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cl Section
Article of die Zoning Ordinance
VVFHEREAS, violations of A
, Section=Cr- 1 the Building Code have been found on
, Section cf The Code
ff4ese premises, IT IS HEREBY ORDERED in accordance with Flip above Code that all persons cease, desist
from, and
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at once pertaining coostrucaltpr
c ien I !Jr repairs on these premises
lonnwa a ----- I LAI ( P rj 4:
All persons acting contrary to this order or removing or gautilating this notice are liable to arrest
unless such action is authorized by the Department.
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W DEPARTMENT OF BUILDITNG INSPECTIONS 4 VI 1
212 Main Street 'Municipal Building =_
Northampton, Mass. 01060 r'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
L
(ii censeelperini nee)
with a principal place of business/residence at:
(phone #)
(s tieet/ci ty/ staie/a p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
.
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Ex Date)
(atta.& additional abed if neccisary to inchIcic information pertaining to all contractors)
( ) I am a sole proprietor and have no one w orldng for me.
(am a home owner performing all the work myself.
NOTE: please be awuc that whilo homcowncra o& o employ persons to do maiatenance, straction or repair work on a dwelling of
not more than throe units in which the bomoowncr resides or oa the grounds appurtenant lherdo arc not generally coatidcrtd to be
employers under the worker's occriperrsaiien Act (GL152,fs 1(5)), application by a homeowner for a license or permit may evidence the
legal slain of an employer under the Worker', Compomatioa Ad
•
I understand fiat a copy of this rtatcmcci may bo forwarded to the ■cportnmi of Industrial Accidocrbe Offioo of Inwrsnco for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to tbo imposition of criminal penalties . ,
e misting of a fine of up to S1,500.00 ancifor imprisonment of up to ore year and avtj penalties in the form of a Stop Work Order and a
fins 0(3100.00 a day against ma.
For d Li-' only
Permit Number
.— 4 (42
. 4" '-Z 'LZ) ' Map# _--- Lot # .
i lntahtm of T .- ..,,, m.- .-.,,; f+, Thh
IONAS
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
4. Re er a s ome ninrar rnen .n factor% ' , y 'r W 4 ,:6 Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
,SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this ai
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
a
J "4, -4z-1 ri i VA'
1 ®B B i,t1 i I1'
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) far
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner
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 tl
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 homeowne
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall
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 t
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for pers
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, to and Local / Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature �`
N T'
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/26/[. -e-e'
N ECT! N ¢ S ,.TAI ® � • s" e
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v ' . -:xx, a x #. :. 'u 4 -; % xv u5 .,<, ,..� .coati' , , ,, ..r ifie ":.f M.4
New House ❑ Addition ❑ Replacement Windows Alteration(s) f ' Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: cda - • -- - - - iirt
Alteration of existing bedroom Yes o Adding new bedroom No ` r •+.
Attached Narrative ❑ Renovating unfinished basement Yes
Plans Attached Roll D - Sheet ❑
FillfI lOWIliou a n`� ar. addition to a ist ng fious'in =: cbm lee lie fiollou ing
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. Mascheck 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 _
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
°is:SEC O it OWR A
NE O RIZATIO N T COMPLETED HE
WN
O444 S,AGEN SAONTRACTOR APPLIES FOR IL 1NG PERMIT
I, , as Owner of the subject prc
hereby authorize tc
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, , as Owner /Authorized Agen
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Si under the pain nd penalties of perjury.
P nt Name
Signature of Owner /Agent Date
z ;744:47r-
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size s /o c i
Frontage 0 l it .
Setbacks Front Z 3
Side L: ` �') } R: r ;]- 0 3" L: R:
Rear C, • 3 if
Building Height
/•
Bldg. Square Footage 7 (.9
Open Space Footage
(Lot area minus bldg & paved CP
parking)
# of Parking Spaces `L
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW ✓ YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 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 �' DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , 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 V
IF YES, describe size, type and location:
�s pit of Northam ton t,, �° 3
ii t6 l ' ' Y P
I :, ilding Department 2 e , , ' A - .-- �`1 <
�I j. 212 Main Street S��` �a ��
,
FEB Room 100 i
Nort ampton, MA 01060 q o I ,� � � :'
1-- -- -- r fffi `` 13 -5:7 -1240 Fax 413- 587 -1272 A ' '. k 1 _
--- - ...��..__��. ,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE fNFORMATION
�rThis section to be completed by office
1.1 Property Address: A t , ' w� � = L, -T R � �
S o U maps 7 L.t ' :Unit '
. Z
/;I of oS 3 one ' Ov,e ' 7 , z
Elm St. District - "CB-District
SECTION 2 — PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: ,t /
J A i� /G a t,rAd ill 4- 4,Ccx-r-ocL / I'"-• . l�¢,i...."1„,. - ) 4 , t p4 cvoc,.r:3
Name Current Mailing Address: � QtQ 2 9�3
Telephone ✓ C�
Signat e
2.2 uthorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - !ESTIMATED - CO COSTS
Item Estimated Cost (Dollars) to be Official UseiOnly
completed by permit applicant
1. Building i g Tr (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
6. Total = (1 +2 +3 +4 +5) Check Number A � , c700
This Section For Official Use "Only . ,,,
j 7
al-1.00. Permit lumber - Date Issued .
Signature
BuI(ding,Com ss"4oner /Insp Bq;(ldirtgs : Oft „ , „ , „ ' "
ri STOWELL ST BP-2002 -0715
GIS #: COMMONWEALTH OF MASSACHUSETTS
sap:Block: 11C - 031 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0715
Project # JS- 2002.1174
Est. Cost: $1800.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 7361.64 Owner: PEREZMONTALVO JAMIE
Zoning: URA Applicant: PEREZMONTALVO JAMIE
AT: 7 STOWELL ST
Applicant Address: Phone: Insurance:
7 STOWELL ST (413) 586 -8753 0
LEEDSMAO1053 ISSUED ON:2/20/02 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN & BATHROOM & INSTALL
REPLACEMENT WINDOWS & DOORS
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/20/02 0:00:00 108 $100.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo