32A-035 (6) i
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7'-7- V-61" 6'-6r r-sj" 111-6j"
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SECTION 8-Cd1iIqTRUCTION SERVICES
8.1 Licensed Constirbiction Supervisor: Not Applicable t
Name of License Holder
License Number
Address Expiration Date
Signature elephone
.Realstered Home lm rov ment Contracto Not Applicable
Company Name Registration Number
Address Expiration Date
ephone
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...... !
11. - Home Owner Exemption
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 1083.5.1.
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 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 res onsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local g Laws a d State of Massachusetts General haws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement ndows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[[3] Other[CA
Brief Description of Proposed (r �WIAV� 13a I�.&—dL
Work: 'Q�cwtcVC at-0 (c 1JCJk4c'� CD�i�r i°S� �►sS`("D 6l Y � (�t'ax--_ .) CJ QS 441UL L ""-> 9b►(, '--
(17 'Vaon-. rZ.F_rL.4 p
Alteration of existing bedroom Yes V__1'No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No �f� 1`�w tNl,✓ W
Plans Attached Roll -Sheet
6a. If New house and or adMion to existing housin-g, complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of her
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. asscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is nstruction 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 Sup y
SECTION 7a-OWNER AUTHORIZATION-TO B COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FORBUILDING PERMIT
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this buil ' g permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and information on e 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/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
N4 C"AO 1!{G To Existing Proposed Required by Zoning
10 1 This column to be filled in by
u j
+� 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 Q DON'T KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO M
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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Department use only
Q City of Northampton Status of Permit:
DBuilding Department Curb Cut/Driveway Permit
9 241k 212 Main Street Sewer/Septic Availability
SEP ' Room 100 Water/Well Availability
hampton, MA 01060 Two Sets of Structural Plans
plumbing& 87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
-4-1 C.t-Ce1z-g:-C S-rp- p--T Map Lot Unit
Ito/L-r.}.> ,� N^ P -�``�N >✓1/I A'
o 064 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: {
R m t44,7- > r>.
Name(Print) Cum t(aili�gA�ecss-
Telephone JJ
Signature
2.2 Authorized Aaent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building # (v/ O CC> (a)Building Permit Fee
2. Electrical ( o p o (b)Estimated Total Cost of
i Construction from 6
3. Plumbing $ cs O V Building Permit Fee
4. Mechanical(HVAC) ^�
5. Fire Protection
6. Total=0 +2+3+4+5) (°� 0.0 o ----- Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature: S
Building Commissioner/Inspector of Buildings *40%— Date
.1 \M\
SEp �9
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File#BP-2015-0328
APPLICANT/CONTACT PERSON LLOYD RICHARD&BINDA COLEBROOK
ADDRESS/PHONE 8 FOURTH AVE NORTHAMPTON (413)586-5425 Q
PROPERTY LOCATION 71 CHERRY ST
MAP 32A PARCEL 035 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out / h/ JU
Fee Paid
Tyneof Construction: REPLACE KITCHEN CABINETS REPLACEMENT WINDOW&DOOR
New Construction _
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
eolition Delay,
fie of m
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.
71 CHERRY ST BP-2015-0328
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-035 CITY OF NORTHAMPTON
Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0328
Project# JS-2015-000552
Est.Cost: $19000.00
Fee: $114.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 4660.92 Owner: LLOYD EDWARD E&PHYLLIS R
Zoning URC(IOO)/ Applicant: LLOYD RICHARD & BINDA COLEBROOK
AT: 71 CHERRY ST
Applicant Address: Phone: Insurance:
8 FOURTH AVE (413) 586-5425 ()
NORTHAMPTON MA01 060 ISSUED ON:912212014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE KITCHEN CABINETS, REPLACEMENT
WINDOW & DOOR
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 9/22/2014 0:00:00 $114.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner