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32C-295 (6) PT t- �us��s TrJ�lu�i �-19 p iyao Uc '/l c ax J(a PCX,16(e t 6,/ 1Y)a& pC�/ cue fJ<c. 1 41/ gal Jcreex. pcv 2 - 3 6 j' rf eet 1 - a k sp No + f 2 0 c--) IY oc- Y1 o4 JF P— c), 16 Cox R - p � i C(l t�q Con c)�e ale— ac6 c-i d?- N. pent 16 a r�Clvr Z o' pt�LK IV nNT- lj of ?c' To (- T L►'„t n� ZZ ova( =s,(- b / Tv l � C-PC, - E. b) Wye T� roc i2C'�t ��6 I1(,J �fv�SE �0 4t tv>f nTOy F E 0r iI ofl�o> i1�a111}lfnit _ �tc�inr ncrl(e- V h - DEPARTMENT OP DUILDP\C 12,4SpecTIO1:S = 212 Main Strect • Municipal DmIdinc Northampton, Mass. 01060 WOMCEWS COtY PENSA'nON CNSURANCF AI,FMAVI r tit r� n I _ v.lth a pilncipal place of business/residencc at --- � � �- S�"f�� ����1G�.-�►•P� N1�} (l;hoac ') �fl3�7 oS-�3 (srr�t/city/stalc�z�p) �J(DEC _ do hereby certify, under tic pains and penalties ofperjury, .hit ( ) I am an employer providing the follo%vin✓ workcf-'s co(noensLaorl cove arc for illy ctupluvccs worUng on tills job (lazuf Com=Y) (PeL c;N aadx r) Da c) ( ) I am a sole proprietor, general contractor or homeow-oer (circie one) aid have hired the coouactors listed below who have the foHoVviog workers C,0=ensz�on policies: (1`+'QIDC 0- Co'.l'mc"07J (If1R3r-anc-c. Coinoa-n)'/hGt)c'f (NLtne of Contractor) -- (Insura_occ Comoan,,vPolict, (EXI)L :tion Date) (Name of Conmclor) (LaSUMnCi CompanylPoLC) N;u bJ) (Lxpimaoo Daic) (NaiDC of Contractor) (Ins-uranc�z Comralry/Pohcy Nuvnt��) - (L-xpuation Da1L) (eu�c?��d?,;;cr,l c!ice.J❑crs,� to inc!ue�infery-i.:i oa pcstr_iau��to.11 occ-:._r_o�) ( ) I am a sole propnetor and have no one working for me 1 aal a home owner performing all the work myself. NOT}',plcsc k cwzre tF,..w{Jc hemrn a n ubo cmplay p iom Lo dD Ohl� � c- - �c renir•'or on.d�.1L;�of Got 11x. 0_.:LL-r--L-Ili in u,vcf,the born,- -..ver rrvd�a oa the Lo t, catployc-�tv�G�La:,.�i:c>✓:off-,cz_Lon/ttx(GLI Sty 1(5)�cppUcnl�cn try .bortu ,—fc: a F-,nh n_y cads«11x 1cgJ taa c of cn r_ploy-uodcr dw\VGAI r,C� Act (undo'rr.�d tha> on of thi,ct>i.cmcm m.y bo f----id to tbo Dq—tn (of Ind.wicl.\cam dam;'OfLoo of Ira—f-the oovmsc v TTjcm loo nad th1 L-ik c w s oa `covcrbsc under Soc600 25A of 1,(OL 151 can Ics.d to the of mmma j PM-16c ooasirr of a rux of up to S 1500.0*ardor­rPrUomocal of up to o y�cad aril 1 m 1-00 to be form o(>Sop Wort;order and n firm of 100.00,d_y'Pawl©c «cScp..-un�r+,c onl y Y/02 pc�rrt�I NL>�t>cr — Signntur of LI(Xn$CCJPCnniUcc --��� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 4a-� Name of License Holder: License Number -- -—--—--—---—--—--—--—--—--—--—--—--—--—---—--—--—--- --------------- Address Expiration Date -------- Signature Telephone 9. Realistered Home Improvement Contractor: Not Applicable Comiia7nVjk�-—--—--—--— -—--—--—--—---—--— —--—--—--—--—- —--—--—--—--—--—--—- --- Registration Number Address —--—--—- Expiration Date --—--—--—--—--- 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 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"h r"certifies d assumes responsibility for compliance with the State Building Code,City of ',f and Local Laws and State of Massachusetts General Laws Annotated. Northampton Ordinances, atece 1 les an W� Homeowner Signature v SECTION 5-DESCRIPTION Of PROPOSED WORK/check all aualicablel New House ❑ Addition Replacement Windows [Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition C New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed 12ee/,qCe ytn ! 2 Work: L- A Wr�'J �tiCl.�� 7-5�4Sov, 4op',�A Alteration of existing bedroom__—_Yes_ -"--No Adding new bedroom------Yes —_---No Attached Narrative Renovating unfinished basement _— Yes __ No Plans Attached Roll -Sheet --- y 6a.If New house and or addition to existina housing complete the following: a. Use of building : One Family___ ✓_//Two Family—__—_—Other—__—__- b. Number of rooms in each family unit:_ t!r Number of Bathrooms c. Is there a garage attached?__ w _ d. Proposed Square footage of new construction.----7-97 Dimensions ------------------------ e. Number of stories? t f. Method of heating? ---__— Fireplaces or Woodstoves Number of each—__- g. Energy Conservation Compliance.—__—�( Mascheck Energy Compliance form attached? h. Type of construction_P(904' 4'r'4""� i. Is construction within 100 ft.of wetlands? ____Yes 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. 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 11---------------------------------------------------------------- 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 1,---t-�WN - --------------------------------------------- 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 w nt I I 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 p f Frontage 5-( ' S 55, S ft?' Setbacks Front NPr Fr Side L:T_R: z z L:/7)- / R: 20 J Rear 77 / — Building Height SJeYC Gf o�Si° p o)-A 15for-e y (Ij Bldg. Square Footage 2 7 % 'S i o, ti Open Space Footage % (Lot area minus bldg&paved Sg 07 7� 5--?/I park-g) l #of Parking Spaces z— Z, Fill: N It �"k 7— volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: 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 City of Northampton Status of Permit: Building Department Curt,Cult/Driveway Permit 212 Main Street Sewer/Septic AvaltabiiityI '' ,, Room 100 Water/Well Availability L� L ( ( Northampton, MA 01060 Two Seta Of Structural flans - phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans_— Other Specify APPLICATIOA'T6 CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTI!Wjj p ION 1.1 Property Address: This section section to be completed by office Map— ��.•!__ Lot_ 30 V P(L,L 6 6rr E 6-F Zone-�,��..�Overlay District —_—__-- Elm St District--_—_--- CB District­__--- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 30 V4446V '5746607 Name(Print) Current Mailing Address: -------------- -- ----------- Telephone Signature 2.2 Authorized Ascent: 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 /2 ODD (a)Building Permit Fee 2. Electrical 3 (b)Estimated Total Cost of Construction from 6 3. Plumbing h Building Permit Fee 4. Mechanical(HVAC) r/ov/e 5. Fire Protection P7.70C 6. Total=(1 +2+3+4+5) /Z 30'a Check Number Q – This Section For Official Use Only Building Permit Number. Date Issued: Signature: ------------------------- -- -- — Building Commissioner/Inspector of Buildings Date File#BP-2003-0307 APPLICANT/CONTACT PERSON YANIS LYNN ADDRESS/PHONE 30 VALLEY ST (413)587-0513 Q PROPERTY LOCATION 30 VALLEY ST MAP 32C PARCEL 295 001 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: REPLACE OPEN DECK W/ 18 X 16 3 SEASON PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 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 Commis ion r 2 - 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. 30 VALLEY ST BP-2003.0307 CIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-295 CITY OF NORTHAMPTON Lot: -001 Permit: Buildinl? Category:ry: BUILDING PERMIT Permit# BP-2003-0307 Project# JS-2003-0520 Est. Cost: $12300.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sq. ft.): 7187.40 Owner: YANIS LYNN Zoning URC Applicant: YAN I S LYNN AT: 30 VALI_F_Y ST_ Applicant Address: Phone: Insurance: 30 VALLEY ST (413) 587-0513 O NORTHAMPTON MAO 1060 ISSUE,ED ON.9126102 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE OPEN DECK W/ 18 X 16 3 SEASON PORCH 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: Lh S Rough: Rough:�..2/ ?_ House# Foundation: >/ Driveway Final: Final: Final; _ Rough Frame-r , �\ ` `��a p�4� ,> Gas: Fire Department Fireplace/Chimney: Rough: Oil_ Insulation: Final: Smoke: Final: ©if R'v�3 'O3 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF � ANY OF ITS RULES AND REGULAT S. Certificate of Occupancy si nature: ' Fee Type: Receipt No: Date Paid: Check No: Amount: Building 9/26/02 0:00:00 576 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo