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25C-193 (2) { vk DEC - 5 zoo? DEPT OF BU LDING�NSPECTIOryS r�^4TNAA4PTC�4 01Q60 Ey g 1 P�(L"� � 6,qkWO AV67 SCWpc�' p, 23 N kL4,W`0 Au c, F Ii DEC - J 2001 DEPT Of BUILDING INSPECTIONS pir,a7w!,TTON,P.A DING k PC's z s i Z X sq \V G G�A i I (� LLZ��t i� l -2- b LeeQ Tros i C— � c 1 �k f0S IL S t� Utz 10`p LA r 0.�iw-rnT of �\To fflamptoil �= — DEPARTMEIJT OP BUILD0\1G INSPEC7101:S 212 T1ain Strect ' Municipal nuildin� Northampton, Mass. 01060 WORT R'S CONQ'CNSA-nON MSUMA--NCF AFFTDA�TF (�, PC rn]1(L a) V.qth a principal plat-- of business/resideriee at _ max �n 11u e A G 1"3 (f hone::') ��7�� �___ L (stTcet/c i ty/stalcra P) do hereby cerdi , under the pains and penalties of perjury, .ha: ( ) I am an employer providing the followinL workcrJs comncnscLIOn cove:2ge por my cloployces wor!aing on Li)is job. (tnstr� Corr,v) (PeLic; N.Lmaccr) -- (� ;pinion Datc) ( ) I am a sole proprietor, general contractor or homeow-oer (ccie one) and have hired the coop actors hstc-d below who have the ionowlflQ WOrkel'S G0W-Dens-ann policies: (i+QI➢: 0. Con!1-:)ci0rI (1n i!Ti1ncc ComoanyiPouc,- NI='cc:) Manic of Contractor) -- Rastrrance Company/Policy (-Lxnir:tion Date) (Name of Conn-aeto,) Gasurancz Compao),/Polic). NumLi r) (E\pU-36on Date) (Nanc of Contractor) (Las-U DC-- ComaauyfpOticy NUJMI r) Z."Pif-ation Daic) (na,c3r �ccil c'xci tfococs.-�.to an ud=tafonn..aoo P--t inns do.11 I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work lf. myse . NOTE:pies:be ea-arc tti• uU- c bccnoc n n wbo crnplay peroat to Cr �P � u : of ant Mort L--a t�tmij wad�or oa h7O1 tbccn DCK -=" va�;d--d to LI cmployc v eo Act(GL152�I(S)�zfpicaton Iry a hoMcowvc rc ir-- a permrt rn:y c.1&aoc the I cgJ rt-au of ea er;>loyx under din Workze-Componvlioa Act t un&c r d dirt a oopy of LbC.mtammt m.y bo fo--rded to Lb-pcgnnm,of L-b,,ri l Arodca y C CG—of tn—for tb- covmSc vcriLctioo and 0"L•.ilurc to coaut`covcr&gc under soc boo 25A of MOL 151 ao lad to the ia,os tioa of m-ia>1 pcaiW- ooasinmg of a fioc of aW to S 1}00.00 and/or of up to ooc yti end aril pco tja in tS form of-Stop W orb Ordcr nod e bm of S 100.00 r day a For dcp.r --Ij u.c oaly PcTmit Number — )� )I D mwp,,,'-- Lot " Sig- m of Liacnscclpcmuttcc e S11'1CN$ `frON5TRUCTION SERVICES' 8_Licensed Construction Supervisor: �.� Not Applicable ❑ Name of License Holder: J A�v►f✓S V S S oL* t�4)v� lAddr License Numb er MA- ©iori Expiration Date ` 2 ?-11�3 re Telephone r :� p _ r...... Not Applicable ❑ 3Jl ?-- Qy1L �}2S Company Name Registration Number &�g_4 c,.� Iy , ,titer_ a Ic�q'3 o3 67,h)? Address / Expiratio6 Date Telephone SECTI©N 10 WORKERS'COMPENSATIQN INSURANCEAFFIDAYI7(M G L°c 3152, 25C(5)) 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...... ❑ 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 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 ' 4 P 4P SE S CTI 5 F1ESC IFT ON D W (the 11 li able New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ DemolitionK New Signs [ ] Decks [ ] Siding[ ] Other Lam. Brief Description of Proposed Work:]bcano u S Ili E ASTOG ?_Ad -01r. EgccSS {z4v l �a'Ae_ €x;5,1 N& silo R$ ArK �-TT60. lV eW '57rN OLS Ld►-I.13c c n v cacti - e.rS IN;11 retie bb U^,n if— Alteration of existing bedroom Yes No Ling new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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 SCFY�OJV DOWNER AUTHORIZATION TfJ B'E CO`IVIPI. D WHEN OW., AGENT,ORA;OIV�RIICTORAPPLIES,FDR113UfLD1�I PERMIT as Owner of the subject property hereby authorize, )i 1`aSS x(314 (� d t� 1�— to act on my behalf, in al,[,matters-<elati w�authorjecl by this building permit application. f"� Signature o ' Date �fWIE-5 'b ' 6S- 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. -i ft , T). Print Name l Signature of Ownel/Agenr 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: I a0 hampton �9 ui partment 212 Street 100 `d L CEC Northam on MA 01060 hone 240 Fax 413.587-1272 pCPT OF BJtIL'ING INSPECTIONS YA 01060 A TION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION .1 Property Address: °This' i tp b�g f C 3EGTfON'2-'PRORI:RTY,�Y,,ERSHI NAUTHORIZED-AGENT ?.1 Owner of Record: 'dame(Pri Current Mailing Address: i' Telephone iig ure ?.2 Authorized Agent: (� �fl"!'�IrcS �� J71 �'��l�.{7�fZ�' k�X_ �.1 �� >,����`'� w►fit- �!�`� dame(Pri ) Current Mailing Address: Z4-7 7�34 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION Item Estimated Cost(Dollars)to beff c�al°=Use Only completed by ermit applicant 1. Building (a) Building Permit Fey 3.., . : 2. Electrical (b)Estimated T6 b Cast,'Of', Construe iz n from 5 3. Plumbing x � � � , Buifdin Permit Fe 1l 3. 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 +3 +4+ 5) his Section Fnr Official Us'eOnl Building PArrnlNmb �a � Date is ye 3 f '. R 9L4 ?Yr 1 t�specto o pl ding x, y R .m.«.� .vim. 3 I] t li. File#BP-2002-0564 APPLICANT/CONTACT PERSON JDR BUILDERS ADDRESS/PHONE P O BOX 66 (413) 665-7587 PROPERTY LOCATION 23 HIGHLAND AVE MAP 25C PARCEL 193 001 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 Typeof Construction: R FRt MID 2ND FLR EGRESS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildinp,Plans Included: Owner/Statement or License 074105 3 sets of Plans/Plot Plan THE F9.LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Signature of Buil mg 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. AV E , ; BP-2002-0564 G1S#: COMMONWEALTH OF MASSACHUSETTS `Jtl5a'-�i933 a CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0564 Project# JS-2002-0877 Est. Cost: $3400.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JDR BUILDERS 074105 Lot Size(ss .ft.): 5749.92 Owner: ROCKETT JOHN J&MARY E COVE& Zoning.URC Applicant: JDR BUILDERS AT: 23 HIGHLAND AVE Applicant Address: Phone: Insurance: P O BOX 66 (413) 665-7587 WHATELYMA01093-0066 ISSUED ON: TO PERFORM THE FOLLOWING WORK.-REBUILD 2ND FL R EGRESS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: !let; r . �olfv Rough: Rough: uu&i - Foundation: 04eway 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 Sienature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 784 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ';<�. xP .�''.. k r _ `"*, •` °€, `d :,� r, 5a* _�' c€ua,,. ur°� �e a � �� a r € c.�_.`z svw', wa #'uC P'•F *tr ' .e:r - .+�i-..G n 4 ro, w.-� `"- r hr•x.n a'3` x t.: ;.� t t ax `^g'�.' '��z a�`5"� ,€ ''"�..: za r` °,' rD#. �a"sry -:.s3 a�, ce`'�`�c'.a`-i#^� "x '� X, -€ r'.- t °�r" �{. 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