Current Mailing Address:
X11 • svr i-t . t t'› 3
/IA. PAL �lf Telephone
Signature 1
.2 Aut orized • gent: y64 .
NJ (9 R'f3 F — 2:11- (0 Name (Print) Current Mailing Address: 010 t D
-- 1- 5 eit)?3LD
Signature Telephone
SECT N 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1 o (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
1 _ 0i 1 . 7 e ) Construction from (6)
3. Plumbing . Building Permit Fee
t
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1+2+3+4+5) I 57 ()(.) Check Number 9V
This Section For Official Use Only 777
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2011 -0182
APPLICANT /CONTACT PERSON JOHN FERRITER
ADDRESS/PHONE 274 Bridge St NORTHAMPTON (413) 586 -9680 Q
PROPERTY LOCATION 88 NORTH ELM ST
MAP 24C PARCEL 029 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid "��
'�i
Building Permit Filled out
Fee Paid 0 y{' <'�
Typeof Construction: REMODEL BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 061398
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
NF RMATION 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
C7L- r g /3V1a
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.
88 NORTH ELM ST BP- 2011 -0182
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block 24C - 029 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- 2011 -0182
Project# JS- 2011 - 000302
Est. Cost: $15000.00
Fee: $90.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN FERRITER 061398
Lot Size(sq. ft.): 24654.96 Owner: YACUZZO DANIEL J & GAIL B
Zoning: URB(100)/ Applicant: JOHN FERRITER
AT: 88 NORTH ELM ST
Applicant Address: Phone: Insurance:
274 Bridge St (413) 586 -9680 ()
NORTHAMPTONMAO1060 ISSUED ON:9/1/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL BATHROOM
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 9/1/2010 0:00:00 $90.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner