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Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working or me in an capacity. employees and have workers' g Y P tY• 9. E]Building addition [No workers' comp.insurance comp.insurance.: Wequired.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3 4A am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions 1,41 yself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: _ Expiration Date: Job Site Address: _City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert"i nder a pa' s and p nalties of perjury that the information provided[above is true and correct Sign A ' C Date: 6� � G l Phone#• Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Reaistered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date 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....... i 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"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State d Local—Zoningj4ws 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 [ ] Other[ ] Brief DeVription of Proposed �! rn fWr Work: �f yn .rly' W� ^! W34 Alteration of existing bedroom Yes X No Adding new bedroom Yes ... No ✓ Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to existina housing, comulete the following: 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 BuilgoOnd Zoning regulations? Yes No . I. Septic Tank City,Sewer Private well City water Supply r° SECTION 7a-OWNER bUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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 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 }` POLIVY eating(Marcus et al., 1990).Average weight has actu- pressed after 18 months than those who avoid or """- ally increased between 1960 and 1980 despite the tre- suppress their grief(Stroebe&Stroebe, 1991). mendous increase in dieting during that time period In this context, it is interesting to note that (Foreyt, 1987). Restraining eating behavior just does Rothenberg (1986) pointed out that desire for or at- not seem to work very well. tempts at control of various aspects of one's feelings or It is not just eating, gambling, drinking alcohol, behavior is a central facet of obsessive—compulsive smoking cigarettes, exercising, taking drugs such as psychiatric illness.He argued that the eating disorders opiates,watching television,and sexual behaviors that anorexia and bulimia nervosa are actually variants of are difficult to inhibit.Closer to home, who among us obsessive—compulsive disorder, brought on by at- i is able to stay awake indefinitely,refrain from urinat- tempts to control eating.He further argued that the hys- ing for hours on end or breathing for minutes, stand terical or conversion disorders so common in Freud's outside in the freezing cold without protective cloth- time and so rare today were products of their social mi- ing, or ignore a painful stimulus applied to part of our lieu, wherein the societal emphasis was on inhibition bodies?To the extent that we can keep our thoughts on of sexual thoughts and behaviors. Eating disorders re- something else, we might be able to withstand such flect the current societal "focus on food, dieting and motivators for a short time, but eventually we must body shape" (p. 45)just as the attempts of Victorian succumb. For example, Pliner (1973) found that the men and women(especially the latter)to ignore or sup- longer participants were able to think about something press their sexual feelings instead of expressing them other than the pain, the longer they were able to keep (the conflict between id and ego)can be seen as having their hands immersed in freezing water without report- provoked the widespread incidence of hysterical and ing pain. Even with this aid, however,all participants conversion disorders Freud discussed and analyzed. found the ice water quite painful and were only too One biographical analyst of Freud described Victo- happy to remove their hands from it when their allotted rian Vienna as marked by flirtatious,libertine behavior 3 minutes had elapsed. Inhibiting motivated behavior "and hedonistic values in the midst of a culture still thus seems to be difficult to do successfully for any ap- mired in repressive patriarchal morality" (Mindess, preciable length of time. 1988,p.48). Apparently the Victorian Viennese were not notably successful at repressing their sexual behav- ior,despite strong societal pressures;their society was Consequences of Behavioral Inhibition simultaneously sexually repressive and obsessed with sexuality.The result was an epidemic of hysterical dis- What sorts of outcomes result from the attempted orders generally characterized by emotional distress suppression of these internally motivated or strongly and obsessive thoughts about sex. Analogously, the desired behaviors? As indicated earlier, the proposal current cultural pursuit of thinness and consequent presented here suggests that there are costs to the indi- suppression of eating has apparently provoked the vidual in terms of emotion,physical health,psycholog- widespread incidence of eating disorders, generally ical well-being,and behavior. characterized by emotional distress and obsessive thoughts about food. Freud himself (1907J1989b) observed that "A Emotional Distress and Disorder deeper insight into the mechanism of obsessional neu- rosis is gained if we take into account the primary fact One potential outcome of prolonged inhibition which lies at the bottom of it.This is always the repres- seems to be emotional distress.For example,negative sion of an instinctual impulse" (p.434). An historical emotionality (such as irritability, anxiety, and analysis of hysterical paralysis indicates that at the dysphoria)has been found to accompany attempted in- time of its prevalence it was widely accepted in the hibition of eating (e.g., Herman & Polivy, 1988), medical community that"loss of power, especially in smoking (Sutton, 1989), and drug taking (Bradley, the lower extremities,is a common effect of excessive 1989). Likewise, a cross-cultural study of emotional erotic feeling"(Shorter, 1986,p.564). problems in children and adolescents from Thailand Wegner and Schneider (1989) discussed the "re- and the United States found that Thai children,who are bound effect" of suppressing a thought, and cited not encouraged to suppress or inhibit all negative and ag- only Freud's theory that attempting to deny or repress a gressive emotions, had more emotional problems ap- thought could engender an obsession with that thought, parently caused by excessive inhibition (Weisz, but also mentioned later work.For example,the work Suwanlert, Chaiyasit, & Walter, 1987). In a similar of Lindemann(1944)on grief indicates that inhibiting APW fashion, clinical wisdom concerning bereavement one's grieving after a loss seems to make coping more holds that it is necessary to face one's grief and work it difficult and leads to heightened grief later. Stroebe through(Stroebe&Stroebe, 1991);evidence indicates and Stroebe (1991) reviewed more recent work that that widowers who do this feel better and less de- also demonstrates the importance of confronting grief, 190 i 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 ft Building Department Lot Size r Frontage Setbacks Front Side L: R: L: R: Rear 1 Building Height Bldg.Square Footage l UU % Open Space Footage % (Lot area minus bldg&paved 13,J U. parking) #of Parking Spaces y 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 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: E. Will the construction activity disturb(Gearing,gr$dintg,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES N0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ft1 c� aJ tC Q) v w aJ aJ a v o aJ.� _O .i aJ _O 3 a �° a ° W "O= 07 r.- cu b4 N c+p� " .O O rn +' -'• w-o ff"-" ° � V Cl a'c3 w0 v, a' � o QJ - C) + Iz cC v w +� aJ O A,clY '� w Q) c/1 �.' co'C9 � 0.- 3 71 cM aJ N cn w •9 CO aJ r..0 CU a! 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E �.�n oC' c' a�« .. o 'U �oU)4-1o _ m co Z-0 y" +' O + sv" O cn u o Q) v bo goo 3o' xw0 > °v .� u N my"'"M4- a) 4-1 O O x +� a) `'= cn o 'O • in v� m v 't3.,4 t•, �,0�4 0~ ate"." � �•�x 4; ��.� ''''•� t". Iz \; went use only \� City of Northampton status OfPennt; gilding Department Curb Main Street oom 100 Wsrf wham ton, MA 01060 Two$�s� tt iral f r . 413-, -1240 Fax 413-587-1272 Pitatt8if inns APP6t !tli5NJTO CONSTRUCT,ALTER, REPAIR,RENO VAT R DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 ProDertv Address: This section to be completed by office Map Lot Unit ±- f V J [A>r Zone Overlay District 6 ' c Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 4 - Telephone Signature 2.2 Authorized Aaent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building ,�,� -A (a)Building Permit Fee 2. Electrical W)J /. (b)Estimated Total Cost of Construction from 6 3. Plumbing f Building Permit Fee 4. Mechanical(HVAC) v U t 5.Fire Protection �U U 6. Total=0 +2+3+4+.5) hvU Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-1050 APPLICANT/CONTACT PERSON JONES MICHAEL E ADDRESS/PHONE 173 MAIN ST APT O EASTHAMPTON (413)527-2378 Q PROPERTY LOCATION 966 RYAN RD MAP 35 PARCEL 050 001 ZONE SR(100)//WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 4449 A444 Fee Paid Typeof Construction: ADD MUDROOM IN GARAGE ADD 1/2 BATH,REMODEL KITCHEN, SHEETROCK &INSULATE WALLS 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 FO�°LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF �t'1VIATION 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 Commission Permit DPW Storm Water Management Demolition Delay LsJ©G 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. BP-2009-1050 GIs#: COMMONWEALTH OF MASSACHUSETTS -= = 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-2009-1050 Project# JS-2009-001522 Est. Cost: $20000.00 Fee: $120.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14897.52 Owner: JONES MICHAEL E Zoning: SR(100,//WSP II Applicant. JONES MICHAEL E AT: 966 RYAN RD Applicant Address: Phone: Insurance: 173 MAIN ST APT O (413) 527-2378 0 EASTHAMPTONMA01027 ISSUED ON.611612009 0:00.00 TO PERFORM THE FOLLOWING WORK.-ADD MUDROOM IN GARAGE,ADD 1/2 BATH, REMODEL KITCHEN, SHEETROCK & INSULATE WALLS 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 6/16/2009 0:00:00 $120.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo