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29-515 (3)
jUL 17 Zppo ' n,FI GF 81}ILG! G INSPECTIONS 1 r- x U � f , r (( i Q l=am � • O �.ti3.a 0 A� E Crif-L) 0f �'Tci fljallIptoII �Zcsenchneclle — DEPARTMENT OP BUIL.Dl�\'C INSPECTIOI:S — 212 Alain Strcct ' Municipal Building Northampton, Mass. 01060 NVOR10ER'S CONITENSA` TON INSURANCE A AVIT i rmittcc) xvith a principal place of burin s/residence --(—!c7,-c ex -- t on M 0 o6 honc;'��/( (stmt/city/sta tc�a p) do hereby certify, under the pains and penalties ofpcgtry, that ( ) I am an employer providing the following worker's colnnens-�Ion cove Zge 'or Illy etuplovecs wor ang on this job. (Incurs Corr c.) (Pelic: ? umirr) ----` (r :pircior Daze) ( ) I am a sole proprietor, general contractor or homeowner (ciucie one) aDd have hued the contractors listed below who have the following workers Camnens2aon policies: (Name of Coat actor) (InR ranee CoIr panylPGUc'i Numbcr) Datc) - (Dame of Contractor) -- (Insurance ComoaayiPolicy Numccr) (-ExpLr-;UIon Date) (Name of Coan-acror) (nsuranc; Compao)•/Poucy Numbu) (Expir6ou Date) (Name of Contractor) (Losurancz- Company/Policy NUMIY:I) (Expi.,,tion Datc) (anac��:ioczl r'_>oct if ncccti� to ck!udr iaformL�oo pat=-ini.ns to.11 oca�-ar_on) O I am a sole proprietor and have no one woridng for me. am.a home owner pefforroing all the work myself- NOTE:plcsc be cw-rc t},,.w'1_lc bcc7,7,0c0 trtio employ pc io to do r•zcmc . =--,tc, at cr rrp-ir wori:m.d,.c l-,-&of oni Mott'h--U lhruo units is u'fxch the bornoowvcr r- ido oc oa the Qounds z.ppu�tbc-ea LT ox l;exrz.11y oecz:d-- d to be eatplay—u--' the—k-'s a=x> -t'oo Act(GL152 n 1(5)),:4*Uc:1600 by a bomeow=fnr e 6=e x—oc perma r=y e.-idmce the IcIP1 ctaau of a7 orPloyx undor[bc Wor✓et Coatpoo aLioa Ad 1 undQCtxad dud a ooyy of thi.aitcmmt m.y bo forxo dod to tbo 13,9,t—od of Ind..Lricl Aoodc &OlLioo of irwrsnoo for the eovcr> vatG=ioa&M dw Eiltae to eo:x=covcrn&,under soetioa 25A of 1.1aL 152 an Imd to the imposdioa ofaimiasl pcaalties ooaurLmg of a fiat of up to S I,Soo.00 wNd ¢t:�y of up to one year rod civil pco hio in d)c form of n Slop Work Ocdcr end a fim of 5100.00 z dry cpioa me roc dcp=rur'c�u,c drily Permit Number Signawrc of L 'cnniu e $WlT N,l -CUNSTRUCT113N=S RVIC S 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone W-111`iill 9111 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WPJRKER MPENSATIQN INSURANCE l#I,FlDAVIT(M.G.L.c. 152,§25C+k6)) 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 ocal Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature f' t _KQTJGN 1 F ,. P c4� a New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ® Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Ete-C_4 GJre --(a Orr c.c� sksxQ x (b 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 building : One Family Two Family ✓ Other b. Number of rooms in each family unit: Number of Bathrooms Z c. Is there a garage attached? Y0_5_ d. Proposed Square footage of new construction. 60 S� 0 Dimensions e. Number of stories? f. Method of heating? t1iA Fireplaces or Woodstoves N!i _Number of each g. Energy Conservation Compliance. NA Mascheck Energy Compliance form attached? Type of construction 1%)--ro c4 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 N/ k. Will building conform to the Building and Zoning regulations? ✓ Yes No . I. Septic Tank City Sewer Private well City water Supply 5E TI©N.!A OWN I AUTH.b#1Z#T►ON TO BE CAMPS VITA!13, WHEN bWN1:R5' GET'Q QWT' ACTOF�;APPI�tES', F IUI)` ING�'ERMNT 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 a caner Authorized Agent hereby declare that the st eme and infor a on on the foregoing application are true and accura o the best of my knowledge and belief. Signed under the pains and penalties of perjury. e Ord a.n -:I i Qc-r Print Name 7C" r L-2-a00 Signature of Owner/A nt Date 11%0 s 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 Departtmeenntty� Lot Size 3 ZV t U i Frontage 6 O Setbacks Front O 1 -2.0 Side L: R:_ (�O L: 150 R: Rear ?j p 50 / Building Height 3 G , I p C�70 Bldg. Square Footage I zm'x t 6 % 0 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 J 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 J 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: y rthampton �� 1 '-wilr epartment a n Street ioQCl 100 - f , ampton, MA 01060 phone 413-587-1240 Fax 413.587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ��ECTIQN � Si'F�i INF�RIYIATt�N 1.1 Property Address: k I <>-r CL rG'C �IO re,nicc H/4 01 06'2_ 34fq SECT,,,,,ION 2 P)I IPERT ID1tVNERSHf'PIAUTHf RtZED;AG,ENt 2.1 Owner of Record: et!� t e,— Q N(cZ OniivR��J 1 �r� CS", Name(P i Cur nt Mailing Address: Te ephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone S [` id'f f� U Ot ST Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building (a)Building Permit Fee v So 2. Electrical (b) Estimated Total Costpf Cob" uction frorri 6 .3:,. 3. Plumbing —" Bu`ilding Permit fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(I + 2 + 3 +4+5) CheckNumber 1003 � This Suction-For 0 ficlal Use Onl ' Date Issued: B�iiiding Permit N�trriber:_ _, Signatufe- E3ui1`ding�Cortisionerllnspctornf l,uiliings Date Vw File#BP-2001-0073 APPLICANT/CONTACT PERSON DANZIGER GEORGE& OWN ADDRESS/PHONE 33 TARA CIRCLE (413)586-4181 Q PROPERTY LOCATION 31 TARA CIR MAP 29 PARCEL 515 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 /DO :� S= Typeof Construction: ERECT 6 X 10 SHED New Construction Non Structural interior renovations Addition to Existina Accessory Structure Buildina Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE OWING 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 Commi ' n Permit from CB Architectur Committee zv �oot� Signature of Building cial 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. 31 TARA CIR BP-2001-0073 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma ock:29-515 CITY OF NORTHAMPTON Permit: Building Catego :shed BUILDING PERMIT Permit# BP-2001-0073 Project# JS-2001-0120 Est.Cost: $1050.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq.ft.): 15333.12 Owner: DANZIGER GEORGE& Zo:irb:U 22 A_nnlicant: DANZIGER GEORGE & AT. 31 TARA CIR Applicant Address: Phone: Insurance: 33 TARA CIRCLE (413) 586-4181 () FLORENCEMA01062 ISSUED ON.7/20/00 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 6 X 10 SHED 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:Qi< THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu an Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/20/00 0:00:00 1003 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo