38B-245 (7) INSPECT'ION'S
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SECTION 8-CONSTRUCTION SERVICES f
8.1 Licensed Construction Supervisor: Not Ap�plica�blle ❑
Name of License Holder: ["t:k L L r, / � 1 r" —�-li!1 W
License Number
09
Address (70 °7 Expiration Date
Signature Telephone
Not Applicable ❑
r? Coo 07 2C
9ReaisferedHome�mprovemen#�ontrac�or ���, � g �z �- �^ ���^�
Company Name Re&tratlon Num i;r
Address Expiration Date
n/
Telephone N/?i 5ST-C'%?i
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...... ❑
11.t_.Horn _OW ;6> %lrnpti h
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-vear 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,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
4
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors K,
Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks Siding [0] Other[Q]
Brief Description of Proposed _/ ` h
Work: I2I�.CC° �Cl� ij'►'1�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.tf=New houseand'or.addifion�txtsting housmg;complete the fo(fovinQ:
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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES F, 'OR BUILDING
I, V cz� as Owner of the subject
property
hereby authorize {'� ' 1 T Hc-(c/7"?I
to act on my behalf, in all matters relative to work authorized by this building permit application.
/ - --Q'�/
Signature of Owner Date
/ -� ���_ ��j 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.
l'S C t-6h Pcz
Print-Nam
gnature of O" g Date
4-'
Section 4. ZONING All Informatibil Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume,&Location)
�
_
A. Hasa Special Perm it/Vuhunce/Finding ever been issued for/on the site?
�_�/~� Y[3 �_����
NO \/�� DONTKNOVV~�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� '"DO T ~/" "«0 YES
\~�
IF YES: enter Book Page and/or Document#
�� ��
B. Does the site contain abrook, body of water orwetlands? NO ^~��� DON7KNOVV �_/ Y[5 \^/
IF YES' has permit been or need to be obtained from the Conservation Commission?
' @eeduuabaobtained ��� Obtained /-� Date
� |
\~� \-�' '
C. Do any signs exist on the propert �� ��y? YES \~/ N0 \.~�
IF YES, describe type location:
'
' ' �
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES' describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre orish part ofo common plan
that will disturb over 1 acre? YES � > , NO � )
`~^ ' `_~
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
.. LLI
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Ab
City of Northampton t "
Building Department
212 Main Street Sewer a afi 4
Room 100 „ ' e vaila t . .
Northampton; MA 01060 vii s s ra art "^ �" K
phone 413-587-1240 Fax 413-587-1272 PJotIS'te Jan � "
C•t�ler.«.S�peClf�F' �z, .-r -� "' �' as � u "+car
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: t; This secfion to be completed byoffice
e 3w JC>u- :MaP Lot Unit-.
�� r-�hex►�{�-� �� � � � zone OveriayDistc�ct
EIm St b stnct CB Aistr�ct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
mac-'?- S'q�c
c--- Telephone
Signa
2.2 Authorized Agent:
Name(Pri Current Mailing Address:
2- nz -(�-12 �- - — 4113-' *7_. ,-3
ignature LZ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed 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 =(I +2+3+4+5) Check Number
This'Section For Official Use Only
Building Permit Number. te
r.
Issued:
Signature: r
Building Commissioner/Inspector of Buildings Date
236 SOUTH ST BP-2007-0700
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B-245 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0700
Project# JS-2007-001052
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KEITH HAMILTON 133811
Lot Size(sq. fo: 25090.56 Owner: SHEA BERNARD DAVID &KATHLEEN M
Zoning: URB Applicant: Keith Hamilton
AT. 236 SOUTH ST
Applicant Address: Phone: Insurance:
17 ORCHARD ST (413) 587-07630 WC
EASTHAMPTONMA01027 ISSUED ON.11512007 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 2ND FLR REPLACEMENT WINDOWS
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 Occupant Signature:
FeeType: Date Paid: Amount:
Building 1/5/2007 0:00:00 $25.006636
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo