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28-013 (4) l ' l I I \ J . � 1 ----A1 r n ' p(l (1-7 1 a' 1 :i)MOS ,a; SECTION 8-CONSTRUCTION SERVICES' .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: '7�Q� "� O ]S 0 73 License Number Address Expiration Date Signature Telephone 9 xRi" r"edkH me:lm r yeF7rznt"Contr`aafdr t ff� #,.. , A Not Applicable ❑ Pp ". .,«K , X28 Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c, 152, §25CM), ; 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...... ❑ i t><<ari 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 force 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 Signature -ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s)❑ Roofing 0 Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [✓, Siding[ ] Other[ ] Brief Description of Proposed Work: /ZEr t AC J( EJ<<17-)•'►6 J)604- /P4 1-4or4-p-AJ Alteration of existing bedroom Yes X— No Adding new bedroom Yes No Attached Narrative o Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet H*� 6'a;t fi[" ►=ti' a nd., atld"t an o-ex'stin ho"s�:� com°"le. t fO ` w" 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 h•_ating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? 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 DWNER AUTHORIZATION-TO BE COMPLETED- WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize .1��'E L; J to act on my behalf, in all matters relative to work authorized by this building permit application. nature f^wne Date 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 Pod penalties of perjury. 4-T S 1 cL-1 f L).mil Print Name 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 Q C T &*—j 70 This column to be filled in by � f r G Building Department Lot Size U, Frontage / �✓ , Setbacks Front l00 r Side L: R: L: /JD t Rear 16 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 ✓ DON'T KNOW YES IF YES, date issued: I' YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW , 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 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: City of Northampton Building Department 212 Main Street Room 100 7 Northampton, MA 01060 $fm<, ' phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ASR 2 ? �v�4 SECTION 1-'SITE INFORMATION 1.1 Property Address: � '` This s+rction tab omp of d office ; r ZS b �i„( LV�1Trtr�- °- Mai'' Lo � R lJnit � istrl V��� � ! g k Etm,St.q[ tr�l � �Is Sol SECTION 2- PROPERTY-OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Print) Current Mailing Address: duhjL IT b S"gr Telephone Dign ure 2.2 Authorized Agent: 71 ,d 1 k .L f t- w 'J �b 64 v)c& C 4-"5*14- Name(Print) L /� Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION'COS'LS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1_ Building 1.41 c7�o (a) Building Permit Fee ', 2. Electrical _� (b).Estimated Totaf Cosfof . Construction'froiYi 6 3. Plumbing Du:ilding ?ermitee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(I +2 + 3 +4 + 5) Check Number This Section For Official Use Only Building Permit Number: e q Date Issui. Signature: Building Commissioner/Inspector of Buildings Date "� File#BP-2004-1032 APPLICANT/CONTACT PERSON Oliver Iselin ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 256 SYLVESTER RD MAP 28 PARCEL 013 001 ZONE RR 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: REPLACE EXISTING DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039073 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION PRESENTED: pol 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 Co 'ssion r 2 oa 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. 256 SYLVESTER RD BP-2004-1032 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:28-013 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2004-1032 Proiect# JS-2004-1553 Est. Cost: $14000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Oliver Iselin 039073 Lot Size(sg.ft.): 390733.20 Owner: LOSERT KIRSTIN Zoning: RR Applicant: Oliver Iselin AT. 256 SYLVESTER RD Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:4129104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE EXISTING DECK 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 4/29/04 0:00:00 1443 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo tit MAW�T w `k City of Northampton " BUILDING INSPECTION LABEL °LXSPPR VEE) t/ 5 ainspector Date i 256 SYLVESTER RD BP-2004-1032 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 28-013 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1032 Project# JS-2004-1553 Est.Cost: $14000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Oliver Iselin 039073 Lot Size(s�1c.ft.): 390733.20 Owner: LOSERT KIRSTIN Zoning:RR Applicant: Oliver Iselin AT: 256 SYLVESTER RD Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:4129104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE EXISTING DECK 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:�JeZ- S c9h Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: O THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS r" Certificate of Occu anc Sip-nature: Xi Feel e: Receipt No: Date Paid: Check No: Amount: Building 4/29/04 0:00:00 1443 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Comnussioner-Anthony Patillo