23D-011 (4) 20140W UCK ST BP-2001-0965
GIS#: COMMONWEALTH OF MASSACHUSETTS
2sm-till CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0965
Project# JS-2001-1729
Est.Cost: $6700.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 10585.08 Owner: ELDREDGE STEPHEN&LAURIE WOJTUSIK
Zoning:URB Applicant: ELDREDGE STEPHEN & LAURIE WOJTUSIK
AT: 20 NONOTUCK ST
Applicant Address: Phone: Insurance:
20 NONOTUCK ST (413) 585-0064 0
FLORENCEMA01062 ISSUED ON:5/23/01 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 3 WINDOWS, ADD DOOR &
WINDOW, RELOCATE SINK & STOVE, ADD LIGHTING & OUTLETS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 5/23/01 0:00:00 1202 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2001-0965
APPLICANT/CONTACT PERSON ELDREDGE STEPHEN&LAURIE WOJTUSIK
ADDRESS/PHONE 20 NONOTUCK ST (413)585-0064 Q
PROPERTY LOCATION 20 NONOTUCK ST
MAP 23D PARCEL 011 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out r
Fee Paid Ir d lL�0
Typeof Construction: REPLACE 3 WINDOWS,ADD DOOR&WINDOW,RELOCATE SINK&STOVE,ADD
LIGHTING&OUTLETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE SOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
!/Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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
Yttzi4 0/
Signature of Building 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.
May 14 01 09: 29a P, 3
s
•
EE C E 11 V 'icy .of Northampton
wilding Department
212 Main Street
MAY 2 3 2001 Room loo
Northampton, MA 01060
DEPT OF BUILDING IN'r '�' ' 13-587-1240 Fax 413.587.1272 ..
NORTHAMPTON,MA 01060 ' 7
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
a3 ) -
5ECTION•1- 1-TE[NFCi ~M CQ { ' _0,tir-
a, i'�-r'--, `�'P 3 r. :.--••'�91.1.7- +2 j�i 9j� � `Tizai � Min .
1.1 Property Address:
�} AAA r> ��I;knr'.s`? :�. � S c,e 1I � i�'3 �F..� p, y � i
rn 7 � .1_ i k' t r T '1����1 :� -i-'�j-,.,ry „z 3 r�
ç\orQvCP J 1 � ` Sr iS,�-f r ;x i'4'' + 71{`41 , �y11 3. t -,44:,: :r d .. I -%t
1 J 4rf 7 £ . ,� a�i y
.4-'-'7.i''''''''',4'-'--err h — ' '.�(!':" `f a e,i 4 t:� '.4:-. ';`'''
SEetiON 2 PROPEiRT'Y-OWNS SMI `'AU1 O0tIZED AGPNT
2.1 Owner of Record:. ,
S' Q, C—I6kre& e vr;e.U6_ ,K ?s_7 kbvc+cV t Qo tc w4 °1°6L
Na Pri t Current Mailing Address: 1. C- (j
I�r 1 Telephone
Signat
( .. 2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
Item Estimated Cost{Dollars)to be �ia1:Use On
completed by permit applicant 9
1. Building ! ®®CJ (a)Biilring,Perttf •4',� #i 4�
t ' S ,,c�.1n'U_+E .7r 17 , rye
2. Electrical ' (•b3 Es'ttrnated Tlst' a. 3 if s
i ,5O Corrst u1lOrj frQ w
3. Plumbing I 1 `Building t�'ermit F :7
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 +3 +4+5) 6C' Cek Iyber �5 }
a ,„ r a Y k si►� r F {
;F, ,: � C: �I l� o` q.icta[. 01i1- • z_K
`9
f (fT , Rermtt Number t. T'.
eft Da a issued_'
:. ,
Srgritre;
Budding.Comma sione.X`-taa4(i for Off �i ttll>gs Date
May 14 01 03:31a
p. 4
in.
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size q,_so
Frontage 6 cc) ( . 5 a uAlz_
Setbacks Front t 5 cl-LL, L
I q�,�
Side L:32 R: � L: lt: " —
Rear 1 6 t 5
Building Height ,Z .L
Bldg.Square Footage 116( Sr. %
Open Space Footage t
(Lot area minus bldg&paved 7.Z t j 3 '7 3.9 s0.Uu —
parking) �t 3
#of Parking Spaces �al/1"-e_
Fill:
(volume&L o c a t i o n) V o t .L
A. Has a Special ermit/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 7 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 re any proposed changes to or additions of signs intended for the property?YES
No >
IF YES, describe size, type and location:
May 14 01 09: 31a p, 5
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W x 4W a k
': w :41
ki-t1ely' 1_4sta),+irt"Fai Q n fps »F,,, i�inyat� tf 1p�l iL-. 9 i;.a
,,
.. Lw 6t '1" ..,b7 1 -4 ,_3t'- ', n Y ? 1 ,, .,?.-
'-g.77 *u .�L11 Tlr- 7 4-.- xW' riii.' 1.".1iu.trv":£i(3dLM'N£
�. 2 ALA .S" � '!'1-YL.�{.Y: 1.. 1:.'t6`LdAI1"
New House ❑ Addition ❑ Replacemen endows Alteration(s) " Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ 1 Siding[ 1 Other[ ] 1
Brief Description of Proposed Work: C.► ° . l°f 1+J5 i ! ))r40 j► rt cQ.-`000. ; ' v■ 5'14k S V /
c' , i. I }-►t . 004+,
/
Alteration of existing bedroom Yes 'No Addigg new bedroom Yes 1/No I
Attached Narrative❑ ffenovating unfinished basement _Yes l- No
Plans Attached Roll❑- Sheet 0 i
i'..n'_=La, i1,j',s._.:- .,..:�,1L;. °° :6staTAr ,, ..s t., 6),!: ')J'__° = ., '1.rk 11 )=.i;4::.: N0
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?
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•,y i','.fir. t Yq vh 6 .-It P-..1, 4= 1t $ °C $ ... _ L 741-
m,R Cr>iiF)14,$i="a.-,_ fit .C,-F " 'VF 9 . S r Q':, tI 7',Ki'e 1 it 1 .+.
a"`te 4,, 2 e� z .. ,�,,.., ; LASS 1,�'97,''-,'-','4!:'''`r "" L,. Oat .: a ,_ t'vf •r
, 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 Iir
I, ?_HD■ r 4/41 � , �4L—a –=--� , as Owner/Authorized Agent
hereby decl. 'ghat the statements and nfor it tion • the foregoi'gap• ication are true and accurate,to the best of my
knowledge an• selief.
Signed under the pains and penalties of perjury.
. CI-DP-C.06-e- - L- w c W o,1�v 31)4.-------'
Print Nam: l.„,,,
!��1 A. ! F^ ,�f`_ „ 5-/ 22-'! I
Signature ••T,i er/Agent -- Dile
•
May 14 01 09: 31a
p. 6
W r }
}y} •�
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
/ I
' Not Applicable ❑
Love ()1 101 1F?�
Company Name Registration Num er
Address Expirati n Date
A1,44141-stSt) M A 01,�Z- Telephone 1113 Z5 82)
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 the building permit.
Signed Affidavit Attached Yes No ❑
-
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 108.33.1.
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,Sta and Local Zoning .ws . State f Massachusetts Gen . . Annotated.
Homeowner Signature - ,rid •.. _,4 4.1 ���� �
May 14 01 09: 33a p' 7
a"�` �;
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fyl :: �(�1! lasearlinettle =i`-!��+
"'w:-'= DEPARTMENT OF BUILDING INSPECTIONS -
a
_`
212 Main Street • Municipal Building �/�
Northampton, Mass. 01060 ur
,,�-WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, e \ C' Laurie (,0 -QS''‘t<
permittee)
with a principal place of business/residence at:
Z kh VtV V o ck S 1 r -AO'A ce i f A-oiO6Z (phone#) 64g C^ I
(street/city�state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
am a sole proprietor, general contractor o om (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
Loy, ISU
A 6KP1- - No 0.tv 1 eNica
(Name of Contractor) . (Insurance Company/Pohcy Number) (Expiration Date)
)avCi .\ nu r-es te�. ilir.S_c, ,�- We M(�D(Oq�f70o U I l zt 10(
(Name of Contractor) (Insurance Co any/Poiicy Number) (Expiration Date)
(3fir,;S QC� c-Ncl? -e�,okikc,Co, tub-uZ � TJij (91
(Name of Contractor) (Insurance Company olicy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attsah additional sheet ifnecessary to include information pertaining to all 000treeton)
( ) I am a sole proprietor and have no one working for me.
( ) I am a borne owner performing all the work myself
NOTE:please be aware that while homeowners wE o employ pnrooa to do znaiDunaacx,construction or repair work on s dwelling of
not more than throe units is which the hot:mama resides or in the grounds appurteuaatthxeto are not gaoaatty ooasidered to be
employers under the worker's oornpeusnlion Act(Oil 52,ssl(S)),application by•homeowncr fora limas*or permit may cvidcace the
legal status of an employer under the Worker's Campamatioa Act
I undestaad that a copy of this natemem may be forwarded to the Departaseot of ludcsstri l Madera Office of luwreaoe forth.
coverage verification And that failure to secure coverage under section 2SA of MOIL 152 can lad to the**aka of esia isti peonItiea
c o n s i s t i n g o a fine o f t r p t o 31„500.00 a a d f a o f ti p t o ow y e a r and c i v i l penalties in the form of a Stop WorkOrdri and a 1
fine of 3100.00 a.day against one.
i Far departmental use only
'., ` I I rte! �__.. Permit-Number
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I Lill I MAY 2 3 2001
DFP1 OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060
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