29-119 WING CONSTRUCTION , INC .
City of Northampton
Building Dept. \
Dear Sir or Madam:
This letter is regarding the issuance of a residential building permit for 76
Forest Glenn Drive in Florence, MA. Currently, there is an existing carport
attached to the home. The homeowners have contracted with Wing Construction,
' Inc. to enclose the carport,thus creating a garage. It is the intention of this letter
to declare the sole purpose of the renovated space to remain a garage. At no time
in the future will it be converted to a living space. k
Mr. & Mrs. Alfred Schoen (homeowners) are aware of the colditions of the
permit and have signed below to confirm compliance. Should any further
concerns arise, please do not hesitate to contact me at the number below.
Sincerely,
Brian E. Wing
President
Alfred c oe
-'4-��re.d SWo�'n aid b6abo ra-
Barbara Schoen
Ay dommiss6 Eor
ioh20,M
9 GLENDALE WOODS DR. SOUTHAMPTON MA 01073
PHONE: FAX: 413-527-2549
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DEPARTMENT OF BUILDDIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
fan'1-L Lot M�
(licenser/permittee)
with a principal place of business/residence at:
MCA (Phone#).
(6treet/city/ rip)O sere 3
do hereby certify, under the pains and penalties of perjury, that
(L�'I am an employer providing the following worker's compensatiorxcoverage for my
employees working on this job:
A E L C W(.L '�-ObD L24,t.7 5 Z-C& i l !lv a 2
(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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atianh additioml short ifneccmiry to incWc infennition pertaiuing to ell ccatradors)
( ) I am a sole proprietor and have no one worng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be avarc that whilc homcovol>=who employ paiom to do rna„�coustR=on or repair worse on a dwmTmg of
not more than three unit in which the homoowncr reside or oa the grounds ap�thacto arc no(grna-ally ooesidcred to be
employers under the workers ads lion Ad(GL152,s 1(5)),application by n hotncown r for a Uc=e a Pamir may evidence the
legal dates of an employer under tho Worlcoes Convto3Ation Act
I understand that a copy of this rbacmcat may be forwarded to tbo Depermoat of I.&Lxriad Aocidm&Ofrioo of Insurwco for the
coverage verification and that failure to sxure covcrago under section 25A of MOL 152 can Icad to the impositioa of criminal pcmlties
oonsistm&of a fine of up to S1,500.00 and/or imprisonmad of tip to one year and civil pcm}ties in the form of a Stop Work Order and a
fum of 5100.00 a day against me-
Foe deputm�l 1310 only
permit Number
4 µ" Si-PMt 'e of Liccns=JPcJrmittce
SECTION 8—CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: -j�� C_50� 1,� Z C7 J
License Number
C
yt L�X00-5 bcN bo/0 3
Add r ss Expiratio Date
Signature Telephone
Ft etlFornem rbuement'Confracto'r
1,P
u„ Not Applicable ❑
oci 2-
Company Name Registration Number
Addr ss -J Expiration D to
.ttFw. Y� t c Sl C94JZN 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 he building permit.
Signed Affidavit Attached Yes....... No...... ❑
om. ® ne em.p nl
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
SECTION-5;,btSCRIPTIONbF PROPOSED WORK(check-alVapalicable)
�s
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Sig-nssi[-,] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes X No Adding new bedroom Yes _ No
Attached Narrative❑ Renovating unfinished basement Yes �4- No
Plans Attached Roll ❑ . Sheet V
,���If�IV'ewhouse andor��atldi#�on�..to�ezi'st�ng�liousing `corrpTete' #he�:followin�:
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 .
f. Septic Tank City Sewer Private well City water Supply
SECTION 7a,-OWNER AUTHORIZATION,',-TO BE COMPLETED .WHEN
OWNERS:AGENft R CONTRACTOR APPLIES FOR BUILDING'PERMIT
J�ee/ o as Owner of the subject property
hereby authorize to act on
my be alf, in all matters lative to work authorized by this building permit application/.
Signature of Owner Date '
as Owner/Authorized Agent
hereby declare that the Wtemenis and!( ormation on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
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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 /J0 w GYM t
Frontage k
Setbacks Front ��'
Side L: R: �� L: J� R:
Rear J/U
o
Building Height / 1-
Bldg. Square Footage % /Z 5
Open Space Footage %
(Lot area minus bldg&paved 1 13� A-1
parking) l / J
#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. Ar there any proposed changes to or additions of signs intended for the property ?YES
Noz
IF YES, describe size, type and location:
City of Northampton 5
Building Department G
212 Main Street
Room 100 a "
Northampton, MA 01060
hone 413-587-1240 Fax 413-587.1272 l?" Steyr
(CATION TO CONSTRU , ER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
J U N 2 0 2002
SECTION I -#Tf
44FAW4qj ON S
1.1 Pro er —AT&ess: This section'#oFbe complefetl by offtce
1 011
_ - �,6
� S �L1 C2 P
Z-on
�, .� Ouerl�yDistrct
Elm St. District istrict "
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
A
Name Print) Current Mailing Address:
Telephone
ignature
2.2 Authorized Agent:
_��l l� - �'J :.I�r �t�tSc,'� �►� c� �4 y.�� lNetjl?S e... lrl
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 o, (a) Building Permit Fee
2. Electrical ' u C� (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) C /';z • 0 0 Check Number Uri"
This Section For Official Use Only
Building Permit Number: T pD tl za Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2002-1138
APPLICANT/CONTACT PERSON WING CONSTRUCTION INC
ADDRESS/PHONE 116 VALLEY ROAD (413)527-2549
PROPERTY LOCATION 76 FOREST GLEN DR
MAP 29 PARCEL 119 001 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 050 L)
Typeof Construction: ENCLOSE EXISTING CARPORT 26 X 12 TO GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 051993
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,XMATION 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 ssion
Signature of Building icia J4�
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.
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76 FOREST, ta-2002-1138
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29- 119 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-1138
Project# JS-2002-1832
Est. Cost: $9150.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WING CONSTRUCTION INC 051993
Lot Size(sq.ft.): 12893.76 Owner: SCHOEN ALFRED C&BARBARA A
Zoning:URA Applicant: WING CONSTRUCTION INC
AT, 76 FOREST GLEN DR
Applicant Address: Phone: Insurance:
116 VALLEY ROAD (413) 527-2549 Workers
Compensation
SOUTHAMPTONMA01073 ISSUED ON.7115102 0.00:00
TOPERFORM THE FOLLOWING WORK.-ENCLOSE EXISTING CARPORT 26 X 12 TO
GARAGE
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:Of(
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/15/02 0:00:00 13384 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
•
-Anthony Patillo
.,,,,Puilding Commissioner
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