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(insurance CO[--.I C" �-��' �i�_-! � .,�r�.t.o❑ Date)
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I undo tared th,i a Cpy Of the ct etca-s:n:ay to tir[Y.t>or tetx-a of Irrjii<n;J Ate%-nti O`.L•oo of!:::�.0 =a for tine
CO% - f c vcriLczlioc and slut fnlurc.to:n-tuc cUVCrno„ut.-icr 25A c f M('i,1'2 can Iced to Ot,im; niictl c� ^i:.al pctsl;:cs
cmnaiuting of a fax o(up to S I•SC�.CwJ n:�'ln ir.iiri r u-r1 of u,to cn-5 ai c::il,-rultic3 i❑ r_C;nn of e S!�.•',:rni_0r rend e
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SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: (( Not Applicable ❑
Name of License Holder : �� ._ �� _i f 7 0,
License Numb re
i
Address 4// Expira ion Date
xignature Telephone
9 TRegisfe"r'ed Home$improvemeit Contractor M Not Applicable ❑
L'f t Gt MFG
—�!
ompa M Name g� �—�--- T -- ------ --- Re istration Number
C� {
y3 u 0
Addreffss f Expiration ate
Lc) J Telephone_ Z
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. _
Signed Affidavit Attached Yes....... ❑ No... .. ❑
11 Home owner5Exemption
The current exemption for"homeowners"was extended to include Owner-occupied DwellinV_s 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 them
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 buildiny- 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 fi-which this pennit 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 Windows [Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. El Demolition❑ New Signs j Decks [ ] Siding [ ] Other f ]
-
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes N
Attached Narrative n Renovating unfinished basement --Ye
Plans Attached Roll ❑ Sheet ❑
sa. if New,h'ou"se and:or`addition to existing Musing,, omplete the following_
Use of building : One Family_ Two Family _ -_-_Other
b. Number of rooms in each family unit: Num'per 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
R- Energy Conservation Compliance. "."ascheck Energy Compliance form attached?
h. Type of construction _
i. Is construction within 100 ft. of wetlands? Yes _ -_ - t�fo is construction within 100 yr. floodplain
j. Depth of basement or cellar floor below finished grade
k Will building conform to the Building and Zoning regulatio s2 Yes _ _ No .
1 Septic Tank City Sewer .__ Private well City water Supply _
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of 'the subject properr,
hereby authorize ___ to
my behalf, in all matters relative to work authorized by th , d!rp permit application
-
Signature of Owner Date
_ 40 1 _ as Owner/.Authorized Agent
her y declare that the state ents a d information on the foregoing application are true and accurate, to the best of n y
knowledge and belief.
Signed under the pains and penalties of perjury.
—U�ft, VO 2-- ------– --------------------
Print Nam
gnature of wn /Agent D to
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
Side 1,: R: L: R:
Rear
Building Height
Bldg. Square Footage %
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 _?C
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:_ _
. - DepakrTfentu"seu l
City of NorthamptonStatus of Permrt � x
Gulldina [) f)artment (Curb Cut/Driveway Per i
2 r. Street Se`verlSeptrc-"A atlabr
r�61cm 100 Water/Well AT labihty �
� . .:
Northa:rii 'ton, Nl/� X01060 TN�oSets'of Strdctural Plans �r
I E �
I ��1Jfl „ 8/11 0 ?X 41 5 11'10t/Site PIanS
Other Speci
AppLt{ r � bHS-1-Rt3,CT, ALbi ER, REPAIR, REN'0VA E OR DFPsOL!SH A ONE OR TWO FAMILY DWELLING
I --
SECTION 1 - SITE INFORMATION
— - - - This section to be completed by office
1.1 Property Address
- Map ---- Lot Unit-----
; –7—!-1... AA{-,�–�. -- --
Zone _ Overlay District
Elm St. District CB District__-SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of—Record: CCU U —
2--.2 A t t!ic;,r-ized_A writ: %
C)d7
1 SECTION 3 ESTIMATED CONSTRUCTION COSTS
stimateo Cost rD�-� la Official Use Only
cr-.-,-rd-ted h\ perrnit [.. `
_ l
l�
'-VC�
• - - 'P.rfillt Fee
�) 4-1
Total Cost o!
c-ist,uc'ion from b'
rnrt % E3uilding Permit Fee
_ - t 2 t 3 �) rt ck P:u�T�ber
b i ota
This Section For Official Use Only --
Building Permit Number: � _ T ate Issued:--___ - -
Signature:
- — -
E?uilding Commissioner/Inspector of Buildi ,gs ate
E v,M a
} #BP-2004-0030
APPLICANT/CONTACT PERSON KEITH HAMILTON
ADDRESS/PHONE 3 LORD ST (413)527-7767 Q
PROPERTY LOCATION 7 ALAMO CT
MAP 29 PARCEL 134 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: REPAIR FIRE DAMAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074129
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
--(.,Approved 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 Co ' ion
C14ao—' 20 ca
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.
7 ALAMO CT BP-2004-0030
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 134 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0030
Project# JS-2004-0049
Est. Cost: $54000.00
Fee: $270.00 PERMISSIG,,V IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group_ KEITH HAMILTON 074129
Lot Size(sq. ft.): 78,10.80 Owner: BALISE P.ICHARD W&BEVERLY A
Zoning URA Appiicant: KE I I ! ^:/!s"!3._.i:> N!
AT: 7 ALAMO CT
Applicant Address: Phone: Insurance;
3 LORD ST _ (413)527-7767 O _WC
EASTHAMPTONMA010211 ISSUED OP 7/9/03 0:00:00
TO PERFORM THE' FOLLOWING WORK.-REPAIR FIRE DAMAGE
POST THIS CARD SO IT 1S VISIBLE FRO_4 THE STREET
Inspector of Plumbing Inspector of Wiring D.PAV. Building Inspector
Loder—mina: Service: 3teter:
Foot::.gs:
Ron 0. - �, Rough:.— ! ',-louse 4 F oLudatic;.:
Dr:ve,vay.iaal:
El. `�"' Final: -
�` Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: ()il_ Ij;sulation: [/ )
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupant Signature: `
FeeTyue: Receipt No: Date Paid:_ Check No- Amount:
Building 7/9/03 0:00:00 3611 $270.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo