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25C-261 (3) 3AH-12-2004 14:56 FROM:ACTION FIRE INSTAR S 1 413 594 7BO2 TO:914135e71272 P-.I/.! ALTION F I R F I W r, T A D C C D 11 i 1 11 v L E 3 5 9 4 - 7 8 0 0 / (800} 7 8 3 - 7 66 8 FAX : ( 4 1 3 .) -S 9 4 - 7 R0 ? FACSIMILP FROW COMPANY n A,r.. FAX Numar.R; T&T iii-NiD,15i iPAVQ:S J.NLLUDING LOVER: ,L.nn fAk :Uv7 RGLNT t7 FOR RE.vi uw Li CONf,-,[F.NT 0 PLFASE R[:PLY ❑PLEASE RI-C-.-(-LF NOTI-NICnMMI-ml I L T, ll�T,A r,Tr—,-yliE xRONIC OFF!CE,PLa-.cE DES TR.'y A*f IF.C0NTr-NTS,r',ND NOTIFY ACTION FIRE THANK YOU. 30 HAINk.S LIMLLL JAN-12-2004 14:56 FROM:ACTION FIRE INSTAP S 1 413 594 7e02 70:911135871272 P:2/4 L4 P, ipa R L• rk"T I . { ��i�r c:nev� j � 'IWO ta <-A66 Ir 1r i L [�I fo\ C7 HR S 1 41,3 t,9,1 (80c� f-U*:�;i 1,4 P:3-1 j,-� 1 I LtosE� i C loser jHN-1(2-L-lblJz4 14:t>( FRUM:HCTIL)N F INb'l T." K..O G-fil�Lf"A � � f L4P, W'NU%\u7 5-I-r JAN-12-2004 14:57 FROM:ACTION FIRE INSTAR S 1 413 594 7802 TO:914135871272 � f i I ' f f r d l � 1 I DEC-10-2003 11:10 FROM:ACTION FIRE INSTAR S 1 413 594 7802 T0:914135e71272 P:111 ACTION FIRE INSTAR SERVICES Phone: (413) 594-78001(800) 783-7668 FAX: (413) 594-7802 FACSIMILE TRANSMITTAL SMFET C 10: NORTHAMPTON BUILDING FROM: DIANE SWAYGER INSPECTOR COMPANY DATE 12/30/03 FAX NUMBER: 413-587-1272 TOTAL NO.OF PAGES INCLUbING COVER I Kendrick 48 Walnut SC ❑ URGENT X FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE Gentlemen: Repaim duc to extensive water damages. Kitchen,Diniugroom,Livingroom-8 Hall Gut to Studs Replace phistcr w/ 5/8"sheetrock,new wood flooring,replace finish tnm,doors&cabinets. Other moms:Decorate,finish flooring. Sepuate permits for Fxtcnsive Electrical cork, Plumbing Lie new henting srstem (boiler) �OL 30 Haynes Circle Chicopee, MA 01020 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 Workers' Corn ensation Insurance Affidavit Property Owner Name: G, t-A Job Location: City: ti Phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one working in any ca acit . I am an employer providing workers' compensation for my employees working on this job. Company Name: M.Demos & Son,Inc. dba Action Fire Instar Services Address: 30 Haynes Circle City: Chicopee Phone#(413) 594-7800 Insurance Co. New Hampshire Insurance Company Policy#WC7165853 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: Company Name: Address: City: Phone# Insurance Co. Policy# 11 MINE= Company Name: Address: City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify er the pains and penalties of perjury that the information provided above is true and correct. r Si nature ° G. Date 1 Z/O U Print Name 'A•,--I Phone# 'Y�y���j r✓f� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/license# ❑Building Department ❑Licensing Board ❑ Check if immediate response is required ❑Selectmen's Office ❑Health Department Contact person: Phone#: ❑Other S€CT-10 8 CONSTRUGTI:ON SERVICES' 8.1 Licensed Construction Supervisor: Not Applicablee ❑ 1—G Name of License Holder : �t«� �?� ��k�' c>1 If k�o License Number V\AVVN 0C, Addr s C�u� Expiration Date -a -o°z3-L Signature Telephone Runns ere omemn ovemerit ontrector Not Applicable ❑ 1K� cn +�`�ti ��s`i'DQ- as'T Z- Company Name Registration Number :2o i6sA� Address r Expir'atioA Date Telephone SECTION 10 WORKERS' COM PEN ,SAT,ION INSUyRANCE,.AFFIDAVIT(M,A.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"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 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 SECT= E5 R RAT OOFPROPOSED +YORK(check It applicable New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ) Siding[ ] Other Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes _No Attached Narrative D Renovating unfinished basement Yes X,_No Plans Attached Roll 0 • Sheet 0 A:ew 4 o Se TW-dditror to ex sting li.o sing;cot�ap:le�e #fie oCloKrrn: 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? a f. Method of heating? �71�f�` �E Fireplaces or Woodstoves Number of each g. Energy Conservation Compliiance_._ (gyp Mascheck Energy Compliance form attached? h. Type of construction_ 1—q tonj '�1,iit�tt� i. Is construction within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No_N& j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? x Yes No . I. Septic Tank City Sewer Private well City water Supply SCTI©�� 1NNERAUTHORfZAT10N TO BE COMPLETED WHEN OWNSA EITCON CRCTOR gPFLIES FOR BUILDING PERMIT as Owner of the subject property X1 X hereby authorize f v -`r by. VNL.-�C- av 610,0.� to ac T. on ehalf, in 11 ative to work authorized by this wilding permit application. ignature of Own Date I. 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. Print Name l Signature of Owner/Agent 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 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 i City of Northampton Building Department = - -._ 212 Main Street Room 100 4 d `a Northampton, MA 01060 phone 413-587;1240 Fax 413-587-1272 5 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION i-SITE INFORMATION Thsecbo to<be completed 6y office 1.1 Properly Address: r?� sF, £� , r tr 4-N. 1—UT OrK 1l t; I IJm SI�lstrict c .u.e$�IS17Ct SECTION 2-PROPERTY-OWNERSHIP/AUTHORIZED.AGENT 2.1 Owner of Record: Print Current ailing ddress: , f Telephone natur 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION:COSTS Item Estimated Cost(Dollars)to be Official Use,oPly completed by ermit applicant 1. Building �� Qpp (a)Building Permii,Fee 2. Electrical Do (b)�EstimatedTotal Cost of (p� Construction�fram -6. 3. Plumbing Dl) Building:Permit Fee 4. Mechanical (HVAC) ( �� 5. Fire Protection 7�� CIO 6. Total = (1 +2+ 3+4+ 5) Check Number ,j 3 L This Section For Official Use,Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0674 APPLICANT/CONTACT PERSON ACTION FIRE RESTORATION ADDRESS/PHONE 30 HAYES CIRC CHICOPEE (413)594-7800 PROPERTY LOCATION 48 WALNUT ST MAP 25C PARCEL 261 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out _ Fee Paid L 66­ Typeof Construction: REPAIR WATER DAMAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 074416 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. 48 WALNUT ST BP-2004-0674 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C-261 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0674 Project# JS-2004-0965 Est.Cost: $46000.00 Fee: $230.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groukp: ACTION FIRE RESTORATION 074416 Lot Size(sq. ft.): 3310.56 Owner: KENDRICK GRAND J& Zoning:URC Applicant. ACTION FIRE RESTORATION AT. 48 WALNUT ST Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 594-7800 Workers Compensation CHICOPEEMA01020 ISSUED ON:1113104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR WATER DAMAGE 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• Receipt No: Date Paid: Check No: Amount: Building 1/13/04 0:00:00 54533 $230.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 30/ v1�9 chi - }{GNAT � 4 ) City of Northampton BUILDING INSPECTION LABEL APPRC0VEU _se 7 Inspector Date Z-aD- O 48 WALNUT ST BP-2004-0674 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C-261 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0674 Proiect# IS-2004-0965 Est.Cost: $46000.00 Fee: $230.00 PERMISSION IS HNREBY GRANTED TO: Const. Class: Contractor: License: Use Group ACTION FIRE RESTORATION 074416 Lot Size(sg. ft.): 3310.56 Owner: KENDRICK GRAND J& Zoning:URC Applicant:_ACTION FIRE RESTORATION AT. 48 WALNUT ST Applicant Address: Phone:. Insurance: 30 HAYIES CIRC (413) 594-7800 Workers Compensation CHICOPE E-MA01020 ISSUED ON.1113104 0:00:00 TO PERFORM THE FOLLOWING,` ►'CORK:REPAIR WATER DAMAGE 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/x��(�r%f, Rough��/3d/n3 House# Foundation: X�eccclRe7�� ! Driveway Final: Fina1:o�S�YjD�f �1,t)f�j Final:>1/ Q���/ v'[ Rough Framq�7K Gas:rS-1— D Fire epartment Fireplace/Chimney: /J��� Insulation: Rough: Oil: Final 0 \ Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA�N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature Feel e: Receipt No: Date Paid: Check No: Amount: Building 1/13/04 0:00:00 54533 $230.00 212 Main Street,Phone 1413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo