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25C-224 (2) ,.Grity of Wart4aurptan Z r I�8338ChliSttf3 + � DEPARTMENT OF BUILDD�ZG INSPECTIONS /= INSPECTOR 212 Main Street • Muuicipal Building Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i,is/her construction sup,;:%?isor. T he state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or twoami - dwelling, attached o, detached structures accessory to Fuch 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 ftgulations. 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 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. (Flom(ow er/resident's signatur requesting exemption) I will call o hedule all required building inspections necessary for the building permit issued to me. Date Address of work location j°��1Gc3.c.T0 y " . f F e (rii of �c�rf(}id711�JfD1t - _— � 9 J f ��asaRrhrsctlla' - _ Q DEPARTMENT OP BUILDD\'G INSPPcTtoNs 212 Alain Street Municipal Building Northampton, Mass. OlOGO WOIUCER'S COiKPENSATTON MSURA-NCF All :A,,Vj-j-' I (]i ccusxJ�cr¢7i tfcc) «ILh a ptuncipal place of businessfresidence at: --- (phone:') do hereby ccrdf--, under U.ic.pains and penalties of pe, -Ury, ihal I _ ( ) I am an employer providing die follo%vine!workcr 5 comocnsatio, cove g.c for Illy emplovecs worang on t-ius job: (IbsuJ-a Corer mv) (Folic:?;u_-air) -- (r:-pimdor Dat ) ( ) I am a sole proprietor, general contractor or homeowner (c cie one) znd have hued the cone actors listed below who have the i000%vino worker's coLoen_saaon pa!icies: (Nam, 0i CQ°1r;;3Cior) Grist rdllc- compaSlpl�ouc Date) - (Namc of Contraeior) (bis-arancz-ComoaawPo!ie: \tlsncrr) (-Ex Dir.6on Dale) (Name of Conrraclo.-) (Ibsuranc;Compan)•/PoGq- Nambt) (Expiraoa Date) Ol amc of Couaactor) (Lnsuranccc Comrany/Poticy Numbcr) (Expimaoa Datc). (aaac3 •{i:�ocal bca,ifnoc --to cx U,6= lo�au�oa pctniain.6 to..i!oo,a-so^3) { ) I am a sole proprietor and have no one wort,-ing for me. I am.a home owner performing all the work myself. NOTE:plea be ew-art tfi.• +laJc 6cmco.+vc. u•bo cr=Play p�—Urm w 60 t--kz -.,a= c=s rjoa C rgaII work as of CD(Moce thca tbr—t^niJ is uiyob the boraces-o<r r=ide a oa the V Oun.6 a�s the eo e r ax rDy ae d-cd to be eitplaye�uL ce--the A,=(GUI 5Z=l(S)} rppticatioa by a boa=%-=for a tics_a permn r=zy evide-oce the lcgal cta.'ut of ea er�loyx uodcr tbo WocSccla Coa�omsyiCa Aec- 1 tbst a Copy Of this entcm¢a my be roi•- ded to the pcpettmcct or lodaazti J Aoadoa'OIM—or tru+t.00a rot tbe co cfa rc-ifGiioa a--td that L-ihac to scant,t0%,Z�undC scetioa 25A of MOL 152 an Ind to the izrxxitioa o(aimi-d pca-tW<s eooss;.stg of t fine arup to S1}00.00 andlor iat�ri3pQ�oCup to ooc yr-,e,od a%i)pmahin in dc form ores Stop Woric Ordcr aad a fl=o(S 100.00■CL'y ap,iast me ,. For dcp++taa-=-J use only . permII l Numbcr — S i 1v(ap• -- Lot of Lic=L5e:&P do �>e J SECTION 8-CONSTRUCTION SERVICES { 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Re iserecl=HortYem 'rnre`metCoiitrao " ' D w Not Applicable ❑ Company Name Registration Plum er — - - 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...... ❑ = R i�•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 Gable 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,Stat and Local Zoning La and S ate of M %chusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all+applicable) New House [_� Addition ❑:. Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition New Signs [lam] Decks [[] Siding[0] Other[0] Brief Description of Proposed Work: V1 gOUjCq� Cs d+� Alteratio f exi ng bedroom es No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet S.s -w, es^ t . .^ *atv'rs-v fit: _ .et.r:= ..,.w. 3'q, _`5 wt., 6a.{ W6' °house a +a� tlitiol to zlst�nct-bauslncr.eorx>wniet fhe o�fovuFng: 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION,- COMPLETED,,-WHEN COMPLETEDHEN 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 as Owner/Authorized Agent hereby de tha the statement an info n the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date Section 4. ZONING All Informatibn Must Be Completed. Permit Can Be Denied Due To Incomplete InforrrIption ` Existing Proposed Required by Zoning This column to be filled in by Building Department � a?r,, Lot Size I Frontage Setbacks Front s Side L:' I R:w L! Rear Building Height i l Bldg. Square Footage `�1 % �? 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 0 DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book Page; and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES Q 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 0 NO 0 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 0 IF YES, describe size, type and location: I 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 r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. p �(I Nora arnpton I ing Department U1 1 ain Streetr e� I 9 2004 om 100 a NQy No ham ton; MA 01060 sro St ho e 41 - 87-1 40 Fax 413-587-1272 Put st DEPT Of 131110`111 INSPECTIONS W" ION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Thrs section,to be completed by office 6 o WSJ r�ut sto l- NIap Zone Overlay,D�stnct' f' Elrit S District CB DistP'ct SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT- 2.1 2.1 Owner of Record: Name(Print) Current Mailing Address: 0 i d 7 3 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 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from B 3. Plumbing Building,Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number ` This Section For Official Use Only Date`s Building Permit Number. Issued: Signature: i Building Commissioner/inspector of Buildings- Date File#BP-2005-0576 APPLICANT/CONTACT PERSON PODOLAK JAMES L ADDRESS/PHONE 15 EDWARD AVE SOUTHAMPTON (413)529-2003 Q PROPERTY LOCATION 60 WALNUT ST MAP 25C PARCEL 224 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid YRIW Tvneof Construction:_DEMO DET GARAGE&PAVE FOR PARKING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: _ Owner/Statement or License 3 sets of Plans/Plot Plan i FO O WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ATION PRESENTED: pproved 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 Co n Ar 1'rX-oaq 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. 60 WALNUT ST BP-2005-0576 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-224 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: BUildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category demolition BUILDING PERMIT Permit# BP-2005-0576 Project# JS-2005-0760 Est.Cost: $3000.00 Fee: $15.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 6969.60 Owner: PODOLAK JAMES L Zoning_URC Applicant: PODOLAK JAMES L AT. 60 WALNUT ST Applicant Address: Phone: Insurance: 15 EDWARD AVE (413) 529-2003 O SOUTHAMPTON MAO 1073-9483ISSUED ON:11 115104 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO DET GARAGE & PAVE FOR PARKING 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 Occugancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 11/15/04 0:00:00 1357 $15.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0759 APPLICANT/CONTACT PERSON KEITH HAMILTON ADDRESS/PHONE 3 LORD ST EASTHAMPTON (413)222-6463 Q PROPERTY LOCATION 60 WALNUT ST MAP 25C PARCEL 224 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �n n Fee Paid Typeof Construction: RENOVATIONS TO CONVERT 2-3 FAMILY New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included• Owner/Statement or License 074129 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION Pl jESENTED: 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: § 6e Finding Special Permit Variance* tl-� Two 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 Stre ommission Z �o z0 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. �Tt1AMp�, r Gl ity of Xart4amptan r � � �lassac3�ccsrffs DEPARTMENT OF BUILDDtG INSPECTIONS / INSPECTOR '212 Main Street • Mui icipal 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 l:is/her construction supr< .,; ;or. 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'ly —_ 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 fegulations. 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 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 i Y i oy d DEPARTME1-rr OP nUILDr>\,G INSPEC•T1O1dS 212 Alain Street • Municipal Dudding ?Northampton, Mass. 01060 \N'ORICEIZ'S COMPENSA77ON GiSUR CE AITMAVIT ion, (Ii OMS=jpermj ttcc) principal placc of business/residence- at: _ — -- - i (sa-�-t/ci ty/sta�ctD p) do hereby certify, under dic.pa-ins and penalties of perjury., :hat I am an employer providing the foil owint'!workces comocnsado, cove2Je for In), ctuplovees wotiDng on this job: L .ev 315-=33`I5"�ftt 1 I 27 OmAuan=COOD:_ey) (PCue:Nu--nb--r) (`:pircior, Dale) ( ) I am a sole proprietor, general conTractor or homeow-Der (ci:cie or!e) and have hired the contractors listed below who have the follov.,-inQ worke>'s comper–�snon pokiest (Name 0: CO„^ci0") (Insurance CornoanwPouc; Datc) l i . (Nzmc of Coalrcior) (Lnsaran= ComanwPoue; Numcrr) (L., D rz6on Date) (Name of Connaao;) Onswane; Compan}-/Policy Number) (Expirtien Date) I - (Name of Contractor) (Insuran(mm Comraay/PoLicy Numb`r) (Expiration Date) . (ntu ad ts::oca.l dccf,ira« -y to mc?ud_iafor�uSOo pcta;Aniag to.0 coca--ton) O I am a sole proprietor and have no one working for me. ( ) I am.-a home owner perforTni.ng all the Nyork myself. 1 NOTE:pil�be cK trc Ehx K} JC hemCA1a Ki�o cmplay p,-,am L4 dj c—c oa r mpau work as a d%--U--y or apt moct tea t`l.rv-_rata in--sch the bomaowocr r=ia.or cc the vv zd6 zVp ut =tbe- n L c we C=�. Xy oc-=r.daud to be citplo)—uadr the c=--�p --..oa Am(GUI 52-a 1(5)a :pptinrioo by a bomco--=fc: a pczxait f=y--id—tbc 14ruA ct=lu of a employee a &d dto woricela Coospom.lioa.Act i - 1 a.Ddczznad tha a copy oC thi,az:c�tray bo r«-�.nrd<.d to tbo p�,pnrtm�of ladutriJ Accd�i'Offioo oC[rur•o�Cor the cova6-veilc=ioa-nd thet LzJtse to se==Love U-6S uodt;sovtioa 25A or MOL 152 ua I-d to the M,osaioa cda'imiaA Pcn-%W° coa-Ls ora Sac orup to 51-500.00-'-N-ix� orup w ooc yrsr cad civil pca,.ttia io the form ors Stop Wort;Ordc nod a C=0(:S 100.00 a d_y tpa D t Mr- cell - i Pcrmtt NUIDL--T ' Lot _ a p _ tt haturc of Lic=iscrJ crmiucc e 1 SECTION 8-CONSTRUCTION SERVICES ,:. 8.1 Licensed Construction Supervisor: (. Not Applicable ❑ Name of License Holder: �('T YJ I II 6 A tA r 7 License Number Address Expiration Date Signature Telephone ltea�ster e'� rontractar� Not Applicable ❑omemaroveme Company Name Registration Num er - -" - Address _,ii Expi— ration Date 7 OiCkat Cpl s 5,-i u1 Telephone 527-d 39t SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT'(M.G.L c.152,';§25C(6)j 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 buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r SECTION 5-DESCRIPTION OF,PROPOSED WORK(check-all applicable) New House [] Addition ❑;, Replacement Windows Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [[ ] Decks (Q Siding[{D) Other[a Brief Description f Proposed ` I� Work:VeW y it rAW �±n �r ecf'r� 1"�u rl dq � c'+�t Alteration of existing bedroom -r Yes No Adding new bedroom Yes No Adaabiad Narrative Renovating unfinished basement Yes _ No P ed oil -Sheet saalf � o xinb" utw nd r I. Lam, %5ekMc,- uslngrt mp a: .,.__.: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms 2- Par- On �' ( C tc fo L) c. Is there a garage attached? /1 Q- d. Proposed Square footage of new construction. Dimensions e. Number of stories? t) f. Method of heating?-(2:1 Fr,,c-A doc Fireplaces or Woodstoves/^Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1 I. Is construction within 100 ft.of wetlands? Yes x No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 1 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-PTO BE COMPLETED WHEN OWNERS AGENTOR COIiITRACTOR APPLIES FOR BUILDING: WHEN as Owner of the subject property hereby authorize to act on my behalf HY a matte g ork auth rized by this building permit application. — Sign ure o Ow ner Date KP as Owner/Authorized Agenl 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 IK Print Name S. nature of 0 Agent Date Section 4. ZONING All Informatioh Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by r -jp , Building Department Lot Size 2�pc, (ritt'-T Frontage Setbacks Front Side L.- �s R:= L: R:i 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 Perm it/Variance/Findin 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 DONT KNOW 0 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 0 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 HOC IF YES, describe size, type and location: HOC E. Will the construction activity disturb(clearing,grading,evavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ,. NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I j`City of Nortf ampton - wilding Department 2.12 Main Street Room 100 Northampton; MA 01060 phone,413-58 1240 Fax 413-587-1272 PIara ©the eettic � k '^ , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfion to he completed by @ffice 1.1 Property Address: - ff L c s f�' � 1 J) It Map Uot Unit ���r f�� •rl /�G ' ZojyFne Overlay Distract 7M f}Elm St.Distract CB Distract SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT , 2.1 Owner of Record: Name(Print) Current Mailing A dre s: Telephone Signa re 2.2 Authorized Agent:++ � } Cat mr t6 A 0(Ck61i'C S C�4Sf-WtAM�? Lj �� Name(Print) Current Mailing Address: cr6 3 Sig ature Telephone SECTION 3-:ESTIMATED CONSTRUCTION COSTS- Item - Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (,J �y U(� O/n (a)Building Permit Fee l J 2. Electrical (b)"Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(I +2+3+4+5) Check Number This Section For Official'Use Only Date Building Permif Number. Issued: Signature: i Building Commissionedinspector of Buildings Date now File#BP-2000-9� APPLICANT/CONTACT PER/SON PODOLAK JAMES L ADDRESS/PHONE 15 EDWARD AVE SOUTHAMPTON (413)529-2003 Q PROPERTY LOCATION 60 WALNUT ST MAP 25C PARCEL 224 001 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: RENOVATIONS TO EXISTING 2FAMILY NO CHANGE OF USE RESUBMIT APPLICATION FOR RENOVATION OF EXISTING 2 FAMILY NO CONVERSION OR CHANGE OF USE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 133811 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _jZApproved 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 Stre7) s ion. 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. 60 WALNUT ST BP-2005-0759 G1S#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 25C-224 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate og ry: BUILDING PERMIT Permit# BP-2005-0759 Project# JS-2005-1061 Est. Cost: $90000.00 Fee: $450.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH HAMILTON 074129 Lot Size(sg. ft.): 6969.60 Owner: PODOLAK JAMES L Zoning.URC Applicant. KEITH HAMILTON AT: 60 WALNUT ST Applicant Address: Phone: Insurance: 3 LORD ST (413) 222-6463 () EASTHAMPTONMA01027 ISSUED ON.314105 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR RENOVATIONS 2 FAMILY 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 3/4/05 0:00:00 $450.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2005-057'' UT ST ��� ,►�. , ,y COMMONWEALTH OF MASSA�..IAS.�ISE� 1Vlau.Block: 25C-224 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) L' BUILDING PERMI,,, I Cate ory: demolition Permit# BP-2005-0576 Project-4 IS-2.005-0760 Est.Cost:_ 3000.00 Fee: 15.07 PERMISSION IS HEREBY GRANTED TO: Class.. Contractor: License: Const. Clas Groan: Homeowner as Contractor Use Lot Size(sa ft.): 6969.60 Owner: PODOLAK JAMES L Zoning: - AT: 60 WALNUT ST Phone: Insurance: Applicant Address: 15 EDWARD AVE (413) 529-2003 O SOUTHAMPTON MAO 1073-94831SS EED ON:11 115104 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO DET GARAGE & PAVE FOR PARKING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. Underground: Service: Meter: Footings: Rough: House# Foundation: Rough: g Driveway Final: Final: Final: Rough Frame: Gas: Fire Deaartment Fireplace/Chimney: Insulation: . o:;e:-. Final: Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Si nature: Certificate of Occu anc Check No: Amount: Feel e: Receipt No: Date Paid: Building 11/15/04 0:00:00 1357 $15.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo P