37-001 (12) ( 1
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LIVING AREA
394 sq ft
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder : 5 � c t/,.// ✓�f` 2./) OK6 /8 `7
License Number
CJ,r�h
SS% /0 24 �r�S
Address Expiration Date
•
Signat e Telephone
rove` c : L -Contr.. 5.4= ', .. Not Applicable ❑
%r'c,4 `D., /2u (o
Company Name Registration Number
1 ; c �►n?, � L D C 6' .fro, //, /Cr c�
Address Expiration Date
s ' , 5 7 / ch c ,/ 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 ❑
1, l'41140 l l �, , .WIta . KiXeMIUlan
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
4 K ttAXt P2
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• -- P `` t•' "� 61 JRcasachttsctts -
/ ^f 1 �ti �
- cc> DEPARTMENT OP BUILDING INSPECTIONS
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Main Street Municipal Building t�
Northampton, Mass. 01060 r'
WORKERS COMPENSATION INSURANCE A.FF'Ii)AVTT
.i (7G . „✓1 `� cv, )1 )16
(liccnsce/permittee)
with a principal place of business/residence at:
(s tr ct/ci ty /scat e in p )
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all ooa ran.o s)
( ) I am a sole proprietor and have no one working for me.
( I am a home owner performing all the work myself.
NOTE: prose be aware that while homeowner, who employ persons to do ma %r+t rte, 000sruuioo or repair Voris on a dwelling of
not morn than throe units in which the bomoowncr resides or co the Bounds appurtenant tbccto art not generally oomidcrcd to be
employers under the worker's compensation Act (GL152 e11(5)), application by a homeowner for a license or permit may evidence the
regal atasua of an employer under the Work is Compeoaatioa Art.
►.. I understand that a copy of this eEalcroc t may be forwarded to the Depertmooa of Industrial Ancidmtn' Offroe of lnwrsooe for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 cm (cad to the imposition of criminal penalties
coosistirg of a fine of up to S1_500.00 and/or imprisonmeat of up to one year and civil penalties in the form of a Stop Work Order and a
n1=0(5100.001 day against me
J
Foc ..w.::.._- dJtasc coly
�--� Permit Number
MapK Lot
Simla turn of t irrncrr/Permittrr Late
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s);1 Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: ! c fit, &' 4/ << (t'1 `' ) 11)4 f 1'4}641 ‘c"C'Yii"iQ (' :I 41i S '131//
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative ❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet ❑
6a
If New - h+otse anid: addition tc ,_e> fisting l ng. cernptete the following:
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. Mascheck 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
— DLi h h o , as Owner of the subject property
hereby authorize 5 J to act on
my behalf, in all matters relay - to work authorized by this building permit application.
✓�. —d/ -/A1110 _ /a
Signature of Owner Date
, 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
Signature of Owner /Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO X. DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO '4� _ DON'T KNOW
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 NO ,(
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:_
City of Northampton so
Building Department p
B t D A'
s s q
212 Main Street vvisep, > a r
Room 100
Northampton, MA 01062 Te ! �'r
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phone 411587 -1240 Fax 413 - 587 -1272
rfi. -, -- •__.,.__ N ,,. , .� .rpax „— ..r fi 6.1/441
APPLICX tO Mile et Iiiittft ItEPA/R,I 0 ATE=0 DEMOLISH A ONE OR TWO FAMILY DWELLING
.` T 1 9 "
OCT i �
SECTION 1 -11TE INFORMATION
,_° j This section to be completed by office
I
1.1 Phyperty Address:
r-- Map _ Lot Unit
Zone Overlay District
Elm St. District CB District
SECI"2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
cI;r,J ` .,h II s3_/ l2 ,
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection ree)
6. Total = (1 + 2 + 3 + 4 + 5) /a „5 Check Number //
This Section For Official Use Only
Building Permit Number: Date Issued:_
Signature:
Date
Building Commissioner /Inspector of Buildings
File # BP- 2005 -0476
APPLICANT /CONTACT PERSON RICHARD DENNO
ADDRESS /PHONE 551 FLORENCE RD FLORENCE (413) 584 -0852
PROPERTY LOCATION 551 FLORENCE RD
MAP 37 PARCEL 001 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �� 6 4t3
Fee Paid
Typeof Construction: REMODEL KITCHEN & LIVING ROOM & REPLACE 3 WINDOWS & DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 066189
3 sets of Plans / Plot Plan
THE FO OWING 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 Commissio
.2 7 /4c0 117 (—
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.
V/4 f
/e/f-rid
551 FLORENCE RD BP- 2005-0476
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37 - 001 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: BUILDING PERMIT
Permit # BP- 2005 -0476
Project # JS- 2005 -0627
Est. Cost: $10500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD DENNO 066189
Lot Size(sq. ft.): 40467.24 Owner: DENNO KAREN H
Zoning: SR Applicant: iUCHAi:., i E :NO
AT: 551 FLORENCE RD ,
Applicant Address: Phone: Insurance:
551 FLORENCE RD (413) 584 -0852
FLORENCEMA01062 ISSUED ON:10/21/04 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN & LIVING ROOM & REPLACE
3 WINDOWS & DOOR
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: , / u .440%A 1 / House # Foundation:
�> ( , . l Driveway Final:
e6.13 8 > 1 4 Final: ,/, f�' b _5� i F
riTc t- r,(0< i t
/0 3/03712/44P. Rough Franie:49 g-/-05-----/
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation: d k 2.-1-o 3-_
Final: Smoke: Final:Ot 6, -z'G „0 5 �p�
THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy '
ccupancy ' -�' �" Signature:
FeeTwe: Receipt No: Date Paid: Check No: Amount:
Building 10/21/04 0:00:00 1830 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo