34-005 (2) 0 0 (rrf 1 of Northampton 1 *_ _-
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45 E Mcsartthncctt a _
• st a. ,. DEPARTMENT OP BUILDING INSPECTIONS t
212 Main Street Municipal Building . 1 7' .%
1\Torlhampton, Mass. 01060
WORKER' S COMIPENSA'ILON INSURANCE AV1eAV1T
I
(9 j ( tie" J I A.-----
(li ccnsx/permi ttcc )
with a principal place of business/residence at:
n II N a r � 4--
3 6 le". b7, � ���^ 1� (ph =) `I 1 )__,r - /2 ZLI
(so ts t/ci /staic/2ip)
do hereby certify, under the pains and penalties of perjury, :hat
( ) I am an employer providing the following worker's coinocns non coverage for tnti'
employees \ \'ornng on this job:
t i i
(laserao Coelr,:.�v) (PoLic: Nu r) ( ;- pinyon Date)
( ) I am a sole proprietor, general cone dctor or homeowner (curie one) and have hired
the contractors listed below who have the following worker's cocipenstion policies:
(Name of Contractor) (Insurance Cornpany/Pobc Ntunh. (-_xnnnt:on Bale)
(Name of Contractor) (lnsurancc Company /Policy Nuncrr) (Exoirauon Date)
(Name of Contractor) (Insurance Company/Policy t•umbu) (Expiration Date)
(Name of Contractor) (Insurano Company/Policy Number) (Expiration Datr)
• (ecu.da add,fDeal ixd if oct.s.ray to a)C- iaf0r111.noa pc as w all oCKTr_cco:7)
( ) 1 a i a sole proprietor and have no one working for me.
( ) I am ,a home owner performing all the work myself.
NO pies:, be cw i hr i µ ]C boar von Nbo employ pc -zoc3 to dJ (^ -1*-+ cc - co x) c feriae , ori, co i cl of
not a.1.« th -r• t1itt tmti in uauieb the bomoowoa- r aid.= o- oa th te- i i tbc-ro 2 no( v_ occz: 5 - d to be
cmploycs ur,r' the t.tzi;c>'a ccrp, •lion Act (GL I52_n I (5)), :.pptiation try n hoc cowva far c l: _ a pclmit ran y cv -dcmc trc
Icgil ctaau of &o cxploycc undo- to Woo Work.ela Co rpom. ion Ant.
I unda rt�d th. a coy of lb cxitc n 1 m. tb
y bo fon,oVvied to o D nm
cper of l <,drral Modem' wti ,
cov
riod' Of5oc or lrr�oo fa- t rise vrriGelioo and ttu C_iltrc to cocurc co 'crags tatdcor section 25A of MOL 152 can Iced to az i. asit:on of pcn loci
ooaa,,risg of a iiinc of up to S1,500:00 ancitoc a>zprisoomc,-yt of up to roc year uaa civil pmtroc in tk form or n Stop Work Ord-z end a
fun of S 100.00 . dhy Splin i cr
Foe cicp.-cm75—'11 u,c only
Perm Number —
Ma W' _ I.ot
Signature. of LiccnscdPcnniucc 1.)t."--J-
1 Licensed Construction Supervisor: / ., Not Applicable ❑
Name of License Holder : O) l V {r l lSo ` , 390-1-3
License Numiper
b ,re.„ -,•, 0 - r cf . �1 �- `f' 1 3' 1 OJ
Address Expiration Date
9 I) -1TY -, 2 z y
Signature Telephone
-' , , �- %, - ' .���,, . �' - x .,_ �4, r���� 1 Not Applicable ❑
Company Name Registration Number
s)q1z'�i
Address Expiration Date
Telephone
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 Gi No ❑
yr m
..w....: 4 I '..�.+J,w.e,�. k ..,.,., .:,va ., x,., .� m `�,.e..r .. '' ,. .4 3 .
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 faun
structures. A person who constructs more than one home in a two -veer 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
t
Z � r , za
' - � _ � ,. .4, . `' a1k - .41Q. Kati aa- .�. L' .,�'. ka°dµ< _ aee'1L o iet
1 s
- ��n$ , , - .�,x., , ',M,' 'S., . ,�.,.. ,m: s 3� .,u,, n.• , nu z��.a,W s% „ v} «assWt `' ..., , .., s_ ._. /
New House ❑ Addition ❑ Replacement Windows Alteration(s) L'i'" Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: ""^O 1 4 of ivt&z..., f etkkot /4f' c a T.- f'4 ; r C art - J
Alteration of existing bedroom Yes 'No Adding new bedroom Yes '��No
Attached Narrative ❑ Renovating unfinished basement 'Yes No
Plans Attached Roll D • Sheet ❑
b .. .?.. ... ,. , .. 2 . , . .. ;, .!•.:',:,,' , ,A .. _a , I ... , . .c. ,.3. ^Y . ,,. e.. : -.. >, _. ,.., „: : _.. . s 'd. 1"g3:1�. i y b:ili : a.
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?
. 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
,,s..4, ,, A44,404 - - '„, 0 X I r i WHE ,
. � 55 b H tl 1 s 4 Al P '''',.,%,, MIT
�^^�^' Tv l G `� -l�Y , as Owner of the subject property
hereby authorize `11"0L { v.S'r 1."-"' to act on
my b- j? °• : - - - - dative to work authorized by this building permit application.
Sign. ure o! Date
I Y �1�-� "`� , 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 th pairs and penalties of perjury.
p, c je. I,. --,.)
Print Name
3)18
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
y . ° / J 6>d)S --� Building Department
Lot Size V' ( �f
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 "" 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 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:
9a r r y . z- yr� y
i ty of Northampton
_5 uilding Department I ' ° �����
, -
s 2 013 212 Main Street k
1
Room 100
DEPT R, 1 h ,; N rthampton, MA 01060 '-� .�
x ' ,
NORTHAMPTON, Mi. ■ ;i ( " —s 4 1 •587 -1240 Fax413.587 -1272 ,;',''..'2.-.',‘ t -'
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
' ,,,,:•]
,� . p er r :;. s ' r x ' r 0( i i d ra
1.1 Property Address: '� � . f - ,.
2 9 6 � ,�� 1t 1( 3 $ 0 '.'
j a • .
1 ..; ,a $r � '- - ' fin sa X " n r
'?' c
99 ' ' A 'ffil ' �� �R AG NT
C
2.1 Owner of Record: y� f / -
J �.�1�k �C r e_ \ Z 7 6 / V" r - . -A )1 j .
••e Print) Current Mailing Address:
—. �' I - � 1 � /2 J 'I
`
.' —" -` __. _ Telephone
2.2 Authorized Agent.
(FoL . , isGi , , J � 6 e -r-,.s -� �e — P --
Name (Print) Current Mailing Address:
V (J JRV / L 2- q
Signature Telephone
Item Estimated Cost (Dollars) to be tcaai Use.,Onty
completed by permit applicant
1. Building 1,2,.i" (a). 1861t Ling Perrt at Fee
2. Electrical (b) i - Stirrie /'dd "i at t� .,0-t of
C st�cticir� �, )�
3. Plumbing / ,i% Pernnt1 ee ' s
M2i fi
4. Mechanical (HVAC)
5. Fire Protection
U
6. Total = (1 + 2 + 3 + 4 + 5) 3830 Checkttur»,be , 1 1 1 . °:3 '
, Z ,, Y x ��or Officio! Use nIy
.ov tA,,k 4 .. � I 2 b
i
8t - adir-�rM N rnta ;r " , Date Issue
0rg�ett��, � , y
ti u d Cor rnassiorer /Inspeotor'at Bt ir�gs " Date. -
File # BP- 2013 -0839
APPLICANT /CONTACT PERSON OLIVER ISELIN
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584 -1224
PROPERTY LOCATION 296 TURKEY HILL RD Ce1( I 7 -320 5
MAP 34 PARCEL 005 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 0 247 I
Fee Paid t '7
Typeof Construction: RENOVATE BASEMENT & RELOCATE STAIRCASES
New Construction / I . b`l
Non Structural interior renovations j �, _ ,� -� `l
Addition to Existing e e R SIT/in
Accessory Structure N.
Building Plans Included: i 1 7.14,J
Owner/ Statement or License C 039073 ( C 'C
3 sets of Plans /Plot Plan C 4 Jy 0 L r
THE FOL G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
D- •,olition Dela
00r r
Sig n e of Bui ding 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.
296 TURKEY HILL RD BP- 2013 -0839
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 34 - 005 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 -0839
Project # JS- 2013- 001442
Est. Cost: $38300.00
Fee: $229.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLIVER ISELIN 039073
Lot Size(sq. ft.): 80019.72 Owner: CLARSON JENNIFER
Zoning: Applicant: OLIVER ISELIN
AT: 296 TURKEY HILL RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584 -1224 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:3/20/2013 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE BASEMENT & RELOCATE
STAIRCASES
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 3/20/2013 0:00:00 $229.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner