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25A-060 (6) Q EcEE v JUN - g 2001 DEPT Of BUILDING INSPECTIONS NORTHAMPTON,MA 01050 o3 oe �a6� I 3(P . a� �M Grit-�) of �\Tn tljuillptoil g � E �lc�snctlnccffa' `Z _0 - i _- DEPAR T ME1,rT OP ©UILDO�C INSPPCTIONS — =, 212 Main Street ' Muoicipal Dudding Northampton, Ma6s. 01060 WORICER'S CONfPENSA'aON CNSURANCE AJII'U ; M' — ------ -- (liccvscr/permittcc) vvr1th a principal Place of busMtss/resider1cc al: do hereby rerun;, under the pzit-Ls and pen<dties of perur;, .hat ( ) I an an employe, providing the followine worker's comocnsrLjon cove,2gc for Illy eluplovccs worhjng on oils job (PcUc; N,unirr) 1, 'l am a sole proprietor, general contractor one) Lad hired Ole coop actors lasted bolo`-/ vt'ho liz, e the follmv worker's G T: e. s2,on pel:cles (tai,I ale 01 CQ:S ciO N-un't ;) of Cool,cloy) -�� (Insttranc ComoanvrFolicv Date) (Name of Coacracwo ) (Insurancz Compauy/PoLi-q' Numbu) (E\pil Uo0 Date) (N-lLuc of Con(ractor) (Losurmcz Compamy/Poticy Numb,,J) Datc) (en�c�`b!:�ocil c'.ue:it oc�-..-v:} to cn:!uc�ialo�ni'i oo�Crtaia>ns to.1J peas--C.o:�) ( ) I am a sole propnetor and have no one Working for me ( ) I am a home owner performing all the workfmyseif. NOTE:plc be cmrc LE,utJc bc,r� n Wt>o cmplay pcson3 co 63 r--.� of apt 2m t)•._c LE t=Y.r in u y a the txxnoo vcr ru do oc oa the U Ouo i to h cmployc-3 oar's the..ai da ox�_t ca w(GLI52-�1(3)� o zppLic�i a by>born > fcr-bcs_-r a Pcr nit r Y c;d.-ncc tEc Icgal nxyc or n cr,loyx uod< d—Work-1,Co�on Ac(- I undart.nd the a Dopy of thi,ml t my bo fw-xnniod to tbo pcportmcizt or lndut iJ AoadmU'OfL oo or Lrcv'zvo°ror the covm&c va-Tial loo n.M t1L1 L-Lxc to sccurc`covcrysc under soe ca 23A of MOO 132 c n Iczd to the z auboa of criminal pcae C3 ooasis of&Gnc o(up W S 1-5W.00.rxyor impri3,0 m or up to one yc�r tod Ci it pcn..P.i in tic form of n stop Work Ordcr and e fires o(S 100.00 i d_y cpuwa me For dcp.rtcx���l u.c oril y Permit Numtxs W4-m of Li /Pcrmiucc l SECTIt)N'8` OSRt ' 155., V�CES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone QL "Mill 9: er m n n r � i, .. .'� F Not A licable ❑ pp Company Name Registration Number Address Expiration Date Telephone SECTION 10-WOIRKERS71 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...... ❑ IDNI .. `O Sao.. I�e> E ,. ptl0it 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 faun 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 Massaohusetts 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, to and Local Zoning Laws and State of ssachusetts General Laws Annotated. V/ Homeowner Signature �`' SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet 0 6aIfi.�N"e' r�ft'ousend?:or.�,aciditi"On-to exstrng'°housing:.cd"mplete:thefollowin�: 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? 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 L as Owner of the subject property hereb uthorize to act on my behalf, in all matters relative to work authorized by this building 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. Print Name 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 VBuildin Department Lot Size av Frontage to 2 Setbacks Front qQ Side L: R: L: R:_� Rear Building Height d- C G Bldg. Square Footage % 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 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 —V�— DON'T KNOW YES I 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: r .__,n a '�., � __ i r _. ampton Qilin artment a Street JUN - �n' R 100 849a MA 01060 413-587- 240 Fax 413-587-1272 DEPT OF BUILDING INS IONS NORTHAM21ON gin APPLICATION TO CONSTR ER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfian#o be completed by off►ce�, 1.1 PrODertv Address: g MapLtS Zone ..Overlay=D�strrct �k EIm,St District CB D strict SECTION''2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n tm (P rint Current it n Address: Telephone Sign re 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 b permit 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 at q 6. Total = (1 + 2 + 3 +4 + 5) Check Number This Section For Official Use Only Building Permit Number' 5� Date Issued: I Signature: Building Commissioner/Inspector of Buildings, Date'" File#BP-2001-1035 APPLICANT/CONTACT PERSON BARCOMB JANE M&ALLEN F ADDRESS/PHONE 13 HUBBARD AVE (413)584-0989 Q PROPERTY LOCATION 13 HUBBARD AVE MAP 25A PARCEL 060 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid — Ty eof Construction: INSTALL 18'ABOVE GROUND POOL 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 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 C ission Permit from CB Architecture Committee 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. 11 � BP-2001-1035 GIs# COMMONWEALTH OF MASSACHUSETTS � °=1jGU CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: Above ground pool BUILDING PERMIT Permit# BP-2001-1035 Proiect# JS-2001-1838 Est. Cost: Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq ft.): 8973.36 Owner: BARCOMB JANE M&ALLEN F Zoning:URB Applicant. BARCOMB JANE M & ALLEN F AT. 13 HUBBARD AVE Applicant Address: Phone: Insurance: 13 HUBBARD AVE (413) 584-0989 (� NORTHAMPTONMA01060 ISSUED ON:6114101 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 18' ABOVE GROUND POOL 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 T e: Receipt No: Date Paid: Check No: Amount: Building 6/14/010:00:00 129 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo