32C-128 (7) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable n'T❑,/
Name of License Holder: � �]' ��n � 6 % 97
License Number
J/ JJ6�U'16C 1Vo:&7714 0TbN Al 17A0
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration
Telephone 1509
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...... ❑ ez<,K R -4TE d AJ F//f
11. Home 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding [❑] Other[❑]
Brief Description of Proposed
Work: &D a mcyj 3TE6?— E6je'r.4 g 33-117JX � 2>DOR fk0)LJ A A'1!' )E&L p 19A0,O)C AFAI r
Alteration of existing bedroom X_Yes No Adding new bedroom Yes A 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
yAl9 I'D/V as Owner of the subject
property
hereby aut orize BOB R9C'kA A.)
to act o y ehalf in II m er relative to work authorized by this building permit application.
Si atl✓ire of Ow er Date
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.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
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 tilled in by
�t Building Department
/Y
Lot Size o 01119N " 4 /v �or�/Al1 09
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 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW � YES Q
IF YES: enter Book Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO W DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q 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 Q NO
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 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City�of Northampton Status of Permit:
AB,,ding Department Curb Cut/Driveway Permit
�ij,2 Main Street Sewer/Septic Availability
'l 'Room 100 WaterMell Availability
i.;UD Nompton, MA 01060 Two Sets of Structural Plans
phone 41�-587,1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO C T G. ,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: J) This section to be completed by office
T A 6?0/T Sfree-T Map Lot Unit
IV 0977 0MFP VNI M 016&L) Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ELAM y� 6k TL r-rt:et,nlvRMMIOT&I kf A
Name(Pr ) Current Mailing Address: ,
5(JV ' `Y{q 5-6
Telephone
Sig at re
2.2 Authorized ent:
B05 Ret?kwAiy .31� 3EAVX6 06NTER NvRTfwrnPIMA M
Name(Print) Current Mailing Address:
S8ILI- /4I?L/
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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=0 +2+3+4+5) 0 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2007-0111
APPLICANT/CONTACT PERSON Robert Reckman
ADDRESS/PHONE 36 Service Center-Unit 2 NORTHAMPTON (413) 584-1224
PROPERTY LOCATION 42 FRUIT ST
MAP 32C PARCEL 128 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvneof Construction: CONSTRUCT NEW STEEL EGRESS STAIR&DOOR FROM 2ND FLR APARTMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessoly Structure
Building Plans Included:
Owner/Statement or License 009498
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 mmission
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.
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42 FRUIT ST BP-2007-0111
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 128 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2007-0111
Project# JS-2007-0167
Est. Cost: $9000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Robert Reckman 009498
Lot Size(sq ft.): 8319.96 Owner_ JOHNSTON LELAND P JR
Zoning: UiZC Applicant: Robert Reckman
Applicant Address: Phone: Insurance:
36 Service Center- Unit 2 (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:81112006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT NEW STEEL EGRESS STAIR &
DOOR FROM 2ND FLR APARTMENT
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: �1 3� a t
Rough Frame: a,� 0 Lo�
f I
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: :nsuiatior.: �� £
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 8/1/2006 0:00:00 $50.0011851
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo