31B-101 s"Ite7Me . • s CT WC) %KM 1s %MOW 117 6s/s7. 11:ar.......- --
iCiw....,...COR di CERTIFICATE OF LIABILITY INSURANCE [ ��` 1 0 0
PNoWcm TI4IS OERTIPICATI IS q! NIC AAA NATTER OF INF TN*
Iirnsna1 aai Insurance rafrses+rr A,ge>neay TAO
ONLY AND COSMOS NOM iTS UPON INS corn CATS
100 Whiting Sams Road T T fill$ CSRT'1FIGATE b _ NOT A XTSN®O R
END,
Holyoke, MA 01040
i INSURERS AFFORDING COMSIlAOF NVG II
wiwiDO _ ________T____ _ .____..__. P _._ .I.. arrsu
ct�1 ax�sTtrcait_ _
Sexton Roofing ! tF __ + ���
P.O. Box 6327 ', +►tpewtRC: - - ::::::::11 1
Halyok *, MA 01043. i ffER -. .� ...,_. ,...1
«,. - .- $ _ _
THE POU $ � I ( N � ' SURANCE LIRTFC E6t�.�'YM HAW WEN ISSUIC TO NI PrSURI ABOVE FORTNE FE OO I �r, TED, NOdWITI $T/YJ0i
MI AR N I �C3W 3 Y T 4$ CONTRACT O. O ESC BIRD *SMUT TO ALL TTNEl'EFlM $, MIMS IC AND CONDITORS OF SUCH
POIJC4SS, A+3GRMATE LMAITE SHOWN WAY NAVE EiEF.N ROWED BY PA )C1A,IMIf
� 1 ,
i3A o wy
A ! ""'" Zoo etit rr RG,L /$43 -09 6/16/09 6/16/10 .QO.0o0
L. I I CLAM w oe L2Li accuw i j i MEo fan swv oto aw.tnf ■ $ 5,000_1
I __ i r tONALa AM I NlY ---122A21-1
.-J _...._,_._ __..,_..._ i ! Gamic m aal oos $ 1. Q00. No
( ! 4ENt A6alterI'II (JAI APPU$PM i 1,F1 %1L'S•COM�OM AUG , —72-14122.
r j C000rri 3N LELWIT ;
Os seekirot
r_ i MT Lilo ) .. __ _4
ALL OWNED AUT 1 1 $
eCIISOUt.CpAUCOIS I Pitpw
h rum moo; �eacto !sway
, r IVM SiE f
•••
SMASSUASIUri f •"••••�• 'AUTO ONLY• AACCIDlEW ,_$
p AMY AUTO
f pp
1
i TOOMih �.�C. $ �..-
a............... — t .. . 1 -- .
CU 1 omou i f.JAUA*t Y
' man ._..._ CLANS MACS I WARM i
">� r arc 'jT r ` ' at.. tee "coop/ z L
' .V a *II --- DSO rlf t tiI RitR" ` .... ;...,..... F.. :.•........._......,+111. 5YLASILA ._
I
E
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t
Deem *Ml llpLl SEEULY ara / ticarNN JNfiNt'%Ia{ tome I it Kummer a, Witte marmot*
~ j
Ropfino and aiding eentxawto.tr'
•
TIF# A HOLDS ....,..1
SHOULD site 4p'I'ir[ArronColDGrouNitsKiietiii1MANtfiliCHMiraiit et10 MTWAr ti
Olin MON A rat ISSJ$ P to wen ma. selbtkeit to was. ja,,, nays wares
Seaton Roofing rano 10Trw 01 10Ine4TIENKAIAMYNSD niuovWN weak 10msD
To Show Coverage t a In LUoat OES NO ?DUG■TON LA Lkale iTT a No Me soak AS wawa as somas at
sans
Ait ' VII ' ,
AG01 28 C300111101I 0,11 A Nilo reoarwd.
Tar AO13IW name artd foge era rogistaed mutes Of AGDRD
'
SE�TIAN B - CONSTRUCTION SERVICES f
...
„.lLa ad Construction il+oerwtaer, y Not Apt�licable L
Name of License Haider : F Yl4 C•'� t _ 6 / 9 _ _
nssa Numbe
I /tdd r ea I Expiration irate
Signature Telephone
y„,?4??.ey....)..9
� r Registered Mane Improvement; Cotitrttet : .. Not Applicable ❑
` y
Cotnrrsny,N on Reoistraticn Number
Address Irxo.n.orilcte
+
— . Telephone yty /' /13)
r IECTION10 - WORKERS' COMPENSATION INSURANAIS AFFIDAVIT {M.Q.I.. c. 152, § 2 SCI 5 1»
workers Compensation Insurance affidavit must be completed and submitted with this a;plicetion. Fslure to provide t'7t affidavit wili result
in the denial of the issuance of the building perrrit
Signed Affidavit Attached Yes 0 No.,,... J
11 H Owner ExenlDt o
The current exemption for' homeowners" was extended to include ner occttldl_c w , tin s of °lir (1) or tw,,(2 f<irnil ie;;
and to allow such homeowner to engage an individual for hire who does not possess a lieen5C, provided that the owner acts
as supervisor. CMR 780, Sixth Ed
Defiajtion gragil eoworr: Poreors (s) who own a pascal of land an which he /she .residos or intends to ros:de, on whirlh there
is, or is intended to be a one or two family dwelling, attached or detached structures accessory to such use and! nr farm
structures. A person who constructs more than oae honie In a two-yet geriutLshwll ao a cctI$ dgjed a homeowner.
Such "homeowner" shall submit To the Building Official, on s form acceptable to the Building Official, that beishu shall bs
responsible for all such work performed under the bsddiat permit.
As acting Construction 5uperrlsor your presence on the job site will be required from tirr1c to time, during avid upon
compietioc of the work for which .hie pertrat is issued.
Also he advised that w;th reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries net resulting in Death) of the Massachusetts General Laws Annotated, you may be 'fable for person(s)
you hire to perform work for you under this permit.
'The undersigned "homeowner" certifies and assmnes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, Starry and Local Zoning Laws and State of Massachusetts General Law Atnotated.
Homeowner Signature - _ __
t00 Z ZL7, ILB ;CI1 IVd LT:Ii 800i Fsi %C4t
SECTION G. DESCRIPTION OF 1 WORK icheck all applicable)
1 N Houses i� Addition ED igiopinoontont Window& [ i E1 owri t --
( — ._ Accessory Bldg. J Demolition El New Signs ILI] Decks iii Siding [MI Other (El
Brief Des on of Proposed J I - f 414 V
Work: • . S 'tQ +AC'S.
Alteration of existing beernorn. — Y _ No Adding new bedroom Yes No
Attached Ns era tive Renevatine unflnfshee basement _ Yes No
Plans Attached Roll -Sheet
9a- if New house and a r additit�n to x nn. cotnole the folloW
a. Use of building : One Family two Famliy Other
b. Number of rooms in each familu unit _ Number of Bathrooms
c. Is there a garage attached?
O Proposed Square footage of new construction. _ Cimenaions
e. Number of stories? _�-
f. Method of heating? __ - -- ---- - - -. -- Fireplaces or Woodstovea Number of each
C. Ener; y Conservation Co1rpllance, - ------ ___ --- Ms check Energy Compliance form attached?
r. T ype of construction
II i. Is construction with!n 100 fl, of wetlands? Yes T No. Is construction within IOC yr, fioodplein ____,Yes ._- -___No
i, Depth of basement ar Kellar 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 p1QENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. rr /YAP _'if — , as Owner of the subject
property
. hereby authorize 3 VV'1 (fr (c .-- - -, - -- - --- —
to act n my bP alf 'n all mat! ela' a to mile. authorized bythis building permit application.
V'' 11---G? -- — —.
I Owner gee----
I, ' / O • , as Owner/Authoried
Agent hereby declare that the statements r ind information on the foregoing application are hie and accurate: to the beet of my knowleCge
and belief
signed under the pain angieneitlies of perjury. .______
Pr l• . e --""-----2:1—"-----...___.."—_.=jr-
Signature cf Owner/Agent Date - - -- --
C002 ZLZTLf3cCTt 3Nd Lilt SOOZ /6T /CO
Section 4. ZONING Alt Information Must ae Completed. Per Tag Can Be Denied Due To incomplete Information
Existing T Required by Zoning
This column to bt.- WM in by
Building Departniont
......,
,L,Qt SILO .
Frontag:
T ____
S etbacks Froni .
...........
---_
,...._ .... ... ... ,
Li R:.,....._..
.. . . .
Building Height ... .... .
___....
Bid Square Footage
.... .....__ , . ... .
1 ....
Open Spire rootage
(Lot area MOO Nig & MEd ' ....... .. . .
arkm1)
[
1
' Fili
1 fvo'urnt 6: Lacroir
A. as a Special Permit/Variance/Finding ever been issued forfon the site?
NO 0 DON'T KNOW 19 YES 0
W YES date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 PONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document #
13, Does the site contain a brook, body of water or %Pretends? NO e DON'T KNOW 0 YES 0
ir YES, has a permit been or need to be obtained from the Conservation Commission?
..... ..
Needs to be obtained
0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO V)
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of Signs intended for the property r YES 0 NO (S
IF YES, describe size, type and location:
E. Will the construction activity disturb (ci atin, grading, excavation, or filling) over 1 tore or is it part of a common plan
that will disturb over 1 acre'? YES NO G
IF YES, 'hen a Northampton Storm Water Management Permit from the DPW la required,
zoo it ZiZTI.92tTi' XVal LT : tT 9(O
------,-:-, I — '
"
• \ ! e-
i
-,.........--- No 1
\ , -!'''' "• ' ' ! ..t.!!:' ':''' 0 .'" iiatitnentilte;bntY:
of N rthampton
\Olidin • a apartment
' -'2 ' ' ''' ' . - 12 Main Street
_ .... ,
\ Room 1CG :'':.
\.-------- Northampton, MA 0106a t446sitiiiticuciutiii:Tlans:.
phone 413-587-1240 Fax 413-587-1272 1:4403 :Pir*:‘:..:
cialor SPedN •
,..—...
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DeMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
is section V) bo completed by office
1.1 Projegpafte as:
---- Map Lot - Unit
11 0PieSpte.r 61 - Zone Overlay District
Eim St. District CS District
_.,—
.... _.
SECTION 2. PROPERTY OWNERSHIP/AUTKOR42E0 AGENT
L.__— . ----- - --
Z,1 Owner of Record:
5 1 1/ r/C--
16 Z/44/(k-X*
Name (Print) i zili _
2,2 Authrizett knit __
E..
Narrla (Pr( my_ r f i
, 1 ,,,, , current Mailing Address
----
Current Mailing Address:
9 Z S3 Y1Z 3 K
—
Signature _.— Telephone
C
SEC 3 ESTAMMIL,MUCTION l an _______— ..........■•■Y■NMIIIIIINOwN MIII■
......amMON■*
item Estimated Cost (Dollars) to Ils °Mali! Use Only
cornpjAt.Ldtuz2a2Ltent
1 Building Cl rtr
FOC) ---- (a) Bulidng Permit Fee
r ----. . -
2. CiOetelo•I al) Estimated Cost of
alstrucli m 6
3, Plumbing Building Permit Fee
4. Atlechanica( (KVAC)
5. Fire Protection
6, Total = (1 - l - 2+3+4+5) ,aip __Ac lg.
Chmcic Number .461111111111Kmmillre —
This Section For Official Use
Date
Butioling Pern Number__ lostleck------
_____ ----- 4.....— ••••••••• —
Signatuna: _
Building commibbicner/lrispectur of auldingli Date
TOOrin ZdZILViltit YVA LT:tT 900:6T/CO
•
`t BP- 2010 -0202
GIS #: COMMONWEALTH OF MASSACHUSETTS
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 -0202
Project # JS- 2010 - 000249
Est. Cost: $9800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq. ft.): 6490.44 Owner: JOHNSON WILLARD M
Zoning: URC(100)/ Applicant: SEXTON ROOFING CO
AT: 70 PROSPECT ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534 -1234
HOLYOKEMA01041 ISSUED ON:8/24/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 8/24/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo