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11C-009 (5) �7S°lam Sol ° } t -j 0 <04-f q WAI glh- P,,sez( G(o&��J ce- ( I C a �Q4e C J e G.ct<,eck C ZA Slog 1p.4"^^^ "f2 A�Atil V-)vv- �o Z- Marvin Order Management Project Egress Summary Report Date/Time: 6/26/201411:06 AM Job/Project Name: a/a Sales Rep: JIM PAWELL PK Version: 0001.19.00 Quote/Order Number: XVINZGY — Organization Name: R K MILES INC Net Clear Opening(sq Line Mark Unit Unit ID Brand Product Width Height ft) 1 Al Integrity Wood-Ultrex Traditional Double Hu 317/8" 203/32" 4.45 SgFt Glossary International Building Code-2003 and 2006 Section 1025 in 2003 code and Section 1026 in 2006 code-Emergency Escape and Rescue Minimum Size:Emergency escape and rescue opening shall have a minimum net clear opening of 5.7 square feet(.053 m2). Exception:The minimum net clear opening for emergency escape and rescue opening on the ground level at grade 5.0 square feet(0.46m2). Minimum Dimensions:The minimum net clear opening height dimension shall be 24 inches(610 mm).The net clear opening width dimension shall be 20 inches(508). The net clear opening height dimension shall be the result of normal operation of the opening. Maximum Height from the Floor:Emergency escape and rescue opening shall have the bottom of the clear opening not greater than 44 inches(118)measured from the floor. Operational Constraints:Emergency escape and rescue opening shall be operational from the inside of the room without the use of keys or tools.Bars,grilles,grates,or similar devices are permitted to be placed over emergency and rescue opening provided the minimum net clear opening size complies with Section 1025.2 in 2003 code and 1026.2 in 2006 code and such devices shall be releasable or removable from the inside without the use of key,tool,or force greater than that which is required for a normal operation of the escape and rescue opening. Code restrictions may vary depending on your local building code. OMS Ver.0001.19.00(Current) 10 SMITH Product availability and pricing subject to change. 10 SMITH Quote Number:XVINZGY Architectural Profile Number: UNIT SUMMARY The following is a schedule of the windows and doors for this project. For additional unit details, please see Line Item Quotes. Additional charges,tax or Terms and Conditions may apply. Detail pricing is per unit. NUMBER OF LINES: 1 TOTAL UNIT QTY: 1 EXT NET PRICE: USD 452.67 LINE MARK UNIT BRAND ITEM NET PRICE QTY EXTENDED NET PRICE 1 Integrity Wood-Ultrex Traditional Double Hung 452.67 1 452.67 RO 36"X 50" OMS Ver.0001.19.00(Current) Processed on:6/26/2014 11:18:46 AM Page 2 of 6 rkmiles.com PAGE NO 1 P All xpl�ravcil material returns aed si�blect to a rexroriting fee. SINCE I b1N dvl+cil sfrrec s Pa box 1 125 ss rxr}ian�,e street•lta biix 746 1940 Ivtierrhaitdlxe returned innst have been utchaxcrl frr>ni lomidwsrc:r cenret,Vermont 03233 HAM&cbury,verMnour 05753 r.k,MILES within.30 d2yx and most be in rcxalublo rendition. sox g61 1051 roll fred AAA 447$6.15 sat jas 1,711 fall free s00 3641721 C'roof ofpurrhxse is raaiuire4 on all returns.Speeixl order rk items are non-returnxb[�c. 353 Bale a.e�iva f wale stsere Act:oanca#tat}Said when due are otd4ect to a SERVICE charge of wilhwus own,niasaIcilu"M 01267 west harfidd,mass2alursetts gloss 1"%Per mouth until Paid which is an ANNUAL RACE of 18%. 41)4$8$121VOUfr"$006 70 7431 41324783©a tallfrea$6644082a BUILDING MATERIALS SUPPLIER Customer No. Job No. Purchase Order No. Reference Terms Clerk Date Time *6 INTEGRITY— CASEMTN NET ON RECEIPT JRM 6/26/14 1 11:27 Sold To Ship To **** CASH **** JO SMITH/ 413 325 6500 JAY DOC# 409102/4 9 BERNACHE EXPT DATE: 6/25/14 TERM#100 ************* LEEDS *SPEC ORDER SLSPR: 54 JIM PAWELL ************* (832) 578-6889 TAX 040 MASS TAX ORDR 409102 SHIPPED ORDERED UM SKU DESCRIPTION LOCATION UNITS PRICE/PER EXTENSION 1 EA ZZ004409102011 RO: 36" X 50" SO 1 452.67 /EA 452.67 INTEGRITY WOOD ULTREX STN WHT/ BARE PINE LOWE W/ARGON FBRGLSS SCRN 4-9/16 JMB INTEGRITY-42473—SMITH MID:1 387305 APP:140 XR:40 407 ** ORDER ** ORDER ** ORDER ** ORDER ** ORDER ** ORDER * TAXABLE 452.67 PRIOR DEPOSIT 453.37 ** DEPOSIT AMOUNT ** 27.59 NON—TAXABLE 0.00 ** BALANCE DUE ** 0.00 SUBTOTAL 452.67 BANKCARD PAYMENT 27.59 BKCRD#XXXXXXXXXXXX1709 TAX AMOUNT 28.29 TOT WT: .00 TOTAL AMOUNT 480.96 X Received By City of Northampton A S, Massachusetts ti� A;_ s—el DEPARTMENT OF BUILDING INSPECTIONS = .x r i € 212 Main Street • Municipal Building 5J1 b Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 rouqh 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 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, 0 C1 '1 V`c-- SVA"L4 f 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 I Aev-.qc-CCA < ed S VA- The Commonwealth of Massachusetts r Department of Industrial Accidents M + r Office of Investigations 4� 600 Washington Street ` Boston, MA 02111 ' - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: 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 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. F-1 Remodeling ship and have no employees These sub-contractors have g, E] Demolition working for mein any capacity. employees and have workers' g ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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.Lie. #: 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 $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 coverage verification. I do hereby certify under the pains andp�enalties ofperjury that the information provided above is true and correct. Signature �-----_ Date: Phone#: ^� 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: License Number Address Expiration Date Signature Telephone 9,Rectistered 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`:=-M e, Owner`Exe'mptionl. 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 Signatur SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[0] Brief Description of Proposed Work: lMH]Gn� a �in�Ci��� 20�v► iYl �'X��4-i'ncr �[�f7C. S✓7 titQ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet . ._ sa:if`New house and or addition to7existing.houstnq, complete th646 li'o"w' 'ing: 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 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. Signature of Owner Date 1 14 V1'n C `V% 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. P Signature of O er/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 'nis column to be filled in by Building Department Lot Size FF Frontage Setbacks Front Rear L—J, Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bIdg&payed #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONTKNO0 0 YES 0 IF YES, date issued:! � IF YES: Was the permit recorded ot the Registry ofDeeds? � ' NO `� DON-r xnuW 0 YES Page"' and/or Document# IF YES: enter Book ag B. Does the site contain abrook, body of water urwetlands? NO 0 DONTKNOY/ 0 YES IF YES, has u permit been or need tobe obtained from the Conservation Commission? Needs to be obtained -/�~� v��Obtained �~� Date Issued: � ' C. Do any signs exist on the property? YES �~�~�� NO �^v�� � IF YES, describe size, type and location: D. Are there any proposed changes tnor additions nf signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: f \ E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre oriuit part ofa common plan ' that will disturb over 1 acre? YES 0 NO K ) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ' � Depart n#use oral' i City of Northampton OUR*! '"� a Syr�• I�. k,q irrig �l'�F % r I+.; j t _ Building Department Carla Ctt/Driye�vay Perrrti#f 212 Main Street Seyver/Sep#IClyaiCabllrty v. k Room 100 WeieR6 t h JUN rthampton, MA 01060 Two sefs df S#rtctural Pfans phop413 587-1240 Fax 413-587-1272 P[of/Slte Plans rt Fiurr, r r ect ;OtherrS;peclfy "'I rc31 r 00 - ....._ CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: Th'IS sect�orr to be completed yi office `ii^� Map Lot ' Unit t e�S _ I o Zone Overlay D►stnct l_ EIm St Rrstrlct CB Distract SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �`✓l S' Name X n t) Curr t Mailing Address: 2 t s- �-� Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building —I n5�« he (a)Building Permit Fee aO wet t%s %li&ndo^I 2. Electrical (b)Estimated Total Post of -7000�� . Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 00 5. Fire Protection 6. Total=(1 +2+3+4+5) —7000 Check Number This Section For Official Use Only- Building Permit Number. IIsssued: Signature: _ Building Commissioner/Inspector of Buildings Date File#BP-2014-1402 APPLICANT/CONTACT PERSON SMITH JOANNA ADDRESS/PHONE 9 BERNACHE ST LEEDS (832)578-6889 Q PROPERTY LOCATION 9 BERNACHE ST MAP I 1 C PARCEL 009 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Z:3 Pecs Ty_peof Construction: FINISH BEDROOM IN ATTIC SPACE 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 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 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. 9 BERNACHE ST BP-2014-1402 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I IC-009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category renovation BUILDING PERMIT Permit# BP-2014-1402 Project# JS-2014-002372 Est.Cost: $7000.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 8015.04 Owner: SMITH JOANNA Zoning. URA(100)/ Applicant: SMITH JOANNA AT. 9 BERNACHE ST Applicant Address: Phone: Insurance: 9 BERNACHE ST (832) 578-6889 (� LEEDSMA01053 ISSUED ON:612712014 0:00:00 TO PERFORM THE FOLLOWING WORK.FINISH BEDROOM IN ATTIC SPACE 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 6/27/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner SEOMON 8-coN}3RucTioN SERVIcEs 9.1 Licensed Construction Supervisor: Not Applicable G fume of License Holder, d f L cease Nur?de` IAddress Expisaton Cate i SGnature Telephone Not ApPlicable n ' �rt�fe~i.- �rtlDeaVQ�zt+et"eF.oQntt� R; Company Name Registration Number Address Expiration Date Telephone, i SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.15Z 25C{6}) a 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...... 0 No...... 0 The current exemption fur'-homeoNvners"eras extended to include Owner-occupied Dwellings of one(l) 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.CINtR 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 them is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use an&or farm structures. A person who constructs mare than one home in a two-year period shall not be considered a homeowner. Such"hsomcowxzer'"shall submit to the Building Official,on a form acceptable to the Building Official,that helshe shall be restzonsibte for all such work performed under the building Permit. As acting Copstruerinn'+unervi or 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 I33(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated..you may be liable for personts) yom ' ur you under this pe=1 t w i 1-he undersigns i"hopteai�+3acr"certifies and assumes responsibility fiir compliance with the State Building Code.City of N"orthatnpton Ordinances,State and I..0c31 Zoning Laws and State of Massachusetts General Laos Aimotated- Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appliSgIfte Roofing New House F-1 Addition F7 Replacement Windows Alteration(s) Or Doors Accessory Bldg Demolition New Signs (0) Decks [M Siding Other Brief Description of Proposed 1Ap,,AA+e iPiSuka�iov-� Work. Qodallw—aiv,n me roo�*ok—Arof axlsttv 8lilq�'N ow:rew 1p�ocwa in'UIRT t)�Mn, exmt�N Alteration of existing bedlo�.. Yes No Adding new bedroom--Yes No -e– Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet h66 ",6=21ete the If—New hoiiii""ri 6iF"" t6l gm"n 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 healing) 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 Depth of basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulatons7 _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 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 Signature of Owner Date 1, � �as Owrer�Authcr2ed A g Fe�n�t—he i e b clalraejthat Ithe sla�tements�andinform�afion on 7theforeg'oing app4cation are true and accurate,to the pest of my kn ,ow*d,,;e and belief Signed under the pains and penalties of perjury A- AA I T– P– 'A SignMure of Ownip�Agent claie 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 filled M by Building Department Lot Sire Frontage Setbacks Front Side L. R: L: _R:, Rear Building 11eigOwt Bldg.Square Footage °v Open Space Footage % (Lot area minus bldg&pavcd arkins) of Parking Spaces Fill: ivalume+�Lt�:ationl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW� YESFM IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO = DON'T KNOW F?71 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 EM 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? YESM NO Ln.i IF YES, describe size,type and location: E, Wit the construction activity disturb clearing,gradin a vatlon,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YEf-M NO IF YES,then a Northampton storm Water Management Permit from the DPW is required. io .I fur'qlI City of Northanipto t Building Department 212 Main Street Room 100 Northampton:MAO i 060 phone 413-587-1240 Fax 413-582-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A O#£OR TWO FAMILY DWSLL=NGU SECTION t-SITE INFORMATION 1:1 Rro?jrb Address: This section to be ocrm ted by #et ' jt✓.tit.GlaG }— Map Lot �G tGt s t MA- 01053 Zone Overlay District Elm St Mstrict Ce Dsswi SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Joanna Smith Name{Panto {' c r*P^,Mai'-N Azd-ess 9 bernache St,€eeds,01053 zec^cnz i 7 C ics a s Signature 2.2 Authorized Aoent: Name(Pant) Curmnt Mwong Andress.. Signature SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Gfaa<Use Url'y completed by oermit a olicant ¢ 1, Building 4500 I,(a)Building Permit Fee 2 Electrical 500 (b)Estimated To Cost of Construction from 161 3. Plumbing Building Permit Fee t n1a 4. Mechanical(HVAC) 5 Fire Protection 200 6 Tctai=(1+2,3+4+5) 5200 $ Check NLMt*l -7.1, This Section For Official Use Only Date Building Permit Number. Issued Signature: Building CoM1rh*$*"er1lnaf ectcr of Buildings Dale d �e ul' �� � � �S 9 BERNACHE ST BP-2014-1402 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I IC-009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category renovation BUILDING PERMIT Permit# BP-2014-1402 Project# JS-2014-002372 Est. Cost: $12200.00 Fee: $73.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 8015.04 Owner: SMITH JOANNA Zoning: URA(100)/ Applicant: SMITH JOANNA AT. 9 BERNACHE ST Applicant Address: Phone: Insurance: 9 BERNACHE ST (832) 578-6889 O LEEDSMA01053 ISSUED ON:6/27/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.FINISH BEDROOM IN ATTIC SPACE-ADDED ON 7/11/14 - UPDATE INSULATION IN EXISTING BEDROOM. REPLACE DRYWALL ON KNEEWALLS & CEILING. BRING ELECTRICAL UP TO CODE. INSULATION WILL BE OPEN CELL R=20 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 6/27/2014 0:00:00 $73.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner