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25C-225 (5) WIN 212 Mniii Street 7dumcipal Buildill Nor th a in pt,o i i, M riss. 01060 womc-L,,n,S COMTEN'SATION. 1-P;SUVANCE ATMAVIT ��j C p nlacc n f'b'L E ii c s sJ,­2 c:'cc y 1 7 O-f r--4 CD t 16rr7 (2 1i11J)0,) I E�L c6 n D-Lc) a Scle PF-OU71":'Or, -,C:It7L, One) anC s c -j t 2 S-a_G F., t -a=Fs S-t�� c c c co-I of cop D 7i: 0 A C'Izrlr�I copy —Y -4 Lh--:[jurc to f,7%:!.---c cj c"I to tf� o[ of up to -�C'()CIO c.f�, o�n c y :lilt SECTjON 8=.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ©7 License Number Ad ess Expiration Date Signature Telephone Re °t"erie "o�me�,l ffl11'i.' i+^em n rGontracto -.=" =;"` Not Applicable ❑ 8999 ZZZ ( ELI) •131 Company Name bH1Sfr3 Registrati n Number Is 0 8 a H 8 0 Z1, (se City O F Stop ,� -- Address N01 I I �r y/H F, 1 I 3x Expiration a e Telephone — ,-,S 1NORKERS.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...... ❑ 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"homeo,.vner"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 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 AIMS SECTtONs's.IDES°-R�fP�TIOtJ OFFROPOSED WORK(check all=applicable) VVM . a s . New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks �>4 Siding[ ] Other [ J Brief Description of Proposed Work: kle w roof Lokkc ��� otat RA 1.1L bF Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D - Sheet❑ 5a1Nevirhou a a"" dor adiii#fon"to_ezisting-.housing co'm°plefe thefallow�n a. Use of building : One Family Two Family _Other / b. Number of rooms in each family unit:__ Number of Bathrooms 1 c. Is there a garage attached? 40- d. Proposed Square footage of new construction. bimensions 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 SECTIOTt�a OYVNER A U DH ,TO.BE-COMP,LET,ED WHEN OWNEkSrAGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT; n .. e. `� lt�ti { ~as Owner of the subject property c hereby authorize ad/'t ! n to ac on my behalf, in all mattep relative to work authorized by this building permit application. Signature of Qwner Date aalt, J as Owner/.Authorized Agent hereby declare that he 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. Print Name Signature of Owner/Ag t D to 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 j Lot Size I 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: . AP. City of Northampton Building Department - ' 212 Main Street rt Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR; RENOy%TF 60 dl#W*I !"ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION n to;be completed by office 1.1 Propel tyAddress: Main Unf Overlay Distnct E{m St Dir�tt st CB D�s#rct k SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (Name(Print) Current Mailing Address: ~d- 1A4335- Telephone Signat 2.2 Authorized Agent: 4-1 �' d��l l Name(Print) r "� Current Mailing Address: �- �l7 - 23 6 Sign re Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b 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 Lf OVP 46 tom© This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2005-0826 APPLICANT/CONTACT PERSON KEITH HAMILTON ADDRESS/PHONE 3 LORD ST EASTHAMPTON (413)222-6463 Q PROPERTY LOCATION 24 PARSONS ST MAP 25C PARCEL 225 001 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: PORCH REPAIR&NEW ROOF OVER 2ND FLR PORCH 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 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 mmission 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. 24 PARSONS ST BP-2005-0826 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C 225 CITY OF NORTHAMPTON Lot:-001 Permit: BuiidinQ Category: BUILDING PERMIT Permit# BP-2005-0826 Project# JS-2005-1142 Est.Cost: $12000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH HAMILTON 074129 Lot Size(sg.ft.): 3484.80 Owner: ELIAS JULIE A Zoning:URC Applicant: KEITH HAMILTON AT. 24 PARSONS ST Applicant Address: Phone: Insurance: 3 LORD ST (413) 222-6463 O EASTHAMPTONMA01027 ISSUED ON:317105 0:00:00 TO PERFORM THE FOLLOWING WORK.-PORCH REPAIR & NEW ROOF OVER 2ND FLR PORCH 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 3/7/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo