16D-032 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: 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"r KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YEE O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ..
License Number
�.L> t' 2 C fir: �.a;�: I � .� _ ���°•l��
dress ,4 / Expiration Date
(,nature ! Telephone
9. Wistered Home lrn roveme Contractor: Not Applicable ❑
Company Name Registration Number
s a .—•
Address r Expiration Date
�-k,rot\,y 1A 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.
Signed Affidavit Attached Yes....... ❑ No...... ❑
11. Horne Owner Exemption
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-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs ® Decks [❑ Siding K3] Other[�
Brief DescriW�tion of Proposed
Work:
Alteration of existing bedroom Yes Io Adding new bedroom Yes �No
Attached Narrative Renovating unfinished basement Yes (NO
Plans Attached Roll -Sheet
6a. If New house and or addition to existing!housing,complete the folloWina:
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. Masscheck 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
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i, 2 �-�" as Owner of the subject
propel' 171-1
hereby authorize C -'r- �J'" C''N
to act on my hehalf, in all matters reI ti v t w rk u rized by this building permit application.
Signature of Owner Date
l 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 penalties of perjury.
Print Name
Signature of Owner/Agent Date
I't
IC' of Northampton
�1������=�---•• Building Department
YC kT'w".
` 212 Main Street PIP i 51
JAN 3 0 2014 Room 100
Northampton, MA 01060a � r
phone''41*587-1240 Fax 413-587-1272 � 3
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION-1=SITE INFORMATION
71
00cb-W i"d by
1.1 Property Address: This secttortto officer
_t1 ° ���j y done : flveriay Drst ct
( f lm St..teict ? cBFolatric _
SECTION 2-PROPERTY OWNERSHIP/AUfHdIZEDAGENT
2.1 Owner of Record: L t..�y -5T—
n ^
.z t t t ��r �C.Cr; ry�
rird) Current Mailing Address: N
Telephone
Signature
2.2 Authorized Aaent:
Nam ( Current Mailing Address: T^
3L
5' ture ? Telephone
-
"SECTION 11 A. ESiI ATED -ONCOSTS
Item Estimated Cost(Dollars)to be official Use Only
completed by permit applicant
1. Building v �.� c� (a)Building Permit Fee
2. Electrical , / ��� (b)Estimated Total"Cost of
Construclion from 6
3. Plumbing �'"' t3uilding Permit Fee
4. Mechanical(HVAC) n Z
5. Fire Protection ..2 Z
6. Total=0 +2+3+4+5) Check Number
Thu$Section For Official:U tail
bate
Building Permit Number. Issued:
Signature:
®r
e Building Comma/nspecfior of Bidnp
58 LILLY ST BP-2014-0846
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map Block: 16D-032 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2014-0846
Project# JS-2014-001478
Est. Cost: $19325.00
Fee: $115.95 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin SOUP TO NUTS CONSTRUCTION CORP 004599
Lot Size(sq. ft.): 23304.60 Owner: ABBOTT BRUCE J&PATRICIA F
Zoning URB(88)/WP(44)/URA(12)/ Applicant: SOUP TO NUTS CONSTRUCTION CORP
AT. 58 LILLY ST
Applicant Address: Phone: Insurance:
10 MCKINLEY AVE (413) 527-5359 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:21412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW WINDOW & REPLACEMENT
CABINETS
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 Signature:
FeeType: Date Paid: Amount:
Building 2/4/2014 0:00:00 $115.95
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner