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32C-198 (4) F 44 , � r ti� � ��� s P 1+ r � lio , v. VAR i rte. r �r♦• � � f � 1 t l � yL 301 to zo oFP 5 Of- 461 1N t`�t�wS 5'fi��cC FROM CASE HANDYMAN SERVICES FAX NO. 413 5134 7706 h1ar. 10 2004 02:49PM P2 Of 01A 11LIIII)d foil v rc� - oernn T Meta-r or nt)trr>n.0 INSPeCt it:t,ts — 212 Main Strcct ' Municipal Dvd.d;vg N'orthnmpton, 1 fn€a. 1110,60 WORICEI2'S CO'i'UENSA'MN MSM ANCIr AITU),tVrn- {t i ccn:,ax/perma t tct} V-gLh zz ptzicspaJ placc of busiaess//residenu at: U 137-14 (Slriw(lCtt}'15i21LiZ1�l} / do,hereby cer*u-�-, under the P—Ilti Ana penalties of pc3: Y, (VJ i m an erupioyer providi,r- d e following workers cOr covcrr2c ;or my ewpiovcc5 ivo(lDvs on uris Job Cony^..: ....., it ci ci.N --... , ' K,...'. z sole proot ctpr, genera! c0otraczor or homzowtue hLred the coIIlfRCtors Isste� beiov/ wt;o t><ve Lhe iotiotvine workers code:SP—DOn policies (tiomc v.Co^."!ctorl (In zrant Comp�n�vFClc: ?.' cn% •) -..;>i;J� t) .(c) !N=r-of Cootzacot) — -C , t �. (ItLZ r2oc .� pane.Faln' fruon Dec) (N:,mr of\ (>QtlacL6.) t+i���Q LtlumfAujfTVlc)- iV:ixi U.il (N=c of Conuactor) (Lasuranc� Coroozay/FoUcy N=Iyj) (L---,pinaon Date) (Lau' id`_'�ac;al baa ijoctv_^-s.:i W mcuL infOr\6IJOe�antnip�,in.t!aoaa�,on) ( } i am a solc praprietQr and-have no one w0r6AS for me. ; { } I am a home 0wncr petfo(micg all the work myself EdGiE:�i ..Q c rxrc c . wf Jo pom�rL crrz wbo�PtoY➢C w w t--irl wt an"tk�tLro J a+"!1;4h:tz dse�x» �id�a w be pcanc�,: ,rt�n-r 4 n o� -r�atlu avdacd t cyc� c�Ca be ru{Gt_tszp .k Icg+J raa,.�:.a..r�loywt•tx06Lr t1�a WOr+,y„�a Ceeapczb,z.;on 1.ea, t••••,��._•sb.e',0o'pY a[iitis mzcmaa ma cvk-.6S ntiG�ioa Y b.(orrent.e cc tde }.p�wmms e ..... . oe of.o f--te. Ld tru to LOO"°b�"'c"y�s sm LOW*-73.A d MOL 157 c,a 1--G to ti..:<+O M-s/ei>2ral p—w- ooasi-Y.iv oP e 15-or T tc S 1300.00.rdvu 0(up W ax y—and o.i)pauper ao tSr(a,.er•$tap Word Order.Od r n(S!Woo.dpzPLzy� (Sr 4Wrs�a.c V x avp 1 �tg�x lot If t Si> turc c(LicrnSCC/Perntiuee "-' 2 _� ) SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder CS 0-735(5y License Number 0 4///0 by Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 ��m�aW�14�me Registration Number Address Expiration Date Telephone 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. 11. - Home Owner Exemption The current exemption for'homeownm^was extended minclude one(|) mtwu(2)families and m allow such homeowner m engage uo individual for hire who does not possess ulicense, as supervisor. CNIR 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. Such^^homcownor^shall submit to the Building Official,onufonn acceptable to the Building Official, responsible for all such work performed under the buildin2 permit. As acting Construction Supervisor your presence on the job site will hc required from time m time,during and upon completion of the work for which this permit is issued. Also bc advised that with reference to Chapter }52(\Yorkom' 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(orporson(s) ynv 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 1�e Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [v/ Siding[ ] Other[ ] Brief Description of"Proposee�d 11 t Work: C nc%.J C 6 e vv1 W l amt'S S Alteration of existing bedroom___--Yes_,&_No Adding new bedroom---Yes __K_—No 1 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?-_IJ U _ d. Proposed Square footage of new construction. _Z ___—______ Dimensions—_ X —_ -----____--_ e. Number of stories? f Method of heating?---�G�dn_s�_--_—_.__-- 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 X_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? —_4 Yes _No. I. Septic Tank_—__ City Sewer --- Private Private well_--- City water Supply_----- SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I — /�pC _ _ r s.veL���1 --------- as Owner of the subject property hereby authorize rro �'�� —�'!�3t os to act be alf, in all matters relative to work authorized by this building permit application. - ---- Signature----- -����-�----------------- -------------------------- -- g of Owner Date — a •• �f _ —__—_--_---_ _,as Owner/ onzed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my and belief. Signed under the pains and penalties of perjury. --------------- --------------- - Print Name - - - - - ---� - _-------------------- z/a 7/__-!------------- --- - --------------- Si nature of Owne ge 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 G y Setbacks Front Side L: 10' R: 'S� L: R: ,s Rear 5 b, LD Building Height L/a Bldg. Square Footage % 7 Open Space Footage % (Lot area minus bldg&paved 3070 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 T YES IF YES, date issued: TT IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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: Department use only e' y of Northampton Status of Permit: �r l''B +IdiGlg,Department Curb Cut/Driveway Permit__ 212 Mein Street Sewer/Septic Availability_ — _— 1 0 �I RO©m 100 Water/Well Availability ---- — �' ` �thampton, MA 01060 Two Sets of Structural Plans--_— phone 413-587-124 Fax 413-587-1272 Plot/Site Plans— _ Other Specify--_ APPLICATION TO CONSTRUCT,AL ER,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 Map �!— Lot �j7-----Unit--------- /07 ����l�yytt S 5 Zone&P4_1-----—Overlay District------------ / , .t 2 X4" A Elm St.District District____—_ SECTION 2.PROPERAY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: _ �` ---------------- ` –Z?ys---------- Telephone ignature 2.2 Authorized Agent: ---I!c .►.-• �_s_ 4/"'�'----------- 2'S .�9•�.ls•� 4 ve. c,�c s'/ ----------------------------------------------------- Name(Print) Current Mailing Address: - �� ""''Q--•'—�<-z"4 ----------- -- -------'SD's!-27-00--------------------------------- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building I q (a) Building Permit Fee 2. Electrical �..� p (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) -7 O 0. 0 o Check Number This Section For Official Use Only ����g� — Building Permit Number: q Date Issued: Signature: —_ Building Commissioner/Inspector of Buildings Date File#BP-2004-0864 APPLICANT/CONTACT PERSON CASE HANDYMAN SERVICES INK BLACK,INC ADDRESS/PHONE 137 DAMON RD SUITE C1 NORTHAMPTON (413)584-7700 PROPERTY LOCATION 107 WILLIAMS ST MAP 32C PARCEL 198 001 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 Typeof Construction: CONSTRUCT TX 6 MUDROOM&HANDICAP RAMP New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 073454 3 sets of Plans/Plot Plan THE Eed OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF TION PRESENTED: 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 Pemlit 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 Co ssion 1oa Signature o uilding 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. 107 WILLIAMS ST BP-2004-0864 GIs#: COMMONWEALTH OF MASSACHUSETTS MU:Block: 32C- 198 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-0864 Project# IS-2004-1282 Est.Cost: $19700.00 Fee: $95.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CASE HANDYMAN SERVICES INK BLACK, INC 073454 Lot Size(sg. ft.): 11194.92 Owner: KOWALSKI STANISLAW Zoning_URC Applicant: CASE HANDYMAN SERVICES INK BLACK, INC AT. 107 WILLIAMS ST Applicant Address: Phone: Insurance: 137 DAMON RD SUITE C1 (413) 584-7700 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:3118104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT TX 6 MUDROOM & HANDICAP RAMP 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: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: 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 Sienature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 3/18/04 0:00:00 977 $95.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo