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36-274 MORTGAGE LOAN INSPECT ION 7111 IS PLAT 1S FOR IDI NTIPICATIC?N`PURPOSES ONLY AND DOES kr CONSTITUTE A PROPERW SURVEY 241.87'+ - w rJ m • 2 STOI;Y I+ 17jvjjtr Po ACC►i FBIT I bR\VE I 1-72.34�- ! 7o7ilr; NO THAI-AMON CMPETATIVC $AIJK AND 7IIC FI�'Jr. ��� t'IC�1�1 -iITt1: CO_- ONIy To the best of my knowledge,information and belief,I hereby report that 1 have examined the premises and that this inspection plat shows the improvement or improvements as located on the premises described,that the improvement or improvements are entirely within lot lines,that there are no encroachments upon the premises described by die improvement or improvements of any adjoining premises,?gUli there are 4�tiAN PTO g d w < �:saazrhnsctta e m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ' WORICER'S COMPENSATION INSURANCE A+ + AM I Sze P 3 �Io t�-e -------------------- (h ceuser/permi ttec) v✓ith a principal place of business/residence at: Sao F ofob� /v Rd /oaee�,ce mss (phone#} 5 - © D 0 (st C t/city/statfhz p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on t1'job: y �D Li 6 Al 3 9,F_ c��D I� a 3 0 3 (ma=ce Compauy) (Policy Number) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workels compensation policies: (Name of Contractor) (lnsurancc Corupany/Poticy Number) (Expiration Date) (Name of Contractor) On urancc Company/Policy Number) (Expiration Date) (Nam_1_ 0 f Contractor) (lIl$tlrallC: Company/foGcy Numlkr) (Eiration Date) (Name of Contactor) (Inurarice Compa-ny/Pokcy Nlirnbrs) (Expiration Date) (attach addit evil dart if ncccsziry to include iafbnnjLnoa pertainin"to all o a actor ) YNL I am a sole proprietor and have no one working for me. ( ) I am a horde owner performing all the work myself NOTE:please be awaz<that wftilc hancaw�xrz wNbo a ploy pczoas to 63 m intcuncr,cm°_n:c,.ea cr repair w mk an a d ct &of not a oce th tl tbo units La wi?dn the ksrncouvcr r ez des a oa Ltie Qou xs zppurtcra t!thercio e c n t cx alty oo Ji curd to be c;zvloycra under the Nvorir&M cczrq zsticn Act(GL152,-3 1(5)�r.{ptir on by a homcowvcr for a Lo=:i c cc per nit nuy nidcs-oc the 1cga1 ctnt"of an amployer under d10 Worlcoee CoMP,,os liar Ad_ I und�d that a copy of this ctatcmccd a y bo forwnrded to the Dcpartmast of Ind.L iel Acci'&.c OfIioo of 11vA s co for tlm coverage vcrificatioo ead that f_.ilum to t-a=covcntV und:r scctioa 25A of WIL 152 can lead to the imposition of cr=nsl pcm+ltics oa ustiag of a fmc of up to S 1,500.00 anNor in prisonttxr of up to orx)W and civil pmallics in d,c forrn of a Stop Wcrk Ord--and a Lao oC5100M a day IEniml me ,� FoedcputNtuni cT oily Permit Number gyp;{ Lot . ; Signature of LiccnseclPcrnutico e s .. SECTION 8'-;CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :_ �� hC✓\ _, t' V 1 C _ � License Number (�a0 0AzC C T +2e..,.ce V"14-5S UO �. Address ExpiratioPDt, �"SOOO Signature Telephone 9.eRegi$teretl iTbrrre Imprpuem`ertContractor. ;,_�, , � „gi„ , v�� „x� � �; 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....... ❑ No...... ❑ :. fir,„ BO ®caner 110M n zl 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 fe-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_ _ SECTI Nli,5 IDESCIRIIIRTIIONI,'�' F PROPOSED WORK(check all applicable) 3 New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding Other L ] Brief Description of Proposed Work: Ll X as _T�_— p STo,,e /4Jd%t-% JA/C" Jc�1p1-, Alteration of existing bedroom Yes_K No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes _X—No Plans Attached Roll>Q Sheet U 64 Jf New liouse,antltori-aiidition'to existing'hdusing con ple"te the:%following a. Use of building : One Family Two Family_ _Other b. Number of rooms in each family unit: 10- Number of Bathrooms__ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions / -/ X c� e. Number of stories? a f. Method of heating? &tRceJ 14oT /1"k-_ Fireplaces or Wood stoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction W<3 O _ i. Is construction within 100 ft. of wetlands? _Yes A No. Is construction within 100 yr. floodplain Yes _XNo j. Depth of basement or cellar floor below finished grade 5[a B o n S' 1?A01 C w k. Will building conform to the Building and Zoning regulations? __X_Yes No . f I. Septic Tank X City Sewer Private well _ City water Supply SECTION 7a+-OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT,OR CONTRACTOR APPLIES FOR BUILDING PERMIT l - as Owner of the subject property hereby authorize _ to act o-, my behalf, in all matters relative to work authorized by this building permit application. lSignature 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 0 ner/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 3� 1s� Lot Size Frontage Setbacks Front 1 ILi r�(J u4 Side L:400.y I G}�, $? L:aop R: Rear '�H l� ± `a: 46 1 ± ( V Building Height Bldg. Square Foo age 1 6�� Open Space Footage C7 (Lot area minus bldg&paved 'yI, parking) #of Parking Spaces i 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 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 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: ew w - City-6f Northampton Sat s P '—Building Department Curb� ut/;fix �IS,e f- 21.2 Main Street Room 100 Se. p" Ihl er/We " DEC 1 Northampton, MA 01060 phone 413-5,87-1240 Fax 413.587-1272 ' ,: � � Other Specify APPL1CATtONJO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1 This section.to be completed by office 1.1 Propep rty Address: Ind M Map Lot . Unit ��t�r2erCt 0�A55 . 0 1 0 � � Zone Overlay:District �a Elm St. District CB District " SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1_Owner tiof Record: 0 n ` Aq z- IOC vv P, Name (Bfint)� : ,,-rent rlailhin d ess- s� 5 Signature , 2.2 Authorized Agent: G n CPI-tV-11- Name(Print) (",rrent Mailing Address: yv�hs� 595- -- IRO op gnatu I elep'nom SECTION 3 - ESTIMATED CONSTRUCTION COSTS tem Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1 Building 7oTr,,t CO't °f (a) Building Permit Fee —-- -- O 0 0 0. --- - 2- Elec.ncal (b) : timated Total Cost of Construction from 6 3. Plumbing — — i Building Permit Fee 4. Mechamcal (HVAC) I Fre 5, Protection 5 G C� _total = (: + 2 + 3 + 4 + 5) 000, _ Check T is Section For Official Use Only Building Permit Number: -P Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2003-0582 APPLICANT/CONTACT PERSON STEPHEN BROIDE ADDRESS/PHONE 820 FLORENCE RD (413)585-8000 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid o _ Typeof Construction: CONSTRUCT 14 X 22(2)STORY ADDITION(NEW KITCHEN) New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 039880 3 sets of Plans/Plot Plan • T THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)AMATION 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 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.