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34-007 (5) -D U NC,/ 2 L T y DEP l Qly�- . . r . ..E!NG 1INSPECTIONS Ci -T *LC co 10 t w --) Y w6 d H at ILI dSw 0 CC5 , w AN Co -0-E cc> -C U) 2 a Q oc� 6. 4 3M T ITS w z Am E a Ar 0 06 C t, 0 f3 ii cm 40- Ir 1. M- C 1-.0 06 T U CL 00 x 1p 0 0 o0 H Y a v4 W °> u > w 31 0— 0,0-00 –wio c m w 0 .c g 43 L. 1.0 .L8 eSa 0 C36 La -C -F ct WI:5 TT- 0 0 - 8 6 �laisacfltssctta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licenserJpermittee} with a principal place of business/residence at: (phone#) (stre city/statelap) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees worlang on this job: (Insurance Company) (Policy Number) (Expiration Date) xI am a sole proprietor, general contractor or ;eowner( cle one) and have hired the contractors listed below who have the following wor e s compensation policies: (Name of Contractor) ce Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (iva_ae of Contramtor) (Ins ranee Company/poky Number) (Expiradon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoct ifnooc uy to include information pertaiains to ev ooatradots) ( ) I am a sole proprietor and have no one worldng for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that vihilo homoowo=who curploy pc=m to do m icd c=tA etioa or repair work on a dwelling of not morn than thnoo units is which the homeowner resides or on the grounds appurtmn thacto arc not gcacrally oo=i krcd to be employers under the worica .compeasatioa Act(GL152,Ts 1(5)�application by a homeowner for a licam or permit may evidence the legal ctxhrs of an employer undertbe Wor[ x C,ompemaiion Art I undcniwd that a copy of this riatcmccd may be forwarded to the Department of Iodrutrial Aocidw&Offioo of[nsruanoa for d- oovaxge verification lad that failure to secttre coverage under soction 25A of MOL 152 can lead to the imposition of crimi penalties ooaU3t ng of a$ne of up to S 1,500.00 and/or imprison of up to one year and civil pcmltia in the focra of a Stop Work order sad a find of 5100.00 a day against me. For d rise only Permit Number blap-# Lot# = Signature of Licensec/permittee — i r 4 -sw 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: \AJ M\ C.M License Number Address Expiration Date Signature Telephone Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECT10N410 ,YV0RKERS' COMPENSATION INSURANCE AFFIDAVIT(M G L.c. 152, §2.5C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 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( 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 �y i I�t E I SRO New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors ❑ Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: 0 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll❑• Sheet❑ 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 I 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 b C�i'vl��AI'r�,t�3�F'0 ' ��►` G r��i�ivli�'� ,� Do as Owner of the subject propert hereby authorize to act my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I as Owner/Authorized Agent hereby declare that the state ents 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. i!�Aa.;a AAU kF Print Name Signature of Owner/Agent 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 V , 7L11% Frontage / Z Setbacks Front � 010 Side L: R: R: Rear V �d 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_I 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. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: t y r•• Ci orthampton l N0V 7 2001Bu n Department 2 ain Street �10Ns Ro 100 NSA:;„prti�t(}N, •� on, MA 01060 one 413-587 1240 Fax 413-587.1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING St;T10N x S1TEIIFQFMgIN � 1.1 Property Address: �L- ke'4�1 �Ma »Zone EImSt vt)istr►ct � „ , - SE„CTION'2 PROPERTY OWNERS HIPlAUTHORIZ,ED AGENT ,.. , 2.1 Owner of Record: Ciko.:re nc ¢r i Y- i-h'LlPA , F69ren ►- Name(Print) Current Mailing Address. I sB1-f — -1 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone Item Estimated Cost(Dollars)to be ©fftcaal Usenly . completed by per it applicant 1. Building d A I (a) Building Peri Fe'e` ` rJ' 2. Electrical (b)Estimated Total Cosf of Construction;from: 6 3. Plumbing Building Permiff00 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 +3 +4 + 5) Check Number This$,ectionTor Official Use,Only. Date,`issued ME s� ��gnattl�8 #a m o m s�o nsptc off 1 %A File#BP-2002-0550 APPLICANT/CONTACT PERSON HUTTLINGER CLAIRE ADDRESS/PHONE 158 TURKEY HILL RD (413)584-0609 Q PROPERTY LOCATION 158 TURKEY HILL RD MAP 34 PARCEL 007 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid IWO Typeof Construction: ERECT 12 X 10 SHED 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 INiFXkMATION 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 s on Signature o uilding Of icial 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. K BP-2002-0550 GIs#: COMMONWEALTH OF MASSACHUSETTS VIap:Bt©ck:34'=6if9' CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: shed BUILDING PERMIT Permit# BP-2002.0550 Project# JS-2002-0842 Est.Cost: $2700.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin Lot Size(sq. ft.): 109335.60 Owner: HUTTLINGER CLAIRE Zoning: RR Applicant. HUTTLINGER CLAIRE AT. 158 TURKEY HILL RD Applicant Address: Phone: Insurance: 158 TURKEY HILL RD (413) 584-0609 (� FLORENCEMA01062 ISSUED ON.111291010:00:00 TO PERFORM THE FOLLOWING WORK:E R E CT 12 X 10 S H E D 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/29/010:00:00 815 $25.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo