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29-491 (2) 06/07/2012 06:11 FAX 4135871094 NORTHAMPTON WWTP 0007 • w - - w , . -1 )( 1 l IIIIIII J _.. . . ,..•... . - - dr .. 6 X ) 77 /N6 06/07/2012 06:11 FAX 4135871094 NORTHAMPTON WWTP Z006 1 t.\ 1 1 ; 1 7 ,, �'l 06/07/2012 06:10 FAX 4135871094 NORTHAMPTON WWTP 0001 1 CtTY OF NORTHAMPTON MASSACHUSETTS 01060 3 �� � wastewater Treatment Facility • •'gie' • 33 Hockarwm Road animm 9 , J/J o/c. FAX NO,: 413= 587 -1094 - DATE TO FAX NO. 7- 12 7. TO ACTT. SUBJECT : IJ�yo1A1 S ENDER NUMBEEL OF PAGES : COVER S rXE. T + p PAGES I F ALL PAGES NOT RECEIVED, CALL 413-5 8 7 / " 06/07/2012 06:12 FAX 4135871094 NORTHAMPTON WWTP 2] 008 CA) l a , / �t 1 \f 06/07/2012 06:11 FAX 4135871094 NORTHAMPTON WWTP 0 005 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9, Renilitered Horne lmprovel€netit entractor. Not Applicable ❑ Comnanv Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.I_. c. 152, § 25C(5)) - 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 ;...Afome 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, gmicled 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 _ ..._ �. e_ 06/07/2012 06:11 FAX 4135871094 NORTHAMPTON WWTP 0 004 • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition n Replacement Windows Alteration(s) Roofing ❑ Or Doors d Accessory Bldg. r_Ff Demolition ❑ New Signs Decks [l1 Siding Om] Other [©I Brief Description of Proposed Work: CONS retie Tj ON Ole to 11 Gc Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil - Sheet 6a_ If- New : house and or. additioh to existing-housing, con1tjiete 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 I, , 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 , Wi ti /A L / � /✓� / . 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. • M Id Print Name 4 d i Signature of Owner /Agent Date _ 06/07/2012 06:10 FAX 4135871094 NORTHAMPTON WWTP el 003 Section 4. ZONING Alt Information Must 6e Completed. Permit Can De Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage ... Setbacks Front • Side T.,: _ .... 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 Spe 'al Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW 0 YES 0 IF YES, date issued: . IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW Q YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 / DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained I Obtained O , Date Issued: C. Do any signs exist on the property? YES (3 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb (Gearing, grading, excel ion, or filing) over 1 acre or is It part of a common plan that will disturb over acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • 06/07/2012 06:10 FAX 4135871094 NORTHAMPTON WWTP 01002 Deparhnent: use drily. City of Northampton Status of Permit 212 Building Department Curb Cut/Dnveway Permit � � 212 Main Stree# Sewer /S�pt,ep i�rty Room 100 Wa ep/Well �4V�ilabtl ,' g Uy� 0 �N 10 °' Northampton, MA 01060 Two;Sets'gfS)rutty 'i PianS ` t ' �� , :, '� O P VE phone 413 -587 -1240 Fax 413 -587 -1272 PlofilS to.pfarri :> 't ` dther'PecifX 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 7 er " Vb f 1l 4'p Map Lot Unit P l O / ENS E Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I4/i L L ,, M . C L. f�f KI . , gP, / e9/?gAI A. Name (P - 1) Current rng Ad ss: s (s Telepho 13 i4-0 y �Yl Signature 2.2 Authorized Anent: Name (Print) Current Mailing Address: Signature Telephone gECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) a Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3 + 4 +5) I Check Number This Section For Official Use Only Building Permit Number. Date Issued: _ Signature' 6/1 ra Building Commissioner /Inspector of Buildings Date 457 RYAN RD BP- 2012 -1091 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 491 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit # BP- 2012 -1091 Project # JS- 2012- 001535 Est. Cost: $5204.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 19994.04 Owner: LAMERE WILLIAM C & PATRICIA A Zoning: Applicant: LAMERE WILLIAM C & PATRICIA A AT: 457 RYAN RD Applicant Address: Phone: Insurance: 457 RYAN RD (413) 584 -1589 () FLORENCEMA01062 ISSUED ON:6/8/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 18 X 30 DET GARAGE 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 6/8/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner