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25A-097 May 02 01 08: 19a P• 7 r i OQ'T�f nib 4 8 �txssxr>?pxrtls DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER`S COMPENSA'T`ION INSURANCE AFMAVfr (liceaStrJpermittee) with a principal place of business/residence at: (phone#) (street/rity/statrizip) 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 an this job: (Insurance Company) (Polio Number) (Fxpimtion 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 Compazzy/Policy Number) (Ex{sim6on Datc) (Name,of Contractor) (Insurance Company/Poiicy Number)� (Expiration Bate) (Name of Contractor) (Insurance Comparty/Policy Number) (I xpiradon Data) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Data) (attach additional$bed iftteeMU Y to incilscie informstioo P=t6ning to alt oodmcwn) ( ) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOM,plena be aw=dol valo homcowoers who employ pcnom to do M*intoaaacq,consuvetioo ar rgraa work on a dwelling of not moor than tree traits in which the homnowaa r=lm a on the Vouo&apptutenatrl tlructo are not ge=211Y 0003ida4 to be Cmployrra i, the wockeez oompeaulion Act(GLtS2sa l(S)�apptiration by s homeowcxr for a 6CMM or permit may WidC=the legal status of an employer under the Wockeeoi Campeautioa Act. I undem*ad that a Copy of this 0XtCW40ttCAy be fww ended to the Dtpa�of lmhtstriel AxWad&Offioo of hnuranoe for the —rap vaM-lion"that W—to aoauc cove W tmder wdoa 25A of MUL 152 can bead to the WVO$i ion ofttimiad p=W= ooastttirsg of s 1'me of uP to 51500.00 sadlor imlxnoa�at of tip W aqc year and dvt�pemtlia in the focm of a Stop Work thdetand a ` rm of S1t10.00 a day sgximt me. For dqmtmtfttd use only Map# Lot# SiPaWM'.a3fUCCnse6Termitt= 1 May 02 01 08: 18a p. 6 8.1 Licensed Construction supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date }� I Signature Telephone I Not Applicable ❑ Company flame Registration Number Address Expiration[late Telephone _.�6_ia.,c 'r°��¢�'� r.t�k3� }�ag�y�� r� �+ y2 .. , d ) 1 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...... ❑ 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 1083.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which helshe 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 helshe 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 Stat of Massachusetts General Laws Annotated. Homeowner Signature j Mati 02 01 08: 17a P. 5 a,mi MINIM pdd N� t7• � � � F d e.!..x�a.a„qi t [ ��&i 7YS1^sf::�''�M New House D Addition Replacement Windows Alteration(s)❑ Roofing ❑ Or Doors ❑ Accessory Bldg. .Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ Brief Description of Proposed Work: K g S{1cd ro Alteration of existing bedroom Yes _No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes —ZC No Plans Attached Roll 0- Sheet 0 a. Use of building: One Family two Family Other "-9, e_44 ` ~ 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? I. 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 4 j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I 1. Septic Tank City Sewer Private well City water Supply I I Rye ► ` �LJ LC / as Owner of the subject property hereby authorize --to act on my behalf, i 11 matters relative to work authorized by this building permit application. Signat re 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 � l Signature Owner/Agent Date O Sb May 02 01 08: 16a p. 4 { 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 Sim 9b )C)204 ApP,x Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage `,g % Open Space Footage �1 % (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 X� YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW , K__— YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO X 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 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: ___.. May 02 01 08: 14a p• 3 City of Northampton Building.Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587.1240 Fax 413.587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING �r 1.1 Property_ ddrgss: a: .F z sr She.2vh,4Ar Aj c- , R �ttY c�111INERSH1PiAUrM4 [ C?AC "f 2.1 Owner of Record: CI A 6 vi 0'(y-0 R © Name(Prin \ Current Mailing Address: Sjyf—a'79-/ _ Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: _ Signature Telephone jot V Item Estimated Cost(Dollars)to be Official uo completed by ermit applicant x 1. Building 9 � � BlcYfiaF"A� tit �b 2. Electrical �� f� e�rxot"f; t ofI fi �— t a°ix 4[5iif .,. E9 3. Plumbing 1 ft`Ir F�it`F�� 4. Mechanical(HVAC) 5. Fire Protection 6 Total (1 +2 +3 +4+5) (� e �Sr - .. :yA 4k Ew t at'E'i p (pf1 $uEjld' '�.l� rttFsst�rigr/Iny,Pe .. ,�.� Date'. :. . of �► BP-2001-0871 GIs#: 3 ., COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:- Permit: Building Category: BUILDING PERMIT Permit# BP-2001-0871 Project# JS-2001-1603 Est.Cost:$905.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: Lot Size(ss .ft.k 9278.28 Owner. NATALE JAMES F&EVELYN E Zoning:URB Applicant: NATALE JAMES F & EVELYN E AT. 59 SHERMAN AVE ApplicantAddress: Phone: Insurance: 59 SHERMAN AVE NORTHAMPTONMA01060 ISSUED ON:5121010:00:00 TO PERFORM THE FOLLOWING WORK.-PUT UP A 6 X 8' UTILITY SHED 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: 1+ NO- THIS 11 Y 'x PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 5/2/010:00:00 512 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo