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32A-035 (4) E;ti 2 5 r. MY+ s 00-3 N CP Y3 � Q N 1 � � 1 V l 1 � ` �•' 1 3 2 5 2000 • s C lot) � � o g a Pei �1 C', '�t v� S c"IS c� )- $ 8 �lassacEittsctts_ 4 DEPARTMENT OF BUILDITIG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORI{EWS COMPENSATION INSURANCE AFFIDAVIT L (licenserJpermittee) with a principal place of business/residence at: (phone#) (stret;t/city/statrJ�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 worlang on this job: (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 Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml shit ifnooessary to inch►do information pertaining to all ooatrndors) ( ) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:plate be aware that while homeowners who employ perwns to do maintenance,construction or rcparr work on a dwelling of not rttoce than throe units in which the homeowner resides cc on the grounris appurtenant thereto ace not generally comidemd to be employers under the vmrkees compensation Act(GL152,ss 1(5)1 application by a homeowner for a liomse or permit may evideuoe the legal si-, of an omployor under the wodceet C.ompemation Act I understand that:a copy of this dafemeal may be forwacdsd to the Depa rues of Lukotrial Aocidm Offioo of Insurance for the oovftvgp verification and that failure to secttre covecago under section 25A of MGL 152 can iced to the imposition of criminal penalties menisting of a fine of up to S 1,500.00 and/or im{xisoamcnt of up to one year and civil p=&Wcs is the far of a stop work Order and a fire of 5100.00 Idly agaicsst ttye For dgmtmmw use only Permit Number Map# Lot# Si ia�asee/Perad SECTION 8-CONSTRUCTION'SERVICES 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Not Applicable ❑ TO I Company Name Registration Number Address Expiration Date Telephone SECTION..IO-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152,f 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...... ❑ Y � 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 fob 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 complianc with the State Building Code,City of Northampton Ordinance ,State and Local Zoning Laws to of ssachusett General Laws Annotated. Homeowner Signature ` C SC IP New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 11 Or Doors ❑ Accessory Bldg. ❑ Demolitions New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: c1oy Patv- Alteration of existing bedroom Yes No Adding new bedroom V Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ thz 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 7a .OWNER AUTH0RIZATION 402E UE C0MPUTED WHEN OWNtRS AGENT O CQNTRACT+O►R APPLtt FOR BU'1XD NG PERMIT as Owner of the subject property hereby authorize 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 perj ry. PrU Name w 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 Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height 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 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: CO prthampton Buildjh pepartment AUG 2, Street t00q1 100 MA 01060 Fax 413.587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE NFORMATION y� I +rIi IN. 1.1 Property Address: y y 1 1 �� V F' ` 1 y Fes' ✓/�-�r �� f" g � v� SECTION 2:-PROPERTY OWNERSHIP/AUTHPRt�ED AGENT 2.1 Owner of Record: C C< <a� u `� .C� . sue 9� .ti�-h-� Name(Print) Current Mailing Address: Telephone -0� 13 Signat re O� O 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone S CTION 3 ESTIMATE&`C.ONtTRUCTION�COSTS, Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building O©d (a) Building Permit Fee. 2. Electrical (b) Estimated Total Cost of 1 60-0 Construction from 6 3. Plumbing Building Permit FOB 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) C)C) Check Number This Section For Official Use-Only Building Permit Number: B ,� � Date Issued: SigMt> re:. Building CommissianerllnspOctor'of Buildings Dafie File#BP-2001-0217 APPLICANT/CONTACT PERSON CLAYTON-JONES MARY C ADDRESS/PHONE P O BOX 90 (413)586-1019 Q PROPERTY LOCATION 71 CHERRY ST MAP 32A PARCEL 035 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 26 i Typeof Construction: RENOVATE&RIEPAIR 1 FAMILY-2 FAMILY ADD(1)BATH,(l)KITCHEN,ADD& RENOVATE NEW BEDROOM&ADD 2ND EGRESS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 3 sets 9f 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 Commiss' Permit from CB Architecture Committee 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. 1 1 71 CHERRY ST BP-2001-0217 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-035 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2001-0217 Project# JS-2001-0346 Est.Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq. ft.): 4660.92 Owner: CLAYTON-JONES MARY C Zoning:URC Applicant. CLAYTON-JONES MARY C AT. 71 CHERRY ST Applicant Address: Phone: Insurance: P O BOX 90 (413) 586-1012-() NORTHAMPTONMA01060 ISSUED ON:8129100 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE & REPAIR 1 FAMILY - 2 FAMILY ADD (1) BATH,0) KITCHEN,ADD & RENOVATE NEW BEDROOM & ADD 2ND EGRESS 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 8/29/00 0:00:00 2251 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 3W-3-5- [FFF EIVE Clayton-Jones P.O. Box 90 g 2W 44 Cherry Street Northampton, MA 01061 SNRA00NS t. 413-586-1019 NORTHAMPTON,MA 01060 60'February 2001 460 - Regarding 71 Cherry Street As requested by the building commissioner here is a reanalysis of Casts. Original estimated costs were for repair with some replacement of necessary items. Upon delving into the project damages and repairs needed proved to be more extensive. Therefore the cost of completion has increased dramatically. Original estimate was$5000. New Estimated cost of total renovation is$22,000. For further questions please contact me at th above telephone number Sincerely, i Kate Clayton-Jones Y r� a � T r t ie- @' .c 4 r 77r-l- £ y 1; f _ 4 E EY a AMR., + 11 C { ST '° BP-2001-0217 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A-035 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:renovation BUILDING PERMIT Permit# BP-2001-0217 Project# JS-2001-0346 Est.Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot size(sq.ft.): 4660.92 Owner: CLAYTON-JONES MARY C Zoning_URC Applicant: CLAYTON-JONES MARY C AT. 71 CHERRY ST Applicant Address: Phone: Insurance: P O BOX 90 (413) 586-1012-0 NORTHAMPTONMA01060 ISSUED ON.•8129100 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE & REPAIR 1 FAMILY - 2 FAMILY ADa (1) BATH,(1) KITCHEN,ADD & RENOVATE NEW BEDROOM & ADD 2ND EGRESS 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://///%,)i4 House# Foundation: Final 3 � � Final:zI13f a/.J4, Rough Frame: 6K Gas �`,f ' � Fire Department Fireplace/Chimney: Rough: � .l Oil: Insulation: -B` Final: Smoke: Final:0, r THIS PERMIT MAY BE REVOKED BY THE C ' Y OF NORTHAMPTO PON VIOLAT �OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/29/00 0:00:00 2251 $50.00 NINN 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo