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29-471 (3) ��tw•r nT �0 achnscttaf v~v DEPARTMEI T OP BUILDr?\'G INSPECTIOI,,S 212 Main Strcet Municipal Building Northampton, Mass. 01060 WOEUCEIt'S COMPEMSA'I'L0N MSUTAHCE AF MAVIT (Ii c��x•Jpertni ttcc) v,rIdl a ptb,-icipal place of business/residence at: o i1d'Y 2,P� 5 alV lele A610' _(phone'� I 73�-ad �- n ty/staicl�p) do hereby certify, under the.pz.int and penalties of perjury, .hat (VI am an employer providing dic following worker's cotnocnsa:j'on cove awe or 111y emplovecs woridng on dlis job: GfgArrl�: ST,S► Laz, Co VC, 1139,;2-6 o --- (Lanu-n=Cocs=v) (PeLic: Nu.--Zb--r) (r:pir or,Dam) O I am a sole proprietor, general contractor or homeow'Der(cu C;e one) aid have hired the coon-actors listed below rqbo hive the follo%vinQ workers coipensadon pekies: C'NamC Oi Con': czar). (lOR raft( COIII01S1)/1�GUCi �tUB1LC:) `1-.�t3 1 Qt l�l(C) -- (Name Of COUTaLlor) (Ins-aranc:. Comoanv✓Polim, \uocsr) (E»ir -ion Dattc) (Name of CCoaaacto.-) (tnslr-anc: Compa.n}•/Poliq Number) (Expiraoo Date) (N2-MC of COnMCIOr) (I.nsu=cc- Company/Policy Numbcr) (Expirdoa Datr) (anacb=dut:oca1 dcc.ifnccai-l-cn�c;s�iaronn�oa pertn' to..11 cone-__cn:-.a) - 3 s { ) I am a sole proprietor and have no one woridog for me. O I am.-a home o%vuer perforrn.ing all the work myself. NOTE:pl=sc be aarxrc th••vi::1c bcmr_owD=wbo czuptay p,=-soos to coo -• -. on(most th.-e Urm�ri in u�eb the bomoo vacr raid=oc oa the p-aun z�purterLr thee,L oxcCe)e�ocrzd=-oJ w L- `of ccivloy=untie the Nukefz o=-r--.+;on A=(GLI S2-=1(S)�a,-ptiey7cn by a bomrAaxr fcr c lic---cc pcnnit rz=y add-on the IgPJ cl--- ,of as erployw uader dt Woc$dc Co�oonLrion Act I—8-ro.Lad the a qAf of this y bo foc---d.d to the Dopanmcot of 1.6"uW AccdeSf Off oa of La:ur+oca far th. oova� veilanion tac to vcrygc under som=a 2SA of 1.(GL 13-2=a Id w the iasosi -of aimiaal Pcnatli= rl=0(51 0.a[sac S 1 00.00 =Cup w ooc y�r god c-.i]pcaatia in be form 0(a Stop Work Ord=Lad a Gm oC S 100.00 a For — dcpu" j u-only Pcrm1t NtLIDtk1 LOl A. S i GnMwt ofLi vvrnnrtilrlcc Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructian Su ervisor: A Not Applicable ❑ Name of License Holder s License Number Addr s Expiration Date o /oc ig Telephone 9:Re""istere'c 'Homelln ravementontracro". `TM '� `�° s Not Applicable ❑ 71 14 a4", Company Name �p Registration Number S ,L A v V � // Cl'?s Address 2f[�?� h Ex0iration Date Yr� - Ott 0$ Telepho<ne�/3o1����j SECTION 10-WORKERS'COMPENSATION INSURANCE AFEIDAWT(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 builds g permit. Signed Affidavit Attached Yes....... No...... ❑ 1�1 M INN Mor UP 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$om 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 Window's Alteration(s) ❑ Roofing ❑ ' Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [[] Siding[0] Other[� Brief De i{�op Propo dd ^-� Work: IZfJT} (/�!d l fZ<,t// ��fJGt�/� � C.,� �rLraaa12 odKls Ati0 S/G(,s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a. Use of buildi g:One Family Two Family Other b. Number of r oms in each family unit: Number of Bathrooms c. Is there a arage attached? d. Propose Square footage of new constructi Dimensions e. Numb r of stories? f f. Met od of heating? Fireplaces or Woodsto Number of e h g. E ergy Conservation Compliance. Masscheck Energ�Compliance form attached? h. ype of construction / i. construction within 100 ft.�wetlands? Yes No. Is construction within 100 yr. floodplain�Yes No j. Depth of basement or cell F floor below finished grade k. Will building conform to he Building and Zoning regulations? Yes No. I. Septic Tank ity Sewer Private well City water Supply SECTION 7a=OWNER:AUT-HORIZATION---TOQBE COMI?LETED"WHEN- -- OWNERS'-AGENTOR CONTRACTOR APPLIES.FOR.-BUILDING=PERMIT as Owner of the subject property hereby authorize V 1>6 AV to act on my behalf,in all ma ers relative to work authorized by this b ' ng pernfit application. 4 Sig at a of Owner Date as Owne Authonzed Agen hereby declare that the statements and information on the foregoing application are true and accurate,to the best o edge elief. Snzr the p in and penal s of erju Print Nam L Signat e o n /Agent Dat . ^ ~ - ' ^ 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 filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) ° A. Has a Special Perm it/Vuhunoe/Finding ever been issuodjtr/on the site? �� �� NO �~�� VV �,�^ DDN7KNO YES �,� IF YES, date issued: IF YES: Was the permit recorded at the Registry ofDeeds? NO t } DON'T VV KNU YES�° IF YES: * enter Book page and/or Document#i_ � B. Does the site contain a brook, body of water orwetlands? NO 0 DON70VOVV 0 YES IF YES, has permit been orneed to be obtained from the Conservation Commission? Neodstubeobtained �- \ Qbtoinm� �~� Dotolssued'. «�� �~� . C. Dn any signs exist on the prupert �� ��y? YES �~� NO �~/ IF YES, describe size, type and location: | D. Are there any proposed changes tnor additions uf signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre oriod part ofo common plan that will disturb over 1acre? YES ���> NO ���] IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ` � l+�weA� "t©e--'tmentuse orgy"zXV City of Northampton Building Department 212 Main Street S� a rfabt tt �# f Room 100 V III - ;; =' Northampton, MA 01060 e ta5i< raCPI phone 413-587-1240 Fax 413-587-1272 Pto: if aissj�; APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 ­SITE INFORMATION 1.1 Procert dress: This;seictionto,becompletedbyoffice Zone Overlay Distrrct FLoe_W",t1C,1&j1V14• o r o&,z Elm St-District ' GB.Distnct SECTION 2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: !j!�3—-P6 —4coJ 1C. .� Telephone Signature 41 A 2.2 Authorized A144 A ( �� �d 0.15 /cl��'�'vC% AALCI& 5 ejNv& Adz � Name rint) Current Mailing Address: ur Telephone SECTION 3-'ESTIM TED:C NSTRUCTION z COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermita licant - 1. Building /S (a)Building Permit Fee I 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 „� Q This Section.For Official Use Only ' Building Permit Number. Date Issued: Signature: Building Commissioner/Inspector of Buildings Date was .. File#BP-2007-0615 APPLICANT/CONTACT PERSON ATLANTIC SERVICES INC ADDRESS/PHONE 885 SUMNER AVE SPRINGFIELD (413)747-5688 PROPERTY LOCATION 306 RYAN RD MAP 29 PARCEL 471 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid i Typeof Construction: REPAIR TERMITE DAMAGE TO FLOOR JOISTS&SILLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 014869 3 sets of Plans/Plot Plan THE FO WING 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 lm Street ssion 12- J 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. MAR-20-2fflS 71:04 From: To:14135395311 P.2/2 306 RYAN RD COMMONWEALTH OF MASSACHUSETTS bfjM&12ck:29-471 CITY OF NORTHAMPTON Loaf-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS permit— BUIlding 00 NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Ergiect# -.a_-2007-0009-IA ,F191,CDSJX721AO PERMISSION IS HEREBY GRANTED TO. calarviclon License.- 14C q,qypj ATLANTIC SERVICES INC_SL4169 Lot Si•vua. ft,]; 50, -5,20 Qwmr; T0MA5AUQM&&QNALD J Awligg j=,ATLANTIC SF.RVICgS INC Applicunt A!�dress: 881 SUMNER A—VE. (413LL47-5699.- wc SPRINGFIELOMA01 108-2251 IMUD ON.-IPM06 P.-as o0 TO PERFORM THE FOLLOWING WORK.•REPAIR TERMITE DAMAGE TO FLOOR JOISTS & SILLS PO,5T _HIS CARD$01T IS VISIBLE E&Q&THE jSTREET Inspector of Plumbing Inspector of Wiring D.P.W. Puildhig Inspector Undergrounth Service: Meter: Footings: Rough- Rough: Howie 4 foundation; Drip sway Final., Final; Final: Rough Frame: Gas: We Dcoartment Fireplace/Chimney: ROUP-1 Final: SMULe. Final: Okc THIS PERMIT MAY BE REYOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. _Celificote Ifgc qgan C SIUI Rate Pild: AmRunt'. Building 121512006 0:00:00 $50,004121 212 Main Street,Phone(413)567-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo