34-025 (2) SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervise : Not Applicable ❑
Name of License Holder : ..•. � . (0 07//40
License Number
✓ fir �.-` � � / t1 �) e0.-- ,14 6774 ��ZB // s
Address Expiration Date
! /Or.: = Y/3
ig , : ture Telephone
9ti'l is HO lri' i ninon ttr ctort No Applicable
= 04 , 4- D cR •ss G.w.. 6:., e t e ❑
p / j- ab
onrbanv Name Registration Number
s4 ,ct �.. f o 6 (///
Address Expiration Date
Telephone 9i.5 S /z 1
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 ❑
.• i W t Ennaiititell
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 [El Siding [El] Other [O]
Brief
Description e., o i. /�� / M ��
Work: rte., �(„!✓/ s�yr "� �/
Alteration of existing bedroom Yes v /'" No Adding new bedroom Yes !/ No /'
Attached Narrative Renovating unfinished basement Yes ,/ No
Plans Attached Roll he
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Num•er of rooms in e- h family unit: Number of Bathrooms
c. Is the - a garag: - ttached?
d. Proposed • • uare footage of new construction. Dimensions
e. /Nu % -r of storie
f. ethod 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, Pk !/+ J Cok'C4._ , as Owner of the subject
property �p
hereby authorize 0 Yew
to act on my behalf, in matter -lat v- - • • - thorized by this building permit application.
r
ure of Owner Date 11
I, • , as Owner /Authorized
A ere declare that the statements and in ormation on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
� (74 -4-�. Ce.4 5
Print Nam
7/ ' 17 / /
Signature er /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 in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage l
Open Space Footage
(Lot area minus bldg & pa4c1
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ev een issued for /on the site?
NO 0 DON'T KNOW 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 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 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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc ion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department OM only
RECEIVED City of Northampton Statue of permit:
Building Department Curb Cut/Driveway Per nit
212 Main Street Sewer/Septic y_ ,
JUL 25 I Room 100 Water/Well Availability
• rthampton, MA 01060 Two Sets of Structural Plane
DEFT. O BUILDING INS 41 - 5 87 -1240 Fax 413- 587 -1272 Piot/Site pl
NORTHAMPTON, MA 01
Other Specify
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
lJ r Ti..r�2.y K, t4 f . 4 Map Lot Unit
.4. 44.4 ,a� 'L Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
( _■PA Co A
N ame (Print) Current Mailing Address:
Telephone
I he c f/ st9
2.2 Authorized Agent:
5/c194,...— , t2• s t 3 G S • 12
Name ( int) Curre nt Mailing Address: //
Sign ure Telephone G1 / S3 rd Y.
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /Myl � uJ (a) Building Permit Fee
U
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing 3 2 ,,cJ w Building Permit Fee
4. Mechanical (HVAC)
- —
5. Fire Protection
� ll
6. Total= (1 +2 +3 +4 +5) /� `7- Check Number 3 7a 2
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
A
File # BP- 2012 -0102
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 O
PROPERTY LOCATION 105 TURKEY HILL RD
MAP 34 PARCEL 025 001 ZONE RR(100) / /WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 3/7 7z), do
Fee Paid
Typeof Construction: REMODEL MASTER BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF� PRESENTED:
A 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
• elay
nature o Built g • ficial 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.
•
105 TURKEY HILL RD BP- 2012 -0102
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 34 - 025 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- 2012 -0102
Project # JS- 2012 - 000158
Est. Cost: $11700.00
Fee: $70.20 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 145926.00 Owner: COHEN DAVID G & DONNA M
Zoning: RR(100) / /WP Applicant: STEPHEN D ROSS
AT: 105 TURKEY HILL RD
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 -1224 () WC
NORTHAMPTONMA01060 ISSUED ON:8/1/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL MASTER BATH
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 8/1/2011 0:00:00 $70.20
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner