30B-093 •
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 115 P7 .,(2 . l Ar aftAtARA(L_ ) 4'
License Number
Address Expiration Date
4'l3 -1 a-• !ZZ d-
Signature Telephone
9. Registered - Hom a Improvement Contractor: Not Applicable El - Zs iCcA"-- S w 1 (o Y " b t.
Company Name Registration Number
3(. ivt c-re_ 64,1%."-fc-0 i _ l2( ZZ Zola
Address Expiration Date
f AAA' Telephone 5 d- 2Z4
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) br 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 ❑ Replacement Wi dows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [E] Decks [E] Siding [ID] Other [0]
Brief Des ription of Proposed
Work: wbi -i+oto /flouQS fin^ 9- 11t..A.0'04L t44.1 1G
uvt A T t WE II1C &
Alteration of existing bedroom Yes 1, ..'-- Nct Adding new bedroom Yes N /
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll - Sheet
sa. If New house and or addition to existing housing, complete 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?
CdPfe d. Proposed Square footage of new construction. �� Dime oo•
e. Number of stories? do( t.
f. Method of heating? F -.laces 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 - ands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement • ellar floor below finished grade
k. Will buil• • conform to the Building and Zoning regulations? Yes No .
I. -ptic 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 A H A f''] NJ (__ , as Owner of the subject
property
hereby authorize l, ,1 .(L
to act on my behalf, in all matters relative to work authorized by this building permit application.
_
(o �c 2U U
Signature of •i Date
�A-LAA4rac , 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.
Print Name /
� lte /to
Signature of Owner /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 filler by •
Building Departm- •
Lot Size
J_
Frontage
Setbacks Front
Qv
Side L: R: t.
Rear O�
Building Height 0 to
Bldg. Square Footage % -( „
Open Space Footage % �/ 0 � "
(Lot area minus bldg & paved ,(
parking) s p(` -
# of Parking S . . es
Fil •
•olume & Location)
A. Has a Special Permit /Variance /Findin ever been issued for /on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Re ' try of Deeds?
NO 0 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 0 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? ts4O1 1%-stt-
I.
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO er
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES i NO er
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc 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.
1
t r
Department only
City of No rthampton Status of Permit:
Building D C • Cut/Driveway Permit
212 Main Street `T % r tSeptic Availability
Room 100 ', ,.. 1 Wate r/Weli Availa ility
No rthampton, MA 0 1 060 T wo Sets�a1 Stru rai Plans
p hone 413 - 587 -1240 Fax 413 - 587 -1272 Plta pecify tliteItis
Other S
APPLICATION TO CO NSTRUCT, ALTER, REP AIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property A
This section to be compl by offrce nit
(p (� ®i� ¢ ST. Map
Over ict
Lot U
K �'� . 0 O L Z---
Zone lay District
Elm St. Distri CB D istr use
SECTI 2 - P RO P ERTY OWNERSHIP /AUTHORIZED AGE
2.1 Owner of Record:
K--- # , ('� *\A' f �.+ �� �..... `C: �, f °'C. G (r.' �:�^1 : - �C'..1? r't (t` 1'
Na (Print)
Cu Cur Mai Address 6t
Telephone O , C .
Signatt�Ie 1? tt �ii ' 17 - D
2.2 Authorized Agent:
�o�i � ts•��•.� L S II N t (Jr. Gc,r- r �+�+c /".1-
Name (Print) rrent Mailin Address:
4 toe) — — t 7 iZUA
Signature Telephone
SECTION 3 - ` ESTIMATED CONSTRUCTION C licant
ROSTS
Item Est Cos (Dollars) to be Offic Use Only
completed by permit app
1. Building 7 O (a) Build Perm Fee
u
2. Electrical ( 0. (b) Est i m ated Total Cost of
Con fr om (6)
3. Plumbing Building Permit
� u u
4. Mechanical (HVAC)
t3u.
5. Fi Pro �j
6. Total = (1 + 2 + 3 + 4 + 5) 5 2 206' Check nly
Number , «,' ✓ j 3
This Section For Official Us O te
Building Permit Number: IsDasued:
Signature:
Building Commissioner /Inspector of Buildings Date
t
File # BP- 2010 -0743
APPLICANT /CONTACT PERSON ROBERT WALKER
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584 -1224
PROPERTY LOCATION 60 FEDERAL ST
MAP 30B PARCEL 093 001 ZONE RRJURB(100) / /FFR/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /� 43/3 020
Fee Paid
Typeof Construction: REMODEL KITCHEN, BATH & INSTALL REPLACEMENT WINDOWS /DOORS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 034783
3 sets of Plans / Plot Plan
THE W�LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF�IRMATION PRESENTED:
�V 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
Signature of Building Of cial 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.
60 FEDERAL ST Plant b I .L f 1 BP -2010 -0743
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30B - 093 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 -0743
Project # JS- 2010- 001098
.Est. Cost: $52200.00
Fee: $313.20 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq. ft.): 20603.88 Owner: CONNELL GRAHAM K
Z irg P Rif TRE(100)i /PFR /WP Applicant: ROBERT WALKER
AT: 60 FEDERAL ST
Applicant Address: Phone: Insurance:
36 Service Center (413) 584 -1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON :2/19/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN, BATH & 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: Ili C 5 c
t - � '` .
Footings:
3 ' � D u
Rough: - gh: / / J a ,/0 House # Foundation:
F61,-41)v6 .. W Driveway Final:
Final: b _ T `1 Fina :
" - / o Rough Frame: Z ic elf 4t i O L 1, (
OPT PcQCt c1-( `i'f 2 ° ic L-0 - s
Gas: Fire Department Fireplace /Chimney:
* 17 iO Rough: Oil: Insulation: QK
,
Final: Smoke: Final : f 7 _ � S, �` ``�
-i t Le
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG ATIO S.
Certificate of Occupanc� Signature: ~/
FeeTvpe: Date aid: Amount:
Building 2/19/2010 0:00:00 $313.20
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo