37-021 (5) r
a., • •
•
• • • R
I
Cc 1 no I- t., 13/114-
P
•
R 6
46, r-714^..*40`14' 16ac, sr Vw
It
S X11 i1Y
II
7731. f
N c txdS rf for 4v,--
•
•
rte•
I
117 611-70 4 s
. . -'• ' `
" ... '
. .1'..-
<‘._1-."_-1--'1,-1%6-_..<7?--s'T-;-`i,.--C---;-/'•';4,11 9,-.
(1-ii of ,No
rtha
mpton
1 i •€
W---_--_1-__-4----r,
DEPARTML14 1 OP BUILDING INSPPCTI01S --:„1-I L-r..-_----r"-_-_--,---_---------_-___-
_ = —
712 Mar) rtt,1 cet - Municipal Ituildinr,
-0,
Northampton, Macs. 01060
\V()111i I.,IC1- ( '()61_,PE,NSATt()N INSURANCE A FF1_1)/\\FIT
1 01. i ve-/c-- 0 d ..J
(licensrdpvlinittce)
. with a him, ipal plae:' ol-lag-mess/residence at
:3 6 ,r/6-4. i„) c.6._
c iti )1-614- /t)7, (phoncin SP-1 1 LZ. I/
(mIc.11city/sulicizIp)
do 110101)) U01 i117 iindel the pains and penalties of peitury, (1101
eani on employ e! pi oviding the following \voiket's coinnensi-,:imi coverage km Oi iii)
nit this job
(--- "%ti il-,041(_ igiltikt-vbi5/pr. - 72?-3Y 3 1 8) Z- Oa 3
(1„„„:...,,n, ( o ,,mv) (poi,,,, Numb-or) (1: piraton Dais)
( ) 1 or a sole pm o i l et oi, general contractor 05 harlICOVVI1C1- (CUT_ ,".'_ one) ano have lutca
the contractors listed it)elo\v viiitio have the following \vorker's comp'..11.S,?.ii On policies.
(11151.11-,111CC. 1'01111):1;F1n0l)fiCi .',•1)111.1.7.:,/ (1._Aprrat:ort )arc)
(I‘b.inc or (..orttr:t(r or) (Insufanc.c Conmailvil'otic-r Nu_rab,...r) (Exutr.):oon Daft)
. .
-
(Hanle of Conn ac lo:) (lnsarrancc. Conypany/PolIcy N0.1) (Expu-ation Daft)
- .
(Natlic of Coon semi) (Insuraucc Coinram'/PolicY NuLDIKI) (Expis-door) Daft)
(,),,-)),a,-).,-,,,,,,I ii- 1 if ne. ,1 if■ ln ro-Itl,l,tofC,IllatIon Tar-II-ter:11,C to ell c,(:r.c.00)
( ) I dlii it Sole pFoprretrn and have 110 one 5001 him.; for me
( ) 1 out a home owner peal-drilling all the work yself
00Th it--,-t,,, r.,,,,,Orr! ...kirk.bear,or,o,,tab',cattplery pr,rorri to rt,r,,a.OrIc-rlar,,,.cr.r.,....:',:J.,to fr'0211‘IO■i:.<rn t ti"'llr'i;01
flat •,-,..<, ',.,...:1 0,,,t,IIII in‘,.1-;Hr 10-.tx-n.1,-,,,I},I carit,Oc at tOt f;r0Ona-I1 2;1,11 terlte.t 1.1,,e-O7 r.,or e tT,O,:lly c‘xn..(k.,,../to t:',
,npleyr,n:‘,'..-: On aI.a..1:101.a.,.,,I.„..,I1Orl Act(61_1 52,a1 I(5)), nivlo,I)r,I try rt bry111/-0,11,1 lot r.!IC:2.11,Ca'1,fillit fl-,)CyreirT.rarX tin
le =.1 alaOrt of en r--...1-7.dloyef Iro,l, it n W,gc re t C.,47,2--..1,11,,,,Art
1 I ',,",,`I 0,,,,t—ry,,r rr,.It lir,zwr3t otey I,fc,,,...“14,1 to then Dc1,71t,,,,0 of 1.1,iits,4,1 A.r,3,3,-,17'O1I,00 of Irr,urvrron for tl.
1F-,c vrnficrnIon r,:,1111,1 I,Ihnc to to-lot cov,InFo Make..tecill00 15 A of).(00 I 5)c--113 Ir:IA to th,tnrf>outicAl of cruninAl VICil-all./C73
crootia'riraz of a,fir,of op to S I.V.),)00 p,,i't,M711111.0,111Kni of lip to ow yr,ef0 civil p..7nkton In Or focn,of n Stop Work rticr end a
Ono of 1 I 00 05)Idly apitrA f'l
Fr', ala-oartor.,:.11 kJ arc.Only
Oct 11111 Narnbcr ----
NI:11)': I,ot fi
,'-',irnatrin- of I t(r-m,:cil', 1111)11,r T
-1Il
ISECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Cam-� 146-v1 cf1. q ® �
Name of License Holder f Ec i��
License NuI1 / 3
er
fl(-A- 0-, Tali 17
Address / Expiration Date
SeLe
Signature - Telephone
t8i4Wili ed` lore frtipt•ivei tent Con ractor: Not Applicable ❑
Company Name Registration Number
Address Expiration late
Telephone
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 ❑
t §ii �o ne 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
"ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition ❑ Replacement Windows Alteration(s) B' Roofing ❑
Or Doors 0
Accessory Bldg. ❑ DemolitionD New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 74-144"4- /N PG1-i 7. j,j1-G-_S 1 f 4 1- -- eoL k-,G-T
Alteration of existing bedroom Yes Adding new bedroom Yes No
Attached Narrative Li Renovating unfinished basement Yes No
Plans Attached Roll C7 - Sheet H
eillifiNeWlietigeltritrof addition to existing ho icing, Complete the=follov�ri
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. — Mascheck Energy Compliance form attached?
. 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
/ ft] LtriMtir , as Owner of the subject property
hereby authorize to act on
my •ehalf, in all matters relative to work authorized by this building permit application.
0 1, C1r.Ul1�h.� /4 tq t)
s : attar- of OvvYierr Date
I `-" �' � Ll fJ , 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.
Signe. under - pains d enalties of perjury.
OL [ v - -
Print Name
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
/(!A This column to be filled in by
Building Department
//J >''`' /ry.,t /t-
Lot Size / r
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces _
Fill:
(volume&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 DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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:__
w
0
• • Northampton S i : . � �, 1 �
�$u . g Department
ain Street ,
20 Om 100 . t
:?:2 Piort . • on, MA 01060 " ® '
phone 413.51'7.1 .40 Fax 413-587-1272 1
(DING INSPECt10NS
• • • STRUCT, 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
61(.1 fL '- jG/J Map ...4,3 9 Lot Unit
Zone k Ovetrlay D3stei t
Elm St. District 'CB Distwlcit
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
!. ,t
r ,Al lAA 1-'4- q ..T v e- h1 cz TD'' 6 (.1 if fit..° .'' /<•.
Na••e(Print) Current Mailing Address: c..7
Telephone
,ignatur-
2.2 Authorized Agent:
ILL r ✓i(r - Xs e4- ,-.) 3 h 3 -
Name(Prin 7 Current Mailing Address:
C_ �,/
. 3-eke / zz
i
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing ki` Building Permit Fee
4. Mechanical (HVAC) /
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) � Check Number //4'7 Y+�5 d
This Section For Official Use Only
Building Permit Number: (L5— 357 Date Issued:
signature:
Date
Building Commissioner/Inspector of Buildings
File#BP-2003-0357
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center (413)584-1224
PROPERTY LOCATION 644 FLORENCE RD
MAP 37 PARCEL 021 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid f��/ c5� —
Typeof Construction: REMOVE INTERIOR WALLS,INSTALL POCKET DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 039073
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFIRMATION 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 Stre Commission
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.
644 FLoR. NcB BP-2003-0357
GIS#: COMMONWEALTH OF MASSACHUSETTS
ap:Bioc1c ,'.D 1 : CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0357
Project# JS-2003-0586
Est. Cost: $4050.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sq. ft.): 367646.40 Owner: STREETON SUSAN A&
Zoning: SR Applicant: Oliver Iselin
AT: 644 FLORENCE RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:10/9/02 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE INTERIOR WALLS, INSTALL POCKET
DOOR
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/9/02 0:00:00 1167 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo