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42-095 FROM : FAX NO. : 5292176 Dec. 11 22)12 09:56AM P1 T ------ 1 . — . , ... _ _ . RECEIV. • , 1 a 1 DEC I I 20i2 1.4 • 4 DEPT. OF E.JiL., ' 1\,f- E710N Z•4 Z.': NORTHAMPTON MA 010b0 0 a N ,•• -i- 1 el _ ___ 'fc-- i 1 , I I • •• ' / I 1 , .. '., • I ' i.-- ...1,.. t 1 P ; 'I ■ :4, ' 1 1 t ).".."' ) : S, ' ' i 1 _____—_• f I I r r ■ k , 4 . 4 014 4 0 1 0 • - NUL w riiiama*. , 4 : ../............ t• _ i I I . 1 t ;42 , L 1 1 . , t , , 1 6 i 11 I i ; r N-------T--- 11, 1, ,-, __ 1 1 1 I I NA 1 1 1 1' IL I".0). A71"14 1 Cv\ofAc, 1-'1 Vi-LE- g.._. -- F - - : : , KV - bC - -7 Z2(,) C:11.__.e\„\NLE City of Northampton ` L i 4 , -ata�` Massachusetts w � "Y s '� lf �, c u y X�,r a: U °, h . m' DEPARTMENT OF BUILDING INSPECTIONS w ?,, 4 212 Main Street • Mu Building Jti ' - � Northampton, MA 01060 SS` y� 3 S k~ ~C INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts --- Department of Industrial Accidents Office of Investigations R 2t 600 Washington Street ig •_-' Boston, MA 02111 • www.mass gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Legibly • Name ( Business /Organization/Individual): •TPE m Address: ?o S tZk City /State /Zip: C1 �1 D tJ # . Phone #: 13 529 -- 21 7 6 Are you an employer? Check the appropriate box: Type of project (required): 1./I am a employer with 4. n I am a general contractor and I 6. n New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietdr or partner- listed on the attached sheet. 7. Bike—modeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' Y P h 9. ❑ Building addition [No workers' comp. insurance comp. insurance.T 10.❑ Electrical repairs or additions required.] 5. n We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their 1 1 . ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: .t Q,P1 f X12 S Policy # or Self -ins. Lic. #: ,1V qj 5 3RS L J'B Expiration Date: 3 -1 3-°1 3 Job Site Address: 72.0 (7L F s4 f ec City /State /Zip: -fa) e,Y.1'i` 1 4- p IC) 6 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certefy under the pains and penalties of perjuiy that the information provided above is true and correct. Si • Zature: Ai I ' Date: Phone #: 4 t 3 `' 2 — C 1 " a 7 - Official use only. Do not write in this area, to be completed by city or town official Cit or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder : 1 IPk t''E `S License Number :1'40 1 rAa3e, `JI' . 1• r?t)t.1 1 VA Pt Address Expiration Date jC?-)ertfrusk, 3 Z. - - ; - 2— C t 2A 1c3 Signs" to Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ HAteX V.C12 Company Name Registration Number fir • 44� > (r' 2 \ 3 Address' Expiration Date 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 buildin rmit. Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption 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 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 buildine 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 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 /• o . &.C. i Frontage itO 1 Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage /_O Open Space Footage (Lot area minus bldg & paved parking) �" # of Parking Spaces t.J Fill: (volume & Location) (/ A. Has a Spe ial Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW © YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 NO CJ IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing El Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs ID] Decks [p Siding [01 Other [d] Brief Description of Proposed _ Work: 1 jr` j _alT�iZt ^14; iki- , t o W70 CAP—>i 1.3 1 t Elkl� tJ L — y2.i 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 house and or addition to existing housing, complete 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. 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, c , as Owner of the subject prope her by authorize to c t my be alf, ifi _ .. -tters relative to work authorized by this building permit application. k Signatur •'^ - r/ Date V- k1 D1`_ , 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 underr tthe pains and penalties of perjury. Print Name ;PMC)1■3 11 Signatu o er /Agent Date - - Department use only RECE `� wn_%__, of Northampton Status of Permit: !Building Department Curb Gut/Driveway Permit NDV 2012 2'12 Main Street Sewer /Septic Availability ' l Room 100 Water/Well Availability DEFT. On: c North mpton, MA 01060 Two Sets of Structural Plans NO F+i! " " -5 -1240 Fax 413 -587 -1272 Piot/Site Plans 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 d 2.4) (1 -14 , g Map Lot Unit T `D —, �� �- '/ `� Zone Overlay District � iet %' Elm St District CB District ' SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.10 r of Reco ) cr�nis /C��T,0r ('Q O /U&S -- 11111'I S�.ESc2 AreSnic`ta V.2 I�IaS / '7ut a)e-f4ke/ Na Current Mailing ress� 0 ` G2 Telephone 3 Signature rm.- if 2.2 Author d Agent: Age -, �� 2- 5 '?Ake. .. C - F"ikN Name (Print) Current Mailing Address: • 11 :..-A. e Ill►.li`. 0 '-h 11 52si -z.1 b Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building L , (a) Building Permit Fee 2. Electrical ? , (b) Estimated Total Cost of 4-0() Construction from (6) 3. Plumbing ?, 600 Building Permit Fee 4. Mechanical (HVAC) (rt f 5 CJ 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) SZ ?, ic0 _ Check Number c$ o 31 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0610 APPLICANT /CONTACT PERSON MARK BONDE ADDRESS /PHONE 205 PARK ST EASTHAMPTON (413) 535 -9529 0 PROPERTY LOCATION 220 GLENDALE RD MAP 42 PARCEL 095 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid ‘—.?// 3 3• c) Typeof Construction: MOVE INTERIOR WALL,NEW CABINETS,HEATING & TRIM , `t tee New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included: Lel Owner/ Statement oicense 67758 3 sets of Planfri -Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved 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 ►. - olitlon lay 4 7 44.4 _ 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. 220 GLENDALE RD BP- 2013 -0610 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 42 - 095 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catenory: renovation BUILDING PERMIT Permit # BP -2013 -0610 Proiect # JS- 2013- 000987 Est. Cost: $50600.00 Fee: $303.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: . Use Group: MARK BONDE 67758 Lot Size(sq. ft.): 52272.00 Owner: BRESNAHAN SUSAN & DENNIS RABTOR Zoning: Applicant: MARK BONDE AT: 220 GLENDALE RD Applicant Address: Phone: Insurance: 205 PARK ST (413) 535 - 9529 () WC EASTHAMPTONMA01027 ISSUED ON:12/12/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:MOVE INTERIOR WALL,NEW CABINETS,HEATING & TRIM 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 12/12/2012 0:00:00 $303.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner The Commonwealth of Massachusetts ` -- Department of Industrial Accidents .' ;� ,. - 0` - . = Office of Investigations , `, � 600 Washington Street Boston, MA 02111 '`:',.%::..?, www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /PIumbers Applicant Information Please Print Legibly ,, � Ai Hanle ( Business /Organization/Individua]): ( /�' � �� — Address: City /State /Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 4. I am a general contractor and I 1. El I am a employer with 6. ❑ New construction employees (full and/or part-time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub contractors have 8. [1 Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance. iquired.] 5. f We are a corporation and its 10.0 Electrical repairs or additions m a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions W A' myself. [No workers' comp. right of exemption per MGL 12.E Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City /State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day aga' e..t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigatio the DIA '• insurance coverage verification. I do hereb rti und: i : • ' • ; : • • 'ides of perjury that the information provided above is true and correct. Signature: i Date: /-- '1 ` Phone, #: 1 //3 3ae9 , 2 b • , Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) ' - Independent Structural Engineering Structural Peer Review Required • Yes 0 No Q SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i 7 I, 1 1 I � ...... -4 . � .a , - � . i _ _ _ _. _ a Owner f the subject property hereby authorize �� act on y behalf, i all ers relative t. .r tlaertzel by this building permit applica Signature of O - 'WI" ,- Date / hereb declare that y the statements and information on the foregoing application are true and accurate, to the best of my knowledge ~. belief. Signed under the pains andpenalties of erju . Print Nam: `, Si +nature of Owner nw,e MINI' - Date SE • ■ - • NSTRUCTION: SERVICES 10.1 Licensed Constructs u.ervisor: Not Applicabl- • Name of License Holder ._ -„ d.._ ,. __ . . _. - ....m.... .... .........., _ Lice : - Number Address..., .. ..._.._......._.:._. ._ . ... ....... .._...__......._...- _.. Expiration Date __ , _�� gnature�Telep • e � i SECTION 13 - WORKERS' COMPENSATION INSURANCE • !DAVIT (MG.L. c. 152, § 25C(6)) • Workers Compensation Insurance affidavit mu e completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi ermit. Signed Affidavit Attached Yes 0 No 0 Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN' AND CONSTRUCTION SERVICES - FOR BUILDINGS STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF EN,LOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number y .__ __. S ' Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone • Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by honing This column tore 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 i =" Fill: (volume & Location) A. Hasa 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 0 YES 0 ._.._, IF YES: enter Book " Page and /or Document #! B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 W 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: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. WII 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE : , Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other 0 Brief Description Enter a brief description here. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE VSE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ `r= A- if- A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F -1 ❑ , F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify:: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING! RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: _v__ __ _ __.,__, _. __ _.. Proposed Use Group: Existing Hazard Index 780 CMR 34): _________ _____ ,_ . Proposed Hazard Index 780 CMR 34): , __.._ ._..__.___._ . _ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 sc w...___.. 1 --.md —,_ -. 2nd _ 2 nd ,_ _w...,. 4 h 4m , Total Area (sf) Total Proposed New Construction (sf)_ Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone ____ ,, Outside Flood Zone❑ Municipal 0 On site disposal system r] Version1.7 Commercial Building Permit May 15, 2000 A o : e D v onl City of Northampton StiataatPerrri+t F S ; ` r Aa `t , Building Department curb Cut{Dnveway I?e it F 212 Main Street SewertSeptil ailabiitty I ni Room 100 afe C A ityN p $ w v Northampton, MA 01060 T , S teofi strict cai4Plansg6 N4 d g A IO phone 413 -587 -1240 Fax 413 -587 -1272 PIo Plart Other Specify r APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCU NCY ANY B ILDING OTHER THAN A ONE OR TWO FAMILY DWELL G ' ' ���° - � I SECTION 1 SITE INFORMATION 2013 This s do to be completed by o 1.1 Property Address: (Z , (` U l=- -) L ilk" C � 0 Map .LntNCa H� rTo knit oye-h C i n 1 / _ Zone Overlay District Y'� 0 tl� CB District - �.,_. - ...�._. Elm St. District... SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT • 2.1 Owner of Record: Name (Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: D �. "' t . .__. _ ".�. -._ _. ' Current Marlin Address Name (Pant) �; Signature `_ �►�i/ Telephone SECTION 3 - ' ESTIM • E ! 4I PSTRUCT(ON COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant _ 1. Building (a) Building'' Permit Fee 2. Electrical --' __. n rr _ (b): `Estimated Total Cost of Construction from -(6) ._...__._ __..__.._,_ __.. .. 3. Plumbing ; Building Permit Fee 4. Mechanical (HVAC) " `._°°.'_ "'"".."_""".".,_`"" '." 5. Fire Protection _.,.__.. _ .,_,.__" 6. Total= (1 +2 +3 +4 +5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date • 220 GLENDALE RD BP- 2013 -0610 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 42 - 095 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 -0610 Project # JS- 2013- 000987 Est. Cost: $50600.00 Fee: $303.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 52272.00 Owner: BRESNAHAN SUSAN & DENNIS RABTOR Zoning: Applicant: BRESNAHAN SUSAN & DENNIS RABTOR AT: 220 GLENDALE RD Applicant Address: Phone: Insurance: 42 MOSELEY AVE (413) 320 -8626 0 WESTFIELDMA01085 ISSUED ON:12/12/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:MOVE INTERIOR WALL,NEW CABINETS,HEATING & TRIM 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 12/12/2012 0:00:00 $303.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner