31B-036 (5) „,,
•••.. -, '1 ,;e. 1.7o-z.II:.:-9,7.i'i7.1;•&.%:FiZZ:. (,,iij'i-..I.Tsage227:]12s,:-Iff,--::.
, .____,:_,._ vear...-frtm-,:•3: o, ca.. ,.;,%ti Af.e...7;:.geRts
,...,,i• .:z-,3—,...=.;,,fh
Office z.7)111,3ves1igtErio.5.JE
1.1,' .c___.----1_„.1.--7,1'1,::',
-,-,
•,x‘.'.....,F,77•77 7-;'-',..,7n:573, ::-. •.:;::::,7 7.:''
r,,... --...-,.._‘__L - .
2 n.,:]".."..:7=./(.7.,.,:i.'::7
... _,...-
Work!.-e.re (-.:ORYil.Fien,Sntic,11 T.Dsz.,...-'.:-_,Tic, .-.L'-fi:7".r:CT.C.,74..f.:`.; .7--_,"Tlik-iZ-1:',"2/C0Fat'2,1:::::0:.'iliTi."1-ii".:1-TiCiif..,:fi.as11-'inu.•,,Llel:s
.A zplica.r2i, Tr-forr,atica 7fieme.7rint Leq..5-4v
• •
, ,, 6
Name (7..--_,us;:-.1:-..-ssirt.-22.nIzt.vde.n/H:,::-...:::,:uz;): 47-roina__ ___ _- (.111,Lba:\__3 _
21 -. s_NiSp_s-pa__ —
1 0S0 77.:;-,:.:--_. :, It"3- (0(.0-7- 113o . .41 ..).1 4--,241 Li.
, A...n.21147;73:t-,:n(.:Til.q.:)-'22Y277? C.:71=•.!".7.1,._2-'a;,•,......77,111:,::pr:::-::::C::72:;7":; . . : 7:.:7,2 ff:71,..',';a,2.:(,1,-.2.7.s..-.17.-t_.,-:7:.): 1
_-_,
i
. . - - . : ,.:.•.. i , i.-i-5,v:,c.or.struc:.1:...*;.-.7.
iplos(fuli .-Ar _ .:-.- .- na--h-:: SUC,-,:::.).7,-:_:.a-::::',3:s ! ---= •• i
III
Li
—
I 1
1 et'.,;:ing air mf-..--.in any '.."..a7..a'...*1:y.
trc,_-....1,:-...z-Ets a:1,r... —, , .. . . ....
0:17..-.-".). ::-.F.r..77.7..-.-.,.--. . - 1
7 :72,-4.,z.a...34 : 0,: L,._- 1, ; ■ .:(...; I Ei;:::;:rif:-:_,t iz:F,,.....-(cs 73=-;-..1.,:iclitcnt:
I re r.112:37.72:'a.
CDng. r..F. -;':::::: :: ,::i-3ef. acic..aions
:'..13 v.:on:Lt.:Ts.
I ,._;•::`!:;:i.i:,..::::-;:;. 5,i.::.:::::1.::.-.7:-_--.2' i
c:::::::::::. ir...suys-..:-.::::,..-•77::::::::::::::':::: 1
trim:,che--...az i:1-...-::.•.-,..--1 z7,7.:Ei el.,-...3 i.,25....p.:ItIr.. __t--:.27.,', .:0"-.'.'EtD,:.7.11'G•:-.i7:::',7;','31'."::::-i. ;-...-_,:i..;:r:::211...n.1-...3!ic,y'.nfer,... f.(.jc.-i.
)ii<2.-.2-towiltrs-dal;submit this ati'LL.--it intiimit-1,;,..ilcy:::::.(f.-.:;,.7_,-;.,..2ii.--.vc-_-:: :-.i..-.-_!G..11:;:....Cr.:7.7,:::::::;::13,JS,...S:111:::,lie Z.1--..:,:-.,cif daYli.
j:C.C1r4VEV-0:73 CCM CtitT,I.r.titiS box rats:c...1.,....:.::2.3.‘,Ev...71nrit-iilk:n......3:;:-...,..2::::.I.1.1,.,.in.:;_ :::1-.1.-..-s.:::.c,i1.-Lt r.,..1...;-:.-zInt-,..c;.:1-...n.:L---E7..sini,:.:rdmi.h21.-C-7 riCil iiI0S.Cr-nitiLtShr.'.'ir:
f...saploys. if eagavr.V.,.r.:.,z-.....o.re camployacr.,1-.::--dy 7.:11::.11-mvii.-:-..::ti.lei.... 'VZ)7,?..1"::.
.—..---.....---*------.--------
I.61;1 1.1•1Z iiN17,/"Oye?.?fj3f3:-,` 2g. :::.?1•';O:'..:,5T.7.::'”
.i.ftr7-9. 7;2•Viail2... , ---.-.
. -h4.-____
__--
pclic.,,,...,, or:-.1:‘:-..•;_f-ir..5.. Li.:::.-.=,-•;: 1-0 6.0 I (LI 0 I C'4 ,,,-,.::-... r:n. :.....-J.,„: t \ -CI - Is
Sc.)13-Si'ty7;i':.6-Or,ess: i b Mi r4-1,/(----Stid"
i _____ ''•''''2-.--iz- jlor-thorellIAlaii- Di b (ie)
ef'-j2c,..'..,...,o z' .2c-mpaaf.:::_ltl'.7.C.'2..a..."-:-;:7 ":.;,::::::.1..':-,2%.".•:::.7,272::::,.....'7, ',.:::12*-.2.:1:1:::::!..-3'..la•-1.:7.,T.I.:-..y L.,',...,, ,-..-..,.-?....'ce.,.::::::-.r.a-z-...Ta:In.TV...,:_71:.-7.;r.:1".7:,.-:).
F-aiii.z..1r-:t.t.c.s......-.7.1za--, c.!..".A.fm.z...a;7.:;:731.;.'-,c;.11-:;i13:2f-:::::::::„:1.2±:,; 1.7:1'1,-Z-21_, .-_-.. -..:-....:_c=izE.d-:-.;_,-:.i.y....;ir:17..-521"Ficn of c,-:;:rninsi pcnalties of a
fine up-zo E.1;.503.03 aridlcr cri,..:-yea::'.::::1pie .az--.v&i::.-,...s,:,::-::::::.7-5:::E.:It:es:n the fs=of a ST'.31-7',...,r,31.7a OFL!'=_'?,and a fine
of up to$250.00 a day aafdasl:the 7101=2. Ef:ig,:IVISZt di.2.1 a. Sa:lier.11er:t:Tay :.3 :Porvircecie-LI-•..0 iil's':Office of
investiczations of the DI:A fc...:ins-,-s-i.anf;-..s.;co--.,,,az'age--;:-- .-,-,Hc)-.-...
---- -- —
c.7 : ".7.-..:::::::',.'.'..:-.'f.;: ,:-_-.•::: .'327.,
•
7-'•"•
-..,..,,7:.
Tilioat:g: -1-f 1?)-- up ch.i••••,--.5. 1 ,30 4---Ii - )1-k- -2-,-1,14-c-
- --
-;
Qfici.-.7,f Ls:6-..,14-2,i_-,,,, Do 4,-,:a.:.•ti.,,.,,,,,;,..•.,,,,,1„,,•,•;,,'„,_„:„,,,,,,„.„,,,,-:.;,.,,,:-,•„„:„,.......,;,41.:.„•„•,„..,,,,-„J.,.,,,?:-.3:cs,,,:-,-,.:::.-,,,;.:,i,ti,-,7c...,,,•:!:, ,
:1 1;
ki iti
I — — '•
li lissuin.7,3.4.u.th.cirty(:•..1::,..?.c..-_,.cw,_,:-.: , :
11 L Board Vii-TI,?.:Yle...1.: '.2... 3y:::-aztr.::-:-..71.-..!rif. -;,.,,72:f.:--11-7.,,-......-... .:1-;:-:: -:. ..Y.a-.. ..,.. :. :LE:si.r... . _;,,-. 5_ 1.17:-.,mi"3irag 17.n-2.7z.e:::::er r.
D ..•-: (--,';',-.1....
ill t...Cint'....1t: '..-'`,....irso::: i:::::.ii:7::'.. il
ti
--.......-......-_-_-:-.--......--- -. .......-......,..,....,............____.....,,,.............._______—.....-.------
,
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
*
Name of License Holder: 1i'
��� License Number Di (z L
Addre s Expiration Date
Signature _( ,;Telepone / 'r 3 ,&-ea 7- 3) .3 0
(fir I t It
9. Register- •-7, mprovement Contractor: Not Applicable ❑
0AL r co Sri(LL*dr\ S
Company Name Re istration Number
)01_ ri _soyuh fnA Olos
Address 1 'r Expiration Date
b Telephone q/3-61o1-7.--3)37U
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 Dwellines 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 stnictures 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 D
Accessory Bldg. ❑ Demolition El New Signs [p] Decks [CI Siding [p] Other[D]
Brief Description of Proposed`��-{ ----
Work: l �) GL"""I C�!�
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
6a. If New 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: 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 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , as Owner of the subject
property —33:\--(-L 1
•
hereby authorize \ -
to act on my behalf,,in all matters elative to work authorized by this building permit application.
Signature of Owner Date
1, I , as Owner/Authorized
Agent hereby declar 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 a T' Date /( /
,i i
Department use only
ity of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit
OCT 5 20}3 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Electric, Plumbing
Northampton, MA�Ga —� N rthampton, MA 01060 Two Sets of Structural Plans
tn -587-1240 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
1.1 Property Address: ,- e This section to be completed by office
1 mm r—I-k & d Map Lot Unit
1 � 1�
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
f� 1t�•
le(A) Sm D
{�
Name(Print) Current Mailirddress•
( t_ac'p '`" - Telephone ! 3 l ^1 1s-3
?
Signature I c� cf cam
2.2 Authorized Agent:
(VA__ ? t)-11)(\
Name(Print) Current Mailing Address
Signature - x *: (413- tit/1 -313 G
C, . _ Telephone
SECTION 3-EST TBONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Wv D0 (a)Building Permit Fee
2. Electrical (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) Check Number to?"
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0464
APPLICANT/CONTACT PERSON JAY BOLAND
ADDRESS/PHONE 12 PISGAH RD HUNTINGTON (413)214-2414
PROPERTY LOCATION 10 MYRTLE ST
MAP 31B PARCEL 036 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ' �j'
Fee Paid a�S o
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 101880
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
L---"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
Demolition Delay
,/7—..-4„?
Si o uilding •fficial 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.
10 MYRTLE ST BP-2014-0464
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B-036 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2014-0464
Project# JS-2014-000802
Est. Cost: $800.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAY BOLAND 101880
Lot Size(sq. ft.): 4530.24 Owner: SMITH ANDREW&EMMA GILBERT
Zoning:URC(100)/ Applicant: JAY BOLAND
AT: 10 MYRTLE ST
Applicant Address: Phone: Insurance:
12 PISGAH RD (413) 214-2414 WC
HUNTINGTONMA01050 ISSUED ON:10/17/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION
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 10/17/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner