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23C-100 (4)
• 214 WARNER ST BP-2005-1211 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C- 100 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-1211 Project# JS-2005-1630 Est.Cost: $9610.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HARRY FISK 135756 Lot Size(sq. ft.): 50094.00 Owner: BURGER H ROBERT III&ANN M Zoning:URB Applicant: HARRY FISK AT: 214 WARNER ST Applicant Address: Phone: Insurance: 324 BRATTLEBORO RD (603) 336-7725 HINSDALENH03451 ISSUED ON:6/9/05 0:00:00 TO PERFORM THE FOLLOWING WORK:SHINGLE ROOF OVER EXISTING 1 LAYER 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 6/9/05 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo shl Departmette- y4 114, City of Nortfampton Statttof Permt G . Building Department Curb €tt�Dtvwarint 212 Main Street Sewe-xSept �adabtttty �' -� Room 100 Water/ eli Availabilit r Northampton; MA 01060 two Sets ofStwctararPrana;i phone 413-587-1240 Fax 413-587-1272 Plotts t Mans _ . Others eet APPLICATION TO CONSTRUCT,ALTER3REPAIR%R O.----j-41 .7% - OFZ DEMOLISH A ONE OR TWO FAMILY DWELLING \n SECTION 1 -SITE INFORMATION' �1 C1` ',) \, \\10,,,i, `� -section to be completed by office 1.1 Property Address: Map 3)his Lot Unit, ,-'Z ne �, Overlay District o c ' cec /�tP Elm St.District . CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4A.t kl M' 1ccf , Name(Print) Current Mailing Address: ' YZe ' , Telephone Signature 2.2 Authorized Agent: j.� _y J �/5 i� t ,g4,9///e io o ,Y,4 4 !T/l✓, Name(Print), Current Mailing Address: GUGL � . r!� E mss' 3-34 -.7-2z5. Signa ure G! / 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 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number �{g// 0a� This Section For Official Use Only v `�I' Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date f Section 4. ZONING All Informatibii 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 LotSize ____________ _ ______...______.. 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-8c Location) ------°----- — A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? e-N /-"N NO kj DON'T KNOW YES kj IF YES: enter Book ' Page ' and/or Document#:� B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW ci 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 0 NO 0 IF YES, describe size, type and location: , D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) n Roofing Nr Or Doors CI Accessory Bldg. n Demolition El New Signs [0] Decks [E] Siding[O] Other[o] Brief Description of Proposed , / /� / Work: got; o 'el.. ek'tShyp Stmt' /Vie 0. i 2/i ' 1,4,1 PS t h/A 35 'I2 5-44 ;) Alteration of existing bedroom ( Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house-and-or-aciiiit an..to:_extstic q-housing,=-coriEro[ete the,foIIo tnq: 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 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, /492/1 J /- ,S 4 ae-6wrrelAuthorized Agent hereby declarethat the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed and r the pains and penalties of perjury. Print Name A '1 - _ ...Y . lh.S Signature of e - 'fit Da - f F SECTION:8-CONSTRUCTION SERVICES I 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: t 7L 4 C/Z V 3- )` c �c a Z21. 6 License Number e io iiie Lo7,'o ?1e2 t51(�, Address Expiration D e _ _ 4 fl/i c3 /5f Signature Telephone 9:Re.ist e" ome=b`ri'e rovement Contractor , , %2 ,;.;T A ,,. ,4I, Not Applicable ❑ /la/CA j 3575'6 Company Na a Registration Number g 3.2V i1 'i ,/ Nfns il ,/ 43 Vs' Address Expir io Date Telephone 60J---"j'L" .2)2'" SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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 ❑ or>krrelrel Eg�>rrpa>a The current exemption for"homeowners"was extended to include Owner-occuivied 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 be/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,von 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 o i5.s,qj , Q.,Titp of Northampton ... Islar.i•- . • -.)-! =----_-:---. r �}•A 'arl9'SSAC}�llSttfB •- +[ �'t`e )U _ I 111..._t �} " DEPARTMENT OF BUILDING INSPECTIONS 1 j% INSPECTOR 212 Main Street • Municipal Building 7,- Northampton, MA 01060 . HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:.'s sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. lithe homeowner hires UtL el trades to perform work/eleCtr1c41, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. , Date Address of work location P. •� (y/ ci Northampton ;14,P44117 DEPARTMENT OP Burt_or'G INSPECTIONS 212 Main Street. Municipal Building Northampton, Mass. 01060 r WORKER'S CO\III'ENSA"i"I.ON [NSURANCE AFFIDAVIT (iccii xlpc.rtl.ittcc) with a principal place of business/residence at: --- 7?V 13,1e9f//P -• /c g,, Jil/f (phone ) 60_7—.35C -)2 c�S (st/ci ty lsZatcr�p) do hereby certify, under the pains and penalties of perjury, that (> I am an employer providing the followint'worker's cotnoensnan cove age for my • employccs worng on this job: Avirrei;24 f(` T s : C ct p 5i17117064, °` a s� (Las-uranc.Comr_■ •) clic: Nt cr) Day_) ( ) I am a sole proprietor, general contractor or homeowner (cicie one) and have hired the cont:actors listed below who have the following worker's comoen_tadon policies: (Name of Contractor) (Insurance Coinoary/Po ci Numscrl (E: irauon Date) (Name of Contractor) (Insurance Company/Policy `um er) (Ifi»iration Date) • (Name of Conmctor) (Insurance Company/Poticy Nosier) (Expiration Dale) (Name of Contractor) (asuranco Company/Policy Number) (Expiration Date) . (oath z.dditiccal c`cCtfnccci.v to ndud;inform oc=5 to..tic --_corn) • ( ) I am a sole proprietor and have no one working for me. ( ) I am.a home owner performing all the work myself. NOTE:Pi=-44 be ncnrc tfi••w't:..le bcmr .acra wbo axploy poi to do r-a •r —..:e_,00 r rryau work oa.d‘•di of alt more tl_a t t=a;is which ttx bomoo•.vocr raced=oc cc the croutait zpp. too r: redid-cd to be eixployea t,r1e the wack c c -,,ea A.=(G1.1152.=1(5)).=pplintiao by n boo fc c ticzcz a pcmit rz_cy cvklcooc the 1c .l ns.'ue of ao c ployor under dao Wocir dr Comgoocu ioa Act I uodczzaad that a Dopy of Chia eatemea may b.foe-word-ad to the pequtmoot of I„..arrici Aondmts'OQaoo of locurcooa for thm criminal d cov '�oa of (� �clTatioa aced t1Lt C:.iJtac to sa�rtc'co trr,.ir;section 25A of h 1 2 can Ind to Lb.�'c vcra.sc SA loL S cc m zarg of a floc of up to S 1.500.00.ndyor irmiariaeacommi or up to hoc yc-s tad dpi]pco.dtio io tSe form an.Stop Work Ord nod. rtrta o(S 100.00 1 day cpias me For dqv' vac only --- f/o Permit Permit I't um Humber ✓ ✓!�-' S��/� '� Map::-- Lot S;i T t�czns /Pc rmiucc to -- J i oat ^ Page# f of pages Proposal Submitted To: Job Name Job# Art EV v .e0 Address Job Location 0lc( tiJOn0Pi? s'it Date Date of Plans 17 InaAnrF' /4fG 5.5 5/96105"— , Phone# 1 Fax# Architect / We hereby submit specifications and estimates for: __(boo-rt»e,� o t.'�c� -- 4,k_1',4 1,101 i2 -� --_O t r�,1 .-- KO C liA-I}cdcl L,( -)v- cn ;\c._n. tc C. \T I.Ak li /Q/ fY1. iv,_altf..,_ 1 705-1A_li t ,?t',L. 1 tic ', c. 1*11L,1-�Ltiri;i�_b� (9t� t (Lair I- f__ 7r +<4411f�_ Iii 5 IC K 1 lAo,(26.5I �_ t�5 A )1 .(L'Pc( __ C�©_?�:?e i-( _ 5G_ U/ �12 f of _C G1 f vi-f-rl(�i_ . tf2..,) t�z 9 S f -I �'N 5.-4,0 11 .C''_3 I )1 v v!1 r VI c)/4-/ -� 1 1 1 i I 0(.7 A L,.\ 5, (- C t--; f l) _ LO - ,e '0/-41,_ 11( FLt ! n.'ti c-i K iii y ' l i r d We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: 96/f ot9 I n) / ?t r p /n�„S�J,1O j h /f t;vt r4 1e C cl 1-(2 r) C 1 l r?f�5 <'FnI$ Dollars with payments to be made as follows: 50 r' '� do Lr..)r) /76)/4-/A/on/(0,e L! c'Ya t"r-77-4 4 r/rrr1-a Any alteration or deviation from above specifications involving extra costs will be Respectfully y/ ,,.�.' executed only upon written order, and will become an extra charge over and submitted / �� ittS �__. above the estimate.At agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may b i drawn by us if not accepted within TSc days. / \ acceptance of Vropos'al The above prices,specifications and conditions are satisfactory and are J „ Signature C- ,• ) , . ,/v c_, ,, hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of l ceptance /'a r - 7 '26). 26-(---3 Signature / t • a NC3819 MADE IN USA