39A-018 (3) -
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4
e - DEPAP OP BUILDI IC INSPECTIONS •
212 Main Street - Municipal Building
Northampton, Mass. 01060 .
WORKER'S COMPENSATION ONSURANCE Aib Yll .)A \'-iT
(iicws. -xJ u - tics)
v, -jib a principal place of business/residence at: —
(phone
— (s t/ri t- J /suizh p)
do hereby certify, under the pains and penalties of hai
( ) I aril an employer providing the foilowing'worl:er's cotnocasadon coverage for in'
employees wori on this job:
(l surmc Comm.') (Policy NL�bcr) (" DzL.) .
( ) I am a sole proprietor, general contractor or homeoWner (circle one) and have hired
the contractors listed below wbo have the following worker's comoe,nsanon policies: .
/''� D
(Nuns of Contractor) (Instranc;. COiT101IT`j / PGi.i Ci �`�t ilII'krC'} t i_'.J1Fd;?Qt }
(Name of Con (lns rancc Company/Policy Number) (a Date)
- -
(Name of Cm:Immor) (Insurance Compan3-/Poticy Nurnbu) (E.iPiroon Datc)
(Name of Contractor) (I rural c Comcatiy/Policy Number) (Expiration DasL),
(ar -icj-t .iocii.! i±,- if acccssic w inc s& iaforta,- oa pcta:ril s to .1.1 ooc --c.o a) .
( ) I ana _ a sole - proprietor and have no one wori;3ng for me.
`y' I a >t, a ho owner performing all the work myself-
NOTE_ plc: be s '''..21c t5,,. t+Jc bccar vets a.bo c pcRCa to da r ,--",---,•-•--, cr _ oo c T , •mX an a d of
ont
or maw= ttt:.a L rtr_ amt's is Ix the bomoo+ vac rued= or co du crotts43 wintrtc = the - ....o _z ox s madly arsd. - oi to tie
citPloy^ U the ,- o;i:&: - .--+=o Aa (GUI S L's 1(5)). applicraoa by a boarAo• fc a ti c a t,•-. wit maty c -idcocc tbc.
Ic-.! et-J,r of ea c= ploys under the Woricolt Co . pam.iioa A .
I uodc>zaad the a copy of this cztrmma may be foe,n riled to the D•.«rtmcd orlada-=r4.1 Ann ore O Soe o f Ita moo. for the
cove -a ve eioa and t1 t L to s4=urc borera o trot -- t of 2.3..& of MOL 152 Cad 1od to th sition of cimitsl pcoallics
cocni:3 of a Lice of up to S 1 300 -00 ata'tror i tsoe -• orup to ooc y-_� ear', evil pcail-ua in tx form or. Slop Work Ordc and a
fi= of S100.00 s day ap.in i ii
r t c i. i V For dq.rt::a s1 vac coil
Stpaan of Li sr_..IPcrrni . ate -- -
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition ,. Replacement Windows Alteration(s) Roofing n
�
( rcr Or Doors El
Accessory Bldg. J Demolition New Signs [0] Decks [0 Siding [0] Other [0]
Brief Des ription of Proposed i
Work: M� +
P ri1lD fl C`PiN�CIJtxA Co r �
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓No .
Attached Narrative Renovating unfinished basement Yes f—l�o
Plans Attached Roll - Sheet
sa_e ddioo eacrs'r'n cfiasinc;�catteehfoFf u� rr� r
a Use o f b • 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 Ta - OW 'AU
NERTI-IORIZATION TOBEGOMPLETED WHEN
OWNERS AGENT OR APPLIES`FORBUILDIN'CPERMIT
!, S-T '� e_N\ A , - ( c-ipa f C3'C r- tt 5 c■\ 1 0_1_1—_ , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters reeAtive to work auth95 ze by this buildi g permit application.
Signat re 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
ck
City of Northampton
Building Department
212 Main Street
:7,7'
Room 100 e 211
2ito
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
leth
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1.1 Property Address:
(0{13h-i- aili2iitke •
Nor*axelon ,MOL
OIDGO
SEC PROPERTY'. OWNERSHIPfAUTHORIZEDAGit
2.1 Owner of Record:
Pc\
S+e-0"}-ei^) e_airn ne COM YIP I I cl Wfiqi/r1- Q k 1Wio&, ffk
Name (Priift) Current Maili Attidress: at/63
913 -- ..5gzi-70 4 -/
Telephone
Signature
2.2 Authorized Auerit:
Name (Print) Current Mailing Address:
Signature Telephone
. ' •
:SECTION ESTIMAtEG:CONSTIIUCTION :COSTS:
Item
Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
. . .
1. Building -f(a) Fee
2. Electrical ; 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
9c/ j
.This SectiotifdrOfficial Use Only
Buildina .`
u .
„ . .
Signature:
Building Commissioner/Inspector of Buildings Date
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File # BP- 2006 -0896
APPLICANT /CONTACT PERSON O'CONNELL STEPHEN A & CAROLYNNE O'CONNELL
ADDRESS/PHONE NORTHAMPTON (413) 584 -7047 0
PROPERTY LOCATION 9 WRIGHT AVE
MAP 39A PARCEL 018 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 97oQ
Typeof Construction: DEMO & REMOVE2 CAR GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PASENTED:
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
P
Water
Septic Approval Board o
Well W a Potability Board o f H
Sep h tic 1 proval Board of Health
..a v
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm S t Commission as===.„ Az 4 0, 4 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.
. w
DEMOLITION REVIEW APPLICATION
Activity Tracking Sheet
Prope ■ •4,,. 1
Map Pi Parcel 01 •
Received i Building Department:
Referred from Building Department:
Action Taken/ Northampton Historical Commission
Action Taken By: Entire Commission
i/ Sub - Committee of the Commission
Commission Designee/ Staff
Date Action Taken: 4 /L(D Initial Determination
' li Hearing Public ea g Held
Determination Made:
A 'roperty has been determined not to be
Significant according to Ordinance definition.
No further action will be taken. Demolition
Permit may be issued.
Property has been determined to be Significant
according to the Ordinance definition and a
Public Hearing has been /will be scheduled.
Demolition Permit may not be
issued at this time.
Public Hearing has been held, Property was
determined Significant but not Preferably
Preserved. No further action will be taken/
Demolition Permit may be issued.
Photo documentation may be required.
Public Hearing has been held. Property has
been deemed to be Preferably Preserved. The
demolition review period has been initiated. No
demolition permit may be issued until the
Historic Commission approves an alternative plan or the
twelve month period concludes.
Alternate plan has been approved/ delay terminated.
Demolition may or may not be approved as part of plan.
Twelve month time period has expired, demolition
permit may be issued.
Referred by: Q,4 (,?et -P /2L Date "OA (p
File # BP- 2006 -0896
APPLICANT /CONTACT PERSON O'CONNELL STEPHEN A & CAROLYNNE O'CONNELL
ADDRESS /PHONE 9 WRIGHT AVE NORTHAMPTON (413) 584 -7047 0
PROPERTY LOCATION 9 WRIGHT AVE
MAP 39A PARCEL 018 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 9 �f �
Typeof Construction: DEMO & REMOVE2 CAR GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF;dRMATION 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
Pe o't from Elm Str ommission
Signature of Building Official D. e
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.
BP- 2006 -0896
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2006 -0896
Project # JS- 2006 -1375
Est. Cost:
Fee: $15.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 5967.72 Owner: O'CONNELL STEPHEN A & CAROLYNNE O'CONNELL
Zoning: URC Applicant: O'CONNELL STEPHEN A & CAROLYNNE O'CONNELL
AT: 9 WRIGHT AVE
Applicant Address: Phone: Insurance:
9 WRIGHT AVE (413) 584 -7047 ()
NORTHAMPTONMA01060 ISSUED ON:4/12/2006 0:00:00
TO PERFORM THE FOLLOWING WORK: DEMO & REMOVE2 CAR GARAGE
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 4/12/2006 0:00:00 $15.00950
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building ____ • ,
Northampton, MA 01060
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction sups: ,;sor. 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 i egulations. 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
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DEPARTMENT GP BUILDING INSPECTIONS 4 -
7 1 - ---- ..
212 Main Street ' Municipal Building
Northampton, 1\4 01060 .
WO CON'ITENSATION MSITRA.NCh.. AFFIDAVIT
. .
(1iccus
\vitla a principal place of businessfresidenct at:
hone)
(s
do hereby certify, under the pains and penalties of perjury., :hal . .
- -
. •
( ) [a112 an employer providing the following workers compensation coverage For my •
employees working on this job:
,., .
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(nslaran= Company) . (Policy Nurnbc.r) ( Datz) '
• - •
( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired
the contractors listed below wbo have the foiloc-y worker's co Ein el policies:
(1\lamc
of Coco) (Insuranc. Company/Policy N:) (P-=•:pu• Da tc)
- .
--
(N2mc of Conn (Lasuraucc CompaayiPotic7 Nur) (E4Irzrion Dale) .
- .
. .
. ,... •
("Name of Contractor) (Insurance Co mpany/Po lic N lumbar ) ( Datc)
, . .
•
. .
(Name of Contractor) (Lasuran= Comparry(PoLicy Nu.mbcs) (E.\. D'ai.c) .
(nosch cldizioM1.1 Mcm,if ncoms.._-y to inclu& infonmoa pc-tainin; to .11
( ) I. al:0 . a sole proprietor and bave no one worinng for me.
I dm- .d. home owner perform 0 a ll th w ork myse
NOTE: Pl-÷1. bc ' 9 ' 2-rc thy: s b 'to CC=P I C P ... r. 0,11 . LO do r-. o -,--- =.---..:.c-Joo m moon work cm • dwralME, of
not Ca0C th•t= T.0. tit t in w'diclo the bornoownm maid= or ca dic GroumoS wr...utco.L.mt tbc---o ...-r ox c-mmolly comitd--od to be
the wcziz.c• c=;:i.c....=ica A= (GUI 52...m1(5)). z.pp Lici.6cro by o bousconam fc . I.i...- cc pcmit may mridcocc the
omploy.c uodor dao Workx•-•• Coccm.maiorn Ace._
I uodcru.ad MAL a o"py of th.i., cmoccoom rr....,y b..• forword....<1 to lb. Dcp...rsmost ari...i... OfLo. or In.unoo. For Um
�vc- vCinC '31:1 the Elk= 1 .0 s4Curc 'covcra.,,%-e inzde-- ion 25 A of Mai_ 152 Ima Im.4 to the impcnition of mimics! pcmaliim
cocoLtime of • floc of up to S1 ..S00,00 ardicc ioxpri. °Cup to moc y---2..r Lod Csill pcn.inct in Mc form Or. sto Work Ordm
fir= of 5100.00 • thy opit= cuc.
A i 4. ' ' 0 id For Oco•rtL- oxo coty -
0$1.4* ' Pcrmit Numb=
r
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I M- _ . — — ' - -'" • " If
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Signatur of Li=- ce
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
•
• License Number
Address Expiration Date
Signature Telephone
9 ReQisteEecflonierip�caveinent .CarttactoT r „� ; "El Not Applicable ❑
Company Name Registration Number
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 ❑
•
The current exemption for "homeowners” was extended to include Owner- occupied Dwellings of one (I) 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 II VR I tt.-,_1111_
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check alt applicable)
New House Addition E.., Replacement Windows Alteration(s) n Roofing n
ter Or Doors D
Accessory Bldg. k: Demolition ICI New Signs [El] Decks [p Siding [0] Other [CO
Brief Des iption of Proposed,
Work: D P mu1l11 O 1 (R 1'9o \k k 0/ Co r C . -
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes t--Ko
Plans Attached Roll - Sheet
a. 6a_ If He �ic�erse rdci ac�c i> io o extst�n a sinct,'cornDtete:th� IIo*ii Q:
Use c f b • 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 Ta - OWNER AUTHORIZATION - TO BE_ COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING, PERMIT
1, 1r •A"' . � • N. N , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters re % tive to work autho '7e? by this build g permit application.
Signa re 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
. , r
Section 4. ZONING All Informatibn 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 ' 5 4 �1��,.5-5 F -
Frontage -- '
Setbacks Front i I
Side L ' R:' L R:
Rear "
Building Height ___ _ _ _. --
Bldg. Square Footage ( % i I
Open Space Footage % ,
(Lot area minus bldg & paved :
! -,...I ; l ! i I
• parking) '
# of Parking Spaces
Fill: — ,'
(volume • Location) --
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DON'T KNOW +► YES 0
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW t YES 0
IF YES: enter Book Page; - and /or Document #'�
B. Does the site contain a brook, body of water or wetlands? NO 1 DONT KNOW Q 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 Q 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 a
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 O r NO e
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,
�� De0a►ls nei ;
City of Nortf��mpton stag o� "-
Building Department rre aP r<u
212 Main Street 4 ep r �� � - � eS y ' ii
Room 100 r • iC ,t407-4=;
Northampton; MA 01060 T,�o �S ,`" r
phone 413- 587 -1240 Fax 413- 587 -1272 Ftot�slte �
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ttherispectfy . : ?; a
APPLICATION TO CONSTRUCT, ALT REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITEINFORMATION
1.1 Property Address:
This section to be compfetedbyo
q (ono ht CtAter ke Mai Lot =U ni t
NO e a;r „ �71v n 171°- Zone Overlay D�stnct
r t,F' r” o, ' O E lm St Distrrct CB District
SECTION 2 - PROPERTYOINNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: On
S hf ° t - 0LD rr nee nv1P I ` �fl9 Q.(i ,. A t` avy�ietil , '(
Name Prin Current Maili A dress: r^)�C�
4J 3 .5 R�1 - 76 y 7
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)
91"U c , 5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section' For Official' Use Only � -�
Date
Budding Permit Number. issued:
Signature: r
Building Commissioner /Inspector o f Buildings Date
File # BP- 2006 -0896
APPLICANT /CONTACT PERSON O'CONNELL STEPHEN A & CAROLYNNE O'CONNELL
ADDRESS/PHONE NORTHAMPTON (413) 584 -7047 Q
PROPER
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 9 ot/5
Typeof Construction: DEMO & REMOVE2 CAR GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P],t'ESENTED:
Approved 1/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 S t Commission _ �� G r c `
z. 2610
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.