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36-332 (2) SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : F) E. t'`, & j C S a 7 j 3 License Number C > e .. d2 x7o-+Activ?l w yt . t v/ t t (r 3 Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ P+ VIE PT - l"-+ lA-�. t�tiC 1 _7 2 Company Name Registration Number 7- t4 C.4 . 5714-1 2-0 1 4-- Address Expiration Date Telephone 4- 1 12-4 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 Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, 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 CI Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [II Siding [D] Other [D] Brief Description of Proposed Work: +ME ?,-...).% ■-� cA i / (L 6-ww• / (nr'A1 S , CS , CrA t.-e rite' '' lk teC. Alteration of existing bedroom Yes ��// N o Adding new bedroom Yes if Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6p, If New house and or addition to existing housing, complete the following: a. Use o'f• uilding : 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 ondtru tion. Dimensions e. Number of stories? ,., Di-- f. Method of heating? . eplacesprw toves Number of each g. Energy Conservation Compliance. Massche Energy Comnce form attached? h. Type of construction .. ,`... i. Is construction within 100 ft. of wetlands? Yes No. Is construction within )011 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, Jf rix\ j , as Owner of the subject property 14 1 ,� hereby authorize efts a to act on my If, in II matters relative to work authorized by this building permit application. •- 9 - / Signature of ner Date 1, ? C W \rt,,iGAc,1t , 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 % ■ J' 1 1Z- 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 filled ' .y Building Departme Lot Size Frontage ._,. Setbacks Front Side Rear 1:5Z Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Sp. s -- Fill: . ume & Location) A. Has a Spe ' l Permit /Variance /Finding ever been issued for /on the site? NO 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 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 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 Q NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, ex ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use f •. '1 ` , City of Northampton ai " s � � Building Department Ct,€ 0 . 0* 33�Verm ��, �� � 212 Main Street F �wwer� epttcAvaitabf��� yzxx %i Ufa. �«� Gu�2 Room 100 taterANell Aya(Iablift Northampton, MA 01060 Se sruptyrat Plans 41- 587 -1240 Fax 413 - 587- 1272tl' { sn 0 s "� .. r ,. yf� d f ��rr ��i8�4 i ? E 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 '2-U t Map Lot Unit Fly{( 2v`C( ) ‘AAA 0 tC:Co� Zone Overlay District EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: Telephone Signature Mr 11 . 2.2 Authorized Agent: Name (Print) Current Mailing Address: 5134 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ei (a) Building Permit Fee 2. Electrical a (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) S 5. Fire Protection 1 6. Total = (1 + 2 + 3 + 4 + 5) 7,4 "1/50 Check Number /L/78 /1 This Section For Official Use Only Permit Number: D ate g I ssued : Building Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2013 -0150 APPLICANT /CONTACT PERSON ROBERT WALKER ADDRESS /PHONE 36 Service Center NORTHAMPTON (413) 584 -1224 PROPERTY LOCATION 130 CARDINAL WAY MAP 36 PARCEL 332 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out r 0 Fee Paid ��$$ Typeof Construction: FINISH BASEMENT REC ROOM 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 F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON F ATION 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 B - • olition Dela V 0 • • • 0 7-/o �-- S u r e of Build ng i ffi 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. 130 CARDINAL WAY BP- 2013 -0150 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 332 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- 2013 -0150 Project # JS- 2013- 000247 Est. Cost: $24700.00 Fee: $148.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sq. ft.): 19558.44 Owner: BERRY STEVEN Zoning: Applicant: ROBERT WALKER AT: 130 CARDINAL WAY Applicant Address: Phone: Insurance: 36 Service Center (413) 584 -1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:8/13/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT REC ROOM 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 8/13/2012 0:00:00 $148.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner