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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable le
p ❑
4
Name of License Holder : V .1 a - eq ' c J / 7 / f a
^// License Number
Co Suii4�'.`,1 Li"1 , �j4u/„, ma-z • a/o-CC .3/2y/20/,2.
Addre� Expiration Date
;Xi
Signature Telephone
9 R;et #5'tet s 1461 - i tit#"i in Ci nlr�lot#sri gieigi a :i ce. " Not Applicable ❑
64e _-, Pu,3G 1-5'6 ?a0
Company Name Registra on Nu r
_c0 S(4 P i , Ln Lail �v (• f�i oS "77O.51 .,6 //
Address Expiration Date
Telephone
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 X
11,4/Kg mIOw M-
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 1083.5.1.
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 1174
Or Doors D
Accessory Bldg. ❑ Demolition El New Signs [0] Decks [I] Siding [0] Other [0]
Brief Description of Proposed yr ll�
Work: 5 A—b, -40 /� R Pet' C i pir o i- Poe F
Alteration of existing bedroom Yes N No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes / V No
Plans Attached Roll - Sheet
0Of l ri tine lita tialig t . ~r g
. a � ncllialiiiiWthi1611ciWr:
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 RA APPLIES FOR BUILDING PERMIT
property
V as Owner of the subject
CC -
hereby authorize 0. c y J t e Lk,
to act on y be alf, in all matters relative to work authorized by this building permit application. VA 5 lib
Signature of Owner D ate
I _--i� // , 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.
GAR., 7 ‘ P. d',..----
Print Name n
,cwt, l
Signature of Owner /Ag */01-6/40
te
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 1 q Sq2 RS6 ' "
i p --,
Frontage .
Setbacks Front i
t f I I
1
Side L R I L: J R:._..... . ,
i
Rear = Ell
Building Height f
Bldg. Square Footage F-1 i % F.--1 i €
Open Space Footage
(Lot area minus bldg & paved 1 t 3 ' ' _A
parking) •
# of Parking Spaces i .m._ --
Fill: I �.. . a .b. _. a ,
(volume & Location) i ',`
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 el YES 0
IF YES: enter Book E Pagel I and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO V 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 1
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 e
IF YES, describe size, type and location: a
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 ® NO (►
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton ; °° ,;' 4 � , ,
Building Department , 1 i L's... � fl
212 Main Street 1
'
�`�� Room 100 ;� �,„ , '
k--V.\ 2 ° a orthampton, M A 01060 s '4 Y �� $ : ,
k � a F ..` '� { (�,�Y
phone 4,,3- 587 -1240 Fax 413 - 587 -1272 I
APP 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
a�.,,��. ,4 S S Map Lot Unit
i
=:bane Overlay District
o ,07Yy '1 1' 5.
4 Eire St District CB District
SECTION 2 -: PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 5- S (4 q e e, 7Jl' Li-L,
-, 1€ L,,tJ4W, inms, 0/ o6
Name (Print / 40, / Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent: ` P( ‘4..... Lam+, i� i (k. t..1 ✓l o •Z )- r� u r +S
Name (Print) Current Mailing Address:
—� (44 (3 ) skC9- 411
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building Pe ` F. , q r 0 co., - (a) Building Permit Fee
2. Electrical g :-__.
(b) Estimated Total Cost of
ss.te;% Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number %17(,3
This Section For Official Use Only
Date
Building Permit Number., Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
25 WILLIAMS ST BP- 2010 -0946
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 259 CITY OF NORTHAMPTON
Lot: -001 PERSONS CON 1RACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0946
Project # JS- 2010- 001405
Est. Cost: $9000.00
Fee: $35.00 • PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GARY J RUEL 97190
Lot Size(sq. ft.): 4399.56 Owner: KATZ ELIZABETH D & LETICIA S MUNOZ
Zoning: URC( ;. Applicant: GARY J RUEL
AT: 25 WILLIAMS ST
Applicant Address: Phone: Insurance:
50 SUNBRIAR LANE (413) 519 -5465 WC
LUDLOWMA01056 ISSUED ON:4/28/2010 0 :00:00
TO PERFORM THE FOLLOWING WORK: STRIP & SHINGLE 2ND HALF OF ROOF
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:
Rope t: Dil: Insulation:
Final: Smoke: Final: oft 6114110 Ill •
S
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLLATION OF
ANY OF ITS RULES REGULATIONS. + j0u '
,� 10
�7 • r�
Certificate of Oettrarny / ti,/(c) (a ignature:
FeeType: Date Paid: Amount:
Building 4/28/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo