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18C-093 (2) 4co D CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 4,.......--- 10/26/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).: PRODUCER CONTACT NAME: Mary Woodard Paddock Insurance Agency INC. Nn Exte (413) 253 -5555 1 ( F , NoI: (413) 256 -8354 20 Gatehouse Road E-MAIL Woodard @ nathanagencies. com PO Box 48 , INSURER(S) AFFORDING COVERAGE NAIC # Amherst MA 01004 -0048 INSURERA:TravelerS Insurance Company 36137 INSURED INSURER B : Elemental Carpentry & INSURER C: 118 Hawley St • INSURER D : INSURER E : Northampton MA 01060 _ INSURER F : COVERAGES CERTIFICATE NUMBER:CL12102601294 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ ADDL SUER POLICY EFF POLICY EXP LIMITS ILTR TYPE OF INSU INSR wVD, POLICY NUMBER (MM/DD'YYYYt (MM/DDYYYYI 1,000,000 GENERAL. LIABILITY EACH OCCURRENCE S — DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 7310 9/1/2012 9/1/2013 MED EXP (Any one parson) $ 5,000 A I CLAIMS-MADE U 6 802068 OCCUR 1,000,000 _PERSONAL & ADV INJURY $ — GENERAL AGGREGATE $ 2,000,000 ' PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - $ - POLICY P.IFCRO T LOC COMBINED SINGLE LIMIT I $ AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY (Per person) $ — ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY AUTOS NON -OWNED (Per accident) $ HIRED AUTOS AUTOS $ — EACH OCCURRENCE $ UMBRELLA UAB OCCUR — AGGREGATE $ EXCESS LIAR CLAIMS -MADE I $ DED 1 1 RETENTION $ TORY 11MITS I I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN E.L EACH ACCIDENT . 5 100,000 ANY PROPRIETORIPARTNER/EXECUTIVE N/A 9/1/2012 9/1/2013 100,000 OFFICERIMEMBER EXCLUDED? rJB2C695149 E.L DISEASE - E E MPLOYEE $ (Mandatory in NH) E.L DISEASE - POLICY LIMIT _ $ 500,000 If es, describe under DESCRIPTION OF OPERATIONS below DESC RIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION ( ller @northamptonma . gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAT THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH • : POLICY PROVISIONS. City Of Northampton Chuck Miller A O'• D REPRES -•• TA E 212 Main Street Northampton, MA 01060 ©1988-2 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) IN5025 (201005).01 The ACORD name and logo are registered marks of ACORD 4 1 r ' t 5 ' ._ i3vik Mel ___ F---- . _ ___ , ____,....._ _ E � To rc 4,.) c.. / L auAd '' "" d'i N Y 7 �f 1 x e CIA ; ii, Acv l w, r'Toet . 5 -{oral(.. lfi if , 4241 ` —= _ 51-4,1,s +d 1 51 Fl _ t t t3ea,r, %( ,41 d , ,) -f8 {�vo�- { 3 , J o r s few /Y19,� s 1 d '. i .54 o (4,0c I S ee. fie', de S », 5 �te?/" j i3ean ar (.i411 r - ___ . '''' ___ _.__ ... _____ t o o t�f f Ge Ns' Plc, _ -tor Ka-Ay / k kei1i / Cci r / Co/ s/A/Si an y3,..,_ / ' od 02 - 2- ,26 6-le4.so A/arillai 4 Ac...._ _ �. N CD N 08/29/12 5 :12:55 PM RESIDENTIAL PROPERTY RECORD CARD CITY OF NORTHAMPTON, MASSACBJSETTS EFFECTIVE DATE OF VALUE: JANUARY 1, 1998 Q PARCEL 19: 18C- D93 -001 28 GLEASON RD PLOT: LIVING UNITS: 7 CLASS: R - 101 CARD R: 1 CC 1 D. CURRENT O.%ER /ADDRESS NEIGHBORHOOD 1D: 9.00 FINAL VALUE FLAG: COSI CARSON DICK & AVADHAN LAND DATA - ASSESSMENT INFORMATION - 28 GLEAM RD TYPE SIZE INFLUENCE FACTORS LAND VALUE PRIME SITE 21140 MARKT INFL -10 147,510 PRIOR COST CURRENT NORTHAMPTON MA 01060 LAND 163,900 147,500 147 500 81.00 258,600 258,500 2 59,00 DEED BOOK: 6346 TOTAL 422,500 406,000 406,00D DEED PAGE: 233 SALES INFORMATION DEED DATE: 2D0i0B31 TOTAL ACREAGE: 0.485 TOTAL LANE VALUE: 147,500 LAST UPDATE /COST: 20110902 DATE TYPE PRICE VALIDITY 20010831 LAND + BID 224,000 0 LAST UPDATE /COST: 20/10902 79930601 LAND + BLO 155,000 F X GATE: ADDITION DATA Lower Level First Floor Second Floor Third Floor Area DATA COLLECTION INFORMATION A ENTRANCE CODE: UNOCCUPIED B EFP 531 INFORMATION SOURCE: C FrGar 576 DATA COLLECTOR: ED 0 Mnlerr 20 DATE: 19991023 E F DWELLING INFORMATION G H STYLE: RANCH YEAR BUILT: 1952 STORY HEIGHT: 1.00 ATTIC: NONE TOTTAAL ROOMS: FULL TOTAL BEDROOMS: 3 FULL BATHS: 2 ADDITIONAL DWELLING INFORMATION Half Baths: 1 BASEMENT' GARAGE(BCARS) ADDITIONAL FIXTURES: 1 o EXTERIOR WALLS: FRAME BRICK TRIM: X m UNFINISHED AREA: STONE TRIM: X N GROU110 FLOOR AREA: 1684 n FINISHED LIVING AREA: X REMODELING DATA co BASEMENT RECREATION AREA: X 470 YEAR REMODELED: m MASONARY FIREPLACE STACKS /OPENINGS; 1 / 1 v METAL FIREPLAC S: KITCHEN REMSD(Y /N) YES , HEAT /CENTRAL A C: CENTRAL AIR RAH REMODEL Y /N, Q HEATING SYSTEffffffff HOT WATER Q FUEL TYPE: GAS 12 CORD/DESIRABILITY/UTILITY /DESIRRAABILITY /UTILITY GD INTERTORR /�ERIOR GE 21 SAME AM� 31 ¢ �' OUTBUILDINGS & YARD ITEMS PERMIT DATA 19 28 2.a TYPE QTY YR SUET SI2E2 GRD COND DATE PURPOSE PRICE 24 Fr:: 6 RE) 1 2001 1 8D C A 9505 REMOVE POOL , r 25 N WM 1 1963 1 816 C A 3F 6 ,.+ HDi 1 1952 i 234 C A 24 ty�T CO c ' NOTES: 0 m Cpl CO Flemming 8 -30 -12 Key Be ; t 1 Northampton Ma. 12:52pm 1 of 1 KeyBeam ®4.600c kmBeamEngine 4.600g Materials Database 1369 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: IBC /IRC Dead Load: 10 PLF Deflection Criteria: L/360 live, L/240 total 1.250" max. LL Live Load: 40 PLF Deck Connection: Nailed Member Weight: 11.7 PLF Filename: KYB1 Other Loads Type Trib. Dead Other (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PSF) Top 0' 0.00" 13' 0.00" 11' 0.00" 10 40 Live Additional Uniform (PLF) Top 0' 0.00" 13' 0.00" 56 180 Live Additional Uniform (PSF) Top 0' 0.00" 13' 0.00" 11' 0.00" 10 0 Live -rte '� 3 _ a . r 0 . :, .41 t i x s »' _ 3 t �. g. l-f4 ... ¢ y a; , 41,1 u ` T 13 0 0 13 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall N/A N/A 2.273" 5966# -- 2 13' 1.750" Wall N/A N/A 2.273" 5966# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live 1 1891# 4075# 2 1891# 4075# Design spans 13' 1.750" Product: 1- 314x11 -7/8 VERSA -LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Connect members with 2 rows of 16d common nails at 12.0" oc Minimum 2.27" bearing required at bearing # 1 Minimum 2.27" bearing required at bearing # 2 Design assumes continuous lateral bracing along the top chord. Design assumes no lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 19608.'# 21275.'# 92% 6.57' Total load D +L Shear 5068.# 7897.# 64% 0.01' Total load D +L TL Deflection 0.6244" 0.6573" L/252 6.57' Total load D +L LL Deflection 0.4265" 0.4382" L/369 6.57' Total load L Control: LL Deflection DOLs: Live = 100% Snow =115% Roof = 125% Wind= 160% qk All product names are trademarks of their respective owners a a rot f i 3f t el, ^ -°,+:: Copyright (C)1987 -20t2 by Keymark Enterprises, LLC. ALL RIGHTS RESERVED. tots, u.c "'Passing is defined as when the member, floor joist, beam or girder, shown on this drawing meets applicable design criteria for Loads, Loading Conditions, and Spans listed on this sheet. The design must be reviewed by a qualified designer or design professional as required for approval. This design assumes product installation according to the manufacturer's specifications. Flemming 8 -30 -12 eyBe .r 1 t Northampton Ma. 12:52pm 1 of 1 KeyBeam® 4.600c lemBeamEngine 4.600g Materials Database 1369 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: IBC /IRC Dead Load: 10 PLF Deflection Criteria: L/360 live, U240 total 1.250" max. LL Live Load: 40 PLF Deck Connection: Nailed Member Weight: 18.7 PLF Filename: KYB1 Other Loads Type Trib. Dead Other (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PSF) Top 0' 0.00" 13' 0.00" 11' 0.00" 10 40 Live Additional Uniform (PLF) Top 0' 0.00" 13' 0.00" 56 180 Live Additional Uniform (PSF) Top 0' 0.00" 13' 0.00" 11' 0.00" 10 0 Live .11v ,024, a/ 13 0 0 13 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift i 1 0' 0.000" Wall N/A N/A 1.500" 6012# -- 2 13' 1.750" Wall N/A N/A 1.500" 6012# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live 1 1937# 4075# 2 1937# 4075# Design spans 13' 1.750" Product: 1- 3/4x9 -1/2 VERSA -LAM 2.0 3100 SP 4 ply PASSES DESIGN CHECKS Connect members with 2 rows of 1/2" Dia bolts at 24.0" oc Minimum 1.50" bearing required at bearing # 1 Minimum 1.50" bearing required at bearing # 2 Design assumes continuous lateral bracing along the top chord. Design assumes no lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 19759.'# 29032.'# 68% 6.57' Total load D +L Shear 5288.# 12635.# 41% 0.01' Total load D +L TL Deflection 0.6145" 0.6573" L/256 6.57' Total load D +L LL Deflection 0.4165" 0.4382" L/378 6.57' Total load L Control: LL Deflection DOLs: Live =100% Snow = 115% Roof =125% Wind = 160% Design assumes a repetitive member use increase in bending stress: 4 % y ter All product names are trademarks of their respective owners - r i " . , 4 Copyright (C)1987 -2012 by Keymark Enterprises, LLC. ALL RIGHTS RESERVED. I t: ltraiSLS. LLf ^Passing is defined as when the member, floor joist, beam or girder, shown on this drawing meets applicable design criteria for Loads, Loading Conditions, and Spans listed on this sheet. The design must be reviewed by a qualified designer or design professional as required for approval. This design assumes product installation according to the manufacturer's specifications. JAMES E. HASBROUCK " ; U !/ U L Custom Building / Remodeling � �` 125 Gold Street 0 8 4 8 BELCHERTOWN, MA 01007 / (413) 323 -8837 /PHONE to - , i DATE OF ORDER (413) 374.0375 ORDER TAKEN BY Y CUSTOMERS ORDER NUMBER TO .F'. t 11 ' ❑ DAY WORK ❑ CONTRACT ❑ EXTRA 0 dr � JOB NAME/NUMBER JOB LOCATION /ior'f M , 4erl , pj A Q/ e06 a JOB PHONE STARTING DATE ,L fe TERMS: ���,` i Q r„ L�.+ n ..1rv... �xi 5.m r, a MATERIAL , l c.. _,.. ai .,.:: 11 6 F7vor 1 04,1- /15' t( zl p 1 � ?It" ,f RSA - L4� ►ee ) C Ke dew, se Ivictiefici(j a y 0 7o .c/o 1.44( 1 50 /70 OTHER CHARGES C 4- cicrtfz. T[w 4Ad ad/ it" " -6041 5 a 4d es/5 fic -A)4, 4, n - to a /& x- Lee} , MCiteircvej Ov. LL J., 4`,40' TOTAL OTHER � e: f Pefmd '" ,4, f u Ce LABO FIRS RATE AMOUNT > j r fcc,N,4 4cLI (1cttt on duar Iv 5er 4. C(ec r,'ce i gAz,( TOTAL LABOR DATE COMPLETED TOTAL MATERIALS TOTAL MATERIALS TOTAL OTHER Work ordered by gnarl/061V TAX Signature TOTAL Si r I hereby acknowledge the satisfactory completion of the above described work. SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: r / L Nott Applicable �,// ❑ Z Name of License Holder : �'r9� } (� 456'0 4- i /� ( .- • 0.5 1 3 License Number /2 S &'lc( 2Z IC 4 C. - 7 (4-111 � ? (')/ a I / / /`/ Addr ss / Expiration Dale r I r4 -414 ` //J - 31`/ _U 3.� j.- Sighature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ � / / )t') Company Name Registration Number r// %/2 Address Expir tion ate 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 li" No ❑ 1:1 '� -.:'a H © rne- w E xemg ion 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) ri Roofing ❑ Or Doors C] Accessory Bldg. ❑ Demolition ❑ New Signs [D] Dec Siding ] Other [X]] r. i v -" "" irfiji > - .1. - 4 - 7 .c /•i — % - Brief Description of Propose Work: ge ( WW1 Wood.► � With I-AtM 1210.4 iv i, prou�e t t,,d /t,00w,,12ePracing wu.tt5 +ceilin4 • u i 44°7 'tZM 51 S5.444- Alteration of existing bedroom Yes -( No Adding new bedroom Yes X No J Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll - Sheet 6'a. If New house and or addition to existing housing, complete the following: /l1�A a. Use of building : One Family X 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 APPLIES FOR BUILDING PERMIT I, [30A-6 tea- 9. k e (1 y , as Owner of the subject property / hereby authorize �( ewe. ewlto. Cavp�,vtfj -t CSI 51 rcwf2 m . -I / to act on my,.ktehalf, i all .tte ; lative�vs ork authorized by this building permit application. 1 ' \ Apo ( V 2 54 Z.. Signature of swner Date BCIAba.4 , 1 K2.1( , as Owner /Authorized Agent hereby declare thaT the statemerit and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed unde,(he pains and penalties p r ury IL 10 r Print Name A 3 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 in by Building Department Lot Size 0. $S ._.._.,, ` L. ._ . ........ V ...... Frontage t , r . Setbacks Front f Side L: =_ R.. L: R. ,. Rear 1 __J Building Height ( Bldg. Square Footage x 3 % " "Y Open Space Footage (Lot area minus bldg & paved 1 1 parking) # of Parking Spaces - - 1 Fill: (volume & Location) 1 ' A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW a YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book ! Page, and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW Q YES Q 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 0 NO IF YES, describe size, type and location: 6_..... _ . _, _. . D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO r 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 Q NO • IF YES, then a Northampton Storm Water Management Permit from the DPW is required. RECEIVED ° "' rr � � I I „� II �NIN�11 r n Nlulll'IIII�ViIIlu "",I��, I1 > City of Northampton �{{I'4# "111111 �f 1i 'r' °III' "`� � �I II V liitll+ � I '��2*�' x�u" itiF NI r I u h 1 1111 1 Building Department CI r ,1111111h1iI'uiIu P 1 w 11 au 5 2012 212 Main Street 1j rl tc l i b `1 P1 i11111r III Room 100 � Illr bl �� 11 J� 1 tl I `` III r u I I I +� rr I D'-rPT.OF BUILDING INSPECTIONS Northampton, MA 01060 r111V1111 �� �Itlr 11plll'1i'�W1 °rllii�� NORTHAMPTON, MA 01060 _ "�. i 1 rspl i1 Ip r 11w J � to � t it P1h16'iu 1 lury fiu r r N F F1rNu p pnone 413- 587 -1240 Fax 413- 587 - 1272 th rI °1v 1rl11 N1111 %1 01 " iWR 1 yGl 1 "re u1 Ili M 1Vg111 u u .�,s�� , �m �W .,.��r. WuN IIW 1 ���i i iN`'A s �. �}"'� ..• ^�° ,1N ". "E v iINW.m r^ h. 1 'Ii1� 11 19PI 11 11 hl 9» ��N� 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 g 6 k c so y Pei Map Lot Unit A /Ord - hGm P -3-°W) � ' ' Zone Overlay Distr Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ,2 ' "i T , ��� rnAri g 62l�a ron, 12c/ Name (Print / Current Mailin Addr / v/ / CO Telephone Signature 2.2 Authorized Agent:: ( j/� 9 / /{ V � 'L I � C l '� �, . / I ; S b f C'+1 ( . ( J °'.�� � G. /L YLI� ° "`:. 1 Nam; (Print) if/� Current Mailing Address: +tom G� 1 4p //.3 3 7 — c . 1 ature Telephone ECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant (a) Building Permit Fee 1. Building $5'83 2. Electrical (b) Estimated Total Cost of H /A Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) N'A 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0441 APPLICANT /CONTACT PERSON JAMES HASBROUCK ADDRESS/PHONE 125 Gold Street BELCHERTOWN (413) 323 -8837 PROPERTY LOCATION 28 GLEASON RD MAP 18C PARCEL 093 001 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 �a �� Fee Paid Typeof Construction: REPLACE BEAM /ADD COLUMN,ADD WALL,REPLACE BASEMENT SHEETROCK/CEILING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 53135 3 sets of Plans / Plot Plan THE FOLL WING 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 A5 Signature of B ilding 0 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. 28 GLEASON RD BP- 2013 -0441 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 093 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 -0441 Project # JS- 2013 - 000707 Est. Cost: $5830.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES HASBROUCK 53135 Lot Size(sq. ft.): 21126.60 Owner: TWENTY EIGHT REALTY TRUST /BARBARA KELLY Zoning: URB(100)/ Applicant: JAMES HASBROUCK AT: 28 GLEASON RD Applicant Address: Phone: Insurance: 125 Gold Street (413) 323 - 8837 BELCHERTOWNMA01007 ISSUED ON:10/29/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE BEAM /ADD COLUMN,ADD WALL,REPLACE BASEMENT SHEETROCK/CEILING 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 10/29/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner