35-254 SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder: S l' t^-�-� D. I/ 5- 4
C? l/6
License Number
3 4 5--c.rv/ 12-4 �IJ�... .�-- c�/Z-8bc-
Expiration Date
naturo■ Telephone
9.Registered Home Improvement contractor: Not Applicable ❑
Co any Name Registration Number
36 5-W-tharc- - •� 21 s— /
/y t,f
Address / - Expirati n Dat
�d60 Telephoney/) $py / 41'
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 ❑
11. - Home Owner Exemption
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
41
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
Frontage
Setbacks Front
Side L:. R: L: . R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&pav:.
parking)
#of Parking S i.ces
Fill:
(volu, e&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 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 DON'T KNOW 0 YES 0
IF 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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES l0 NO
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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
t
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all,applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [t]] Decks [l=] Siding[Dl Other[0]
Brief Desg.iption of roposed /,,- /dt -'-t"-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.,if N€W 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: Numb- of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new 6onstruction. 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? Ye 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, MA-r•C tiv\_ c ai r'(r. , as Owner of the subject
property
hereby authorize 5 �.--�- D
to act on behalf, in al rs,relative to work authorized by this building permit application.
. 7 /it/i 3
Signature of Owner Dat
5itZ ,t,,___ r t). _05,4 , as Owner/Authorized
Agent Fereby clare 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.
5:7 L..,.- lam. i-a F.s
Print Name
Si nature caner/Agent Da 1111111111111#
Department use only
REGE�� ity of Northampton Status of Permit:
, uilding Department Curb Cut/Driveway Permit I 6`�QR 212 Main Street Sewer/Septib Availability
Room 100 VVater/Weil Availability
DEPT.OF BUILDING 1� P"t`T°"S No hampton, MA 01060 Two Sets of Structural Plans
RypRTHAtdPT°N,:.�; &0 87-1240 Fax 413-587-1272 Plot/Site Plans,
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: /
1 1,AI I tAe SA- 17--d Map Lot Unit
/10./"..e.0.-et- /It' -- 0106 L Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/;�f -c,t.r.. //4 c a:,-✓ S'- (,' 4-(2..d /..wu-e.-" /1-+.k
Name(Print) e+ Current Mailing Address:
c...-. „kfigliettur 'elll it14;;Ill/ Telephone
Signature ((I t 3 _ 5_,7 5,-._/44 S
2.2 Authorized Agent:
Name(Pr t) _ Current/1 Mailing Address:
Or", / 1"--- \ /Gt.,---71att.-- /14 4 dre40
Telephone C/I) irerY / e e ei
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed byyermit applicant
1. Building M// (j (a)Building Permit Fee
2. Electrical e / / ,.,r � (b)Estimated Total Cost of
`"'��` Z,2 ' 1-' Construction from(6)
3. Plumbing
et,
goo. Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection r d
6. Total=(1 +2+3+4+5) 'isr;Vdv . `)t) Check Number 3ug 46/3
This Section For Official Use Only
Building Permit Number: Date
issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0039
APPLICANT/CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224 0
PROPERTY LOCATION 59 SYLVESTER RD
MAP 35 PARCEL 254 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out p
Fee Paid Q
Typeof Construction: REPLACE KITCHEN CABINETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 079160
3 sets of Plans/Plot Plan
THE FOLLO ION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN O TION 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
) J )elaY
410001/ - 1( 7-IP—(3
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.
59 SYLVESTER RD BP-2014-0039
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-254 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-2014-0039
Project# JS-2014-000108
Est.Cost: $15500.00
Fee: $93.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 60112.80 Owner: RYAN WILLIAM J&NOREEN MCGIRR
Zoning: Applicant: STEPHEN D ROSS
AT: 59 SYLVESTER RD
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584-1224 0 WC
NORTHAMPTONMA01060 ISSUED ON:7/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN CABINETS
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 7/19/2013 0:00:00 $93.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner