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35-055 (3) ferl.4 � i Bu -ild Custom Home ers & Remodelers L qfm s-, Inc. 456 Souihampton Roams, PO: Box 698 •Westfield, MA 01086-0698 Phone 413/568-8614 * Fax 413/568-8616 C.S.L.-#016140 fiJ.C. #115137 7 / Date Job =- . �'�i � y � � ',;„ter \n � L �" i `✓ � "' G-�=' s -4 3 _ t l , kly iJJet�t(( L CUSTOMER"APPROVAL t - _ . -----a 1l Boo M a e �i3EArfltcsrtta DEPARTMENT OF BUILDWG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WOREER'S COMPENSATION INSURANCE AFIMAVTT AA (licenser/permitter) with a principal place of business/residence at: { \ ,� � V,,� 10 �, V N > �•„'C7 '1 (phone#) s 6S_ (sh eet/city/state/aP) do hereby certify, ]ender the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: ,,, , ,I, � q / I -6-a- ansarunce Company) (Policy Number) (E_�,pimtion Date) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors fisted 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) (Ins-trance Comparry/Policy Number) (Hxpiradon Date) (Name of Contractor) Gnsumace, Company/Policy Number) (Expiration Date) (aria[,additioml shcct ifncccuuy to ioc}udc information pertaining to all oodradm) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:picas[be awuc that whilo hoa3covvm who employ pasoar to do cocsta=oa or repair work on a dwelling of not more than thmo unitz in tvbicb the hombowncr resides or oa the grmunds app utenant thereto ue not generally oortr4knd to be employers under the worker's compensatioa Ad(GL152,ss 1(5)),application by a homeowner far a license a permit may cvidcme the legal ctahrr of An omployet undertho Workoea Compomatioa Ad. I undasisad that a oopy of thin rhtcmeni may be forwarded to tbo Dapartmr of Indusitial A,,6dm&offioc of Imwwoo for tba coverage vaificafioa and that failure=to&eaten coverngo under souioa 25A of MGL 152 can kad to the imQasidioa of mmi l ptbalties ooausting of a fine of up to S1,500.00 and/or impriso of tip to one year and civil pemtGcs in the form of a Stop Work Ord--and a firm of S 100.00 a day against me For 1 aio poly 1 4 N--Lot# Simahrm r,f r ;_,.,.,. A P < r M O 8 CO T10 E-_�R11,IC S 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder c License Number Address Expiration Date Signature Telephone 0 " f"e"r1e- ome:'m r.: vem racto Not Applicable ❑ CV Company Zompany Name -� Registration Number A dress Expiration Date y S it l Telephone y v SECTION 10 WORKERS',COMPENSAT,1 N INSURANCE AFFIDAVIT(M.,G1. c. 152, §25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this of 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)fair and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner: 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 ti. 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 homeowne Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall 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 t Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for pers 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 f� I fCT 0 .TIO t PROP.OS D O K c c 11 scab e New House ❑ Addition ❑ Replacem endows Alteration(s) Roofing ❑ en Or Doors ,Q v o ✓ Accessory Bldg. ❑ D molition❑ New Si ns [ J iding Other [ ] Brief Description of Proposed Work: -4 Alteration of existing bedroom _Yes No Adding new bedroom Yes Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet TVew o se �°fid or atliiifion to ex<"rst own gM # e fiollf i= te : 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? Fireplacpsjor 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 j. Depth of basement or cellar floor belowshed grade k. Will building conform to the Building and Zoning regulations? -Yes No . I. Septic Tank City Sewer Private well City water Su Pp, _ UTFlOMzATION T"0 BE1aOMP VTED YVHEN O YN S 3 �0 ONTRACTOR A�PPJXSIFOR 0BUILDING PE RMIT as Owner of the subject prc hereby authorize r,, n 6 bv� . ShL_ . r (� O to my behalf all tt s relative to work authorized by this building permit application. c> —o Z,. Signature of wner Date as Owner/Authorized Agen hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Si ned under the pains and penalties of perjury. v r, 07— Print Name - 1f L Signature f wner/Agent Da(e 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 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'T KNOW YES f: IF YES, date issued: IF YES: Was the permit recorded at the,/�egistry of Deeds? r, NO DON'T KNOW;` YES 1 IF YES: enter Book Page and/or Document # B. Does the site contain a broo " y bod of water or wetlands? NO DON'T KNOW YES IF YES, has a permit blen or need to be obtained from the Conservation Commission? Needs to be obtained/ Obtained Date Issued: I C. Do any signs exist an 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: i 1 FEB 1 5 2002 o Northampton L B ildi g Department rib e pLPTOfBtf;vGlNGINSPECTIONS 212 ain Street ,.,;R1HAM�TON,"'A 0,050 o m 100 l Northampton, MA 01060 phone 413-587-1240 Fax 413-5871272 Qt er pe , APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,SECTION.1 ­SITE INF9RM"ATION 1This section#o`be completed by office 1.1 Property Address: v V ,�� �1 1 o1r�'� -zone g Overlay Districts R Elm St. District a CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lt--cs Name(Print) urren g Address: Teleph'" Signature L 2 2 Authorized Agent: �� G cl-0 Tw�� \4> .o Name(Print) CurrePt Mailing Addfess,. Signatur Telephone r SECTION'.3"- EST I MAT ED�CON STRUCTI ON COSTS Item Estimated Cost(Dollars)to be Official UseFOnly completed by ermit applicant 1. Building d Q (a) Building Permit Fee 2. Electrical . G (b) Estimated Total Cost of 2 Construction"from". 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) L_� U c, t 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use:;O tl Bull�digf'erittlurber Date=issued,,: " � ,r. St nature BuiltlmgOorr)m�sslope6fnspector File#BP-2002-0720 APPLICANT/CONTACT PERSON HERITAGE HOMES INC ADDRESS/PHONE P O BOX 698 (413)568-8614 PROPERTY LOCATION 952 RYAN RD MAP 35 PARCEL 055 001 ZONE SR 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: CONVERT 11 X14 ENC PORCH TO 11 X15 FAM RM/MUDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 016140 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 Commi ' n 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. j � 2 RYAN RD BP-2002-0720 �G1S#: COMMONWEALTH OF MASSACHUSETTS „ a :Block:35-055 CITY OF NORTHAMPTON "I ot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002.0720 Project# JS-2002-1184 Est.Cost: $8600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: UseGrou: HERITAGE HOMES INC 016140 Lot Size(sq.ft.): 15246.00 Owner: LAPAN LEO E&THERESA M Zoning: SR Applicant: HERITAGE HOMES INC AT. 952 RYAN RD Applicant Address: Phone: Insurance: P O BOX 698 (413) 568-8614 Workers Compensation WESTFIELDMA01086-0698 ISSUED ON:2122102 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT 11 X24 ENC PORCH TO 11 X15 FAM RM/MUDROOM 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 2/22/02 0:00:00 9110 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo a � € MOM mm VAI am WMW p s e 3 4 4 , -consul a t M S » UK To �r�eta Q.&follow lot WAM1,04,07'a"M WOW 0 Ono Wy top * s �x '� r :c •? a.� r g '��,fl�r"� Y 4E-.7�'r`` u�'���"" + �� ,€t d, =z e t x z 10, pm r '�j�"'�r.�ci vw „y. h x" i, Y'' et mow* nn ONO ew&v to K 90 Mae Now z k kF t c 0 WANT, WQ- k z �+w ..r- r y Mki,So r% 'k. tqr„ to- t 3 t 4 �.Y� � ✓ Allow 00=06M Egg xyg- y,W ' `"+ a x k 1 rvk+r sf 'x�. §',. gown "WA WRINN «3���^rc �8`i �,Y p'. ��,5'c��x'�i� � . i.. .VL .*'�3f_�iT"b '� ) FTi'•° ' T�+x� 4w�t "�i'" 4 t �}`3 k r x s e,7 xka� MITI. I 952 RYAN RD gP•�d�)�•072Q USETTS COMMONWEALTH.OF MASSAC 3tsldng. C-46, sp is- Fei Get.Class: Ceactor; Lose: ` W- HERRAGE HOMES INC a1E�i40 Siz sn ft 1 15246 t r LAP.& LEO E&THEMA HOMES AD MMAN • Pk r Lot I �tR a p 0 B 9", 4 5g-8614, 6-0 98 USUED 0. " taNVRTr11 X4 EC.PQtGH` 1 : UtRQM Undergr�nd r Ammer. �►agh: �r�; '.2fo,�" Bye#� F©en��tlo-�z. ., Rna4 dal: Jr�iS� R ,C I a Roueh cam• , Fireplac kidmney - - - I two `tat. YFitc ' lS �" � !BY'� CITY '.NCRC 'Q1wt ��'' flLA'TflN ? - � r , AA 2/22142 ,: }< " 212 � tt`eet,Phone(413)58'7-1240,Fax:(413)5$7=1272 wilding Commissioner-Anthony Patillo