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31A-203 31A-181 150 75 154 80 • 31A-205 75 2 150 75 31 A -204 114 70 75 150 80 31A-211 31A -203 114 75 118 75 150 112.5 31A -202 70 31A -212 75 118 32 40 75 114 112.5 Q J t‘N 31A-201 �� Q" 75 150 31A-213 146 A -200 75 112.5 75 06/10/10 3:25:39 PM RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACHUSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998 PARCEL ID: 31A- 203 -001 30 WASHINGTON AVE PLOT: LIVING UNITS: 1 CLASS: R - 101 CARD #: 1 OF 1 CURRENT OWNER /ADDRESS LA307 NEIGHBORHOOD ID: 11.00 FINAL VALUE FLAG: MARKET SCHAEFER GEOFFREY M & LAND DATA VICTORIA BRETT - ASSESSMENT INFORMATION - 30 WASHINGTON AVE TYPE SIZE INFLUENCE FACTORS LAND VALUE PRIME SITE 10500 252,180 PRIOR COST CURRENT NORTHAMPTON MA 01060 LAND 241,100 252,200 252,200 BLDG 341,200 309,400 325,400 TOTAL 582,300 561,600 577,600 DEED BOOK: 8308 DEED PAGE: 235 SALES INFORMATION DEED DATE: O2 TOTAL ACREAGE: 0.241 TOTAL LAND VALUE: 252,200 LAST UPDATE/COST: OO80311 DATE TYPE PRICE VALIDITY 20050620 LAND + BLD 655,000 0 LAST UPDATE /COST: 20080311 19820701 LAND + BLD 78,500 0 X DATE: ADDITION DATA Lower Level First Floor Second Floor Third Floor Area DATA COLLECTION INFORMATION A OFP 1sFr 56 ENTRANCE CODE: UNOCCUPIED B OFP Wddk 225 INFORMATION SOURCE: C Bsmnt 1sFr 1sFr 130 CD DATA COLLECTOR: MC D EFP 1sFr 48 DATE: 19991016 E DWELLING INFORMATION G H STYLE: CONTEMPORARY YEAR BUILT: 1929 STORY HEIGHT: 2.00 ATTIC: FULL FIN +WH Basement: FULL TOTAL ROOMS: 9 T 4 OTAL BEDROOMS: 4 FULL BATHS: 2 ADDITIONAL DWELLING INFORMATION Half Baths: 1 BASEMENT GARAGE( #CARS) ADDITIONAL FIXTURES: WD1'FP ".4% EXTERIOR WALLS: STUCCO BRICK TRIM: X 7 UNFINISHED AREA: STONE TRIM: X GROUND FLOOR AREA: 963 13 TOTAL LIVING AREA: 2820 REMODELING DATA FINISHED BASEMENT LIVING AREA: X 6 7 5 - BASEMENT RECREATION AREA: X YEAR REMODELED: //�� MASONARY FIREPLACE STACKS /OPENINGS: 1/ 1 8 8 8 METAL FIREPLACES: KITCHEN REMOD Y/N lFr /EFP 1Fr /OFP 5 HEAT /CENTRAL A /C: BASIC BATH REMODEL (Y /N� HEATING SYSTEM: STEAM 3 12 9 FUEL TYPE: GAS 26 Q COND /DESIRABILITY /UTILITY VG INTERIOR /E SAME ,T) OUTBUILDINGS & YARD ITEMS PERMIT DATA TYPE QTY YR SIZE1 SIZE2 GRD COND DATE PURPOSE PRICE 20071005 5,700 INSU & DRYWAL ATTIC 29 27 10 l NOTES: 1 interior & exterior inspection on 3 -30 -06 with the owner. js /jc 13 2Fr /B FA/fir/5 e / ,-:::_si.. =_—,- /IIMIM: ..../1:-L---- � ; `: _: /1 I -- / ,v■aj a � HH,0 IA / / - . - -- ll/ -1 \\ � \ \\ � "1:::17:1-11:11111i4:14:' , - .- r ? \ d�vvV v A � � � -. � _. -_ _ J � AVA� v U� A �� A vA �A� �;A�� v �V AvA �� vv� AV \V\AA vvA A \; Vv vA \��VA vA� �A 1A�� I \ 111111 . �� v�A.��VA \A \ \\ , , IN � , � n �, +- y_, .11 `1 r n ry {- Fi-fi n ly f7 -- I H1 i I- F; H�+��1 -„r j 1J � J F, -TJ,,-r \r17F�. b n i -( hr , �� i �l1 �� N u. i 1r-,b a � f Nu a �R I_ _I. _i M _ti a a z I ,4-•-• . ■ I 7-; • _ -1 , NJ-I f , - ii■ • ■ ■■■ i■ ,- ,y ht N h 1 "r{ �} ti Hh '\-r\ h� h hfiJH H t IWI, \I_____WR I ..... r \ V V...) 4 .... , N. \ 94 . . 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I ' 1 I ' I .1 q ' [-, I - 1 1-1 HW1 ' I-n-1'1/1114 r-I ' ' ' ' ' V- - 4 = ' , - 13",-., f'."'..-'5.....7_4" II..I.1'41■",,Z - - : ' f - 1 ' -f ' II-1 1-4 f " - f I - f ' 'Il 411 411 it' I ,Lt i ""*"..........................LW11 1.......... i 0 . .---- 1 : 7 : _____ IN . 1111 1111111 I ! i If , 1 . 11 111111 , I , i 4 I t t 1 I 1 ' 1 i n 1 - l : -------_-__ 40;,,,------,,,.---- ' . 1 r Q.__ . 12' -0 n rib 1U - 1 I r I 19 awl to jam J N II- rte.. . , ii DINING Z I 12' 10" R - - 11' -6" 1 ' C,lI - vJ M n ' 1) - 1 3' -0'� 4'-0" 8' 0" FAMILY M IOO', / KITCHEN 14'-5" > A ch 1 v li 11 DN 1 1 2 - - —. 1 19'9" III N 4'6 o ,,_,,,I._ UP-- LAUNDRY \ \ CLOSET DN i 7 1 1 Ix) Mil combo BATH o LIVING ROOM 4 2' -10 "> o ENTRY BSMNT. / O o b y h T 0" STAIRS /` 16'-0" 5' -0" 23' -6" 44' -6" — 12' -0" - A - �9 ( 1 19' -6" 1 1 ft, Q / CLOS. ;CLOSET ' I �� PORCH I� .../.. _ / A C 10'0" — 13. -0" 1 4 I i _ i FAMILY `* co KITCHEN I I I G A I l'.- I k2 , -2 /I - pN I �� _' _ 11- N CLOSET 3 I' 4 , 6.. UP - -- 1 0 J DN I1 1 1PANTRY in —� 3.76" BATH 0 i V I I l / �' ^' LIVING 4.-0" � f I■1 , 1 BSMNT. 2 / i ENTRY 7 , -0 „ I I STAIRS / 1 Y, 16' -0" 5' -0" 23' -6" K 44' -6" - — V-Q-4-I° - 19%6" 12-0" A , , ? )C / 0 EltrZZ._ • '•1 / ' •- 4 ---.. II 8"x 16" x 48" walls b Ik A 6- 8"x16" footings i•--. i? _ 1--- - J ( 2_ A / 0 c72, az,..kj _ _ '- / I REMOVE EXISTING STONE VVORK AND j/ POUR NEW 4' FOUNDATION WALLS / _1 V., WITH CRAWL SPACE 7 \ ! b ' 1 —1 / I i ! !! ! ! I vt i I CUT IN 3'x4' ACCESS TO CRAWL SPACE FROM EXISTING FOUNDATION I I ! tv) I - \ 1 \ EXISTING CHIMNEY 1 r— -- \ EXISTING CHIMNEY 4--- 10'-0" I ! : r'z I Fr) 1 cs, 1 — EXISTING FOUNDATION 1 . - 1 -= 44'-6" – 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 iermits 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 l; 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. Date Address of work location T The Commonwealth of Massachusetts Department ofIndustrial Accidents =-.,-.;:::-.=..- Pm' _ .7,i ►� Office of Investigations �►= 600 Washington Street • Boston, MA 02111 .. www mass.gov /ilia _- -Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumbers Applicant Information - k Please Print Legibly Name ( Business /Organization/Individnai): /T .� CA.) k 1 1-i -- o & . • Address: I e t / lu 6 St - . City /State/Zip: 'J CiCke-i L Phone. #: 'f /3- S3 ^)--1 3 :5 Are you an employer? Check the appropriate box: • Type of roect (required): / yP P ] (�� 1. ❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑ New construction employees (full and/or part time).* have hired the sub- contractors 2..[ am a sole proprietor or partner- listed on the attached sheet.. 7. Renwdel7ng ship and have no, a loyees These sub - contractors have. . 8. E • working for me m any capacity. em�10 - yees and have workers' 9. Q E u ldmg at d tion w o r k e r s ' c o n n p . i n s u r a n c e C A I T 3 p . IIIStitanCp .. -- -- - -- .. .. ed: 5. 0 We are a corporation and its 10.� Electtcai repairs or additions r equn i h i officers ave-zxercsed ter . 11. lamb' r epairs or additions • m 3. 0 I am a homeowner doing all work ffi h . � � e1 o workers' co right of exemption per MGL myself [N comp. 1 /O.. Roof repairs insurance required:] t • c. 152, §1(4), and we have no • , employees. [No o workers' 13.0 Other • - comp. insurance required.). *Any applicant -that checks box #1 must .also fill out the section below showing their wort:es'- 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. 1 Contractcss that check this box must attached an additional sheet showing the name of the subcontractors and state whether ornot 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'imd& Seclion'25A ofMGL c 152 can lead - to the imposition of ci i final penalties of a fine up to 51,500.00 and/or one -year imprisonment,' as well as civil penalties in the form of a STOP WORK -ORDER and a fine of up to 5250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the ()fate of Tnvestii tions of the DIA for insurance' coveiiae verification " _ _ . _ _..... I do hereby certify under the pains , I d penalties ofperjury that the information provrded_abo a Lurie nrd rorr_ert_ Sia.. C r Ti — D : te- 0 - . . , Phone #: 41 5 .':. 6 .. '6 y. ..: - Official use only. Do not write in this area, to be completed ff l y 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. Electrical Inspector 5. Plumbing Inspector 6.Other t Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: W or: G ,' I I ,/ Not Applicable ❑ Iv Name of License Holder : ri k f� t t fL C) dr License Number q otoL 5 6e, (.2 13 5 Address Expiration Date /36,t Telephone /)-- /20 J 9,.:Rectlstei+edl H iliiie:lntprciverne o } rlfira et r ; NN g ,t1 Not Applicable ❑ H .-- o2.. ( Jt Company Name Registration Number /q/ Ai 1 3-) Address 'y,� fL J 7 �} Expiration Date i }1 & • 61 t 01 Telephone W 3 r I i /Zq /.,. °7 5gr SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 2 5C( 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 .LS( ILA(m0 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 r '""w SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition IZI Replacement Windows Alteration(s) El Roofing Or Doors 5 � Accessory Bldg. ❑ Demolition ELI New Signs [O] Decks [C] Siding [D] Other [0] Brief Description of Proposed 5� C 4 r�aof w f ._ _ A Work: � !'1LG.Y.�t if..-61,44-4 Alteration of existing bedroom Yes No No Adding new bedroom Yes 4 No Attached Narrative Renovating unfinished basement Yes U` No Plans Attached Roll - Sheet ¢a if a atls tl ` : a d ` s iiiiitli iia ktn" r Witii citiar iu: a. Use of building : One Family i-- Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? A 0 G, 1 t" X — d - ' d. Proposed Square footage of new construction. J ' .� - Dimensions e. Number of stories? , j � n f. Method of heating? ITk 1-6 t; �� 60 el Fireplaces or Woodstoves /--- Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction U.) IT < 14.1 1 1 1 .- < 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 i- r r k. Will building conform to the Building and Zoning regulations? (1 Yes r N / o . I. Septic Tank City Sewer 1 Private well City water Supply v SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN , OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, D \) \C �5\A t \ ' V ` p, , as Owner of the subject 9 property hereby authorize L ■ ■ (di to - ct on r behalf, in all matters rel. • o work authorized ■ • .- • uilding permit application. s k }AO- Signature of Owne■ r Date MR lv , as Owner /Authorized Agent hereby dlare 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 f perjury. OE- N (IA at 1,C � d 1 Print Name (0 Signat of Owner /Agent Date 1 '4 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 I '7 0 1 f `7 0 1 Setbacks Front -,2 3 Q v Side L:TE R: 2 L:1 ' R:! ..1 Rear __ 7XE r i Building Height __, i Bldg. Square Footage ii= a ( % FE,, c € I i Open Space Footage 5 % r (Lot area minus bldg & paved 1 j i parking) # of Parking Spaces Fill: 1 l 1 I i (volume & Location) ( i A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW al 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 i Pa I and /or Document #: ry B. Does the site contain a brook, body of water or wetlands? NO `if"' DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES i NO it. IF YES, describe size, type and location: J D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO '4v IF YES, describe size, type and location: i 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. i l! City -of Northampton Building Department $ 14 212 Main Street $ g = P JUN 1 5 204) Room 100 < Northampton, MA 01060 phone 413 - 587 -1240 Fax 413 - 587 -1272 ti o 2.z......,_x."^n�. APPLICATION TO CoNSTRUeP'ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: r J� 3 1�.9 was )4 Map Lot Unit Zone Overlay District Elm St. District` CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 5cN►ae-FefL Ie-eF +vIcfbri`iK ;3 U W1N51 -i�v5 4 f me (Print) , i� Current Mailing Address: r 3 5 / 1 — _� '�— Telephone 2.2 Authorized Agent: Wki +Lo -c 19 t S e.Lc ke Name (Print) Current Mailing Address: -)13 5 1-11---2f'' 6`2' f 13 - 5'1 - - 7 9 8 y 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 / j V v Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection o---0 0 6. Total = (1 + 2 + 3 + 4 + 5) J b � u u Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File # BP- 2010 -1144 APPLICANT /CONTACT PERSON HENRY WHITLOCK ADDRESS/PHONE 191 NORTH ST BELCHERTOWN (413) 253 -2235 PROPERTY LOCATION 30 WASHINGTON AVE MAP 31A PARCEL 203 001 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 Fee Paid at Typeof Construction: REPLACE PORCH W/DINING RM, 2ND FLR DECK & RENO KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 061355 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 4 fi 77/ (-) 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. 3(l WASHtI`N ASE BP- 2010 -1144 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3IA -203 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 -1144 Project # JS- 2010- 001678 Est. Cost: $120000.00 Fee: $720.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HENRY WHITLOCK 061355 Lot Size(sq. ft.): 10497.96 Owner: SCHAEFER GEOFFREY M & VICTORIA BRETT Zoning: URB(100)/ Applicant: HENRY WHITLOCK AT: 30 WASHINGTON AVE Applicant Address: Phone: Insurance: 191 NORTH ST (413) 253 -2235 BELCHERTOWNMA01007 ISSUED ON :6/18/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE PORCH W /DINING RM, 2ND FLR DECK & RENO KITCHEN 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 6/18/2010 0:00:00 $720.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo t ' ' //)C., , ✓ V i L -/� ,'� 1 c t (V \ �(��i.5 �� 8' 9. - 29 27' 13 L�� 35' \i ( A) C 3 0 WASHINGTON AVE Q 1 L 12'-0" Q 1 L. ... .01..49c 11 f ) 7 4....".."'-eZ) Cl/ ) ‘'`. /) l'S O - 1 � V' 1 , , L__196" 1 f,11.11111111_ i 4,,..yrin : v c "e i Q _7 75 DINING r ‘1470P1-5)Clt g A 1 CLOS.r ; i < 10'-0" 1 r 13'-0" s.! 1 1 FAMILY °Q 1 ■ ih KITCHEN 0 a II co II i DN —I \ \ . - a _, 1 N 1 CLOSET b - UP I V " l I \ / CLOSET —DN— -, I PANTRY E <- 1 1 4.-6 -� BATH o i mi__ P °' LIVING • BSMNT. 2' -10 "3 (� o ENTRY �/ STAIRS' - I _____ ,,,...-.,..„____, 16' -0" 5' -0" 23' -6" I" -n 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 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 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 Date Address of work location s. -- ---. •,, The Commonwealth opfassachusetts =.-.•=.2!----- Department of Industrial Accidents • Office of Investir,ations . k =LI ........ ; 600 Washing Street .. .. • — — lz Boston, MA 02111 T.,-....-- ..... \ - , www.mass 0 . , • .... -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers - Applicant Information Please Print Legibly Name (Business/Organization/Individnn1): 91 4, Address: f / /V 6 City/State/Zip: 12/4 07/1".... Phone.#: (f( — 2- 5 Are you an employer? Check the appropriate box: Type Of project (required): / • 1.0 I am a employer with 4. 0 I am a general contractor and I 6. Ej New construction have hired the sub-contractors employees (full and/or part-time).* lisMcl on the attached sheet 7. 0 Remodeling 2. I arn a sole proprietor or partner- These sub-contractors have • ship ancl have no e,,)loyees .8. 0 Demolition worldng for me m any capacity employees and have workers' 9. EfBuilding additiOn [No workers' cora/a. insurance 10.0 Electrical repairs or additions required.] 5. 0 We are a corporation and its officers have4xerciseci their . 11.0 Plumbing repairs or additions 3. 0 I am a homeowner doing all work i myself [No workers ' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t ' c. 152, §1(4), and we have no r-, employees. [No workers' 13.i_ j Other con:IP insurance requir-ed-1 *Any applicant that checks box ?Al must also fill out the section below .showing their workers' compensation policy information. 1. 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 woricers comp. policy ntnnber. lam am an employer that is providing workers' compensation insurance for my einployees. Below is the policy and job site information. . - . - - . Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: . . , Job Site Address: City/Stalx/Zip:' Attach a copy of the workers' compensation policy declaration page (showing the policy numb er and expiration date). • Failure to secure coverage, as required under Section 25A OfMGL c. 152 can lead to the imposition of criminal Penalties of a fine up to 51,500.00 and/or one-year imprisonment as well as civil penalties in th.e form of a STOP WORIC-ORDER and a &.e of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avesiiiiitiois of die - DIA. for insurance cOVerlie veriffeatiiiii. _ I do hereby certifr under the pains and penalties of pedal)? that the information providediab ve_iit rue_atu6otrect. _ ._, Signature: 7 2 ..-.(---14.4...rei . Daiz: Y .-. 7/ ° - Phone 0: t f( - 9 --)---.3 c - - • • Official use only. Do not write in this area, to be coin by city or town'official • City or Town: ' • PermitfLicense #_______ Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other . i-• . • Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: __ Not Applicable ❑ JJ Name of License Holder : / t.R J License Number /17 ti O / 3 G .- 5 ". Address Expiration Date A.aei -t4tA 'i - ( 1 t -Y X 5 - 2 - 3 C Signature Telephone i" 3/ 4/L2t,,,z—-- / V24, 1 6 9 ._Rea tered H otniImprove " an -ic r: ... r ` , as i .w _ j.; ..,_ Not Applicable ❑ ‘ame C Company Registration Number Address ` / � f � Expiration Date 6 71/tek_ Telephone 273,.3 s 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 ❑ 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 ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [l Siding [0] Other [0] Brief Description of Proposed f Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa : if i e � ... ...... > ea #stiir�c pia a • v .� oni pi e. ire fo[Iow r c : 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. 3 (a 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 . >& 1 d " e , r 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? 7 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 , 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 (.L--- , as Owner /Authorized Agent hereby decl re that the statements and information on the foregoing application are true and accurate, to the best of my knowledge 9 Y and belief. Signed under the pains and penalties of per ury. Print Name Signature of Owner /Agent Date T r 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 s ' ______I Setbacks Front 1 1 Side L:75: R: €.- -- L: R:= Rear = = _ . Building Height = r I 1 Bldg. Square Footage 1 1 % 1 1 1 I f Open Space Footage Y % 1 1 i (Lot area minus bldg & paved g 1 2 , _ w g parking) # of Parking Spaces 1 i Fill: j 11 1 (volume & Location) # I. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW . YES Q IF YES, date issued:° IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW er YES 0 IF YES: enter Book 1 1 Page and /or Document # ry _.___ B. Does the site contain a brook, body of water or wetlands? NO el DONT KNOW Q 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 e _ , IF YES, describe size, type and location: l D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO e 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 (J NO ,®'' IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton u� Y Building Department g g 9 P t om ''' try ! , { <4a 212 Main Street �� Room 100 - aQ x A, t Northampton, MA 01060 4 phone 413- 587 -1240 Fax 413- 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: 3 U (A = Map Lot 'Unit. Zone Overlay Distract EIm Si District ` CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: C- fit Telephone Signature 2.2 Authorized Agent: Name (Print Current Mailing Address: ( f 007 Gl L(13 - Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COST 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) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) la y " Check Number 5o it) This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP -2011 -0089 APPLICANT /CONTACT PERSON HENRY WHITLOCK ADDRESS/PHONE 191 NORTH ST BELCHERTOWN (413) 253 -2235 PROPERTY LOCATION 30 WASHINGTON AVE MAP 31A PARCEL 203 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT F- - Pahl - Bu Ml ";+ t Filled out `onstruction:_Deck Addition New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 115035 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 Signature of uilding 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. ,,..7 ; T 9 W BP- 2011 -0089 GIS #: COMMONWEALTH OF MASSACHUSETTS ap:Block 31A- 203 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck Addition BUILDING PERMIT Permit # BP- 2011 -0089 Project # JS- 2010- 001678 Est. Cost: $12000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HENRY WHITLOCK 115035 Lot Size(sq. ft.): 10497.96 Owner: SCHAEFER GEOFFREY M & VICTORIA BRETT Zoning: URB(100)/ Applicant: HENRY WHITLOCK AT: 30 WASHINGTON AVE Applicant Address: Phone: Insurance: 191 NORTH ST (413) 253 - 2235 BELCHERTOWNMA01007 ISSUED ON:8/9/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: Deck Addition 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 8/9/2010 0:00:00 $50.00 212 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 7800 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. Date Address of work location t i ]:e Commonwealth of Massachusetts -- Department of lnzdustrial Accidents _,,." :==..:-...,-- Office of fnvesti azzons . 7 600 Washington Street _ - Boston, MA 02111 wnryv. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information PIease Print Legibly Name (BusinessiOrcrani anorvIndividuai): (_ -6/'G I 7P,Z# — Address: 7T At of- . city/state/zip: lorNu,, A!//z?, GIQGL_ Phone =. 4 , /� Are you an employer? Check e appropriate box: Type of project (required): 4. I am a general contractor and I 1. ❑ I am a employer with 6. ❑New cons ruction mployees (full and/or part- time).* have hired the sub contractors 2. I am a sole proprietor or partner- listed on the attached sheet- 7. Remodeling ship and have no employees These sub - contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance c01.41. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or addit ohs 3. ❑ 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.] c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that check; box #1 must also fill out the section below showing. their workers' compensation policy information. 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. lithe sub - contractors have employees, they must provide their workers' corm. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. In Cnrnpanv N Policy # or Seif-ins. Lic. it : 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 tine up to S1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DL=. for insurance coverage verification. I do hereby cer ' _ un, er the pains and penalties of perjury that the information provided above is true and correct. Sicnature: de , . -e- - / � / G Date: 1 _ a. Phone , ✓ S 1 Ofzcial use only. Do not write in this area, to be completed by city or town o City or Town: Permit License Issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 1 i Contact Person: Phone 1 SECTION 8 - CONSTRUCTION SERVICES I + 8.1 Licensed Construction Supervisor: I Not Applicable ❑ Name of License Holder : iy5 /� / ` C / 6 0 , License Number , *Y ic 47 0/66 /V,�°/ padre r - Expiration Date "4 " 6/7 c -7-6 9 C6nature Telephone Redistered Home IrttoroveriterttConfiraetor .. s -� �,, _ , __, ,- _, _,._.,_ M Not Applicable ❑ C t r � c s e , � < « � K . / 76 1 .omoanv Name Registration Number rU�r Or. f 7e - ffIc e fitilA Old 6 l! /! -/ 'a .ddress 7 Expir ion Date Telephone / 57 6 403 ECTION 1.0- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M .G.L c. 152, §,25C(6)) 'crkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result the denial of the issuance of the building permit. • aned Affidavit Attached Yes ' No ❑ I.E.;416111 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. GYM 780. Sixth Edition Section 10835.1. 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 -vear 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, von 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 Eli Addition 7 Replacement Windows Alteration(s) g2- 1 Roofing I I 11��11 Or Doors D Accessory Bldg. U Demolition n New Signs [0] Decks [C] Siding [pi Other [C.'] Erief Deswiption of Proposed Work: -.4,28/q///74/ 5 t/e /o'/c/ an 5 - 4 r. / /e / c — . 67E7 �� I Alteration of existing bedroom Yes INo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes I- No Plans Attached Rcil - Sheet 5e.. (f Ne Ftousoand e c ti = fol 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 c. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft of wetlands? Yes No. 1s construction within 100 yr. floodpiain Yes No j. Depth of basement or cellar floor below finished grade k. Will buiicinc conform to the Building and Zoning regulations? Yes Ne . I. Septic Tank City Sewer Private well City water Supply ,- SECTION 7a -OWNER AUTHORIZATION TO 8E COMPLETED-WHEN OWNERS- AGENT"OR: CONTR4CTOR FOR'SU1LD1NG PERMJT .6✓7 l j 7 ::? ; /�� as Owner of the subject property I, > z ii hereby authorize / r /(e' tp act c+ my beh. , - II al ers relative to work a , on ed by this building permit application. Sig - re of Owner Date r7 .1- . ' as Owner /Authorized Agent hereby declare that tie starem and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penaities of perjury_ - - i? C -zr Print Na - r Section 4. ZONING Ati 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 Deparnnent Lot Size __,... .._... _. _..._. _ _ Frontage _..,.,____. Setbacks Front Side L:'_ _.,._ R. L __. _ _ R: ._._. __„ ____ _ Rear._ ____ _ ,___ - Building Height -_ --- --• Bldg. Square Footage — 1 o/a _._._._._ Open Space Footage __ - I % - -- .. (Lot area minus bldg & paved __- narking # of Parking Spaces - - _ Fill: (volume & Location) •--- -- ----- ------ —. --- -- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW . 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 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 0 , Date Issued: C. Do any signs exist on the property? YES C.) NO g 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. WII 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 Fermft from the DPW is required. ` Department use only City of Northampton Status of Perm , Building Department Curb CutlDriveway' 212 Main Street SeweriSeptic Room 100 WaterhWellAvailability Northampton, MA 01060 Two Sets of Structural Plans '" ..i'- ' '' j phone 413 -587 -1240 Fax 413 -587 -1272 P iat/Site Plans .r ' Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE.. INFORMATION 1.1 Property Address: J This section to be completed by office 3c vU Csi /h /b'I C' Map Lot Unit Zone Overlay District Elni St District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. Owner of Record: ` \ �6V(_____ 1. T� � II � c_..) \ CkA V\ \ / S ` ' 4iiii gorw Name (Pent 1 ---- Current Mailing Address: V 1 '' , ��...,- � r Telephone Sig "Tire 2.2 Authorized Agent: C A rii Xe/(077 Name (Print) Current ^Maiilling Addresss Si nC - Telephone 9 P SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be 1 Official Use Only l completed by permit applicant 1. Building ,' 73 (a) Building Permit Fee f 2 Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Perrnit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7 Cl? , Check Number 9 1 %,■T✓ This Section For Official' Use Only Date Building Permit Number Issued: Signature: Building Commissioner /Inspector c fbuilomgs Date File # BP- 2010 -0630 APPLICANT /CONTACT PERSON C & T CONSTRUCTION ADDRESS /PHONE 15 Fairway Drive FLORENCE (413) 586 -4965 PROPERTY LOCATION 30 WASHINGTON AVE MAP 31A PARCEL 203 001 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 � �� Fee Paid a Typeof Construction: REPLACE SINK,TOILET,SHOWER,TILE FLOOR 1ST FLR BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062884 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 1 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 /V (e) i/f/ A 0 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. • 1 3�� M v `'`` `' BP- 2010 -0630 GS #: COMMONWEALTH OF MASSACHUSETTS � , ' CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pei mit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0630 Project # JS- 2010 - 000921 Est. Cost: $7300.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: C & T CONSTRUCTION 062884 Lot Size(sq. ft.): 10497.96 Owner: SCHAEFER GEOFFREY M & VICTORIA BRETT Zoning: URB(100)/ Applicant: C & T CONSTRUCTION AT: 30 WASHINGTON AVE Applicant Address: Phone: Insurance: 15 Fairway Drive (413) 586 -4965 FLORENCEMA01062 ISSUED ON:1/4/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE SINK,TOILET,SHOWER,TILE FLOOR 1ST FLR BATHROOM 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 1/4/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo