036-315 (2) i vi p -)., (-s1 ' h .3 ciri 4-)
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! SECTION 8 CONSTRUCTION RVICES ,
8.1 Licensed Constructi • Supervisor. Not Applicable ❑
�
Name of License Holder : _ ' t r j V ° 7 25
L i I x. 'fi✓,, f4. I e r e - eo 4 / / f4 License 0 N- z 5 Address I f I Expiration Date
/". —_
Signal ., i Telephone
sties f8i INW. s: W . Not Applicable ❑
IP
, ..., 4. e--, o - - _/1 c'F',./LCOVIA i A 7
C • mean Name Registration` Number
''' ON -/-4 i- )61 A e ,...... jil 7—/5 — 2 e / .7-- -
Address I Expiration Date
1....P /!? `"fi e -I 7 ' ?
SECTION 10- WORKERS' COMPENSM i . INSl7RNICE AFFIDAVIT (MG.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 X No ❑
y u ..
g "w ` -ra -a ,, , , ,z 5. 1: sy ,
ts......
The current exemption for "homeowners" was extended to include Own • r ■ Q ,zc • Dwellin ! of one (1) or two (2) �P O O families
and to allow such homeowner to engage an individual for hire who does , of possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on 'ch he/she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detac ed structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two- ar period shall not be considered a homeowner
Such "homeowner" shall submit to the Building Official, on a form ac ptable to the Building Official, that he/she shall be
responsible for all such worki►erfcrmed nn le the bordinLpermit.
As acting Contraction Supervisor your present.. on the jol site will be required from time to time, during and upon
eompletien- e€the-work-for w - this - perms- 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 • mpliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of , • • chusetts General Laws. Annotated.
Homeowner Signature
_ _ ._______ _ _. _ _ . \.( ( __ ____
SECTION 5.- DESCRIPTION: OF PROPOSED-WORK :(check all applicable)
New House ❑ Addition [❑ Replacement Windows Alteration(s) ( Roofing [D
Or Doors 0
Accessory Bldg. ❑ Demolition El New Signs [O] ' Decks [1 Siding [0] Other [0]
Brief Description o Pr•posed -
Work: 4C1/12'el°
,+
O. 4/4110 Y; a
Alteration of existing bedroom Yes 1 1 - "•••No Adding new bedroom Yes No
Attached Narrative Renovatin g unfi ed basement yes No r
Plans Attached Roll - Sheet
• , _ - /A A -, i S a
.. v ;•.,; :'. ,.%;.:: '. .;. ..i^ _ '.. a..yt:,' �..,.» „,r,.' b .'.F'•y t'�4.aY•+3 ^.: -.. fit"' "Si
a. Use of building : One Family J, Two Family Other I
I
b. Number of rooms in each family unit 1 l Number of Bathrooms
z
�f
c. Is there a garage attached? ) 0,9
d. Proposed Square footage of new construction. 1•' //_- Dimensions ^
e. Number of stories?
f. Method of heating? r .'- _ Illrall1_,, . - Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. � Masscheck Energy Compliance form attached?
h. Type of construction / - ,C2 -
-.r'4'1i'✓t
i. Is construction within 100 ft. of wetlands? - ____F4es� No. Is construction within
,J 10 yr. floodplain Yes No
Depth grade � / tir 't it) 1 004. b
j. pth of basement or cellar floor below finished rade 4 C-'
k. Will building conform to the Building and Zoning regulations? •Yes No .
I. Septic Tank City Sewer Private well City water Supply
:SECTION Za 011IA10.R 4I JGRIZATI TOE COMPLETEC WHEN
OWNERS AGENT OR.COi TRACTOR APPL FOR BI PERMIT
I , g � / J t t�6 T.:)C , S Owner of the subject
CI
hereby authorize � � _ c .JL ' _I, .1.. Centr i... IL.
to act • • ■ o - half, in all matters relative to work autho ed by this building permit application. q(3(426)ti
Signature o • er 411 Date
0 ( A__-4- , as Owner,
and
Age ereby declare that the statements and orm a n. accurate, on the foregoing application are true .- to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury. lo 11
q IA d 0 i -, A!
Print Name .7
Signature of • er /Agent a e
Section 4. ZONING AU 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
at
Lot Size J [ ; J € /
Frontage 1 1 11 V 6
Setbacks Front I w ct
Side L:I I R:1 L:1 f R:+ + E ; �--' 1U v' �
r
Rear ` �
■ 4
Building Height •- - —' .._:%,
Bldg. Square Footage — _ I-- 1 i �J ` y �
Open Space.. Footage.
(Lot area minus bldg & paved II , LJ I I _ .__I t
PAR)
1 * s
_ . __ # of Park �►I t 1 I •
Parking Spaces -- _ .. _ .
Fill: I
i
(volume & Location) I
"°
A. Has a Special Permit /Variance /Findin ever been issued for /on the site?
NO 0 DONT KNOW YES 0 •
IF YES, date issued:; 1 `
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 # ____.�s
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW iilto YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained - Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 NO GC
i
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: ._ M
E. Will the construction activity disturb (clearing, grading ex. vation, or filling) over 1 acre or is it part of a common plan .
that will disturb over 1 acre? YES 0 NO 0 :4
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
",,',777",
t c i ,, .r nil.
3 g
g 7t/h
5..,
} :: ,. s...e
............, ,
RECEIVED. City of Northampton
, -,
,,' ,';' /L'F 4 y - i; ''''' l ^' ' :.. - N . ? .. 4:7,■:;,. ,. '-' 59. , - 4
?
. . Building D e p a r t m e n t
''''':" '
,..:,, 4 7 1: ' • '4 Tt.:::.
SEP -2411 212 Main Street 7
''....r.l.f,..... .
Room 100 1
WOL . * '• : ' , ..-1 17. 4::, -- : ,, wetzr.lv!.,zzr.k , ',V.1:-.v. ,, t, -0 , , w - a::,
Northampton, MA 01060
VOn: W 1664 ''''' .'" . - t;"4tag.'''..-. ' - '' ' ' ' ' ::vm,,,- .,..'
NORTHAMPTON. MA MO oho )e 413-587-1240 Fax 413-587-1272 ' ;11.' .....-:':Z 7
.-7•,"'''',7;:10: 1 ' ';',' . ' ,.'W,Mrk:,`,;:";•
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,
' --
$EATION
' ' tillisectionlatie cerepletetbli:Ofgce
1.1 Property Address: /•-•
• riC Ca 4d(ftice-V ',WC/ • 144 lfrill
-.;..' T.....-. 'a
Ci.r:: '''' „ _
*04: csarstitq
saCt4eitt24aft0C , . , a i Ep*IplAutticitOtti**Eitt4-
'
...... .___ .
2.1 Owner of Record: .
' i i .
6'5 CattkifeEP t i)C-IVI — J — C - CIO IJOILYI etrs - 2Cc) eatte ke — 51.cfe l #0 Ikt 666
( ......,--M = 2_int _ Current MailiajVs_s: 8 5 _ t54:::::60
Telephone
Signature
2 r .:. • rized • !. - i V i
321 P LiZ e_ I 1 54 ' 4Cfdle all
7 7 i
' N. e (Print) Current Mailing Address: 0 /035
At 4 9/I 4T? ' 2 '7
..... arZillk
Signature ■1111111" '''` Telephone
•...--,.:
SEOtioi417:46firiiikft0441461tREJOttifiliebt-tr0-7:•
...... .
Item . . Estimated Cost-(Dollars)-to-be :. ---- • Official Use Only
completed by permit applicant H
r.
1. Building / (4BUildinc.-Permit.Fee
-
' t" 0 C ) P U's
':
- .
2. Electrical 2_000 , i .. A i „,.. "r, Atit:astIiiSted Of
/ V L'E-- - I ("( . COnstiuction from (6) _______
.., r luiriOlng c'' 0
Building' Pernik Fee
.., to e - .--I) --- -
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
Jeheck Number
• :::_:. . -:::::•..-_-::-..--. -, • ----,---.:-.--- _----..: .--:- - . .••••••-:-.-.-.- :.. • -
pate
Building Permit NUMber: . .
r:- Issued:
Signature:
BuildingComraissionerilnspectorotBuildings Cate
File # BP- 2012 -0238
APPLICANT /CONTACT PERSON RANDALL ROBERTS
ADDRESS/PHONE 321 RUSSELL ST HADLEY (413) 530 -2703 0
PROPERTY LOCATION 185 CARDINAL WAY
MAP 36 PARCEL 315 001 ZONE SR(100) //WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �. /�
Fee Paid . ,ai �/VC
Typeof Construction: ADD BATHROOM IN BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 042573
3 sets of Plans / Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
I A 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
( ...--- , 2:,1,. W. -4 P i L a/ li
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.
185 CARDINAL WAY BP- 2012 -0238
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 315 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Budding DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0238
Project # JS -2012- 000366
Est. Cost: $17000.00
Fee: $1 02.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RANDALL ROBERTS 042573
Lot Size(sq. ft.): 17946.72 Owner: 185 CARDINAL WAY LLC
Zoning: SR(100) //WSP II Applicant: RANDALL ROBERTS
AT: 185 CARDINAL WAY
Applicant Address: Phone: Insurance:
321 RUSSELL ST (413) 530 -2703 0 WC
HADLEYMA01 ISSUED ON:9/12/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD BATHROOM IN BASEMENT
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 9/12/2011 0:00:00 $102.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner