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HF 4A 3JLDNGS RE ENIrREL Wil!IN THE LOT L!!‘',E
AS ''TT. , I FIJE:f !-ER Pi.'..P1.1-Z1 THAT HE RPLI1 Nc.:` ':).',.;AlED WITHIN
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Mc'EOff,AG:' L.f)AN i'l1PPCrPP
1L LN INS PLAT-
, I NORTHAMPTON, MASSACHUSETTS
ir, pREPARED OR
.;.
MAURY Z. ABRA
\\ MS, ET AL 47,5032, FEB:..PY 29, 7
HAF:rA_D L EATON AND ASSICC1A7ES, rc
, PRC:f-ETSSIGNAL LAD SI.J.RVEIORE
1 ' STREET - I iADLE'T M/ SS ci I JS:TTS
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
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 ❑
11. - Home Owner Exemption
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 �'J�
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [ _ Siding [D] Other [D]
Brief Description of Proposed Oau ger 0.1 �O '� i F""`f
Work: 00N poo[ZwA- ( tw weep) (p 4.44/ A. ANv /1. (s tO
Alteration of existing bedroom Yes 17 No Adding new bedroom Yes No /
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll ( - Sheet
f New house and or addition to existing housing, complete the following:
a. Use wilding : 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 stones?
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
1-
AV r A51 , P S , as Owner of the subject
property n
hereby authorize --10514 --10514 A6t v5
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of of Owner Date
I tA O (21 46WI5 , as Owner /Authorized
Agent hereby declare that the stat ents 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.
MA Li k-1 A-(
Print Name
L
?C. Signature of Own: 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 ' ( goo 4 6 70 4
Frontage
60' 6,0
Setbacks Front %->r
Side L: /S R: L: ( R: 5
Rear
Building Height �j 30
Bldg. Square Footage y /} %
Open Space Footage Pk % � ��, 0 Tt/ y
/r
(Lot area minus bldg & paved 0 '
parking)
2 --
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Sp ial Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW ® YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 3 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO er DONT KNOW ® YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , 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 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.
r - - -- Department use only
City of Northampton Status of Permit:
1.
APR 2 �� Building Department CurbCut/DrivewayPermit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
�.,.�....,_. :. Northampton, MA 01060 Two Sets of Structural Plans
-------- pho e 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
• • Other Specify
1
APPLIC • TI • N Ti CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
DEPT. OF BUILDING MSPFrnpr4;
NunIrIAMPTON MAO •,:,i
SEC * - • - ATION
1.1 Property Address: This section to be completed by office
(3- t5 (JUST CN1 S Map Lot Unit
012- iti\) ,, I 1 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
I AU tZ -1 c s 1 S CO 6 CC N st-
Name (Print) Current c yltrbAti /\ dre3 j U ,5.3 0s ._ Telephone
( Signature i
ii
2.2 Authorized Agent:
- 1 o `& 3 17 sT eNkrg A - 0 , - - 1 - 1-i 1 P C Nk
Name (Print) Current Mailing Address:
./� (-( ( 3 '' 3 .
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1 f 6 0 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing J 2 0(f " Building Permit Fee
4. Mechanical (HVAC) lJ
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) I 0 0 ac-- Check Number / 31V J
This Section For Official Use Only
Date
Building Permit Number: ed: `
Signature: / � / / v
Building Commissioner /Inspector of Buildings Date
15 WEST CENTER ST BP- 2012 -0943
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A - 043 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0943
Project # JS- 2012- 001642
Est. Cost: $1900.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 1785.96 Owner: ABRAMS MAURY
Zoning: URB(100)/ Applicant: ABRAMS MAURY
AT: 15 WEST CENTER ST
Applicant Address: Phone: Insurance:
15 WEST CENTER ST (413) 307 -5305 0
NORTHAMPTONMAO1060 ISSUED ON:4/30/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT 2 FAMILY TO ONE, REMOVE IN - LAW
KITCHEN & OPEN DOORWAY
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 4/30/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner