09-004 SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) r
License um er Exp' ation ate
Name of CSL-Hol er �+
tin List CSL Type(see below)
A re t�yz tM f� /�—� Tye Description
U Unrestricted(up to 35,000 Cu.Ft.)
R Restricted l&2 Family Dwelling
Sign ature ..cc�� M Masonry Only
Residential Roofing Covering
Telephone W Residential Window and Siding
Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Hgme Improvement Con for HIC /d
s WG,ri�r�erZ� rt� �l��c: c,r1
HIC Company Na or HIC Registrant Name Registration Number
4", n A4, F Lin
A dten , vis a
Kxpiration6ate
Signature 0 Telephone
SECTION 6:WORKERS'COMPENSATION,INSURANCE AFFIDAVIT(MG.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 p._
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, c—zl X4 L1QS�C(J S� t as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative work au tho ' ed by this building permit application.
e d 0///�/
Si re of&ner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1, PnL:. `ic-��� ,as Owner or Authorized Agent hereby declare
that the statements and inforhtion on the foregoing application are true and accurate,to the best of my knowledge and
be, f.
n-
Pri m _e
s
t n ure of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
AUG 25M4
- ;C Piumhing&ca�Ifw�c
e Common wealth of Massachusetts ortharr�pton,MA of_Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR,7rh edition MUNICIPALITY
USE
Building Permit Application To Construct,Repair.,Renovate Or Demolish a Revised January
One-or Two-Family Dwelling 1, 2008
This Section For Official Use Only
Building Permit Number: Date Applied:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 1: 1-'2-INFORMATION
1.1 Pro erty Address: Assessors Map&Parcel Numbers
1.1a Is this an accepted street. yes_ Map Number Parcel Number
1.3 Zonin Information: 1.4 Property Dimensions: -
Zonin strict Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yazd Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public[3 Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
'b Pr/ L/-s7-oty S K I
NarneffrinQ Address for Service:
111-41 4, 411-3- 3Y/ - 3 6 7 d
Synaturl Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work 2:
!Z
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee:$ Indicate how fee is detemtined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fe $
Check No. Check Amount. `'5 Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
File#BP-2015-0225
APPLICANT/CONTACT PERSON ROBERT FRIGON
ADDRESS/PHONE 163 NORTHWEST RD Spencer (508)450-0082
PROPERTY LOCATION 332 KENNEDY RD
MAP 09 PARCEL 004 001 ZONE RR(100)/WSP(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
Tvpeof Construction: REPAIR FLOOR,INSULATE ATTIC&BASEMENT
New Construction ej
Non Structural interior renovations O
Addition to Existing -c-
Accesso1y Structure I TC 7 7,04?
Building Plans Included:
Owner/Statement or License 099564 Q�
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
ay
fz� ep-1;451*1
at uildi g O icial 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.
332 KENNEDY RD BP-2015-0225
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 09-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory: INSULATION BUILDING PERMIT
Permit# BP-2015-0225
Project# JS-2015-000422
Est.Cost: $6744.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT FRIGON 099564
Lot Size(sq. ft.): 39596.04 Owner: LASTOWSKI JOSEPH R&LINDA DARLENE LASTOWSKI
Zoning: RR(100)/WSP(100)/ Applicant: ROBERT FRIGON
AT. 332 KENNEDY RD
Applicant Address: Phone: Insurance:
163 NORTHWEST RD (508) 450-0082
SpencerMA01562 ISSUED ON.812712014 0:00:00
TO PERFORM THE FOLLOWING WORK.REPAIR FLOOR, INSULATE ATTIC & BASEMENT
- all structural work must be inspected before covering
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 8/27/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner