28-013 (5) 5'-6 118" Change existing
door to 2'-6"
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o
l N co
X
C?
0" m 1
Cf' ^5G1
New 2x4 Half wall
to match existing
window sill Height
T-g 114" m
;>
Custom tub
O
surround(phler
-
K-1249
Bath
Custom glass
shower enclosure
i
New concrete shower
Built-In seat base with 1"x1" the
HOBIE ISELIN
X��,o f � �,,aT,�,�,s GENERAL CONTRACTOR
4 J � .
�� 3�-,�-��,,.-� 36 SERVICE CENTER
�f�r Jv„� A�� f..��,�,1Yy NORTHAMPTON, MA Q1060
Z f y I- 6-J-j-&X 7 n (413) 584-1224
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R of Port 11a111}Itoll
A l E �itayaerllncclls
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r)EPARTMENT 01' UUIW0\1C INSPECTIONS
212 Main Street Huutctpal I3uild,nt,
Northampton, Mars. 01060
WORICER'S CONITE'NSA'ITION I.NSURANCF AFIMAVIT
J>t L/rj-------- -
(li ccuse-dix:ru li ttcc)
a principal place of business/residence at:
- 3 6 _� ✓�c x— C�►.��,Yirc- r'��,/ �;honc ')_ y-/Z-Lq
do licreby celTify, un(!er the pain and penalties of perjury, :hat
( ) I am an employer providing the following workces coinpcns .ion covet-age for Lily
c:luployces woliallg On Lilts job:
Qnsw-�uc-- C0013,2.GNI) ---- ---(PeUc: Nu:nir_r) ---- (E pimtion Data)
(t aln a sole proprcto l'cncral c01 or or homeowner (circle Onc) zr)(i have hired
the contractors listed below who have the following workers contoensation pol)cies:
(Nt1mc ui,Com-n+c(or) Da1c)
(N,Wne of Contractor (1dLS,lrancc. Comoauv/Poky Ntuli-2r) ' (L'pi ,,ulon Datc)
(Name of Colin-actor) (Inntrancc CompauyfPoUcy Nambu) (ExpimrLioo Date)
(Name of Cone lctor) (IRStlmDcc Coml:any/Policy NuinbJ) T..\j)itation Datc)
(caada addi:i or:it c!xct ifoc lAn to irv--It ic inform.:ioo Pertaining to all ocarco:-s)
O 1 am a sole proprietor and have no one working for me.
O I am a home o\vucr perfonuit10 all the work myself.
iJO ri:',plc x Lc Gw"1rC ltla:w{ lC t)C(IYA�9=1']Ni>p curplay Pc;-tom Lo cl)m LL:Iczxa�,CL S CJ 1 t:rcpair work oa a d••c1.1ioF,of
not mocr thin ti-T-tmr•c in wicicb tlr_bomoow ucr n=ido or co the Vojoe r zppuzun,tl c-,r-lo Lv nJt CcxrnllY oc<-3i =rw to be
employes u,rScr dx t•ai rfa onmPcz=tim Act(GLI52_sa I(5)�application by a hotnoowm fm a liar_..or p-'r it n_:y c.ita the
IcgsJ naIIU of en ccPloyc uodcr tho Woct.o(a C axpoo tioo Ad
I undernaad that a copy of thu etal.m i may bo fo,—rded to llw Delxiiturccss of li.daatiiJ Arodaatf OILoo of lruu•000 foe dw
covcrxgc vcriliclioo nM Utal f_i1trc to sco,"t covcr'gc under soctiou 2 5 A of Mot,151 can lad to th)-:*)-ition of cruni"pcaat6ca
oomixing of a fin,of tip to 5 1}po.pp ajWcx anluisonnsat!of up to coc)- v end eisi)Ixnahuo in tx form of a Stop Wort Order and a
firn of SIWOO a day tgaitur m�
For akp.rnn::�1 uw drily
Permit Number ----
-----
Map"" - Lot
signature of I.1=1c xc/Fcnniticc ]e
SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �� 1 V 1 I S E 0 �
License Number
Address Expiration Date
Signa/turn a ,.., � Telephone
19 '$ i'gd6Lnl4'11'tpfo4gmgnt'Contractor: Not Applicable ❑
J-A-- e-- /10 ;� S zd?
Company Name Registration Number
e /-/ L z "" y
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...... ❑
=1 -",dome Owner Exem"ption
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 liome 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 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
a
�ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors Cl
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: _ffew°t> 4 ''U30
Alteration of existing bedroom Yes >4--No Adding new bedroom Yes No
Attached Narrative o Renovating unfinished basement Yes X No
Plans Attached Roll 0 • Sheet C
�a If New house a3i `'or"adtl�tion to existing housing'c• omplete the following:
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. 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-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �n f - as Owner of the subject property I
hereby authorize 0 V Z' to act on
my behalf, in all matters relative to work authorized by this building permit application.
02
Signature of Owner Date
phi ✓E-� �L�.( � � �„l
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 eiid penalties of perjury.
Print Name
el V r_
Signature of Owner/Agent Date
•4
Section 4. '
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
L LyL tQ
"j--0X-j-'— This column to be filled in by
,Ajio N&+j rT—) U 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 >< DON'T KNOW YES
IF YES, date issued:
IF 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 .�ON'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:
-------------- /t
pepart;. Q sqkEP iii'r l
C�"it of Northam tones
Y p Status of Perfii
Building Departi-nent Curb Gut/{ r
212 Main Street
03 Sp We'
FEB — 20 Room 100 F�{ 3
s �'�'�tr/w� . zv t
Nprtha'nipton, MA 01060 Two Sets of'S r t' Ir k , j
E phone°`41�3-58�-1240 Fax 413-587.1272 PlottSlte
r. S
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION `l ,
1.1 Proper Address: This section to be completed by office,° '
Z.f b T°7 L v+(s.S'T c. A p; Map Lot Unit
Zone Overlay,District
Elm St. District ce Disttl,Ct r
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: f^
�µi.. �S� yLT [/L1�►�A J LA .�.t /To
Name?in' Current Mailing Address:
rte �f-
Telephone
oignature Z-3 � ZF
2._2 Authgrized Agent_
�•4— & ,.,/ _ Jb ✓�-� vic c LAC-►-tsll-L /try
Name(Print Current Mailing Address:
Ll ' 7-7-Y
Signat Telephone
SE TION 3 • ESTIMATED GON$TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �p , -- (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) / / e70 Check Number �-
This Section For Official Use Only
Building Permit Number:— Date Issued:
Signature: ---- _
�_ Building Commissioner/Inspector of Buildings bate
File#BP-2003-0658
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center (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 4141f;7
Typeof Construction: REMODEL BATHROOM
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
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 Co 'ssion
y Z o
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-2003-0658
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28-013 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2003-0658
Project# JS-2003-1084
Est. Cost: $15100.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sq. ft.): 390733.20 Owner: LOSTERT KIRSTEN&MARA SLANSKY
Zoning: RR Applicant: Oliver I se I i n
AT. 256 SYLVESTER RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:216103 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/6/03 0:00:00 11047 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
256 SYLVESTERRD BP-2003-0658
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28-013 CITY OF NORTHAMPTON
Lot:-001
Permit: B u i I d I ng
Category: BUILDING PERMIT
Permit# BP-2003-0658
Project# JS-2003-1084
Est.Cost: $15100.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sa ft.): 390733.20 Owner: LOSTERT KIRSTEN&MARA SLANSKY
Zoning:RR Applicant: Oliver Iselin
AL 255- S","LVESTER RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTON MAO 1060 ISSUED ON:216103 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM
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:,,M,C e3 &1 10 Rough: . ' House# Foundation:
Driveway Final:
Final: �� �3 6�/Final: ylls/d3/ Rough Frame:
�✓J
Gas: Fire Department Fireplace/Chimney:
Ins::iation:
Rough: nil
Final: Smoke: Final: 0 K q'911"0 3 '�v►�o
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy-'
� � si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/6/03 0:00:00 11047 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo