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12C-080 (6) d-^` P68i-i'8 FROM TO 14132380122 P.01 12 L NOV 2 ORTGA.GE LOAN INSPECTION 1p 40j i i sax W.7 Pat ao PLAN 6W 0 AW Af cr9�� TO; )O X X ��� �{"'"'"""�tiliiam J. 5 John P. Duggan First Americkii Title hisurance Corp_ !Margaret b, batelle 1 herby report tort the peamira sbai n on dais pier is not LOCATION: k"Wd writhiA a Flood Harald Arai as Wwwn alt Um Federal 11 Marc Circ 2 e pMKVMMyhy2&$wm tASwvyWFloodhwwaoosxaaoMap, Northampton, Massachusetts CausonmityNambet can a?. nn A E.$. HOLMBERG &Associates Bfbgdw])W Airil7A 7"D7.� sm I do mpoli,to to bell Of my Imowdodt,taiama6m and a?um orl xTI1=,11Aan1'lA3Q=KA 0102744 belid,that 0"inip04104 pica dw"do iatpi "Ummt or 37 DAlAiM POW ROAD,CIC9712FMD MA 01012.0176 impswemaatr as located as the pamins demo& ,that the 'la ' NOV 2 'r 3 � 0 athe��� ` Crzt� Of 'Wart4ttntptnn as !8 y.aSEiQCl�n8ft16 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Iicensee/permittee} with a principal place of business/residence at: is i14 4!: AV Z,/- � hone# °Ol2 street/czty �P) 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) ( ) 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) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioctl sheet ifnaocrury to include informi6on pertni*+o to all ooatraetora) (Y�I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homcownen who employ Palo=to do maiattaance,suction or repair work on a dwelling of not more than throe units is which the honwwaer resides or on the grounds appurtenant thereto arc not Sco rally o—We rd to be employers under the wvrket's oompensatioa Act(GL152,ss i(5)),application by a homeowner fora license or permit tnay cvid==the legal status of an employer under the Worker's Compemation Act I under sund that a copy of this tutemad may be fbmwded to the Depwtmc of Industrial Aomdarts•Office of Inwrenoe for the coverage verification and that failure to seetu a coverages under=Woa 25A of MOL 152 can lead to the impositioa of criminal penalties oomb ing of a fine of up to S 1,500.00 mtd(or imprison of UP to one year and civil penalties in the form of a Stop Work Order and a fma of S 100.00 a day against me. For dqmtnfttd use Only Permit Number i Map# Lot Al Signature of LicenseelPermittee 11 Wiz `. SECTIONS-CONSTRUCTION SERVICE5 8.1 Licensed Construction Supervisor: Not Applicable�f❑ Name of License Holder: Is. 6&1/0 f License Number /- I a- A o02 Address l [� Expiration Date Signature Telephone Kft F E Not Applicable ❑ 7 Company Name Registration Number 0 -2- ;&-0::Z Address Expiration Date Telephone SEdTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1.52, §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...... ❑ 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 CT ION§-,vRESCRlPTIQN QE PROPOS99' O RK(check all a 'Iicab De New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolitioner New Signs [ ] Decks [ ] Siding[ ] Other [�] Brief Description of Proposed Work: w s s 1-X.+oc-_s4 Alteration of existing bedroom Yes No Adding new bedroom �tlYes? •/ No Attached Narrative❑ Renovating unfinished basement Yes ✓ No Plans Attached Roll ❑ . Sheet -' 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 SECTION 7a.!OWNER AUTHORIZATION -TO BE COMPLETED WHEN 6 WNERS AGENT OR CONTRACT O0 APPLIES tbA BUILDING PERMIT as Owner of the subject property hereby authorize ����=� !C to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of 047ner Date /"/,C- A 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 enalties of perjury. ..1, �_ / Print Name Signature of wner/ gent 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 ,b Setbacks Front rS` r Side L: R: L: R:-- Rear Building Height 2, i Bldg. Square Footage f sv % 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 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 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 there any proposed changes to or additions of signs intended for the property?YES No ✓ IF YES, describe size, type and location: City of Northampton ul Department ain Street om 100 ' U+ NOV 2 8 20j�or ton, MA 01060 phone 413- - 240 Fax 413.587-1272 DEPT,pF i?U;LDING?N APPL 4 UC , ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property is t feted p y Address: ia % y3 Ae / //^/y/q/ Mai + I*01yd s� Zon? `, O►Ier r S Ct d� 4 n ��s y EIm Str tlsrct- C ,DstrlctF .. ..., „H SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 660 e 'l Name(Print) Current gailing Add r ss: . ) ;R— r A Telephone Signature .T 2.2 Authorized A ent- c T �_ .C�o, //q G✓e+.A �t aT o.rt/y/T Ol O 4�� Name(Print Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION!COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 9,5-6, ®® (a) Building Permit Fee 2. Electrical (b) Estimated Total C©St°tof Construction from S 3. Plumbing Building'Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) ©, Check Number C3 This Section For Official Use Only 'Building Permit Number: 97 mate Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2002-0551 APPLICANT/CONTACT PERSON Kent Hicks ADDRESS/PHONE P O Box 119 (413)238-0122 PROPERTY LOCATION 11 MARC CIR MAP 12C PARCEL 080 001 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 Typeof Construction REPAIR DAMAGED FLR BOARDS&OPEN NON-BEARING WALL FOR DOORWAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 066104 3 sets of Plans/Plot Plan THE FO OWING 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 Comm' n 2 Lcab Signature of Building Of icia 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. 11 MARC C1R BP-2002-0551 GIS#: COMMONWEALTH OF Map:Block: 12C-080 CITY OF NORTHAMPTON Lot:-001 Permit: B u l l CI l ng Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0551 Project# JS-2002-0845 Est.Cost: $950.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Kent Hicks 066104 Lot Size(sq. ft.): 11499.84 Owner: RERTRAND GEORGE Zoning: URA Applicant: Kent Hicks AT. 11 MARC CI Applicant Address: Phone: Insurance: P 0 Box 119 (413)238-0122 WORTH I NGTON MAO 1098-0119 ISSUED ON:11129101 0:00:00 TO PERFORM THE FOLLOWING WORK.REPAI R DAMAGED FLR BOARDS & OPEN NON-BEARING WALL FOR DOORWAY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footing`s: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame:O� ,1�- ) U'�Q Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: 0 1,.i' 10—/. O p THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy,, S 2 nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/29/010:00:00 5100 $50.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo