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35-089 (4) 0 7 -Z7 -A W --r7 12 L'.7 .......... ........... JUN 2 2000 -UTIQ NS r a t, JUN 1 2 2000 Ri Z a w G r o All 611 /ZoZ l U r oG LS� r- rte-- V1, rte' r A Z �� 0-'t1W-fp1,0 Crif3 ofN Tnz #llalltptoll '(•" � ��436ACIInertte DEPARTMENT OP DUILD(I�G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 `V O RICER'S C O ATP EN S A U O N LN S URAN CE Ar, I A VIT 01 ccuscrJperrni ttcc) — %vith a principal place- of business/residence at: (stTc--Uci ty/stalclzi P) do hereby ccrtif);, under the pzinS and penalties of perjury, .h al ( ) I am an employer providing dic following wonccr's comocns ion covcr�gc for Inv eluployces worming on tills job (Insu1-._aC-- COO=N') (Potic; Nurnlxr) -- (L;-pir,Lion Dace) ( ) I am a sole proprietor, general contractor o r (circle one) and have hired the contractors listed below v,-ho hive the follo%ving worker's comnen,"don pokies: (Name of Cony ')Co-) (In-�irancc CotnoanyiPo6c-, N`urnbrr) (F.>.pir;uon I�atc) (Name of Contractor) Onssranc; ComoaayiPoticv NuiDcrr) »ir lion Due) (Name of Contractor) (Iasuranc; Company/PoUcy Numbs) (E.\piruon Dale) (htamc of Contractor) (Insuran(-- Comrany/Policy Numbs) (L-xpir-aiion Dac) (enicfr-66i"oc�J t'u l to mc!uu tafortn.tioc pcztainins to.L ( ) I am a sole proprietor and have no one wor4dng for me. ( I am.a home owner performing all the work myself. NOTE:plcs:be--r rc t l..uai.^_]c barn '�H1r0 curplay pcicw w dD r--.=Ca- cc-s`..0 C'r p'U �a.d..c1L:Z of nex rnoee th_n L`.ro-t=ar'd in a the lwcmoavc redo a oa the a-arndr zppu,cn ni thorn LT Doe e:lly oecr:d to L carployc-3 unL Lhc.ixicf c=pc�6cc Aa(GL152-=1(S)�application by e homes ua fa -o porn n y c�d�o tc Icp ctnau of cn cxployoc uodcr din Wo kce,Compoa tioa?-c I uo,Qr d dw>Dopy of thi,rriremmr my bo fo.wn.dod to tbo pcportmcu'of Irk, jd Aeod.-Off—of lrc—for rho eovmse vmGclioo aid ltLt L l nt w ee�rtrc wvern�under soetion 2S A of 1.{OL 1 S2 m lead n the dioo of cr mind pcni - ooniising of 4 fiDc of up Lo S I}00.00 4rd/or�{u-i-warren of up t.o one ye:r to,�civj pm t,, w t4 form of n Swp Work order end e rim of S 100.00 4 dey e&.iII;t ar ra dq.un u,c oily /�L�`iZ�vLt/ ��U/�^Y, Pcrurit Ntunbcr __ 1.4ap;; Lot " Siva to of Liccn:cc�l'cnnit.tcc -- �� SCE 1 N � 5tl l�GT1ON U iCtS 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 5�'f1t N 31,1 iMf}1 �C RS Ct 11(IP N51k1"1QN N URANCt Al FIDAVIT(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...... ❑ 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 GC.d gut IX.) c is i }e New House ❑ Addition ❑ Replacement Windows Alterations) Roofing f� Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[✓f Other[ ] Brief Description of Proposed Work: eet t'hAtJ-" W +l AC& W,Y 21VOW(OnC Alteration of existing bedroom V/'Yes No Adding new bedroom Yes 1--" 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? A/0 t d. Proposed Square footage of new construction. 300 Dimensions 10 '- 10" U f 0 Y, 7 e. Number of stories? / f. Method of heating? G%:! Fireplaces or oods Number of each / g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? 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 //©N'9 k. Will building conform to the Building and Zoning regulations? _�Yes No . I. Septic Tank City Sewer J Private well City water Supply T14N 7 'OWNEt AUTH©RiZA71ON-,TO BE COMPLETED WHEN QqlNI 1 A" I"'T" * TRA..TOR APpM.IES I'OR 80 tD1NG PERMIT i, �"�'�Z / -lY��� �K- as Owner of the subject property hereby authorize o RW Mw-l-i n to act on my behalf in all matters relatiie to work authorized b his buifefing 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. &rm mou�j n Print Name --- � U 616 0 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 o�o� Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage N13-0 % 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 r'� � DON'T KNOW 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 f✓� 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 here any proposed changes to or additions of signs intended for the property ?YES_ No IF YES, describe size, type and location: of Northampton 2 2000 80 ding Department JUN F. 12 Main Street _ d Room 100 No`rthbmpton, MA 01060 -- phone 413.587-1240 Fax 413-587.1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SE T!ON 1.SITE jINFORMAtION 1.1 Property Address: ,, h J, , SECT(t?N 2 VR©PIERTY bWkERSli!nUTTHORIZED Ao£NT 2.1 Owner of Record: Name(Print) Curre ili ddress: �4 - o'er Telephone tignat 2.2 Authorized Agent: 4 n nt- tax u T. i'11Q,4i n 4q, a r i 8 e, tom. �a 12,4 Name(Print) Current Mailing A ess e�� a-, (4,3) 0 -0 7�3 Signat re Telephone S9,gTj, aN 3- ESTiMATVAtONSTRUCYiON COSTS' Item Estimated Cost(Dollars)to be ICrai Use Cniy completed by ermit applicant 1. Building r/ 3, 0 0 0 , 4 0 (a) irig'Perrnjt l°ee'-" 2. Electrical $ t7 p , U p (b) I;stii�ated Total Cost of ConS'truction fro:M 3. Plumbing 3. Soo . 0 U Building`Permit'fee 4. Mechanical (HVAC) 5. Fire Protection v00 u0 6. Total =(1 + 2 + 3 +4+ 5) () . 0 o 0 0 0 Check,Nvmber `his,Section for Official Use only Bujidfi g Por-mit Number: � � Date Issued: ,3►gnatUre: r3uiiding�omrnissiar�erllr#spectPru#.t3daldr�gs .... ` . :,. !. path , File#BP-2000-1132 APPLICANT/CONTACT PERSON MARTIN KAREN&PAUL ADDRESS/PHONE 491 BRIDGE RD#2724 (413)582-0723 (} PROPERTY LOCATION 1195 BURTS PIT RD MAP 35 PARCEL 089 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 D'D IMeof Construction: CONSTRUCT REAR SHED DORMER W/NEW 2ND FLR BATHROOM&INSTALL SIDING&SHINGLES New Construction Non Structural interior renovations Addition to Existin Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE IF LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § _w/ZONING BOARD OF APPEALS 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 Signature of Buildftofficial 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. 1 a i k _ a 4 Jo r_ 1195 BURTS PIT RD BP-2000-1132 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-089 CITY OF NORTHAMPTON Lot:-001 Permit: Building ('Category:ADDITION BUILDING PERMIT Pernhrit,# BP-2000-1132 Proiect# _ JS-2000-2012 Est.Cost:$200d(A.Q0 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: Lot Size(sg. ft.): 971 :t 88 Owner: MARTIN KAREN&PAUL Zoning: SR Applicant. MARTIN KAREN & PAUL AT. 1 195 BURTS PIT RD Applicant Address: Phone: Insurance: 49l BFIDGE RD##2724 (413) 582-0723 O NORTHAMRTONMAO1060 ISSUED ON.6115100 0:00:00 TO PERPIORM THE FOLLOWING WORK.-CONSTRUCT REAR SHED DORMER W/NEW 2ND FLR 9ATHR00M & INSTALL SIDING & SHINGLES Q POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: f Footings: Rough:'It' 7"."Y�t '? Rough: ,l�w, House# Foundation: Jo.xl'ol Final �i` 0 'z�/� Final: Rough Frame:�`;'- Gas Fire Department Fireplace/Chimney: Rough- 67 Oil: insulation:,°I r Final: ��',� Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA IONS. Certificate of Occu anc si nature: Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 6/15/00 0:00:00 868 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo 9 ) JUN ( 2 2000 rb d a � e - f1. O q ,n a - 1 r ' r 3 m . � L LO o � C-6 Z- e 7D 1 c, I