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22-026
SECTION It-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: . Not Applicable _ Name of License Holder , ) . 1-i License Plumber Address Expiration Date Signature Telephone. 9.Registered Home Improvement Contractor: \ Not Applicable Jv \\ _ Company Name Registration Number Address Expiration Date Telephone SECTION 16-WORKERS-COMPENSATION INSURANCE AFFIDAVIT(M.G.I-c.152.*2SC(6f 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..... . 11. - Home Owner Exemption The current exemption f o r-homeowners"was extended to inchide Owner-occupied Dwellings of one i l l or 1wo4,2 t families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner sects as supervisor.CMR-SO. Sixth Edition Section 1083.5.1. Definition of Homeowner Person(Sir who own a parcel of laud on which he she resides or intends to reside_on«Bich 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 rem onsible 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 wwrk 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,von maybe liable for person(s) you hue to perform work for you under this pernmt 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 Ilia sachusett�s General Laws Annotated. ` Homeowner>ignature' q _S- r I`V i,/.r Ai( SECTION 5-DESCRIPTION OF PROPOSED WORK{check all applicable' New House Addition Replacement Windows Atterationlsl Roofing Or Doors Accessory Bldg. Demolition New Signs j ] Decks I Siding ft Other I I Brief Description of Proposed Work: , C•r--- - i1•3 cxc) j\°;e.t,es\-.„ +C� Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement. Yes ti--/ No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: ! Y 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 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 No..c& .'\ . as Owner of the subject property \ hereby authorize R).3;---\\ ,mac : �� \s2 (sDrbvv,0 C eA S �� to act on my behalf. in all matters relative to work authorized byrthis building pe( it application. Signature of Owner Date `.N•-•A • \\ A C?"■%C` N \ 'h\42...` . as Owner'Authorized Agent hereby declare that the statements and information on the forming Signed under the pains and penalties of perjury. \ �Ci\� Print Name (, 4 Cs-.So() %)/14/ / Signature of OwnerAgent i Late Section 4. ZONING All Information Nast Be Completed. Permit Can Be Denied Die To Incomplete Information Existing. Proposed Required by Zoning This column to be filled in by Building Department c��S3�-cc2 „� Lot Size � �, 15 s Frontage 7 Setbacks Front '7 Side L R L R Rear Bni(i{nig Height \ c-, Bldg Bld Square Footage °U \, O\lo ' Open Space Footage 7 oe (Lot area minus bldg&paved parking) 7 w of Parking Spaces �1 O C.Vr.Lar4 Fill: (volume&Location) A Hasa Special Permit/Variance/Finding ever been issued for/on the site? NO DCNT KNOW YES IF YES date issued: IF YE& Was the permit recorded at the Reg<stry of Deeds? NO DCNT KNOW YES IF YES enter Book Page andf or Document # B. Does the site contain a brook, body of water or wetlands? 9 DCNT KNON 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: E. Will the construction activity disturb(clearing. excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES.then a Northampton Storm Water Management Permit from the DPW is required. — RECEIVED Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit MAY 2 1 2013 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEPT OF BUILDING INSPECTIONS Northampton, MA 01060 Two Sets of Structural Plans ......i, NORTHAMPTON,MA 0l° hone-d 1 3-587-1240 Fax 413-587-1272 Plot/Site Plans ''°`'` Other Specify APPLICATION TO CONSTRUCT.ALTER-REPAIR.RENOVATE OR DEMOLISH ACME OR TWO FAMILY DWEr<r tG j SECTION 1-SITE INFORMATION L 1.1 Properly Address: This section to be completed by office `,-,L RCucs \\\\N' )."Z, Map Lot Unit S \o c arc _ 0\- (2 zone overiayDestrict Elm St.District CB Dpi SECTION 2-PROPERTY OWNERS/ff./AUTHORIZED AGENT 2.1 Owner of Record: C`C: ,\ 4 `�� z. C ∎Q XAZ.. SL ' yc1 yc v\\.:\\., W v¢F�c'�nC O\c (Z Nane(Print) U t % V f/ t L Current iaiingAddress v` 5 f��l-©©zy` , e;Ca LE(- QQ " Y ° Telephone Signature i/ L2 Authorized Anent: r ac.42. )L'i.nC tA.. a��c' \� Name(Print) f i n I Current Mailing Address ��0 Q 42;_vQ.,' 0 cLczck ij/v( PU1. . 07 `:- (:-2..‘es..t.a_ r.j,-,_5igiatuse Telephone SECTION 3-EST1RIiAT'ED G COSTS I Item Estimated Cost(Dollars)to be Official Use Only 6 completed by permit applicant 1. Building (a)Building Permit Fee ■a= j 2. Electrical (b)Estimated Total Cost of Construction from(6) , 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ¢ a 6. Total=(1 +2+3+4+5) .0 Sc-_ Z ) Check Number This Section For Official Use Only Date Building Permit.Number: Issued: Signature: Balding Cornmissioner.lnspec or of Buildings Date 56 SPRUCE HILL AVE BP-2013-1119 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22-026 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:vinyl siding BUILDING PERMIT Permit# BP-2013-1119 Project# JS-2013-001849 Est. Cost: $5000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14287.68 Owner: BELL VICKI A&RICHARD W RILEY Zoning: Applicant: BELL VICKI A & RICHARD W RILEY AT: 56 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 56 SPRUCE HILL AVE (413) 727-8244 0 FLORENCEMA01062 ISSUED ON:5/22/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:I NSTALL SIDING 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 5/22/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner