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35-154 (6) 1 Licerse or regibtration N,alid for individui use only f before the Lxpiration date. If found rettarn to: Board o..i.ilding Regulations and Standards Ashh:rton Place Rm 1301 3oston,Ma.02108 r f "'lit Valid 1,?tl1(Ut signature j 00-35.000 cf enclosed space (MGL CA 12 S.60L) 1A-Masonry only 1G-1&2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. f l DIG SAFE CALL CENTER: (888)344-7233 1 P% _ - ;,�, ✓/L(.' TJOdILIILf}IllliCfGCGFI c���ltCC.;1Q�lfL1GCI Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 132751 Expiration: 4/2/2009 Tr# 129433 1 Type: Individual THEODORE TOWNE JR. THEODORE TOWNE j 21 LOUDVILLE RD. EASTHAMPTON,MA 01027 Administrator r �j�� /� JJ r ✓/LC -V4lllllllilGll/Ci,'C'(� fif��l Clf:i.illC�l!'ECl BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000722 ^E i Birthdate: 08/2011962 1 K Expires: 08/20/2007 Tr.no: 2397.0 Restricted: 00 THEODORE D TOWNE JR 17 A GUNN RD EXT C :,OUTHAMPTON, MA 01073 c w Commissioner yr V ` r ✓I!E �dJlb�lLO�Ll1/F[ll�� O�v�(,(/f:i�lC'/tUdP.�.1 h" BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 000724 Birthdate: 09/24/1938 ' Expires: 09/24/2007 Tr.no: 3735.0 Restricted: 00 THEODORE D TOWNE { 26 CHURCH ST G c, i EASTHAMPTON, MA 01027 Commissioner 35,000 cf enclose L)space (MGL C. IA_ Masonry only IG I.&2 Family Homes cailure to possess a current edition of the "Aassachusetts State Building bode s causg for revocation of this license. DIG SAFE CALL CENTER: (sasl 344-7233 -- - P. 03 FAX NO, sEP-15-2 A i-LKTIFICATE OF LIABILITY INSURANCE .��.vrcu K f / "*WJ +ER (413)586-0111 FAX (413)S164481 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i North Kung Street HOLDRER.T11 CERTIFICATE DOES NOTE pi���ITS BELOW. OR NarthalllptoTl, MA 01060 INSURERS AFFORDING COVERAGE NAIC 9 a m—w Tfiiaiire Towne, 5 r. IfMURERA: NOM Iusurance ny 14718 21 Loudville Road wammm WGAR- Savers Property Casualty Eastharpton, MA 01027 ULSUIWR C: VOUReR M. INSURER E: MVERAM THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY AERIOO WMATED.NOTWITHSTANONG ANY REWREMENT.TERM OR CONOMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHINE THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE 013URANCE AFFOROEO BY THE POLDES DESCRIBE¢HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLJCWS.AGGRE0ATL LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TTP!OP INSL IARCR POLICY i1IIMIlOEft Y wrra 08NERdo.LIA29m MP1s11m 06/29/20" 06129 2009 EACNOCCURRCNCE S 1 000. X CDMMeEeCNt GEtAI LYI60.m i S00 0 CLAiNe MADE s R+OCCUR MED e%P wq an pomm S wwo A PERSONAL i ADV INAIRY i 1 Q00 0 Oifel"AGGREGATE f 2A000.000 SeK AGGREGATE LOUT APPLIES PER PRODUCTS-COW40P Ase $ .2.0m. POLICY M go M LOc AUTONCIOU LNUIRM COMONM SINGLE OMIT i ANYAUTO (04 w9mw* ALL OWNED AUTOS GODLY O URY WJGDULEUAUTOS ""RED AUTOS 8001LY SIAIRY NON04NE0 AUTOS (ftfammmt) i PROPERTY DAtitA[IE i (Par acddMQ GARAGE LM1 UTY AUTO ONLY-EA ACCIDENT i EAACC i ANYAUrO ao AGO s LMOUTY EACN OCCURRENCE OCCUR CLAIMS MADE AGORSISAYE f fr� OEDUC118LE i RETENTION I _ MIDItK1gRStOMPEN01►T10N AND AR04Z6012 67/0712019 07107/2 200 x A LLqAmTM E,L,SM"ACCIDENT f loo B fRnI�ER EXCLLIDEDT EcUTNE E.L.DISEASE-BA EMPLOYS 100.000 LIJ_DWASB-POLICY LBIIr i 5 00 MISR Tw*OP opIrATIoNS I LOCATIONS rva OL SO I WCA IONS ADDED w WIDORSMIEIRI SPECIAL PODMONS SNOULD AMY OF TUG AODYE Oel OSSO POLIC"AS GANG UAD 96FORE"M EIIPIRA,nm VATS TNVUW.TN@ B UONO ONIU Mt WELL ENDEAVOR TO NMI. 10 DAYS"RENTER NOTICE TO THaGERT+PICATE Mau=*""To THE LEPT, Theodore & Evelyn Towne OUT FAIUM![To aWL wcN Nonce SHM4,ISPOISE ND oWOATION OR LPMLIIY 23 Loadvi l l a Road OF ANY KW UPON TMe NRi0R18R,in ASEM ON ROPSIMMATrAL East#IW# on, NA 61027 AiR—WiMDRVI MERTAVA 13enna IS&JOR, CIS 7ER �M t5 pw/a) FAX: (413)327-9060 ' OACORD CORPORATION i"I SEP-15-2008 MON 09:05 AM FAX N0. P. 01 AuLm LERTIFICATE OF LIABILITY INSURANCE "Tapmow""'`1 PROgum (413)586-0111 FAX (413)S8fi-5431 THIS CERTIFICATE IS ISSUED AS A HATTER OF INFORM T10N Webber A Grinnell Ins, Agency, Inc. ONLY AND CONFERS NQ RK WS UPON THE CERTIFICATE 8 North King Street FK T DER THIS CERTIFICATE DOES NOT A EEND, I 7E�D OR m"twomil Northampton, NA 01060 MISURERS AFFORDMIG COVERAGE NAIL s New' Thwdom 0 Terri m, Inc, aSURERA: N61N insurance simm 14788 23 LomM l l e Road WSURER a: WCAA- Travelers ftstha"ton. 14A 01027-2529 04URERC: INSURER a NauRER e THE POL DIES OF INSURANCE LISTED BELOW HAVE BF.EIN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,N0r*TWSTANDINO ANY REQUIREMENT.TOM OR GONOrWN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT1ffCAIF NY►Y 91a ISSUED OR MAY PERTAIN,THE WSURANC!AFFORDED BY THE POUCIES DESCRIBED HEREIN fB SUBJECT TO ALL THE TERMS.E)6 LIMNS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN RED BY PAID CLAIMS. TAR Or aN mmx POLICY NIRSfEN tAiMTi GTF67146 05/26/200 05/26/200 EACH OCCUPJMCE ! 1 000. X COMMERCNL GENERAL iNE1L(TY wv T'O TEp ! S4. ctACLAW aE L:J occult "ED�(&V wo owsm s 5 A PERSOMI,f ACV M.AlRr ! 1.000. OENEfW AGGREQATE s 2.000.000 GOA ADORBGATE WIT APPLIES PER: PROOIJCTS-COMPoOP me ! POLICY 0 JkCT LOC AVVQUMMt LIASSM ANYAUTO 1 Ieww)smcle LRar ! ALL OWNED Auros OaDar MJURr ! SCHEDULED AUTos (wr"r-ft) IRRED AUTOa NON-0VPNED AUTOS tOODSia derNl = (PK egd*xm w►8E ! GARAftt"RY AUTO ONLY-EAACCE>W 0 ANY AUTO OTHER THAN W ACC : AM QMr. AGO $ MMMUNSPEL&A LAN LRY EACH OCCURRENCE t OCCUR CLAVA WADE AGGREGATE ! CMCTWM ! RETENTION f taw Alm 018111 1909 6S/30/200s 68/30/2009 X AT TI" WVLGYMLmdwjm 0 4 ARm ;wUTwE E.I.EACH ACCefNT s 100 M E L.WSEASE•EA ar�L ! 100, aNS hmm el.DISEASE-POLICY I.Wr I! S00 60 on" o�gtr#M lQF 01OWTIONalu"awsIvow4m,Sltq,t MM ADM werrIaPECIALPROV00M 3I101It.G ANY of THE AWO 084101010110 Pouaes OF CAwaal P PGFORS THE SK MATH WE TNRREOP,THE MIMR INSURER V&L INWAWM TO W& 10 DAYS VA%r M NOME TO THE CERtIPICATE MOLOw NAMED TO THE Mr, Theodore i Evelyn Towne Dur PALUIX TO MAIL aUON NOTICE aRAU.NIPws No 09UGATION on LWILmI 23 Loudvil l e Road OF AV 00 UPON THE NOWNaR,RS AGOM OR*WRMW,%flVlX EasthW%on, NA 01027 AUTIOVA pREPTNIM lrATwa lCvnthia Henderson CORD 2s{200ilm) FAX: (413)S27-9060 GACORD CORPORATION 1988 Rug 20 2009 3:07PM HP LRSERJET FRX C. 7KIrmumncm THIS CERTIF CATS IS ISSUED AS A MATTER OF INFORMATION ONLY AND C NFER6 NO RIGHTS UPON THE CERTIFICATE Apnc y Inc HOLDER.TN1 CERTIFICATE DOES NOT AMEND,EXT ENQ OR ALTER THE GIOVERAGE AFFORDED BY THE POLICIES BELOW 203 NORTHAMTDN ST Easlhampton,MA01027-0597 COMPAN*M AFFORDING INSURANCE COMPANY A'!';, GRANITE STATE INSURANCE COMPANY INSURED Martin 8amnowdd&Rerwom Purinton 1 Loomis Wry ; EWhamptan,MA D10Z74XM THIS IS TO CERTIFY THAT THE POLICIES OF 1N8URANCE LISTED*LOW HAVE BEEN 18BUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOT WITHSTANDING ANY RECEXUBIONS'EMNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W'MCH THIS CERTIFICATE MAY 8DE3 OR MAY PERTAIN.THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IB BUSJECT TO ALLTHETERMS. AND COMDR OF SUCH POLICIES.LIMITS SHOWN MAY HAVE PEEN REDUCED SY PAID CLAIMS. , P A E P lxPIRA A D ErIPLOYERr Laeltm t�' LIMITS ARy"ARWIMEC THE yV� FICIRSAW CL O EXCL O 8Z��8 11=2006 1/03/201)8 TArJTCWY WAITS ows"Apoo to MA Opp amo Deny. t HACCeOENT S 1,QOD,O0 4 P otter t�t�s s 1.000,00 LD s s 1.000,00 ION 0PMTIOWW0WUMPV.4AL IT t NO PARTNMO ARE GOVERED BY THE WORKER11 COMPEL 4AT ION POLICY. CERTIFICATE HOLDER CANCELLATION THEODORE D TOWNE INC sNOULD ANY OF THE Afq{'E OEtfGla£D PUtICts K CAMCELLEO•EFORE THE EXPItA10"DA?E THUL THE 6604BCOMPANYYfKt£ND£AVOR TO MW N 23IAUDVIUlRD DAYMI(OTENNOTCE TAECERTNICATEHOLDERNAWOTOTHEtUT,PVT E�STHAMMN,MA D1027 FAL.UM TQ MAIL iUCN I ICE ISMAU RIPC"NU OBLIGATION OR t"lLITY OF ANY KMO UPON THE ITS AGENT!OR REPRE/EnTATNEd. AUTHORIZEDREPR ENTATIVE f t: � t ?t 1' CV 1 :a Aug 113 2008 9: 34AM HP LASERJET FAX P• L ACORD CERTIFICATE OF Ll BILITY INSURANCE °ATF 0511812008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION KS.K INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 203 Holthampton St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 597 Easthampton MA 01027 INSURERS AFFORDING COVERAGE INSURED waiRERA: HOLYOKE MUTUAL INSURANCE COMPANY _ M S R CONCRETE wsuRER B: SAFETY INSURANCE COMPANY P.0 BOX 688 INSURER C- EASTHAMPTON,MA D1027 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT O OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ONE MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES IBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH �- POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC Y PAID CLAIMS. INSR TYPE_0FIbgU56WE POLICY NUMBER POLICY EFFECTIVE EXp$tATION V LIMITS - GENERAL LIABILITY EACHOCCURRENCE 51,000,000. A COwhUERCtAL GENERALuAmLTTY CPP0007016949 06!03108 06103109 FIRE DAMAGE ft one fire AtI 000` CLAIMS MADE a OCCUR MED EW VAY am am $5,000. PERSONAL t(ADVINJURY 01000,000. GBdERAL AGGREGATE S2 0110,000- _ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000. _ _X-1 POLICY r I LO � C AUTOMOBILE LIABILITY B ANYAUTO 3116413 0312412008 03/2412009 (OMBIiaD)SINGLELItuIT 51,000,000. t 3 aotitleM ALL OWNED AUTOS BODILY INJURY X SICHEOUIfDAUT05 (PerpKim) S HIRED AUTOS BOOBY INJURY S NO"VAVED AUTOS (Per amdem) F1 PROPERTY DAMAGE 5 (Pea aaidw) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S _ AUTO O NLY: AGG S EXCESS LIABILITY EACH OCCURRENCE OCCUR FI CLAIMS MADE AGGREGATE -- S ----- -- E ]DEDUCTIBLE 5 RETENTION S 5 WORKERS COMPENSATION AND WC BT. ()'T'HL EMPLCIFYIEWLIABILITY BEING REUESTED FROM CO. E.L.EACH ACCENT E.L DISEASE-EA EMPLOYEE S EL DISEASE.POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONSILOCA7Na LFS/EXCLUSIONS ADDED$Y EN[ RSEMENT/SPECIAL PROVISIONS CONCRETE CONSTRUCTION CERTIFICATE HOLDER I JADanxmALINSURIED-.INSUPERLErMFt-I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL ED BEFORE THE EXPIRATION Theodore D.Towne Inc. DATE THEREOF,THE ISSUING INSURER 4NLL ENDEAVOR TO MAIL 10 DAYS WRMEN NOTICE TDTHECERTt. TE.HQWER NAAED TO THE LEFT.BUT FAILURE TO DO SO SHAI.L 23 Loudvine Road Si44: .:; :�;.,°,��(�� EaSthdtllptott Ma 01027 IMPOSE NO OBUGAMN oR LlAett rr t3F'kkQ0 THE SURER,ITS AGENTS OR RMESENTA IN AUTHO 493-787-2646 �'f ACORD 2S-5(7/97) r ORp CORPORATION 1988 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s)who seek to use the home owner exemption, to act as their own construction supervisor,to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before your), a rough building inspection (before work is concealed) insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the prgject until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location w The Commonwealth of3fassachusetts Department of Industrial Accidents °r Office bf Investigations 600 fEashinb on Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /U !j✓L' U/ Address: GU D U E- i( 6 le,�7 City/State/Zip: 7 Alf, Phone #r: , Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. 4 I am a general contractor and I 6 7 New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance.$ 5. 0 We are a corporation and its 10.0 Electrical repairs or additions required.] 3.F-1 I required.] a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions right myself. [No workers' comp. , exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no i�.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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-corttactors 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.#: CF / /Al 9 Expiration Date: Job Site Address: /Z City/State/Zip:2SZ �� 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sianature: C Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official Citv 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#: -NOTE- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED NOTE: SUBJECT TO EASEMENTS AND RIGHTS OF WAYS OF RECORD. wood shed moo• NOTE: STRUCTURES SHOWN ARE APPROXIMATE, A FULL FIELD SURVEY IS REQUIRED TO �j9 ACCURATELY DETERMINE THEIR LOCATION. pavilion shed BOOK 2063, PAGE 162 N PLAN BK. 36, PG. 34 r� LOT #8 00 [+ o�y >�X !STitvlF N a'4 { w I+ , s� µb ISr '7 8.17'± 71.83'± RYAN ROAD TO: EASTHAMPTON SAVINGS BANK & COMMONWEALTH LAND TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY_ RFPOPT TNeT 1!-a-6\/17 c AjinG SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: (� Not Applicable ❑ Name of License Holder: ?, i�C a5 9 License Number �2 M9,,Y,4-c7 Address Expiration Date 0 z Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ —7� 13 r -3a 7`51 Company Name Registration Number Address � Expi ation Date Telephone!y— `YJ!- � ��/ 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...... ❑ 1 1. -.Home' Owner.Egemption 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-vear 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement,Windows Alteration(s) Roofing Or Doors A Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding Other[1--3] Brief Description of Proposed Work: - ��(� Alteration of existing bedroom Yes_ No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes _y No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete 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. ensions 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. o etlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or Ilar floor below finished grade k. Will building form to the Building and Zoning regulations? Yes No. 1. Se ti ank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING,PERMIT 1 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. c Signat re"of Owner Date as Ownerld Agent hereby dec lare that the statements afid 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 Signat a Owner/Agent Date Section 4. ZONING Att Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R:. .. ..... i L:,,,, R Rear .._ Building Height Bldg.Square Footage r' % _. 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 0 DONT KNOW YES 0 IF YES, date issued:` IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW _YES 0.._. , IF YES: enter Book Page and/or Document#', B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit:', Building Department Curb Cut/Dnveinray'Permit 212 Main Street Sewer/SepticAva4abili!y „ Room 100 ai ,h Northampton, MA 01060 © ' Plans phone 413-587-1240 Fax 413-587-1272 ProtlStte Pans Other S APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OMDEMOLISH A ONE OR TWO FAM14Y DWELLING SECTION 1 -SITE INFORMATION -This section to be completed by office 1.1 Property Address: r�cm Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 7-key7-.>0 R t :1-a al'V P_ a3 Name(Print) Current Mailing Address: Telephone _ /J Signature 2.2 Authorized Agent: 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 r 006 (a) Building Permit Fee 2. Electrical / (b)Estimated Total Cost of Construction from 6: 3. Plumbing / Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) f/ 4® Check Number This Section For Official Use Only" Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date e File#BP-2009-0554 APPLICANT/CONTACT PERSON THEODORE D TOWNE ADDRESS/PHONE 23 LOUDVILLE RD EASTHAMPTON (413) 527-9060 PROPERTY LOCATION 792 RYAN RD MAP 35 PARCEL 154 001 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 Fee Paid Typeof Construction: GARAGE REPAIR(ROOF SIDING REPLACEMENT DOOR/WINDOWS) New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included• Owner/Statement or License 000724 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Commission Permit DPW Storm Water Management Demolition Delay Signature of Building fficial 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. a BP-2009-0554 GIs#: COMMONWEALTH OF MASSACHUSETTS ? RIA a CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0554 Project# JS-2009-000791 Est.Cost: $7000.00 Fee: $70.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THEODORE D TOWNE 000724 Lot Size(sq.ft.): 14244.12 Owner: THEODORE D TOWNE Zoning: SR(100)//WSP II Applicant: THEODORE D TOWNE AT. 792 RYAN RD Applicant Address: Phone: Insurance: 23 LOUDVILLE RD (413) 527-9060 WC EASTHAMPTONMA01027 ISSUED ON:121312008 0:00:00 TO PERFORM THE FOLLOWING WORK:GARAGE REPAIR (ROOF,SIDING,REPLACEMENT DOORMINDOWS) 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 12/3/2008 0:00:00 $70.003035 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo 7 792 RYAN RD BP-2009-0554 GIs#: _ COMMONW�, 'LTH OF MASSACHUSETTS Map:Block: 35 - 154 CITY OF NORTHAMPTON Lot: -001_ PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Pernut# BP-2009-0554 Project# JS-2009-000791 Est. Cost:$7000.00 Fee: $70.00 PERMISSION TV HY.,REBY GRANTED TO: Const. Cass: Contractor: License: Use Group: THEODORE D TO'J'dNE 000724 Lot Size(sq. ft.): 14244.12 Owner: THEODORE D TOWNIE Zoning: SR(100)//WSP fI Applicant: THEODORE D TOWNS AT. 792 RYAN RD Applicant Address: — Ph one: ins.arance: 23 LOUDVILLE RD (41 3) 527-9060 -C EASTHAMPTONMA01027 ISSUED ON:121312008 0:00:00 TO PERFORM THE FOLL O WING WORK:GARAGE REPAIR (ROOF,SIDING,REPLACEMENT DOOR/WINDOWS) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wirhig B.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Routh Frame: Gas: Fire Department Firepl,ce/Chimney: Rou;;h: Oil: Insulation: Final: Smoke: Final: l`• lu - - wr..t � THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF F ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy -Sienature: FeeType: ,— Date Paid: Amount_ Building 12/3/2008 0:00:00 $70.003035 212 Main Street, Phone(4I3)587-i240, Far: (4 13)587-1272 Building Commissioner-Anthony Paliilo