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SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
90 r4i'sol-I Pd. � License Number
Addre Expir do Date
Si na re Telephone
9 Registered= `omelniprQv_ement Coritractor"
-
Not Applicable El
_ Tti,7c��� ► l l cey —
Company Narne �j� Registration Number
170 C4 k 5 A--1— ,`� . r/ —
Address Expirat on Date
7
4 h A 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...... ❑
�,'.�� rkk may.
11�r= H:oine�Ovvner�E eME on
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 buildinL, 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
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs I I Decks [ ] Siding [ ] Other
Brief Description of Proposed Work__S61 _o n__E3(/' pov 'p _ 5CC a
Alteration of existing bedroom __-_Yes No Adding new bedroom__ Yes _- _ No roil
1
Attached Narrative D Renovating unfinished basement ---Yes _ __No
Plans Attached Roll ❑ - Sheet O
6a.'if New.h'ouse:and`or addition to existing housing, complete the following_
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?
I. Method of heating? Fireplaces or Woodstoves_ _ Number of each
g. Energy Conservation Compliance. . _— Nlascheck Energy Compliance form attached? --- __-
h. Type of construction
I
i. Is construction within 100 ft. of wetlands? _ --Yes -_ _ 'Jo. Is construction within 100 yr. floodplain _--yes - - N
I. Depth of basement or cellar floor below finished grade
k \gill 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
Lee_ as Owner of the subject property
hereby authorize to ac; o(
-----------------
my behalf, in all matters re tive o work authorized by th s i;�,�i ding -ref rmt application.
Signature of Owner Date `
Owner/Authorized Age n±
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.
—�VE''t_7UtC L�1� ---- ----------- -- —-- ---- --- -- ------
Print Name
Si a ure of Owner A ent Dale
f 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 Parkin 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 bON'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:_
� � � pDePa�tr�fent�us"��...iy
r- City of Northampton Status of Permrt� r�
_.�
4 i'pa[trl�E'-t It Cd b",cut/W iVewayxe1lTTIL3
l in Street Sewer/Septi6yMaailabi t � � A �;r
y s a.
'I rn 100 WaterMW ll AvMtlabrlity –
t(
�1JN ftth 1, MA 01060 Two Sets Of,Structural. PJansfi�
phone 413 5 2 0 Fax 413 587 Plot/Site Plans �t
Other Specrfy
DEPT OF BUILDlKjN p
NORTNA.t11 M
A 'r RUCT LTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
I SECTION 1 SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map------- Lot Unit ---
Ot� A Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.l_ Owner of Record:
Te r r y l-c -
'.�3n
y�,
2.2 Authorized_Agent: !�
1 ® (91� 5���
SECTION 3 E57(MATED CONSTRUCTION COSTS
-- --- -- — —1 --- _ - --- -- — —
Ite Estimated Cost (Dollar;; i�, b�l Official Use Only
competed byperrnit a r-.ph ,nt
,,.jd Ong Permit Fee
Total Cost of
--I r nstruc!ion from (6)
urT�birg 6,uilding Permit Fee
5 Fire Protect cn � I
+ 4 t S t neck Nlumber
This Section For Official Use Only
Building Permit Number:_ Date Issued:—_---
Signature;
-- Building Comi-nissioner/Inspector of Buildings Date
BP-2003-1202
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-1202
Project# IS-20. 3-1870
Est.Cost: $2500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Steven Zucchino 100199
Lot Size(sq. ft.): 7056.72 Owner: LEE TFRIZE\CE J
Zoning:URB Applicant: Steven Zucchino
AT: 44 ELIZABETH ST
Applicant Address: Phone: Insurance:
70 Gleason Road (413) 584-3878
NORTHAMPTON MAO 1060 ISSUED OX-024103 0:00:00
TO P RFORM THE FOLLOWING ff"O''K:STRIP PORCH ROOF, PLY & INSTALL DOUBLE
COVER ROLLED ROOFING
POST THIS CARD SO IT IS VISIBLE FRO NI THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service:
t: cgs:
Rough: Rough: ouse# Foundation:
N,ew ay Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY TE' . :T 1 OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Receipt No: Date ►'aid: Check No: Amount:
Building 6" 3 O:C0:00 252 $25.00
212 Main Street,Phoi:, '413) 587-1240,Fax: (413)587-1272
Building C,�- iiissioner-Anthony Patillo