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30C-082 , O4 �VJAM pi, , w Gz t arfI& Itpfan 11 = *°a a ` 4 . 14 , 4,. B jartssarlinarit8 _v t�� -n� DEPARTMENT OP BUILDITjG INSFECTIONS 4 ` 212 Main Stree ' Municipal Building ' o yM 'y . Northampton, Mass. 01060 ow SV WORKER'S COWENSATION INSURANCE AFFIDAVIT I, 4 LSe'Af EN 1, /// --%/ 1 i ,!�- -77 ‘,/ .rZ. it ,J /L (I.icense?permittee) with a principal place of business/residence a/: 3 le ///2 1.6 2_ ,, ,ii''Z :iP/4.7 7,7?/U Ali' (phone #) 8* ZZ_ (stm,.ticity. / 2 - h - i e 7 .0 do hereby certify, under the pains and perrPll:es of perjury, that: (X) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) ( Expiration Daze) . ( ) 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) allaranCt Conrrpany/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Cniapaay/Policy Number) (Expiration Date) (Name of Contractor) fiance Comipany/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Cornpany/Policy Number) (Expiration Date) (attach additieaal sheet ifnecessary to i:aelucle information periainia ; to all ecctracors) ( ) 1 am a sole proprietor and have no one working forme. ( ) 1 am a home owner performing all the work myself NOTE: please be aware that while homcownxrs who employ pawns to do maintenance, construction or repair work on a dwelling of not more than theca units in which the hotneerrmer resides or ca the grounds appurtenant thereto are not wally considered to toe employes under the worms lion At (GL152ss 1(5)), application by a homeowner for a license or permit may evi c e the legal status of an employer under the Worker's Cotnae=ation Act. I understand that a copy of this slat meat may to forwarded to the Department of Industrial Acrid O.ffica of Insurance for the coverage verificaticn and that failure to secure coverage ender sectiaa 25A of NICOL 152 can lead to the imposition of criminal penalties conistiag of a fine of up to $1,500.00 andiurquiprisonment of sip to ore year and civil penalties in the form of a Stop Work Order and a fins of 5100.00 a day against me. Signed this A r day of / 4 ) ,, ` For departmental use ally �+� Permit Number 77%I f, /� 2 ' Map# Lot it Signature of4 - •ermittee s 1 -St - 1)1 o Consurricr A1 iui tnd Ifusirtess Ret4ulation 10 Park Plaza - Suite 5170 13oston, Niassachusetts 0 1lome 1111proverocni Contrlet()r 1 fiaQi5traton 131945 Noe individual eADication 10113/2012 Tr# 204'5.80 STEVEN A. SIL\lERMAN , 1 268 FOMER RD, SOUTHAMPTON, MA 01073 pd site Atidreus and return card, :Nistris reata,n for thange. >Addresti Kent-nail Ernpio) mew 1J'uit Card 7; '7.:•7 niCtfwfuritvr Affairs istisinrss itcgiaatiou Lit emu rugist ratiou valid tur 'mulls Hui use only HOME IMPROVEMENT CONTRACTOR haunt- the g (late. If found return to: • Registration: 131945 Type: (>f 1:e ot 4.,:oris.unter Affairs alid ft i110.N RiT111A1101 • 10 Paris Plata - Suite 5170 Expiration: 10/132712 17,'diVLIJ.-ni lluston, NI A 0211 Esst;51 7 .I8ILVERMAN STEVEN SILVERMAN 2158 Fah1ER RD, SOUTHAMPTON, MA 01073 Underqfvretftry Nof 1,31iff NNithout. signature 1w lot: - “, Licall-,3> Cs 77279 Fietac;tea CX"/ fea ia STEVO'd A SILVER .x SR)L.JT1-1AMPIONI, MA 01073 .:33t...,a-,a,r3a. R21/2012 , T(33' 25858 | ------- --- 1 SECTION 8 - CONSTRUCTION SERVICES - ---- ---- } ------' ---- ^ 1 Licensed Const,ucti:nSugl.rvisnr: | Nui APp\icah|o �] Haim of Licrose#obJer . Steven Silverman -- D77 Lfnnso N, - nber | / 268 .Tromer Road, • . ,_�� O1/l7� __ 1/1�' xour�s �� 71 ��^� � 584 7523 �� -__ x' - 3/8nmu. ^— To|c0one 9. Regjstered Home Improvement Contractor: 1 NotApp!oab!e Cl Steven Silvezman '_ |1 1omgAnl JName / Ra�istns(.nn Numnr 268 Fomer_Jload � 2. ---- '-- � Address I Expiration Date Southampton, MA 01073 Tn|cphon� 584-7522 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (A8�G.L � c.l5 'Nor Compensation Insurance affidavit must be completed and submitted with ih.s application. Failure to provide iU resiMt in the Genial /f the issuance of the building permit. Signed Affidavit Attached Yes X No O \ �-� - N��00� �� 00' tion _ _ ---- `�=== The current exemption for "homeowners" was extended to include Owner-occupied Dwellings or one (1) or rvo(2)hAnJ.es ancl to nllow such homeowner to cngage an individual for hire vho does not po.sess o license, provided that the o~vucr_acts as supervisor. CIVIR78U, Sixth Edition Section 108.3.5.1. Definition ufHomeowner: Person (s) who own a parcel of land on which he:ishe resides or intends to reside, on vhich theft. 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 u homeowner. Such "homeowner" shall submit to the Building Official, on a8xrn acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Superyisor your presence on the job site will be required from time to time, during and upon completion of the nork fbrphick this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (liability n[Fmp|,,y ors u` Employees for injuries not resulting in Death) ofthe Massachusetts General Lo°s Annotated. you mup be liable iorpc000(x) you hire 0o perform work for you under this permit. The undeoione6^^homeuwuor` certifies and assumes responsibility f�rcompUancc with the State Building Code, Qty of Northampton 0diuouocs, State and Local Zoning Laws and State o[ Massachusetts Genera! Laws Annotated. Homeowner Signature 'CTL p 7112"',1077151170f;37:, A blifr;•. 7/ 1 it, k.-/ISLAAttol (iv ,itiO0i t!C.",,v!ictisg zind or zildition t existing! !lousing, cornpiete Inc tonow:ntr • - -.7 ■.■ ni SECTICii 7i - OWNER AUTHORIZATION - TO BE COMPLETED VVIIEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1C--tif\E- A Steven SilVerraari, Valley Home Improvement, Inc, • Steven_Silxerman,_,Valley_,Horae__Ingrovement,__Inc _ „__ 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 Frontage Setbacks Front Side L: 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 Special Permit /Variance /Finding evQr 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 arjy proposed changes to or additions of signs intended for the property ?YES .� No IF YES, describe size, type and location: . . , . � . City of Northampton -�f\ Build Department , ' r\ ^ 212 Main Street 'f�\ ,''fl0On0 100 Water/Well Availability _ , Northampton, MA 01060 Two Sets of Structural Plans Phone 413 FaX 413 [---~'~"~ APPLICATION TO CONSTRUCT, ALTER, REPA|R, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be corn&eted by office / 1.1 Propertv Address: ' \ C L EVA El\I' �■-• Map _ Lot Unit _ __ Zone Overlay District Elm St. District CB District __ | SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ' 1SV Namn(PrinV Cvr/on� d,n,u�� , ^�4/ �� 49 — � ` `/ --�� "�� Telephone -- — uiQnaturp .2 Authorized Agentj 8 te��o Silverman Valley Home Impro ut, Inc-_______ P.O. Box 60627, Florence, MA 01062 Narne (Fri t v, A Current Mailing Address: A ,. K/ \� 5Q4-7523 ) -- --- -- ---- --- ----- Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by perrnit applicant 1. q ir) .," (a) Building Perm�� Fee Building �� 2. Electrical (b) Estimated Total Cos of Construction from (6) _ 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) S. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) ` 10 Check Number d ^- This Section For Of icia| Use Only Buliding Permit Number: Date Issued: _ __- ~ ' � — " 2 /C> Signature: ,. ^u _ _ — - � n — � ' --- - ! � ngCummiosi.n� � Buildings Date ' BP- 2011 -0534 GIS #: COMMONWEALTH OF MASSACHUSETTS 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- 2011 -0534 Project # JS- 2011- 000876 Est. Cost: $900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sq. ft.): 32539.32 Owner: DAVIS J MICHAEL & ALINE LABORWIT -DAVIS Zoning: SR(100)/ Applicant: VALLEY HOME IMPROVEMENT INC AT: 144 CLEMENT ST Applicant Address: Phone: Insurance: P O Box 60627 (413) 584 -7522 Workers Compensation FLORENCEMA01062 ISSUED ON:12/9/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL LARGER REPLACEMENT WINDOW 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 12/9/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 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 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 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 occupancy 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 permits 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 I, 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 to me. Tate Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents -- _ Office of Investigations 600 Washington Street Boston, MA 02111 www.nt ass.got/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): 2p),, g .4 c .„4 Address: / 2 rt -I 1 / tat' ' vrY. . i, 4 OA Ci City/State/Zip: z a � P : l.✓�t . 4 TA as ►'. Tav ,m rs -`' Phone Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. [] I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2. (I'J I am a sole proprietor or partner- listed on the attached sheet. 7. Li Remodeling ship and have no employees These sub- contractors have 8. fl Demolition working for me in any capacity. employees and have wuikers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. n I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and 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 (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of lip to $2.50 00 a clay against the violator. Be advised that a. copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certfb under the ains and penalties of perjury that the information provided above is true and correct. 0 X# /- Signature: cr•.+ .--- Date: ,k'`o/747 Phone #: Official use only. Do not write in this arca, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person:_ Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ t? Name of License Holder : � 1� � „ ►� h'1ICl �, 1 hJ C► o fv 7 U /dli License Number 1 L / u4.cL 11 W e -r7/v ,�4. 2// /'o•© Address Expiratio Date T r el 41 o (//'f 1 Signature Telephone 9. Registered Home Improvement Contractor: ' Not Applicable ❑ <0 0 t � ✓A tjQlry -4d /0/70y Company Name Registration Number LAMeL 1.4 '1/ 1,rieJ7kky, 771,u. 6, /T y /Zejv Address Expiration D to Telephone V/3,211/4,? 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 ©wnerExe pool 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 fth peisuu(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 rn Addition n Replacement Windows Alteration(s) n Roofing `n Or Doors El Accessory Bldg. n Demolition n New Signs [El] Decks [LZ) Siding [' Other [pi Brief Description of Proposed _ Work: _ T,.. 1... a v W I. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition t "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? 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, ( S cR , as Owner of the subject property hereby authorize ' /A .� 1, to act on my behalf, in all ma -rs relative to work authorized by this building permit application. . �� S 4 Signs ,f Owner Date I L Y4101 e , e i - , as Owner /Authorized Agent hereby declare that t 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 / Vti • Signature of Own: -gent 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 Frontage ,...._.. , „_ __.. __ _ Setbacks Front Side L:.._...__ Rear Building Height' Bldg. Square Footage Open Space Footage ° (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (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 0 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 0 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 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 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 4 Dep artment use only C of North Sta of Perrnr Building Departm Cur bCut I © r ve wa y Pern'ltt 212 Ma Street Sewer)SepiicAva Room 100 W ter1Well A vailability , Northampton, MA 01060 Two'Sets'of St ructural "Plans phone 413- 587 -1240 fax 41 3 -5 87-1272 P1oflStte Plans Other S,pecifj . APPLICATION TO CONSTRUCT, ALTER, RE PAIR, R ENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: n This section to be completed by o ffice r-7 !� D Map'' Lot Unit �i( fi j G- t AfVt C © � a Zone Overlay District EIm St D istrict CB SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: J � A r� fl 5 R L ev� e6' �� T Nam - • t) -� Curren Ma ing Address: Telephone �/ t� � y �}J Signat� �— J' � 'G . .- (p4' �7 2.2 Authorized Agent: i'VP•3 11 Nam (Print) !! Current Mailing Address A e l ,,i i...4_, L /�� ( ie.., 1 ? Sign ature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) t be O fficial Use Only completed by permit app l i cant 1. Building (a) Bu Permit Fee 2 Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Pr otection 6. Total= (1 +2 +3 +4 +5) -Date �SC�� Check Number This Section For Official Use r Only Ruilriin P ermit Number: g Issued. Signature: Building Commissioner /Inspector of B uildings Date r' ✓ ' " `it/ BP- 2010 -0176 GIS #: COMMONWEALTH OF MASSACHUSETTS v_4, :30c4 j 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 -0176 Project # JS- 2010 - 000218 Est. Cost: $8500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RONALD LAMAGDELEINE 8067 Lot Size(sci, ft.): 60112.80 Owner: LEVY JANIS R Zoning: SR(100)/ Applicant: RONALD LAMAGDELEINE AT: 498 BURTS PIT RD Applicant Address: Phone: Insurance: 112 LAUREL HILL RD (413) 527 - 8169 WESTHAMPTONMAO1027 ISSUED ON:8/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE VINYL SIDING 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 8/13/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 498 BURTS PIT RD BP- 2010 -0176 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 082 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 -0176 Project # JS- 2010 - 000218 Est. Cost: $8500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RONALD LAMAGDELEINE 8067 Lot Size(sq. ft.): 601 12.80 Owner: LEVY JANIS R Zoning: SR(100)/ Applicant: RONALD LAMAGDELEINE Applicant Address: Phone: Insurance: 112 LAUREL HILL RD (413) 527 -8169 W ESTHAMPTONMA01027 ISSUED ON :8/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK REPLACE VINYL SIDING 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: d /( /off - R=0 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu•anc Signature: .� FeeType: Date Paid: Amount: Building 8/13/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 498 BURTS PIT RD BP- 2010 -0176 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 082 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 -0176 Project # JS- 2010- 000218 Est. Cost: $8500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RONALD LAMAGDELEINE 8067 Lot Size(sq. ft.): 60112.80 Owner: LEVY JANIS R Zoning: SR(100)/ Applicant: RONALD LAMAGDELEINE Applicant Address: Phone: Insurance: 112 LAUREL HILL RD (413) 527 -8169 W ESTHAMPTONMAO1027 ISSUED ON :8/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK :REPLACE VINYL SIDING 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: 01( / r2 - 9i THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. „01 "," ✓''" Certificate of Occupancy .-/(/°* Si nature: FeeType: Date Paid: Amount: Building 8/13/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo