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29-452 (2) Y /j j yY L � F f I. L � � �`., r rz"�� - 'r ✓°yam Y Y' k. lot x. � 22' 1 I I i v I � I i I II I I I I I I I I I � I I I I , I i I it I I i , I I I , I I loll I l , I I , p I ° Slezek Garage M Construction: 40 Crestview Dr Studs 2"x 4" - 16" oc Florence Sheathing - 1/2" plywood Roof- 1/2" plywood, paper, asphalt shingles , I I , I I � N I I I i I , I I , I I I I � I I I I I I I I I \ I I I \ I I I O I I I O I � I I I I I I I � � I I I I I I I I � I I 0 I N I I I I i I I I I I I I I i I I � I I I I I I I I I I I I I I I I � j I 16074 Slezek Framing Plan 40 Crestview Dr. t 'r I I 4 Foundation Walls 8" x 16" Footings Top of wall 8" above finish grade 34" Door 16' Overhead Door centered j — - Slezek Foundation Plan 40 Crestview Dr. n 14' North New Garage 221w x 26'd A Deck 16' x 22' Existing House 24' x 42' 30 /vs y6,W61s Lot 100' X 100 Slezek Plot Plan 40 Crestview Dr. t O�-S�tAa1P�0 � (rxt� of 'Naztljttlllptoll BassxcE?nsctta a DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE Ar,MAVIT (liccnsetlpermittec) with a principal place of business/resid/e�nce at: �' ��� %UI�� �i� ✓L� �L' � (phone#) (stre—eUcity/sra r/zip) /Olo� do hereby certify, under the pains and penalties of penury, that: O I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expimtioa Date) r (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioail sheei ifntccaary to include iafoecnsaon pertaining to all ccatadon) O I am a sole proprietor and have no one working for me. (-KI am a home owner performing all the work myself. NOTE:please be aware that while hocxownm who cmplay p=om to do -„t .nom o¢4tructionor repair work on a dwrAag of not mete than tbrco units in which the hon»owncr resides a oa the grounds appurtenant tb,- o a�Oct ga)crallY coolidcmd to be employers under tho worpta's caution Act(GL152,s31(5)),application by a homcow n r for a Lc==cc pclm may evidence the 1tg21 dab a of an employer under tin WorkCes Compomaiion Act I understand tbat a copy of this statcmcot may be focwivdod to tbo Dcpartmoo of Industrial Acciecn&Ofioo of rnsursnce for tbo coverage verification and that failure to s,:-=covcrngo undcr soctiou 25A of MGL 152 can l d to tba impost -of ct awi pcualties oomiemig of a f oc of up to S 1,500.00 andlor' of up to ode year and civil pen&Wc3 in the form of a Stop Work OtdC and a firm of 5100.00 a day agninA Mc i Foe dcpartl usb only Permit Number NfhO Lot# :1� Si of Li e e SECTION 8'-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone - ire:.-��"� - �m��� - , �rwxm«-a, 9.fRegistereKA rime I m r: vernent Contract'or� BMW Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS',COMPENSATION I1NSURANCE 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 94 the building permit. Signed Affidavit Attached Yes....... No...... ❑ r - l The current exemption for"homeowners"was extended to include Owner-occupied DwellinEs 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 pen-nit. The undersigned"homeowner"certifies a assumes responsib' f mpliance ith the State Building Code,City of Northampton Ordinances, State and Loc 1 oning La d e/ sachus is General Laws Annotated. Homeowner Signature y SECTION 5 DESdPIPTlON°0F PROPOSED WORK(check all applicable) New House ❑ Addition ❑ , Replacement Windows Alterations) ❑ Roofing E)Or Doors El Accessory Bldg. Demolition❑ New Signs [ ) Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work:C �y /�Cf��%J /��L l Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll U - Sheet sa JUNew..K60— aiiii bef ddition to 6zisting;'housing, complete`the foilowiing_ 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? A/U d. Proposed Square footage of new construction. 577 ' Dimensions 6 e. Number of stories? n o _ f. Method of heating? IVA Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction 6(1e'r"19 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 SECT10W7a OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERSAGENT ORCONTRACTOR'APPLIES FOR BUILDING PERMIT I, 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 Sz–eK—/( 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 Signatu er Age t Date 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 Frontage Setbacks Front Rear Building Height Yll Bldg. Square Footage `7% Open Space Footage % / L/ c7 �oz (Lot area minus bldg&paved r IC, �� #of Parking Spaces (volume&Location) A. Ha | Ponnit/Vah8noo/Finding ever been issued for/on the site? NO _ DON'T KNOW� YES _________ IF YE5, date issued: IF YES: Was the permit recorded at the Registry ofDeeds? NO DON'T KNOW YES IF YES: enter Book Pago and/or Oocunnont # B. Does the site contain a brook, body of water or wetlands? NO _`, OON'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. On any signs exist nn the property? YES NO ~� |F YES, describe size, type and |onation: D. Are there any proposed changes to or additions of signs intended for the property ?YES No |FYE3, dostr/bosize. type and location: ' --' w City of Northampton S. Building Department G ,: a - 212 Main Street e.. tan Room 10 a Northampton, MA 01060 phone 4.13-587-1240 Fax 413-587.1272 PI:a , Ite F ez APPLICATION TO CONSTRUCT, 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 _ y Map Lot-- Unit Zone Oyerlay Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailin V11-3 —dress: Telephone Si nit 2.2 Authorized Agent; e6z Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION;COSTS Item Estimated Cost(Dollars) to be Official Use Only competed by ermit applicant 1. Building e�� ( (a) Building Permit Fee 2. Electrical L"� EG (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) C ° ' Check Number This Section For Official Use Only Building:Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date,.