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37-022 (11) 09/20/2013 10:14 4137733188 LAMORE #1982 P.005/007 I j i i ; i 1 1 - .t- 1 • • I I ' I t i l - I i i I I I I I I I 1 ' I I i H i 1 I I I, I , 1 r I ' - I - ■ I ! 1���, 1 I i I I s I ' I I I I I 1 WI i 1 I I 1 1 ! ' 1 I 1 . I 1 1 11 ' i I i I '! I ! i I j I 1 { I 1--• I s��� 1 — NOW i.. y —4-- 1 II I i •1 1 1 1 I 1 1, 1_ ; i Nat !I -J- j L i 4._. —�_�_; ..._4._ I �� .' _� _lam-I T r ! I 1 ! t ��� • 1 -----t----j I i• l• `-1, - '• I - ; 4-_ __iimmum �iAmo�1���im1� 1 I i I ■I ; 1 i I I j I �- I �® I � ' I i I f I i , i 1 I 1 i } 1 a�>•Iiai11am�lna■riu■�wm • a __ ._._ . . - 1 _ I i I I 1 I � r 4f . -psi ��sT � , i —�• ■'y ' -. r _ I. - 1'r _ � °I '1 I ' i - I iiiIuiu1rT I. 1 G I ! ! I 1 j I I _ _ ■�! !�! —I. ?~-s ue- - - L I��1 1 ; I I , I 1 I. r!^ I --– r– • aa I ;y 1 - _ ,-_ i __s I ; I I I 1 1 I I 1 1 1 ' i 1 ; j I 1 1 1 EMS NM I ; I II I : MI MIMI • I �� ■ I� + 1 I 1 I I . LI L_i A._. _ _!!1_1��—� MI. i ! I I 1 1 1 I .t 1 ! I I I 1 I I I 1� i I 1 1 I I 1 —_-f. 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I I i i I —i 1 ! 1 1—i_ 1 : I � t I� I i I i• I i f - 1 I 1 __ ' 1 1 I — �-_ ___.I____-- I � 1.._---i... I 1 1 � I i I 09/20/2013 10:13 4137733188 LAMORE #1982 P.002/007 • • • • . , . . . : ---f -t I : : .• . . . : : . . , . . . : . . . . . . . : . , , : . ; , , : , 1 : . : : . . : . . . . _.. ........ , : . . : , . . , . : . . .. : . . : . . , . . , . . . . . . . . , . . : , . , . . ____. : . , 7 -^.- ; " • , • • - ' to b • • ---------1----,, . /I : !..• • 3 • -.. X . i . _ li :\ ':. . ,c,,, . • , i . I- : \ :::. , . . 7 1."-:.' .• . : -1 f ; \ . Y O :•:::. , • . ' y : • • • •• z IRI • t '' i ' . . cl ""qa a— r,„ r 0 0 0 t Q 0 RJ c w z Z tr.) E 3 W W cc \ C.-- 0 (040) `J i a v 4- 0 0 UU/1U/LU13 11:lb 41d/tddltiti LABIUM FirlOCS1 Y.000/UU4 The Commonwealth of Massachusetts = ':; +41< Department of Industrial Accidents • ft t . T--2 Office of Investigations • --E t. - ' t.' I Congress Street, Suite 100 `?': 7 Boston, MA 02114-2017 .. •�• r.; www.•mass,gov/dia Workers'compensation Insurance Affidavit: Builders/Contractors/Electricians/ lumbers Applicant Information -• Please Print Legibly Name (Bus iness✓©rganizationiindividual):William.R Lamore dba Lamore Lumber Address:Rte 5 & 10, 724 Greenfield Road • • City/State/Zippeerfield, MA 01342-9752 phone #:413-773-8388 Are you an employer? Check the appropriate box: Type of project(required): . I. El I am a empk yer with s 4. fl I am a general contractor and 1 employees(gill and/or part-time).* have hired the sub-contractors 6. [�'�lew construction _.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling --- ship and hav' no employees - These sub-contractors have 8. n Demolition working forme in any capacity. employees and have workers' 9. [] Building addition No workers; comp. insurance comp. insurance.- f 0.(� Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.n I am a homebwner doing all work officers have exercised their 1 1.0 Plumbing repairs or additions myself. (No'worker•s' comp. right of exemption per MGL 12.n Roof repairs insurance reyuired.f c. 152, §I(4), and we have no 13.0 Other employees. (No workers' •• comp. insurance required.I `Any applicant that the:ks box i l l must also fill out the section below showing their workers'compensation policy information. t Homeowners who suliinit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .Contractors that checkFhis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. I f the suh-infractors have employees,they must provide their workers'comp.policy number. a 1 rim an employer Chat is providing workers'compensation insurance for my employees. Below is the policy and job site • information. . - insurance (:ompank, Name:The Travelers Indemnity Company 6KUB 0248N15 A 11 Expiration Date: 04/08/2014 Policy #or Sell-ins. 1'.ic- #: . --._._....-.-_. - Job Site Address: ' l7 Laurel Pad, City/State/Zip:FLOrPllflj Mk 0106, "Attach a copy of Ole workers'.compensation policy declaration page(showing the policy number and expiration date). Failure to secure o verage as required under Section 25A of MCI.. c. 152 can lead to the imposition of criminal penalties of a tine up to $1,50040 and/or one-year imprisonment, as well as civil Penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 akday against the violator, Be advised that a copy of this statement may be forwarded to the Office of Investigations oftfae DIA for insurance coverage verification. I do hereby certiftF U•der the ins and Pena.•s of Perjury that the information provided above is true and correct. �r . . _� i,` t . Date -7q- 3.... .. . . .. . 413-77B-8388 Official use ai ilv. Do not write in this area, to he completed by city or town official. • City or Town; • Permit/License# - Issuing Autho1rity (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector , 6. Other l•,...F....F Do,,,,;i.,. Phone#: .-.. .. a SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home.Improvement Contractor 2 Not Applicable Company Name Registration Number La ril''OY _ 1‘)m. : /20052_ Address Expiration Date 72 Gepp:v \ p:(d Pd Telephone —773- g, --401601*-1� I D I 3 ' d rM 1 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.l s. £ No £ 11..=..Home Owner.EgemPtionl 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors D Accessory Bldg. Demolition ❑ New Signs [I]] Decks [D Siding [0] Other[0] Brief Description of Proposed c Work: C� ,, rf t c. ,U,' n p p 51- G"r 1 p O p.trvl S k` d. O r, c o('r.r,.?.* Alteration of existing bedroom Yes f ` No Adding new bedroom Yes K' No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa:'If.New house and iord `''ion td existing h"ousinq;:complete the failowlnci': a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: N! 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 ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date l Re C�Ya�+ Mif od ,as Owner/Authorized Agent hereby dtta 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. P.2S0� Mac Print Name s 9, ' /4 ,.O` -'4 n: Date 14 3 Signature of Owner/Age 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 pp Lot Size 1 I !10,,0A-9 Co w i;O A,,,,,-.0c. Frontage _ _1 I I__..._.__—__________.___.._ Setbacks Front 1— I 1-1 I I Side L:! 1 R: L:= R:= I i I I Rear .- I .-.I 1 ' Building Height 1---1 p I. Bldg.Square Footage % tt Open Space Footage % 1-5- 1 ✓ I_ s (Lot area minus bldg&paved i___-___� [1 L__„_,., I _„_ , I parking) #of Parking Spaces 1 I IN l I Fill: Y1 � r T �LY Q i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 —) b u -sWg r , 7.•-r~0-) IF YES, date issued:' ; ,,73 r2 P '� rc c/0. ( fir? ;7,- IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book L_ _ Pagel - and/or Document#1 _ 1 B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , Date Issued: C. Do any signs exist on the property? YES ® NO O } _ (err vide V e?ri 1 S IF YES, describe size, type and location: i sma{M S1'? �' - ' ciF e4.^r4 r cir ,,f,«,(,A, I •• C D. Are there any proposed changes to or additions of signs intended for the property? YES O NO e ---1 IF YES, describe size, type and location: fi 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • ` / 5 f �� . 5 speparfineht use only 7_ City of Northampton status of Permit s t3 �-' t , rt I "� I �� Fh. r ,t'�" i v °' !1 I I'a i h ti J ,,vS�Yti J a x ' , i{ Building Department Ct'rb Cut/Drtr�etvay germs#•r Y t � � K � Rae:„ ,ce �e �. tl� � s I S. 212 Main Street S�wer/SepticA�aifablllty K 'E SEP' 2 0 2013 Room 100 Water/WeiFAvailaf ility` I r' I. ° 4 Northampton, MA 01060 Two Se#s of Str icturai Ptah$ ` ' y,��'`.�,p 413-587-1240 Fax 413-587-1272 PioflSite Plans `M}' fi •i� • • 1tgf, ;%.;;!. .1,7 1d i t J. I 1 y l ght 1 - f I • '._� .Otl`Ier Specify 31 ry+ I e4ST] f 4 i4 ``.. f APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION "• This sectrori to be ompletd y offi 1.1 Property Address: ce Map Lot- Unit N I f 11') f`t6(AM L4 r i J( X4.4! l Zone Overlay District ..,(X.14 it r EIm.St:District CB District `= SECTION 2•-PROPERTY OWNERSHIP/AUTHORIZED AGENT (7 1 ws 5 45 s0(-<R' .Ar„ r o a.r�J o--i3 r U,S.f'-E-1--) 2.1 Owner of Record: pry kA.ro ,s A"''S 9 a M i,-‘1-a L u v•-f2( p .-N• Name(Print) Current Mailing Address: 111.3 3 —� r r f Telephone Signature 2.2 Authorized Agent: Name(Prin Current Mailing Address: /? Cc' ,C! P-0,r ellie 171''' 4!3-- X30 -1-0 r= a.:f Signature `= 6 ...1 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only com feted by permit applicant 1. Building ?cr LIO (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ': Construction from(6) 3. Plumbing Building Permit Fee �� 4. Mechanical(HVAC) I �i{1✓ ‘r 5. Fire Protection `�j� 6. Total=(1 +2+3+4+5) 8" 7q0 Check Number %/ This Section For Official Use Only Date . Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date W1 014-- File#BP-2014-0353 APPLICANT/CONTACT PERSON LAMORE LUMBER CO �D(j S ADDRESS/PHONE 724 GREENFIELD RD DEERFIELD (413)773-8388 0 V PROPERTY LOCATION 25 MT LAUREL PATH-COMMON HOUSE-600 FLORENCE RD MAP 37 PARCEL 022 000 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 05'1( (- C) Fee Paid l i Typeof Construction: CONSTRUCT 384 SQ FT SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: • Owner/Statement or License 120052 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 e ••lition Delay /D—/,6/ - ignature o 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. 25 MT LAUREL PATH-COMMON HOUSE-600 FLORENCE RD BP-2014-0353 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-022 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit# BP-2014-0353 Project# JS-2014-000596 Est.Cost: $8940.00 Fee: $76.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LAMORE LUMBER CO 120052 Lot Size(sq. ft.): Owner: MACLEOD PEGGY L Zoning: Applicant: LAMORE LUMBER CO AT: 25 MT LAUREL PATH - COMMON HOUSE -600 FLORENCE RD Applicant Address: Phone: Insurance: 724 GREENFIELD RD (413) 773-8388 Workers Compensation DEERFI ELDMA01342 ISSUED ON:10/11/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 384 SQ FT SHED 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 10/11/2013 0:00:00 $76.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner