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30B-075 .... -1-S . ' ''' - T._ 1,- - ' ___ _- t _ ,_ = _ -- - -- - - I 1.41i ) I, Wendy Mazza, hereby certy5,* that I hold the office of City Clerk of the City ofNorthampton , " in the County of Hampshire and Commonwealth of Massachusetts; that the Records of Births, Marriages and Deaths in said City are in my custody, and that the following is a true copy from the Record ofDeaths in said City, as certified by me. e econuifaiiii) edit_ affiliagfsdPitttl STANDARD CERTIFICATE OF DEATH RE FfY OF VITAL RECORDS AND STATISTICS 9 1 278 - I REGISTERED NUMBER STATE USE ONLY /13ECEOENT • NAME FIRST LAST SEX SKIE OF DEATH /Ma. DOA FO) MIDDLE I William Micbael - 3333,33 3 sintot *ad ituriteg EATH MIIY/Fmm d• COUNTY Of SEAM HOSPITAL OR OTHER itainunoni PrZel aMale o 16,2010 PLACE OF D , 150 Federal-.StreV -- — - s= Northamptori --- --- =_HarlIParlre SEM WAR VETERAN _ =- - 7 _____ 4' - -V3C4ECtlltra IBM.M - . WAR _i--___ _:-.- - - __=1 nini _ _ . -"CE °5 0FsAl." 134"-"WY '1-g 'Te;•i - --.._:. ,_ .,1zr.. =-"=-= .mtii_ _ _. _ ____:. ..;—..s ;=43dspETAIJ on .. ...__, 7-Arj Num13314769,M RFEMEIB.-13°'" = 71' - -7E-CEDEtrAs EIRMTNITIM.0 1"1;1°,fr'''.4 -,'sn;_ - -- -_- - _ _,, -- .• --7. —:31.W. 1:WW‘*"..A - , -- s- . 040103. Amedean indh3 00 , _ _ „_,,,..-= itanrmy Sas Id- 7) T - s- - srst -==. LAS DECEDENT OF HISPANIC ORISON.= .i., : _ (fl yo Spdedy DAME Man. 03 (SP.‘61 EM White 12 1 a , ABE . L3 031001y 131) ° IIIIITIM N 033 RJ IORTHPLAc€ (C. .n ".. . I: ... 1.9li T T11 3 4 11------4°M/ISAY DATE Of HOURS . INNS - (9I0 I _ E i '3Wdl) tember 1, 1939 e „ Morthampton,MA. OF BUSINESS OR INDUSTRY 70 b ..,. s ,„ 5 , 0 ,„„ * „1. AWNS ANNE USUAL OCCUPATION MARRIED NEVER MARRIED (pow . 2 31333.3 WIDOWED OR DIVORCED 14 1:1..abarni Owner , „. Co- ----.-- ==, --_,_ ,. S op -- -- Divorced , 3 - andra= _7. — ==_ ;T.= 4,,.,- 01060 := - = -- -r•- - -----: s_ - - - - No a sr Y/M9 CC AI NI S T3 a 1 TEMWM- ‘ = — - s — -- __ - =.„., ,._,,,=_ _.:_,- ----- -=-- "s;s.-- _1. 51'DEN- 150 Fede CII ratzredV, = 0.000-- ...-wrATE _ ,., --__ mtn• A FULL NAME — ---fIL_== .. &ow --- - --,------ — NanhaMIRjarMiramp_ _-. --"-....--,-,.„.„„,„„,„,,,„„ us, ___-__=_ -= - mA. „Sylvester OrmeA "'r: 0 ta Ruth -- --7a - udelvvl-cus 19 INFORMANTS 14303 ADE 124)43310 ADDRESS . NR 3 ST.. CITY/TOWN. STATE, 7.1P CODE RELATIONSHIP . Marie Ann Klekot Et l Ha IGNE 1 Gaston OR to o n T. ER DES Street u ,Easthampton,MA.010 : RURAL EHE 27paughter 1.101)400 010 IMMEDIATE DISPOSITION L 033)4)20 1)210 El TU AL FROM STATE _ ) -7 =-3__ 6511 IDEPTATEHTIONUT =4obi_e_"Wayne Graham LOC.ATION ( _= , ,,A -- -= - - . Of DISPOSMON MamAdICTAINDK .... _ _ ___ _ ,, n .---=-....---=--..---- ',------.--=-:- -- - - 7.-- _= 7 -- = - '''Ls- -s - Saint Marv — ES. Nor f,--,----- ADDFIESsOff-ACIWY OR OTHER :_ fS - - == 1 ,---0,76' Dwc"src'sm°N DESIGNEE __ Ati 23 y .1Yst' r'ff-IIIM.7.-- 7+ eraw 18 A6sms _ Itli . ot such is COMM* IMPIM . MA. ME 03j BM.. NII Ncl ART I • En. ha do..., 201 o. IdImMdfd/ EIFI ._Th .r . T . th. EA p LIdarkoneedusams3dhImMORA6p6d/P OR 45 It lin , r ea ..DIATE CAUSE paaf same or 33■31133 3.131139 a. A:, e.ay ..■......).■ ,,,,, m 333 ''.., Sequddilly IN condition. II 3 TAN TO MASA 00/NEOUNCE ON ISM ANON to lomodd. 0000. . 000031)4108 .„0 I __-- „ AiisE Ms/me 0 /M/NY M. F. ,_ , - --- [MEV 1 11%1 AdiidNISIMINIIIN -- : . - ; f.7. 1 , ,ILT ..,:=_. -- -' - -- = = IMMItt IONAMO I n ..;_„„:._. ,..., ,....__ •11.0.01.PAT - a ------ --- 7 — _ 4 -- ' :- - I _ r , r AUTOPSY FI ___ . — ,--,-- , AVAN.ASLE PIIOR _ _ ---= ,- fir MO COMPLETION I, F . )1 1P 61 ) 1 /vp!!? CCIDE of_. 01013 010 INJURY No 3' Of DEATH/ MN m NM 32 (34. , Ehh It..1 TIME OF INJURY 0, INJ . tr : ..11 WORK RED? ji I: NATURAL U ['COULD NOT BE DETERMINED 356 M 36e INVEEMGATION 3S3 W ... . N4 /1/0 ANT ['SUIC IDE 0 FENCING LOCATION (No A SE BEenh3, 3..1 _ 33 11100381010 HOW INJURY 022)1(1050 PLACE OF MIAOW 3 3 ham. 4.33,333C-leatml BOB* MB. z- - — - : -- - ._.. • v 30. T.. b..,,,,w_. 7._=7.7.104iiiii 1 37 ,...............,, - 34 -,----,„- .-. .. . - 11 - r — W- , 7770693097 duA931693■ENT n 7 __ - --- ' -1T1- • -=--1 • if/ __f - . 4 : ,- --- -- - if • 77, - Aidli ona416 .___ VONED Bd.. E Y,4 HOUR OF DEATH TLI DATE ' t • WW HOUR OF GATE . , 0 la , p r. ED DEAD (326. DEA w) 37e PRONOU7ICED DEAD (H) M 2 1 3fib E OF ' MG PIVSICIAN IF 807 CERTIFIER a 3?. IA g u 343 37d ... ,,f , 71 D ADDRESS OF CERTIFYING P31681. 00 MEDICAL I ER M LICENSE 100. P. F/ I -- I' I , , __ . ,v, 11, A _ _ i #,. = , • . -, , ,,. . , 1 , - . ----- - THERE W DA -- =--- — _ — -- — ---, :::: , i'io _ 4.. 1„. _II — -- -ii. _ . r p. Tvrvo , ft , _= —11.-1-_-_ _-_ Wu& 0 PA El Vh4 ' nt1-17- = - - -'- ----- - -- DATE OF RECORD — -- -----' = =.---::. HA . 0 A 11 1 =+ __ cATv4"4°F July 21, 2010 -- - -Yallli n* cuiRK A Cits :KAM sa OF „.......- . - TH AGENT WR 61314NE 1 ...torki-j.. C\ ...1 No HEAL . July 22, 2010 : -,= ...,_ Witness - 11 - atIclandial of said City ON ArtrtiJn p n==- -= __:-,_-_-± __-- - _ ' 4 written. - -_= _: ( -63c)---- , City Clerk WARNING:THEARED j“PIRIO TECTED" LOGO AT THE-R1GHT IS -PRINTED IN A HEAT REACTIVE INKL TEMPORARILY DISAPPEAR WHEN RUBBED. / ,.... ........................-........1 , / 1 r I I ? i } i I 1 , , .,....,...... - - I 1 t f I 4 ■ 1 I 1 , f i ■ , A,... 1 , - ... 1 1 i 1 , i I I \ 1 _ 1 1 , 1 \,...... „. .._ 1.... - 1 ---- . • .. ���� T=� - -- -___ �_-__ ./ ` ' . -___- -_ ----- ( . \ ___- ,-__- � | \ ^_~^__ ~ �� ---`__' ____�_ ____. ___ \ ! | \ / _-_______ _ � / '- -�— � �^���� , ! | | / � -~~~�~_� -_~_- / / | | | �/ / |/ | ____. ����.-_] __ _- _.-~-. ___ ___ ____ _ -- ~~__'' ~__~~- � | - ______'] - _ _ ' _~_~~�~ ___� _- _____ ___-__' __ _ '+ '- '-_ - � -_--___~~�[� � ( �� .. ` ' ` _c�� __�� -� � , �l� __� / ~� �^���- ___ -________________ �~^� __ _______-__-_--��� / — / r� . . ' . ^ ` WALTER J. GAMBLE. M.D. 26 MONMOUTH STREET BROOKLINE. MASS. 02146 ll� 1 �, ) . • | ' \\11 r ----- T --- r - i 1 ...k. To 1 e J ........---. , ,,, $ 1 ,, ) a' 1 , 1 i ,I ,•,. I t 1 1 ) 1 i I L......_ ,, , ....................._ „ , 1 , , ; I I . I , • , 1 .... . i . . 7 , ) ' } t I r l' i _ . i . 1 f f i t I i c . . 73 - /..),(3 oc\ -------- 1 re tr k ! -4 ) 0) . c\ c 4------/°- .' 6VfA ( 4).2,, 49 cik a< c \ ‘„\A ------. ) cicbeir C kcze 1 4- i _...------:- ''. 1,.'.. Ari — I - Qf ,.. _-----, _, .›.... , \ i -4,- c a) C (2 - 1 Milli 1 0 0 1 1 < ; I . 'N >c ',I1,_.-, i :' .1 t '''..-- ( r\ r i r 1 e .. 4,.....? i. 1 ,■,,,, '....'` ■ ! 1 1 171 . ( .... ,, .......,..„ _,,, r C .. 1 ( 67:1 -7) 4,!.(y.:, ! N., 4"1-12c1 cr) - am . ( ' - ' i , - - 0 .. , 6 1: 2,3/4 - -, ...-- . _. . . 0 Date: J SEP 1 6 2010 Ha , hir; ss Pr to Chit, NA* lton, Mass., " v' I Register DECREE Docket No. (...i.,monwealth of Massachusetts H The Trial Court APPOINTMENT OF ADMINISTRATOR Probate and Family Court In the Estate of: William Michael Orzel Late of: Northampton, MA 01060 At the Hampshire Probate and Family Court on: September 15, 2010 • (date) Hampshire Probate and Family Court the Honorable Gail L. Perlman presided. 33 King Street, Suite 3 Northampton, MA 01060 All persons interested © having assented (413)586 -8500 © having been notified in accordance with the law and no objections were made; objections were made which were later withdrawn or stricken; objections were made and a hearing was held; IT IS DECREED that Marie A Klekot of 1 Gaston Street Easthampton, MA 01027 be appointed administrator /trix of the estate named above first giving bond With Personal Surety for the due performance of said trust. IT IS FURTHER ORDERED that: amommoor 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 fandly 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 occuoancv until the work can be inspected. If the 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 1, 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 tome. Date Address of work location 1 . .,- - ,\ The Commonwealth of Massachusetts Department of Industria I ACcidents . ,. Office of Ini7estigationS r T--,-1-701---"-- 600 Washington Street ; Silii= Z Boston, MA 02111 . , vv/dia www.mass o ■ '2, -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers - Applicant Information Please Print Legibly ... -.1 Name pusinesilorpthiationfinctivid.D: , : - - - Address: ,- - , City/State/Zip: - Phone.#: - . i f Are you an employer? Check the appropriatebox: • Type of project (required): / 1.0 I am a employer with • 0 I am a general contractor and I 6 employees (fall ancVor part-time).* have hired the sub-contractors • 0 New coistniCtion Es' ted on the attached sheet. 7. 0 Remodeling 2.0 I am a Sole proprietor or partner- These sub-contractors have. ave ship and have On employees -8. 0 Demolition • worlting for me in any capacity . employees- and have workers .,._-. .._ - 9. 'EjSuil4iiiia&l.tron [No workers' comp-. insurance- - . required.] - . . 5. 0 We are a corporation and its 10.0 Electrical repairs or adclitions 3* I am a homeowner doing all work officers baietcereisecl their 11.0 Pluinbing repaias or additions myself [No workers' comp. right Of exemption per MGL au Roof repairs . • insurance required.] t • • c. 152, §1(4), and we have no • , „ ll . Other employees. [No workers' 13 r comp. insumnce reqiiired.j. - , , • 0 ~ ,, . ' - , *My applicant -that checks box til also fill out the section Moro/showing theirworkers' compensation policy informadm I Horneownera Who submit this affidavit imcating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. . :Contractors that check this box must attached an additional sheet showing the name of the subz-contractcas and stiee whether or notthose anti ties have employees. If the sub-coturaitorshaVe employees, they must provide their wOriceis' comp. poEcy number. lam an employer that is providing workers' compensation insurance for my einplOyees. Below is the policyad 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 the policy nuMber and date). Failure to secure etiverage . as requireliiiictrif Seen 25A 'C. 152 can leatirto the hi:Ilknit:1bn 616 trii:titral iiinalties of a fine up to 51,500.00 and/or one-year inguis' onme4 as well as civil penalties m the form of a STOP W01 andn fine of up to 5250.00 a day against the violatOr. Be advised That a copy of this statement may be forwarded to the Otrti of ._ . • EVestrinfidis ( - - - ._ * . . -',..„...........,:". .–. - _ D Id hid . er,..,:iciiih under the painsttnd penaitiei olpetjznythat the infirmatiOnprotiediaboveditist;:itrid_Coivt ' ignatur e 1 1. ' ' ,) . ) .2: _, .,' '. ,'-' i , : ' : . a th : vse -" . , .. . . . . . - Official aye only. Do not write izi this aria, to be completed by city or townigricial ' . . City or Town: '• Permit/License # • — ........ Issuing Authority (circle one): • 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electricalyzispector 5. Plumbing Inspector 6. Other . Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder : .7' Lt2 6,4?Abrx4 t. License Number 0 } 1 Address Expiration Date 474-71,4,4p/6 N/- eve) 2 7 Signature Tele. 9 '1 _ j / _ ,! , , , 752-7 )• 9.'FteaisteredHome IninroVettiedttOrdiactot::0;, 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.• Homei:Ow:ner. _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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacemenindows Alteration(s) ❑ Roofing E Or Doors Ded Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [C] Siding [0] Other [1 rief D do Vrd � ,p ,,I,, Work: W O ge.mn: � T( frcheAw Vt l v i s � � " c_tigs-40(z. 44/' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa `K 14Mi fuse' nd i ` ,idcfi iiiiat tiititirra olii if eiampieie itt i otl+l rims: a. Use of building : One Family f Two Family Other _ b. Number of rooms in each family unit: 7 Number of Bathrooms I f c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? ( y g. Fireplaces or(llVoodstaves' Number of each I 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, , 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 , 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. P t Name Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information. -.. ,------...w.... Existing Proposed Required by Zoning „,..,,c- LL? `^: This column to be fi11eid in by Building Department i illi ! tiS S Lot Size i . , ._..._ ..... _. _ ,a Frontage __ ° € ...___ ....__ Setbacks Front I f I a Side L i R ,.. __ L: - _•_ R: _ .._.. , Rear _ I , Building Height ( _ m Bldg. Square Footage r ; Open Space Footage , 1 �C= (Lot area minus bldg &paved a parking) I \ # of Parking Spaces 2 ,\ Fill: J �. i � (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book ' € P ageE and /or Document ft B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q 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 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. i \ City of Northampton ta#et ®f ��� � � RECEIVED Building Department ,• *D, °� ^ ° e �'�" , ' : 1 _ x ' ., 212 Main Street • " • , 2 ��� Room 100 re 11it i(i ;; � � Northampton, MA 01060 • ` • s, *ta q ` ~ � � ,' phone 413- 587 -1240 Fax 413- 587 -1272 • !� DEPT. OF BUILDING INSPECTIONS (� a � m��s NO' PTON MA 01060, 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 r ejera I ,St Map , Lot Unit Zone, Overlay District ist Etrn St District ` CB Drict SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: / ame (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Aqent: � e f' ; � - ��i� i���� Gam/ Na a (Print) Current Mailing Address: /7 Signature Telephone SECTION 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 ,k:, , _ Construction from (6) 3. Plumbing I Building Permit Fee .i t 4. Mechanical (HVAC) 5. Fire Protection .)?7Cet #‘°°1 ■ 6. Total = (1 + 2 + 3 + 4 + 5) Check Number , Th Sect For Official Use Only Date Building Permit Number: Issued: Signature: Date Building Commissioner /Inspector of Buildings tl. File # BP- 2011 -0934 �t APPLICANT /CONTACT PERSON KLEKOT MARIE ADDRESS /PHONE 1 GASTON ST EASTHAMPTON (413) 527 -5196 0 PROPERTY LOCATION 150 FEDERAL ST MAP 30B PARCEL 075 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out *tr Fee Paid �j Typeof Construction: REMODEL BATHROOM,ADD BATH,REMODEL KITCHEN,REPLACEMENT WINDOWS,REPLACE FRONT PORCH PIERS Sfrvt-sa, A VI TO c..0 DIG New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 r► �► 6 ? / /,/ 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. 150 FEDERAL ST BP- 2011 -0934 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B - 075 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- 2011 -0934 Project # JS- 2011- 001518 Est. Cost: $11000.00 Fee: $66.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT W. GRAHAM 011408 Lot Size(sq. ft.): 6403.32 Owner: KLEKOT MARIE Zoning: URB(100)/ Applicant: KLEKOT MARIE AT: 150 FEDERAL ST Applicant Address: Phone: Insurance: 1 GASTON ST (413) 527 -5196 () EASTHAM PTON MA01027 ISSUED ON: 5/27/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL BATHROOM,ADD BATH,REMODEL KITCHEN,REPLACEMENT WINDOWS,REPLACE FRONT PORCH PIERS - SMOKE DETS TO CODE 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: Vol /// OitaCe 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner