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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
F'C
Name of License Holder: 'C A. W �"��-Y�tZ Cs— ' 3 4-7 8
License Number
flj C [?&J %(--f 1-'-%-a t•--)C c1- t?rvw i1 r'4 1 0 � I g, / '2C; 13
Addressn Expiration Date
4 -- X27 -
Signature Telephone
9.Registered Home Improvement Contractor Not Applicable ❑
9 �, 1��"41,k)e.trit 17 L 0 (�
Company Name Registration Number
�() tf:. te...e efF • s l (4- t
Address � Expiration Date
Telephone 4(3 "- 'L4 12t
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 EV No ❑ o" G� t
11.• - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [0] Other[0]
Brief Description of Proposed ,
Work: /kOC) A i c ..-,1 4, € mcrtoi� ` 1r1�tc,o -- It �t/Z/_-icet - L AA-Js�'
Alteration of existing bedroom Yes V No Adding new bedroom Yes V No Xo
Attached Narrative / Renovating unfinished basement Yes
Plans Attached Roll -Sheet i/
6a. If New house and or addition t 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 I /Z
c. Is there a garage attached? NL
d. Proposed Square footage of new construction. , ,@- ' Dimensions 4--., 3 x S '
e. Number of stories?
f. Method of heating? ( A..i C-1"2-t( Fireplaces or Woodstoves 1444- Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction t )bcp
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 C(L-P4vL S Qt-4-0 l•-4"
k. Will building conform to the Building and oning regulations? V Yes No .
I. Septic Tank City Sewer Private well City water Supply
p Y
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
G L.A-‘(Lq - c l- , as Owner of the subject
property �(7
hereby authorize 1� v (A.`' L'i.,
to act on my behalf, in all mattersielative to work authorized by this building permit application.
/ all,641_ 77////....?
Signature of Owner Date
go QA',(j i1- , 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.
Tic W' v..)V4,- '44-
Print Name
atP.A U 1-.__ 11 tA. 1 13
Signature of Owner/Agent Date
RECEIVED , Departmentt seort�'
City of Northampton
Status of Permit
JUL ' ' 2013 Building Department Curb Gutbrl?�eyvay Perrlt
212 Main Street
��Sewer/
DEFT.OF UILUING INSPECTIONS ROOM 100 VtraterlW ll Availability k�����i
NORTHAMPTON,MA 01060 Vorthampton, MA 01 060 Two Sets of Structural Pena k ��� i t
phone 413-587-1240 Fax 413-587-1272 Plot/Stte mans
Other Specify F
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
c-ropp,Av.,0 .3TV - T- Map Lot Unit
Ncy Qz cLk°Pnin.,r-R)(`-' VV1 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C L y( A-'1.1.-c Ot. :.ppp -a p cT• / we m4
Name(Print) �C�� /I� Current Mailing Address: `9
/ Telephone
Signature
2.2 Authorized Agent: n
'Kii)) , V�M��/1C C C' S 12-V N G;
Name(Print) n Current Mailing Address:
3 f d-– 1—z 4—
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1 .L (a)Building Permit Fee
2. Electrical Ct 7 (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) t91 ZjW, — Check Number 1S7y
This Section For Official Use Only
Building Permit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
9 STODDARD ST MP-2013-0085
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 3924 a M H
Ma p �t
�
24D
Block 057 -- -- -- , � I � ,I
[u 4� ZONING PERMIT
Lot 1001 __ WCPi
Permit: (ZONING PERMIT APPLI T£RCENTEN APPLICATION PERMIT
Category: (Zoning Permit
Permit# MP-2013-0085 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2013-001360
Contractor: License:
Est. Cost: Expires:
Fee Charged:$15.00 Homeowner as Contractor
1< 1;nce Due'.$.00 Owner: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALLEN
of Fixtures i _ Applicant: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALL
DigSafe# __AT: 9 STODDARD ST
UseGroup
ConstClass
ISSUED ON: 07-Mar-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ZPA-ADDITION
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. 14444,s.
/7c'' cm Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Zoning Permit Application REC-2013-003549 04-Mar-13 6425 $15.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
(:eoTMS®2013 Des Lauriers Municipal Solutions,Inc.
File#BP-2014-0038
APPLICANT/CONTACT PERSON ROBERT WALKER
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 9 STODDARD ST
MAP 24D PARCEL 057 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out / / Vf//)1 9b
Fee Paid
Typeof Construction: CONSTRUCT 4 X 5 SHED ADDITION&REMODEL TO 1/2 BATH&LAUNDRY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 034783
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I FO ION PRESENTED:
pproved 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
; • • 'e Delay
Signature o guild i g 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.
9 STODDARD ST BP-2014-0038
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-057 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-2014-0038
Project# JS-2013-001360
Est. Cost: $19300.00
Fee:$115.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq.ft.): 3223.44 Owner: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALLEN
Zoning:URB(100)/ Applicant: ROBERT WALKER
AT: 9 STODDARD ST
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:7/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 4 X 5 SHED ADDITION &
REMODEL TO 1/2 BATH & LAUNDRY
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 $115.80
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner