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35-259 (2) R L J Case Handyman® Services NFKI ��c k 16 12 Nn 23 2MB 15 23 .� 27 16 FrG 22 011 I 32 OPP 6 �.b Vl��S pl�fLSo�V S LA�UE F1,.0r2 �tG�• Mk i9Z �St GG 137 Damon Road,Suite Cl,Northampton,Massachusetts 01060 Phone:413-584-7700 or 413-584-2180 Fax:413-584-7706 Independently owned and operated. Q-��MpTp S'O a 9 fl Grit r of t lll�1 QTI 9 6 �lasst:cflasrtta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT Ncensee/permittee) with a principal place of business/residence at: (phone#) `�/3 SFSy-7'7oa (St r=ucity/staielap) do hereby certify, under the pains and penalties of perjury, that. (vJI am an employer providing the following worker's compensation coverage for my employees working on this job: CG��93a1GC, 4/199/ �dZ (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shod if nweniry to include infbmn on pertaining to all ooatradocs) ( ) 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 whilo hoazowaen who employ persons to do ms i*�+____M__a� consuvction or rgmir work on a dvmlliag of not more than throe units in which the hoaxWwaosesidex or on tb a grounds appurtenant thereto ate not generally ooasideted to be employes undo the worker's compensdim Ad(GL152,s 1(5)),application by a homeowner for a liocase or permit may evidence tho legal chili$of an employer under the Wodtoea Compemation Act_ r understand that a copy of this statemeat may be forwarded to the Departmm2 of rodiL t ial Axi4w&OZ&oe of rn aw—for the eoovetxgc vexificatioa aid that failure to sattse covcrago wxkr soction 25A of MGL 152 can lead to the imposition of criminal penalties oonsistiag of a fine of up to$1,500.00 and/or iznp iso�of up to one year and civil pe caltia in the form of a Stop Work Order and a fists of 5100.00 a day against tree. For dgx1 use only .Permit Number ice ..-�.•� 'z� t _Lot# Signature of Liccnsee/Permitlee Date SOT1©N 8 4ONSTRUCTI 10, 114 SERVICES 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : /C �'] / OI �' �7`/(,7� > <�'5 0?3 �/ � License Number �/ Address Expiration Date Signature Telephone M '.'. . � f.�' ��._ - Not Applicable ❑ N /74r, y,a -7 Sri v.C r S /32 / 72- Company Name Registration Number 137 ,,'7'1 12 /0 5„Ag0o Z Address Expiration Date Telephone 5�`�' 770 D SECTI00"10-WORKERS'.CGMPEN5ATION 1NSURANCE AFF1DAV1T(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. igned Affidavit Attached Yes....... 2”/ 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 I. P ec" all appligabl e New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other[ ] Brief Description of Proposed Work: 6,04,1- Cle-e,� W14i I)tw 5e ors anj Ad AV6. 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? 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 Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION U...OWNER AUTHORIZATION -TO BE COMPLETED WHEN GVI�NI*RS AdENt©R"CONTRACTOR APPLIES FOR BUILDING PERMIT /-7 �A 1171— as Owner of the subject property hereby authorize C^ 5 c r °�,�, 5<r✓I C-r-S ct-t 4./, 47 IS 74 `� to act on my behalf, in all matters relative to work a thorized by this building permit pplication. Signature of Owner Date I >4� c.1/1 .1 . 1Gj /S as Owner uth hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. igned under the pains and penalties of perjury. Print Name � Z4 y 25 0 Signature of Owner/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 3 A,6e 65' 01 0) 6V-0 Frontage 31) 3 1 1 lC45" Setbacks Front &0 ' 6 p ' Q Side L: 10' R: 3G L: -1d' R: 3(,' Rear I$' ri s 1 40 Building Height Bldg.Square Footage X97 % �!)-� C?--6 Open Space Footage (Lot area minus bldg&paved (� parking) #of Parking Spaces roll Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW X 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 X 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 X 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: City of Northampton Building Department Main Street Q ECE � � � om100 a ton, MA 01060 APR 2 o n 41 3- 240 Fax 413-587-1272 PL UC ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING NORTHAMPTON,MA 01060 S.E&ION 1, IIT;E 1NVORMAT,ION 1.1 Property Address: h 7-o k t P Y orc�ce MA oI btoZ °� s 3 sgCTIQN =PROPERTY OWNERSH,IP/AUTHORI ED AGENT 2.1 Owner of Record: 11 II �eVCr��► ��'�\ 7-o oJe- T I�tirSa� �a .�,cr ame(Print) Current Mailing Address: x Telephone Signature 2.2 Authorized Agent: p `� � l t &y(-/- rJ ti Z b W r S S o w Name(Print) Current Mailing Address: J59('- 3G3� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION W T5 Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building /D, D d O. oa (a)Building Permit'Fee 2. Electrical (b) Estimated Total Cost of 500. o o Construction from,6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =0 + 2 +3 +4+ 5) / 3 O 0, 0 d Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building,�Poxnmissioner/inspgctor of Buildings Date File#BP-2001-0838 APPLICANT/CONTACT PERSON CASE HANDYMAN SERVICES INK BLACK,INC) ADDRESS/PHONE 137 DAMON RD SUITE Cl (413)584-7700 PROPERTY LOCATION 20 WEST PARSONS LANE MAP 35 PARCEL 259 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 4( Tyneof Construction:_REPAIR EXISTING DECK&ADD NEW SECTION WITH HOT TUB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 073454 3 sets of Plans/Plot Plan THE 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 o ission Permit from CB Architec Committee Signatur of Building Official Da 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. BP-2001-0838 GIS�: COMMONWEALTH OF MASSACHUSETTS 33�ri CITY OF NORTHAMPTON Lot:-001 Permit: Buildinq Category: Deck Addition BUILDING PERMIT Permit# BP-2001-0838 Project# JS-2001-1571 Est.Cost: $10300.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CASE HANDYMAN SERVICES INK BLACK, INC 073454 Lot Size(sq. ft.): 30666.24 Owner: EISENGART PHILIP A& Zoning: SR Applicant: CASE HANDYMAN SERVICES INK BLACK, INC AT. 20 WEST PARSONS LANE Applicant Address: Phone: Insurance: 137 DAMON RD SUITE Cl (413) 584-7700 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:4126101 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR EXISTING DECK & ADD NEW SECTION WITH HOT TUB 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: Footings: Rough: Rough: House# Foundation: 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 4/26/010:00:00 368 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo