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25C-150 Tnfn1-m5kfjnn qnd Tns r-Infinns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing enraged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4--,4-07 Fax 9 617-727-7749 www.mass.aov/dia The Commonwealth of Massachusetts ;mot Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Or.-anization/Individual): Address: 7 ���:!Y — L�/"35/ City/State/Zip: N'� �-'[. Phone#: 66 7—0,Z1,., Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. F<Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov age verification. I do here cer ' nder pains art` nalties of perjury that the information provided above is true and correct. Sianature: uC��/ Date: Phone#: �6 _L' 2- %� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 30 aY1$iifi9i gu Conan an a Construction Supervisor License, License: CS 86044 Bi rthdate: 2/1/1 960 Expiration: 21112009 Tr# 9264.. Restriction: 00 a ALAN A MARTINBEAuLT 517 FEDERAL ST MONTAGUE,, MA 01351 Commissioner ��ie-r�o�nmzaiiurea��i o��ivc¢ada�u�ae�.6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR J Registration; 142360 Expiratlon: "3131/2010 Tr# 263299 Type: fJ$A A.A.Martinbeault Bufldars� Alan Martinbeault 517 Federal Street ` Montague, MA 01351 Administrator 15000 Mechanical/Plumbing A. Heating and Hot Water: Existing furnace and ductwork is new and in good shape. No A/C required. Hot water heaters are in good shape and properly vented. B. Ventilation: 1. New Ventilated Stove Hood;Contractor provide ducting and outlet for new Hood. 2. Exhaust Fans; High quality,quiet and effective exhaust fans to be installed at existing Bathroom and new Half Bathroom. C. Plumbing: 1. As required for new sinks,new dishwasher,new garbage disposal and for water line to refrigerator. 2. Provide new plumbing and fixtures for existing Bathroom and new Half Bathroom. Provide allowance for fixtures,owner to select,contractor to install. 3. Waste and water for Washer in Basement. 16000 Electrical A. Lighting: 1. New Light fixtures throughout. B. Power: 1. All outlets in Kitchen are to be GFCI. 2. New outlets and switches as required. 3. New smoke and carbon monoxide detectors as required. 4. Power for refrigerator,dishwasher,range,range hood in kitchen and washer/dryer in basement. C. Phone/Cable/Data: 1. Provide cable and phone lines at Kitchen,one Bedroom and Living Room. 06000 Carpentry A. Exterior Wall Construction None. B. Interior Wall Construction 1. Wood stud construction gypsum board both sides,to match/blend with existing construction. 2. Where new walls extend or fill in openings in existing walls,adjust stud sizes and/or gypsum board thickness as required to make both finish faces match existing construction. C. Casework and Cabinetry: 1. Cabinets are to be European style flush overlay,with Shaker style panel doors and drawers,see drawings for sizes. Hardware is to be premium quality for glides,etc. Accuride or similar quality. 07000 Thermal and Moisture Protection A. Exterior Wall Siding Existing vinyl siding to remain. 08000 Doors and Windows A. Doors 1. Exterior Swing doors are to be premium grade,primed for paint,doors with insulated glazed divided lites or panels. B. Windows 1. Windows are to be new insulated,low-e,vinyl windows,double-hung sized to replace all existing with screens. 09000 Finishes A. Ceiling and Walls: 1. Taped and sanded gypsum board,texture to match typical existing ceilings and wall surfaces in the house. 2. Re-use existing beadboard wainscot at Kitchen where shown on drawings. B. Kitchen Flooring: 1. Ceramic tiles in 4 x 4 sizes. C. Bathroom Flooring: 1. At existing Bathroom; Stone tile,two colors maximum. 2. At new Half Bathroom; Ceramic tile,two colors maximum,4" x 4". F. Baseboards: 1. At Kitchen to match existing in Dining Room. 2. At Bathrooms; 6"suitable for paint where wall finish is beadboard or gypsum board. 10000 Specialties None. 21-23 Orchard Street, Northampton MA OUTLINE SPECIFICATION March 25,2008 01000 General Requirements 01100 Summary of Work The Project consists of renovationing an existing two unit townhouse style duplex. Each unit currently has three bedrooms,one bathroom,kitchen,dining,living rooms,a small mudroom, small butlers pantry,full basement and attic. The renovations will consist of the following: 1. Work at the existing KITCHEN will include: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring,casework and counters. 2. Work at the existing BATHROOM will include: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring and plumbing fixtures. 3. A new HALF BATHROOM(within the existing house footprint)will include the following: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring and plumbing fixtures. 4. Re-Build FRONT PORCH: New columns,decking,deck framing and footings will retain the look and character of the existing porch. 5. New WINDOWS: All windows will be replaced with new,insulated,low-e glazed vinyl windows with screens. 6. WALL SURFACES: All existing walls and ceilings surfaces will receive a new layer of gypsum wall board. 01400 General Conditions A. Codes and Permits 1. All work is to be performed in accordance with all state and local codes and ordinances. 2. The owner will obtain the general building permit. Mechanical and Electrical will obtain contractors will obtain permits for their work. 3. Required inspections will be scheduled by the Contractor or Owner/Architect. 01500 Temporary Utilities None. 01520 Safety and Emergency Contacts Contractor to provide all safety equipment,including railings and barricades,during construction,and shall maintain a safety program to promote safe work practices on the project. Contractors shall Owner/Architect with names and 24-hour telephone numbers of the Contractor's key personnel 02000 Sitework A. Demolition-As determined to be needed and in agreement with Owner. PORCH ROOF n/ 35'-0" LU CL W BATH 0 10 BEDROOM ® (E) BEDROOM Ci O O O 1i. NEW LNN GLOW � c LJJ flN oN c o nor W CLOWT a o V) can QS Q BEDROOM 0 BEDROOM ! L M T! ` V lP � •V TO Arnc Ann N —a O a aoa�r a aoesr O O a air o aps�r Q i Q Am DEB= m7scm O o m WM1MUM uwm U N - 4E) BEDROOM 0 BEDROOM � ' L- 0 0 NZ Consulting Design PORCH ROOF 4a 2510080 P.O. BOX 2943 Affimst MA 01004 NOTES: "K"M WML WVWmU M fRoM"M&ff 720"ATM ® PEW SW WAW OR PJ NG SECOND O SM01M UEIECTOR /�/'� © CAF"MGPEUa7E GEFELTM MOOR ,'LAN Revid= I SECOND FLOOR PLAN DE" DRAWM Ajl SCALE: I/9' ■ P-0' DAM May 25, 2008 A2.1 At . 3'-8" - - t9 ' z F a 0 e ' m f 2 r 21, ° ° 0 �' cw„ Pq 01 § - 4 i i - - - - lit , 38'-10" o 411- o ORCHARD STREET PROPERTY N o• 21-23 Orchard Street 0 Northampton, MA a� �a '. PROPERTY LINE 60'-0" I I I 03 GARAGE I F , EXISTNC �.� , rvlo PLANTM AND GRASS �' W CL rvoo CL 0 BACK PORCH Q BACK PORCH W r i W �� DRIVEw� � � CQ # 23 # 21 ORCHARD ORCHARD Uo = OE aq eeaNr Pala A' C a.,r — LL C CN Z t' Consulting �i 53. 0080�Dn�na ss I l n 411 2 P.O.BOX 2943 Aniwst, MA 01004 WnecoaftoDeswLCOM ORCHARD STREET snm mw PROPERTY ADDRESS: 21-23 ORCHARD STREET NORTHAMPTON, MA LEGAL DESCRIPTION: RevMm PARCEL D. 2X-t%-001 ZONNG: URB DEM1 MAWM t**op� SH PLAN DATE May 2S, 2008 1 �10 �Es I/IsfiB • P_®B A1.0 Sheet NBniwr: 15000 Mechanical/Plumbing A. Heating and Hot Water: Existing furnace and ductwork is new and in good shape. No A/C required. Hot water heaters are in good shape and properly vented. B. Ventilation: 1. New Ventilated Stove Hood;Contractor provide ducting and outlet for new Hood. 2. Exhaust Fans; High quality,quiet and effective exhaust fans to be installed at existing Bathroom and new Half Bathroom. C. Plumbing: 1. As required for new sinks,new dishwasher,new garbage disposal and for water line to refrigerator. 2. Provide new plumbing and fixtures for existing Bathroom and new Half Bathroom. Provide allowance for fixtures,owner to select,contractor to install. 3. Waste and water for Washer in Basement. 16000 Electrical A. Lighting: 1. New Light fixtures throughout. B. Power: 1. All outlets in Kitchen are to be GFCI. 2. New outlets and switches as required. 3. New smoke and carbon monoxide detectors as required. 4. Power for refrigerator,dishwasher,range,range hood in kitchen and washer/dryer in basement. C. Phone/Cable/Data: 1. Provide cable and phone lines at Kitchen,one Bedroom and Living Room. 06000 Carpentry A. Exterior Wall Construction None. B. Interior Wall Construction 1. Wood stud construction gypsum board both sides,to match/blend with existing construction. 2. Where new walls extend or fill in openings in existing walls,adjust stud sizes and/or gypsum board thickness as required to make both finish faces match existing construction. C. Casework and Cabinetry: 1. Cabinets are to be European style flush overlay,with Shaker style panel doors and drawers,see drawings for sizes. Hardware is to be premium quality for glides,etc. Accuride or similar quality. 07000 Thermal and Moisture Protection A. Exterior Wall Siding Existing vinyl siding to remain. 08000 Doors and Windows A. Doors 1. Exterior Swing doors are to be premium grade,primed for paint,doors with insulated glazed divided lites or panels. B. Windows 1. Windows are to be new insulated,low-e,vinyl windows,double-hung sized to replace all existing with screens. 09000 Finishes A. Ceiling and Walls: 1. Taped and sanded gypsum board,texture to match typical existing ceilings and wall surfaces in the house. 2. Re-use existing beadboard wainscot at Kitchen where shown on drawings. B. Kitchen Flooring: 1. Ceramic tiles in 4 x 4 sizes. C. Bathroom Flooring: 1. At existing Bathroom; Stone tile,two colors maximum. 2. At new Half Bathroom; Ceramic tile,two colors maximum,4" x 4". F. Baseboards: 1. At Kitchen to match existing in Dining Room. 2. At Bathrooms; 6"suitable for paint where wall finish is beadboard or gypsum board. 10000 Specialties None. Omw 21-23 Orchard Street, Northampton MA OUTLINE SPECIFICATION March 25,2008 01000 General Requirements 01100 Summary of Work The Project consists of renovationing an existing two unit townhouse style duplex. Each unit currently has three bedrooms,one bathroom,kitchen,dining,living rooms,a small mudroom, small butlers pantry,full basement and attic. The renovations will consist of the following: 1. Work at the existing KITCHEN will include: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring,casework and counters. 2. Work at the existing BATHROOM will include: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring and plumbing fixtures. 3. A new HALF BATHROOM(within the existing house footprint)will include the following: New plumbing,electrical,lighting,gypsum board wall surfaces,flooring and plumbing fixtures. 4. Re-Build FRONT PORCH: New columns,decking,deck framing and footings will retain the look and character of the existing porch. 5. New WINDOWS: All windows will be replaced with new,insulated,low-e glazed vinyl windows with screens. 6. WALL SURFACES: All existing walls and ceilings surfaces will receive a new layer of gypsum wall board. 01400 General Conditions A. Codes and Permits 1. All work is to be performed in accordance with all state and local codes and ordinances. 2. The owner will obtain the general building permit. Mechanical and Electrical will obtain contractors will obtain permits for their work. 3. Required inspections will be scheduled by the Contractor or Owner/Architect. 01500 Temporary Utilities None. 01520 Safety and Emergency Contacts Contractor to provide all safety equipment,including railings and barricades,during construction,and shall maintain a safety program to promote safe work practices on the project. Contractors shall Owner/Architect with names and 24-hour telephone numbers of the Contractor's key personnel. 02000 Sitework A. Demolition-As determined to be needed and in agreement with Owner. i Ila 8 • �� f'1 N aP3 12 2 0 Ni nN � m 38'-10" l o ORCHARD STREET PROPERTY IV o• —23 Orchard Street "i Northampton, MA �a r 3'-8" - - - -, I 1 � I I 8 I � I I I I 70 C 2 o 38'-10" 4'-4" M o ORCHARD STREET PROPERTY N o- 21-23 Orchard Street CD •�- Northampton, MA w w �M —— PROPOtTY U* 60'-0" —— I I I 0 GARAGE 1 t EXISTNC I r000 PLANTM AND GRASS •' I I�.j.� CL 1 0 BMX PORCH Q&MX PORCH W r 1 DRIVEWA;. 5e � Q 1 # 23 # 21 t 1 ORCHARD ORCHARD 1 0 l V 4 O E t I r 1 tv �.• v M t Q FROWr PORCH O o cV Z COnsuiting s• Design 411 253. 0080 7 7- P.O. BOX 2943 MirorBt, MA 01004 ORCHARD STREET Srm PLM PROPERTY ADDRESS: 21-23 ORCHARD STREET NORTKVA"ON, MA LEGAL DESCRIPTION: RevMm PARCEL. D. 25C-1S•-N1 ZONNU UM DESIGN DRAVVWs SH PLAN DA-1E May 25, 2008 �10 SO&Es I/W . I'-®' A190 gmwt Nudger: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date 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...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwelling-s 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 1.08.3.5.1, 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 sball 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 buildiniz 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) JR00fing Or Doors Accessory Bldg. ❑ Demolition New Signs il=j Decks (CJ Siding(Oj Other l'M Brief Description of Pro o d -�e S. e14 - Work: (�LL'ir*P"1IN71�- Alteration of existing bedroom Yes X _No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing complete the followina• 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. floodpiain 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 1, 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. ignature of O er Date I, , as Owner/Authorized Agent he e c a th the stat m is n in o atio n the foregoing application are true and accurate,to the best of my knowledge and belie . Signed under the pains and penalties of perjury. f Print Nam Signatur !I&L7henr Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size 6-7 10 ''�"' r Frontage Ul Setbacks Front , Side L: R:� L: 0 R: Rear 53 IJr Building Height Z Bldg.Square Footage , % ,¢ Open Space F s (Lot area minus bldg idg&p aved parking) #of Parking Spaces Fill: ,r volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO yj DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PloVSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Thissect)+'�`/ gcapT�t � o � ter. r-L. (( � Q Map pt --"`----�._ l�it�_ Zone verl Aist* Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 6EF 0+ %' 2.1 Owner of Record: l i � 00 . N me( Cur nt Mailing Ad ress: Telephone gnature 2.2 Authorized Agent: , wG Ar-- .6 3c,?1 f D jlpf� Z2LE5. Atrw"�. �.weolcsoT Name(Print) Current Mailing Address: 1'z' .3 Signatur Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 7- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ( t fi (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of • Construction from 6 3. Plumbing fC , - Building Permit Fee 4. Mechanical(HVAC) ) 5. Fire Protection ' 6. Total=0 +2+3+4+5) ? / Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-1064 APPLICANT/CONTACT PERSON MUERLE LINDA&BURT EWART ADDRESS/PHONE P O BOX 2945 AMHERST (413)253-0080 Q PROPERTY LOCATION 21 ORCHARD ST MAP 25C PARCEL 150 001 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 Typeof Construction: INTERIOR RENOVATION(2 UNITS)SHEETROCK REBUILD FRONT PORCH ADD 1/2 BATH,REPLACE WINDOWS,UPDATE PLBG&ELEC 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* 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 Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 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. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. WOW r-1 BP-2008-1064 CIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catep,ory: renovation BUILDING PERMIT Permit# BP-2008-1064 Project# JS-2008-001377 Est. Cost: $98000.00 Fee: $490.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: ALAN A MARTINBEAULT Lot Size(sq. ft.): 6621.12 Owner: MUERLE LINDA&BURT EWART zoning:URB Applicant: MUERLE LINDA & BURT EWART AT. 21 ORCHARD ST Applicant Address: Phone: Insurance: P O BOX 2945 (413) 253-0080 0 AMHERSTMA01004 ISSUED ON.61312008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR RENOVATION(2 UNITS) SHEETROCK, REBUILD FRONT PORCH ADD 1/2 BATH, REPLACE WINDOWS,UPDATE PLBG & ELEC 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 6/3/2008 0:00:00 $490.00110 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo