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36-086 (6) d � a.r LJ ....mss _.., r; E.. 4 _ R 1 fir' V x ` s S a iEi • X � IS.3 tom. ry AM m 7 £' cif i� r .� s SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 8.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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...... ❑ 11. - Home Owner Exempt on 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 thgt 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, tate and Local Z ing Laws and State of Massachusetts General Laws Annotated. Homeowner Signature (hl SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) El Roofing ❑ Or Doors ❑ Accessory Bldg. Demolition ❑ New Signs [o] Decks [p Siding[O] Other[O] Brief Description of P oposed , i _( Work: , ,, lox �? LYL�C1 VU� � SU e—KC.1,` n -,T AA, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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. 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 Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ��r� U�, �r�> �S as Owner of the subject property hereby authorize S Yl O to act on my behalf,in a afters relative to work thorized by this building pe it application. l Srg a ure of Owner D e 7Agenthereby as Owner/Authorized de tare that the statements information on the foregoing application are true and accurate,to the best of my knowledge Signed under the pains and penalties of perjury. Pri me Signature of OwnedAgent 140-ate Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed F Require-d-b- Zoning This column to be filled in by Building Department Lot Size 1 e� I Frontage t Setbacks Front c1}c g t / I Side LA ft � � L: 31 R:9106'f/ /D Rear 1r� �- '�-o Building Height Bldg.Square Footage U ry was 3 t Open Space Footage % /J (Lot area minus bldg&paved 'J7 61 1 y3 r{ S� q 3 parking) U cJ e #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NOC _ DONT 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 r ed 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. re there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: t Department 6- only City of Northampton Status of Perm 4: Building Department Curb CuVDriveway Permit 212 Main Street Sawer/Septio Availabiiity Room 100 Wat ilVVeN Ava' Dability Northampton, MA 01060 Two Seta of Structural Plana phone 413-587-1240 Fax 413-587-1272 PIWSite Plans C}ther Spacify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: 9S (�Vev�Ptot� T section to be completed by office Map Lot � Unit IVot^�am�e� JUI� C� �®� Zone S Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mff Na (Print Current Mailing Address: J' Telephone Sign lure 2.2 Authorized Aaent: �,_ xr-) lL 410 Name(Print) Current Mailing Address: 3 - _� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building (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=0 +2+3+4+5) 0 Check Number n p 'This Section For Official Use Only Building Permit Number: t�/b�� Date T- Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2005-0087 APPLICANT/CONTACT PERSON CRAFTS ROBERT W ADDRESS/PHONE 109 EAST ST CHESTERFIELD (413)296-0134 Q PROPERTY LOCATION 195 WESTHAMPTON RD MAP 36 PARCEL 086 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: ERECT 16'R 16 SHED 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9AMATION 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 ssion ZZ ate© 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. 195 WESTHAMPTON RD BP-2005-0087 GIs#: COMMONWEALTH OF MASSACHUSETTS 10-11,11 1 M1100M CITY OF NORTHAMPTON i� PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0087 Project# JS-2005-0106 Est.Cost: $2000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa.ft.): 41599.80 Owner: CRAFTS ROBERT W Zoning: SR Applicant: CRAFTS ROBERT W AT. 195 WESTHAMPTON RD Applicant Address: Phone: Insurance: 109 EAST ST (413) 296-0134 O CHESTERFIELDMA01012 ISSUED ON. TO PERFORM THE FOLLOWING WORK.-ERECT 16 X 16 SHED 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 OccuQancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 7/23/04 0:00:00 2709 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo