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25C-160 (3) g Gzfy of Wort4amptan � � �i assACflnsetfs - s DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 , r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:: sor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper i permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as , required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location r �{ (l�i'iill Of �NLrl-f llallipfoli 6 fil i 55 R c 11115 c t 15 DEPIVRTMENFF OI' BUILDMG INSPECTIONS 212 M[tin Street ' Municipal Building Northampton, Mass. 01060 ' WORICER'S COMPENSATION INSURANCE kFFID .VIT Nvlkh a principal place of busiresS/re: denc l r -- r Y /�IOV ;Ir�p / /7` do hcrcby Ccl-df};: Laacl t11C P !ils i?ii7 pCil IiICS of pC slily illi!t_ ( I am an employer providing the iollov.'i:zt, '•'.'OI'i;CrS COII9T)C;1SaU0n GO`'C:"2�C for 1I7}' employees working on tlhls job: (Insj-=a: Cotapam') ( cli"Number) --- (Tl=?.Lif 70 1 Date) -^ ( j I am a sole proprietor, general c-Dn*=`Or cD- homeos,y�ner (ciicle one) and tla,ie ilirtc, the contractors hsteC be.o�t/'i'1;0 i;S'.'C t�l.. l`O 10.v P.F i�OCk:PrS CO,-U°III OF, GO!IC:cS- (T:enc of Contactor) In�u�nc� Comm-:r,,Pc!icf NwnLYr) run-on, Datc) (Name of ConLnc or) -- 01)MF21)cc Compa7`,/Pchi v NtnCfr) (1 xD: Ii0_Date) R\,'2mc of Contractor) (In;I�sice C:� ;an;iPo!i� Nuts)t; r) x,. T Dav,) -- (Name of Contractor ---- -- - n -- l ---- — Da r (InsZ icy Cotnr :}.I olicy itiumb�*) (H:: : .aloe (c l <1S1'1 I, Ole 1)r01)r1E C)i cl`1 have il0 OIl .'Orlii'i; fOl" ?P_C._ 1iI1 �l 110I11e 0�'+'IlC" 1)Ci:C�1111h all NOTE:picric 1r a:.v c tt;:.5�.ilc tx<r�a nr s: -o c Cr:-Pair 1•, liar.;c. not uxre th n throo uni+s in tat el rc 3 c<oa ` �crrtall, o_ :::::-4:o cmployc3 un; t}r_tvc;}; r s cc •�:_icn Act(GLI52,:;.31(5),,a+:i:c:.:ic: by a ho--o.N•ncr`or r I M a per:i lcS11[tatua of an ms:ploye under the Wo�c1a Co^�coition .ci 1 un&-- - ad the a ropy of tki ru y bo f,,j 3 Lo Sl»IY-(4 SZ1 tL'OF lMl 13 IiJ M-7r�1tf( 1rro of 1: 'r�_a for tlx coverage vc if cation and that L•ilttrc to e• re co%-T-"E un3:; cC.ir 25A of?.1G1.152 cw le_ci to Lx imTInsition co<nistmg of a fur_of up to S 1-500.00 c:t"'rr i m;1r z :,±of;p to cr.-}- ..:.j civil pcnzJt a in to fc�nn cf a Str,: t: f S CT ON 8 C®NS.,TRR 7CTION SERVICES 8.1 Licensed Construction S upervisor: Not rApplicable ❑ Name of License Holder License Number Addr > Ex'piraftion D to Sig e Teleph&ne Ree s:�e:e � OM . Jr toro�er ent °on#cacao = Not Applicable ❑ i COMDanv Name r Re istration Number A ress — �/o �lQ�2 _ Expi ati n Date reef, — 5-, l'6k c/o Telephone SECTION10 WORKERS' COMPENSATION 1NSURANCEYAFFIDAI/IT(M:Ga. c. 152, § 25;C(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...... ❑ AN 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 acecptable 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 :eference 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 J ' EOM aRTalflN�F PROPOSED WORK check aft a Ijcab1e a, New House ❑ Addition ❑ Replacement indows Alterations) ❑ Roofing ❑ Or Doors V Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: S�t� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 t�t 0r a iiitlon�to�� fsti Ti 777sffl omp fie l ow:in : 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? 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 . I. Septic Tank City Sewer Private well City water Supply `SECS© WNER��T•FIORIZATION TO BE COMPLETED WHEN OWNEfSA� E1O�CONTRACTOR APPLIES FOR BUILDING PERMIT 1/✓✓�- �Y V il cJe4-- - as Owner of the subject property hereby authorize 0 G- ,t, ( f / to ac; or half, in all matt rs relat e ork authorized by thi 'D ilding permit application. _ Signature of 0 ner Date C S as Owner/.Authorized Agent hereby bewcfare that the statements Ad information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of per uury. r, Pv Print Name,. 75/(7 Signature Owner Agent Date i 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 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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: i City of Northampton ' Building Department 61F �v 212 Main Street .; Room 100 Northampton,,MA 01060 phone 413-'587:712-40- Fax 413-587-1272 �f APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION This section to iye aompleited by ofFrce 1.1 Pro�ertv Address: '` ` " � " u o- e r 4 r n� iNaP yQa LaQt F k Ian erw O�str x[11 {1D.z,,44 t, k 5 C$DIStCJCL SECTION 2 PROPERTY'OVINERSHIPJAUTHORIM AGENT 2.1 Owner of Record: CA-f, m4 L3 d'p'i C,,,,z �-f� V �'jL y�✓nt'�~' �` me int) Current Mailing�ddr�: N.' Telephone ignature 2.2 At th e prized A ent. , Name(Print) Current Mailing Address:, Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by.permit applicant 1. Building (a}Building Permit Fee 2. Electrical (b).Estimated Total Cost of Construction from <6 3. Plumbing "Wilding Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) I Check Mumber This Seddon;For Official Use-Ont, Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2006-0586 APPLICANT/CONTACT PERSON C&T Construction ADDRESSIPHONE 15 Fairway Drive FLORENCE (413)586-4965 PROPERTY LOCATION 4 ORCHARD ST MAP 25C PARCEL 160 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid ST..) Typeof Construction: Window Replacement New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 116981 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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. y,ORCHARD ST BP-2006-0586 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C- 160 CITY OF NORTHAMPTON Lot:-001 Permit: Building Cateeoa BUILDING PERMIT Permit# BP-2006-0586 Project# JS-2006-0862 Est. Cost: $0.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: C & T Construction 116981 Lot Size(sq.ft.): 14897.52 Owner: Carin Clevidence zoning.URB Applicant: C & T Construction AT: 4 ORCHARD ST Applicant Address: Phone: Insurance: 15 Fairway Drive (413) 586-4965 FLORENCEMA01062 ISSUED ON.1112812005 0.00.00 TO PERFORM THE FOLLOWING WORK.-Window Replacement 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 11/28/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo 4 wa g� lPT � O O of Xort4aillptan z z �xS48t}�ISS[tfD �v DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municip INSPECTOR al Building ' Northampton, MA 01060 ,y HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as hds/her construction sups::":._o.r. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be,a one or two fanu y - 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 home owner." The bull mg department for the City of Northampton wants any person(s)-who-seek-to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and r'.egulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before bacli l), sonotube holes (before pour), a rough building inspection(before work is concealed), insulation inspection(if required) and a final building inspection.:The building department requires these inspections before the work is concealed,failure to secure these inspections can result in failure to obtain a certificate of occupancv until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will.be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued-to me Date Address of work location �O (riff of �\Tnrf[Ia11133toIII �ic:IaAchncrlla- _ DEPARTMEAIT OP BUILDr\'C INSPPCTION's 212 Main Strcct ' 'Nfunicipal BuildinG Northampton, Mass. 01060 «'0R.1<37-R'S CONfPENSATIO.N MSURANCE 1.F IU)A VIT (li ccnsxJperm�tics) principal place of businessfresidenec at: - &L ex p�i� 0/6!G 2 (phone`) i su�t/c;ty/szaulD P) do hereby certify, under tic pzins and penalties of perjury:, Thar — O I alb an employer providing the following!wor-kces comocns-z:30r. coverage Ior my emplovecs worbng on this job: (Lnsu -m=Comr.-zn) (Potic:l:t�ocr) — (T;-pirzdcr.Dz=) i ( ) I am a sole propl-jrtor, general contractor or homeow-Der (ci c.e one) and have hired the cooiractors listed below v--,bo have the `oilocvinQ workers compen–radon pokiest (i+flS12� of Co_tL^cior) (Inst!rattcc. colnp lt -•/hole }-,,UMbc-) (Y`:J1FJ ^?Datc) I (Name of Conlraor) (Insirane Number) (1:»imuon Dae) t I ' (Name of ConsaRo,) (Insuran=.Compza)-/Pol-q- N;tsbcr} (Espir bon Daic) i i (Name of Contracior) (Lo_niranc-- ComrauylPolicy Numb r) (E.%pirdtioa Dau). (atsa.cb�7:srov-i=Sca.ifaccc.�-p to c,c?ucc imfbr=u=oa Pcvu=nc to Jl oc�a-so:z) (Lj"11 am'a sole proprietor and have no one working for me. ( } I am,a home owner performing ah the work myself. i NOTE:plesc be-crate 0—kb:7c bcmeoµvers-to mplc y pcoci to C=—Izc-,00 cr tau—ork oa a d••ci1= of i a-morn tb-,t`lo tmru in%��cfi the bomoogwc r=6s c oo the V"",6 z�purtea_^tbe- ,oot oecid d to be c==VIcyas unC-the kuk=-- A=(GUI 52r 1(5)�=pprin:ioo by.bommava f=a!ice-or Pcmit tr=y C,16—tLe 1c—P1 C==ores c Ploy.r uodcr dao Wack ea comp.om.sica Act I I unde.aud d-a Dopy ortbia mtcmcm m.y bo f----ded to tba Dcpnrmrna of Acd&wy OMoe-r L=—for tb. j cove-&.G�c veirctioc aad U=i L-iltac to xca=tovaa,t>adc soctioa 25 A of MG 151 Qa led to the �ostioa of a miaa!pcaalt;a eoazi;:� of a rmc or up to S 1}00.00-Off i= uoarx or up to roc ycr end c%i1 Penahia is tic form of,Stop WcA Ocde and• ! r>=0(S 1 00.00 a day cpin9 me rt For d4<rta'=-��u.c only - tpatuzr of Lic;.ns�IPct�nitt Ce � SECTION 8-CONSTRUCTION':SERVICES -• 8.1 Licensed Construction Supervisor: - Not pApplicable 0 Name of License Holder License Number Add s Expiration t!a e 7 Skjaatdre elephone Not Applicable ❑ ,�Reais4er' 1�'0rn�'1i►�prarrement°C'oititracto�� � � �C any Name eg trsi ation Number - ---""—_ l� �Gt.c�'�,✓ct� �/� �-��'��ft/� l�t�1�, �10t�Z �lv�4d Address Exifiratibn Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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....... IV- No...... ❑ R 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 f SECTION 5-DESCRIPTION OF PROPOSED'WORK,(check all,aaalicable) New House [--J Addition ❑, Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [p Siding[0] Other[O] Brief Descr,ipptio of Pro osed Work: G� ,1.1 ��d7�/ZC �,�ri?✓ t�li2twyt /��i'titr �4�� Sll� 7`c�%°r — �Ot�✓ Alteration of existing bedroom Yes_ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 41 No Plans Attached Rolf -Sheet x ��.'w„' '.a�'* sa:t€ le hoi�rsa rt Gilamia take ils tc c ioasl,rta:;�or tie 3Ei� c�Cfou a: 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. I. Septic Tank City Sewer Private well City water Supply SECTION”Ta-OWNER AUTHORIZATION.-TO BE COMPLETED WHEN OWNERS AGENTOR`CONTRACTOR APPLIES FOR.BUILDING.PERMIT 1 T"-'i) 0 lei/em C- as Owner of the subject property a c r act on be n alf ers relative to or aut zed by this building permit application. SI attire of Owne Date as Owner/Authorized Agent ereby declare that the itafements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed nder the pains and penalties of erjury. ,� ells Prin Si atbKe of OwnerlAgent Date ^ ~` . . � Section 4. ZONING All Informati6n 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 bidg&paved #of Parking Spaces (volumel&Location) ^ A. Has a Special Perm it/Variance/Finding ever been issued for/on the site? �-� x~� �7~t^' ^ NO ^�� DON7KNOVV �~^ YES �,� ' IF YES, date issued: IF YES: Was the permit rded at the Registry of Deeds? NO K � D `~, KNOW 0=� .-_ IF YES: enter Book and/ur Document# � D. Does the site contain a brook, body of water urwetlands? NO DON'T KNOW 0' YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs tobeobtaimeg ^~�� Obta�oed «~~\ Date � �~� \~_� ' C. Dn any signs exist on the property? YES K l NO IF YES, describe size, type and location: / D. Are-th_ere- unypmposaddmnges tooradditions of signs intended for the property? YES ND� IF YES, describe size, type and location: E. Will the construction activity disturb grading, .m filling)over 1acre or isdpart ofucommon plan that will disturb over 1acre? YEG � l NO ^�� IF YES,than o Northampton Storm Water Management Permit from the DPW is required. ..f City of Northampton Building Department 212 Main Street 51h Room 100 Northampton; �MA 01060 phone 413-587-1240 Fax 413-587-1272 Plott 'tags y * � 1110% . pectfy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE,INFORMATION This section to be completed by ol'f"rce 1.1 Prol2ertV Address: _ � a t_M Lot Unit C����c� 2 ane Overlay Drsfi fcf EImS1±Di5Urct � GB D�stnct .= s ! ,." SECTION 2-PROPERTY-OWNERSHIP/AUTHORIZED AGENT:" 2.1 Owner of Record: �[ o CL ame(Pri t) 1 Current Mailing Address: 1 3a 3 0 275' Telephone ignature 2. thori A en : r, Name�int) Current Mailing Address: Sign a 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=(1 +_2+3+4+5) Check Number This Sectimi For Official Use Only Date . Building Permit Number issued: Signature: i Building Commissioner/Inspector of Buildings- Date File#BP-2006-0796 APPLICANT/CONTACT PERSON C&T Construction ADDRESS/PHONE 15 Fairway Drive FLORENCE (413)586-4965 PROPERTY LOCATION 4 ORCHARD ST MAP 25C PARCEL 160 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: RENOVATE 2ND FLR BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 062884 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Coritission f. 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. 4 ORCHARD ST BP-2006-0796 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 160 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0796 Project# JS-2006-1213 Est. Cost: $9000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: C & T Construction 062884 Lot Size(sq.ft.): 14897.52 Owner: CLEVIDENCE CARIN zoning.URB Applicant: C & T Construction AT. 4 ORCHARD ST Applicant Address: Phone: Insurance: 15 Fairway Drive (413) 586-4965 FLORENCEMA01062 ISSUED ON:211412006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM 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 2/14/2006 0:00:00 $50.003524 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo 4 ORCHARD ST BP-2006-0796 OIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C- 160 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0796 Project# JS-2006-1213 Est. Cost: $9000.00 Fee:$50.00 PERMISSION IS HEREBY GRANTER TO: Const. Class: Contractor: License: Use Group: C & T Construction 062884 Lot Size(sq. fr.): 14897.52 Owner: CLEVIDENCE CARIN Zonin2:_URB jpp lic!cn�:.0 & T Construction AT: 4 ORCHARD ST Applicant Address: Phone: Insurance: 15 Fairway Drive (413) 586-4965 FLORENCEMA01062 ISSUED ON:211412006 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Bonding Inspector Underground: Service: Meter: ,,. l Footings: Rough:j�< ;�,'- Rough: 1�k) House# Foundation: Driveway Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: Ot< 6� -zo(6( THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS l� Certificate of Occu anc _ ,� _� Signature: y FeeType: J Date Paid: Amount: ;-,±' i # Building 2/14/2006 0:00:00 $50.003524 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo