Loading...
10D-033 (3) I'M rylg sT �.pD I Apo u ' 81(L`5 y s�, �c o� Q ALUS7 y"s4�1cc� �3o-n'or� BOARD OF BOLDING TIO License: CONSTRUCTION S AvISO Number: CS 021069 Birthdate: 06/04/1957 Expires: 06/04/2008 Tr. no: 23789 Restricted: 00 PETER J WINDOLOSKi ° 42 JARVIS AVE ICJlYOKE, hAAA 01040 CommissldaN' ' 04/30/2008 NBD 10:51 FAX 1 413 247 8338 Rugg Building Solutions Q004/004 UNIVERSAL FOREST PRODU Fax:4133235257 Mar 18 2008 11:03 P. 04 JIM i Tnrt ype � IM5A. 119 08030288 T2,GE CABLE 1 1 J Ne rslsal PO O 1AA. 7.0304 JM e w os _1 6-" 12-0.0 1 1 fi p e-0�O I e Ot) 1-ao rowci I . mr r ar r . y' I.re(It bM it 1 ] >TJ 1 � A 4M � 1 7 i ] N �= sAM 9tAN Kr a+a • 12-0-0 TCLI • > BPACNG 2.0o GIN oim i In pa q udd Ud PLATES GRIP Pb1�Mia�ae VIS TC 0.49 Ven¢.L 4).02 B f* 4*0 W20 1971144 Luluwtmc+e�e 1.19 ec CM Vwq'rL) 1.9.00 B nff e0 .0 ReP;G»M9K7 YES wa 0.15 Hoary 1 0.00 7 No A Dom 1 0D Cods W2=1P120D2 Oti41Wc) I wont 35b 1 LARiIBERi 1 TOP CHI 2X 4 SPf Not TOP CHORD SRNCwd or"4 0<pates BOTCHOFO 2 X 4 VF Nos eDT CHORC RlOid coa�9 dre>dsY 81 Ore 0 9 oc Cracln0• OTHERS 2X4SPFSkA REACTION6 4 MUM-".lowam-a0.11°414M.",S aGW12-" Nax laa/ 7a429(LC 3).10s42MX 414=3A4(LC Z.9=703"3) lGFD N-I Tendon LOP( iD-1-1:affi1.2.1+� 3¢64/684 181i�J�5B�4B/86.67`--6V13$,7.e>W WTCW@FO S.4"4V/ 4. W sm.9-1�3tjM.74P,8 73 vm" 4-10-1a1N3,S1 1192.60-M4t123 Norm- 1)YYiM ASCE7 409aIpIS 7Cq BCOI'SAPJ�CirD!3f to l era for spacAiM. XWj ft wp-W;L nbW moomwtoomsf 79 71i6viis_dnivlsOfO�C Ck►.._._..____ ..._..-. --d.............. ... 2j TaNdadplwdit,wmdWW wePl.ned*w sow OaesawrtM C,VStlelly�.it �aK�S1N�dxet eEnaoamir I44��1Nlbtlrr�pdinpar toads l+aw oohs mdbe bad a(2A.o pit m2A0&Td3 tmotbaa a=Z pSqm ftoftM s�witl�0"We mbbe"Noboad.[of GNP WKIL• __ As ,bs a 10A pO boMM MW In laid flM0onp111M1k+si1 wgi Wlertiry bads. trMnol ief��sdp DdeRxPOA°otla�han�n0+� ^ca�a�s R{slhse 'oftne talxtaAOrb ir�asaa P� � b axantior Rsele 4eomta. 0]Q491a wgrtrn a0ldbRwlK UKWwd beaft (b161eriva•goad 11 o awrrAOw noaly muted b corned"WIG baartnp wlana dwb uPWlat j ij z and 7. 1t>)DaeH25S�P+msaa>o- �saawarrssaae.d.pwehdaemu�l6aeA11a11.Md9. w : Jt�►� anSMl� aalaw 11)QW1v dpy CodawKwozm1ananfelv�oedslwl�dANSVMC go m"em lades 1n wt9►tila 2803 M1waM01o191iNF10 LOAD CA"sardwd i i 04/30/2008 VIED 10:51 FAX 1 413 247 8338 Rugg Building Solutions IA 003/004 j UNIVERSAL FOREST PRODU Fax:4133235257 Mar 18 2008 11 :03 P. 03 job � TmmT" Ply ng -' 08030288 T1GE %ARE 2 1 1 tlevawr FOlpt .MA 0 t � .Im Tu.Mat t :� 2 140: 11-10-0 I 23-&0 4 t11-0� t1.104 I 11-14.0 1-•0.0 HW1M1 I ' 1 1 7 • I 3 I 4M(W t ' w � � I w *a I V 1 ) ) f I 23." 23-" LaAMdW TCLL M 5 SP1►CMO 2-0 0 C81 Dm I in 00c) Md.t Lm PLATES GNP (GrowM9iaw�a) PL9b.0cmax 1.18 TC 0A1 vw*,4 A01 44 rvr 780 MT20 4971144 TCOL ' 10.0 Lmw k,.. 1.15 BC 0.16 VatKiL) -0.01 14 W, 80 BOLL , 00 RtpStt.csira YBS W8 0.11 Hoa(Tl). 0.00 13 rds ah NCOL, i 10A Ooas� z iM ) I - walpht 61 b LUUeL R iLQ/.CtNG i YW CHORD 2 X 43PP Not 710P CHORD Shw##W ore4-0 oC plrlltc. BOT CHORD 2 k4 9"No-2 BOT C}+)Rb 1"d aft&*coy.opGW or 10-0-0 oo Cr"ft Ct"m U46PPShm MOL KwL2a6s(LC 13K11 0.711 YPL3 8-0.�O�R 8 0.24 1�i0.?�1r�f2S 8 0.2W13?t�80.18�.902580.t7�251I1d 60,+�16u28 8-0.1 W109113 B 0 UDR GrAV2s4 2). 3).+ 1).S0.3t5(LG =--U C 2).22w190(Z 2�1�G a i�1C( 7).17 C Y). 3),191 C 0) b 9(L.0 Zl,iT>533t0.0 9),ta+Zl9(LC al.+&-U2(LC s) ON-Ltdd mm realm ImCA0RD 4$+01!61, Ira M AS.*a=OM.se1W32.64*-W+ee.r4+4MI 64.9-M--49M24.10-11=4sle3.l+-iZwM 0.12-13-asrre.13-"xaMi WCH" 24&WY. Z2, QW.21.22.W7.24-2-CM.err.18-W"M.f7-1 ,1947-W7.ts•1emm7,13.15W" wm rasa-laaltL .5 81i1S 6th-18y1C,b2h48YtT7.y. 1/+08 1017a�A1h10,11-1�10818L.1219�M�1H NOTES. t}tMIte/L9fSE AOCp latmpq fI:TCCL.b..Ope�BCDL=S.pnf:taw/ar p:6m���W+eO:Mt+YFR81low•jib r�tl C-C eaerioe�7)zon.:weever tsR aadtaltLStNS.d;LL.nOr< oft 001=1.3i.Tlmftwi1d wbwO1brGCfornMlnh-andtora.9 aed for&WWMmrrmcfm*opmMed. �d i c ' t % .ew CtI 4)X P�SiA Hl�+ ••oak Pa y d:E c wp rdily 6 pL aMmk' ,a � AlioLina.darlowL..dsrrw tstconlidutdbrfMd.s!WL I JaTtlsluMlt.tYtMd.aptwd Oq&W cf dnrodGm1wdOf20AVdar2A0r mali nortwoncrm tw"h6fw On aotds.. hT+lab.a.M.M.eadtMpwd a+oApLticlbacl�oratiwktrdaoaconne�tw�aryoMsriKneoe 17 lna ase pttlt b.o.arwKbr prwAss of . Lnfsrs�oes a t0.�1111.IItlb119 i1d�pwi oOkdlEona k is iMe fllPafl9i6111b ol1h� I Q M plart2ffl&t MT20 wrMrwk9 iJcaled. h 43"wq.tw.m isrws tftosd b4orllp t�cayMe�awwa�249 14�QIwHtSStrtgei09tlMOp- aaw.ao�wcaM+.nA.abaot.wctw»foeN4gwgiY Sau.bupaRM�(si}zanota. ul Or )MM Eitrtee SM.wW atMl..Mam M=M mded b GLmM I bm to bmi%Nam**b uPT&AN,W W.ZZ,22.24.46,17.16,and 15. 13)Ttdt MUM k de*pwd m wa Uro 2003 ifidoalow fluldl.o Caom mmdm Z30M sad rata wv+194odue ANWM t. LOAD CHEW$Wvdaud 04/30/2008 WED 10:51 FAX 1 413 247 8338 Rugg Building Solutions Q002/004 UNIVERSAL FOREST PRODU Fax:4133235257 Mar 18 2008 11:03 P. 02 [Job nra w!7we 011 1-7 MDA Z FINK 14 1 jab rtirdMl ' Pnducib UA. 1 7, ! sk> el,lnc.Tua .M 2008 Pqp 1-0-0 4 11-iD-0 17.42 29.8p �¢gq 1.0-0 ' B-3-14 54.2 1 5.6,2 $-3-14 140.0 os= i i � I 1 MAI M9 i 3 i 1 ' � I 7 . j 1 $1-15 15-0.1 i 23-8-0 8-1-15 7-4-3 8-1-15 Pty 1 lMDW0 T3.L :��� SPACM6 2-0-0 CS1 DEFI, in (IOC) UdsO 4Id PLATES GRea (G Snow 00} dlosast 1.10 8C 0.06 Yari(LL} -0.21 70 X999 200 Ni20 1971114 Ver!(TL1 -0.45 2-10 X810 14O t1IXl OA Aw Step W YES Wei OAS HOl2(IL} 0.11 6 NB A& BCDL } 10 0 Code 0=0M i IM Pte) 0.16 10 >"4 X40 wwot 76 lb LumeER W Acm TOP CHOW 2 X4SPF Na.2 TOPCHOND ShemwW a 24.13 ocp otm. WrCROW 2X4MW 16W I SE BOTC49M Riyidtp�r+q OppBodpr7J•itocEra�p. Wren 2X4wpft4 - REAC7IOW pWi W 9n479M&4.8-14794" Mat Hms2061(LC MatUPOU. 61.0�205(LC7� Msa QWZ-1 21 v=Ma FOli6 -!Rlldnalpl T,7::.a Ta0lbn ; TDP crow t 2=0151, ,84-20541905.4 -233M908,SV—.1362l1014,4.7a0191 00Y CHOW 2.10-4 6f2DA,11121.1Q YYI WA8=7•QZ 106L'6.OpGt mc0L�ApA Cwm a:evC;wK%"9 MWFRS(io.�s)and C C�mix randta wWft/Odd**wtmad,t1mPIOii9asitlslp�.df� am�! vwfw PFt165tAsttooFYwwk CaM4aY p 6oD C: L !adir00paof20.oPSfforz006masAxmoYlcadaDa.ap✓otono 0ysn0a'•mnama+twip,6)TdaealnkaluandapdboomdlanOnhada anommewthaw onbd.hMWbPWAdatmphaNWA- eeanopo►ro n.ndi� rl0.niooccndidow.it ilte mpw,!,ib yaft* u8llrlrtileoalddnla. O;QM Hz,611 Slate=b01p. almfsCbli rtda00aNafsd b almsd6vM a bMlinO raps dusb upORali4s}2 and 8, TG4„N01•ds+ipllto in .+7&4w 2a0s kkMM*mW gaadaO OC*a aft 2300.1 ano nlwadd ae.ndud ANSI M I. LOAD C/1SM Gbnd G 1 i 1 04/30/2008 WED 10:50 FAX 1 413 247 8338 Rugg Building Solutions [A001/004 E wk HATFIELD LOCATION • 24 WEST STREET - WEST HATFIELD, MA O 1088 • V: 413.247.8300 BUiL�t1�1G 1+:413.247.8338 S O LUTI Q S www.RuGGBuiLDiNGSoLunoNs.com Transmittal Date: To: p� { At Fax: From: Re: .--, S S S Total pages including cover:__q — Message: Nbace of co fndeuiality.•Thisfaesimile transmittal is intended for the addressee named in the above section and may contain information that is confidential and/or privileged.#you are not the addresses or if any pages are missing or unreadable,please contact us as.soon as possible. The foregoing is a true copy of the record in 3ook �, Page a , of the Hampshire County Registry of Deeds. Dace + 3 k ~-a ATTEST: uWW REGISTER, Bk: 09348 Pg: 286 r EXHIBIT "A" The land In Leeds, City of Northampton, Hampshire County, Massachusetts, with the buildings thereon, bounded as follows: All that certain lot or parcel of land, together with the buildings thereon, situate on the Westerly side of Main Street and known as 182 Main Street, Leeds, Northampton, Massachusetts, identified as a parcel of land containing 12,100 +/- square feet, as shown on a plan of land entitled "Plan of Land in Northampton, Leeds, Mass, Owner Russell J. Myette", surveyed by Richard J. LaBarge, Sr., PLS, 110 King Street, Northampton, Mass, 01060, recorded In the Hampshire County Registry of Deeds in Plan Book 186, Page 230. Said parcel being more particularly bounded as follows: NORTHERLY by a parcel of land containing 3,500 +/- square feet, a distance of 39 +/-feet to a point; EASTERLY by Main Street, a distance of 375.28 feet; SOUTHERLY by a right of way to a bridge, a distance of 46.82 feet, WESTERLY by the edge of the Mill River, a distance of 403 +/-feet; CONTAINING 12,100+/-square feet, SUBJECT TO Flowage rights (Mill River which abuts locus) as set forth In instrument recorded in said Registry at Book 886, Page 418, and Riparian rights In said River. MEANING AND INTENDING to convey the same premesis as described In deed of Russell J. Myette to Marjorie K. Ebbeling dated January 7, 2004 and recorded in the Hampshire County Registry of Deeds in Book 7651, Page 257. w ATlW: NAM MMU,� MARIANNE L. DONORn Bk: 09348 Pg: 285 ! J 1 8k:0.948Pg:285 Page; 1 of 2 Reoorded: 121141200712:45 PM MASSACHUSETTS EXCISE TAX Hampshire Dlstriot ROD#13 001 Date: 121102007 12:45 PM otrl#019500 18887 Dooi 00030800 Affected Promises: 182 Main Street Fee: $305.52 Cone:=87.000.00 Leeds, MA K N ON A LL MEN BY THESE PRESENTS THAT I, MARJORIE K. EBBELING, of 491 Bridge Road, #2534, Florence, Hampshire County, Massachusetts in consideration of SIXTY-SEVEN THOUSAND and NO 1100 ($67,000.00) DOLLARS grant to ANN MARIE ROBINSON of 142 Jarvis Avenue, Holyoke, Hampden County, Massachusetts vi th QUITCLAIM COVENANTS The land in Leeds, Hampden County, Massachusetts which is bounded and described as follows: For legal description see Exhibit "A" attached hereto and made a part hereof. Being the same premises conveyed to the grantors herein by deed of RUSSELL J. MYETTE dated January 7, 2004 and recorded in the Hampshire County Registry of Deeds in Book 7651, Page 257. Executed as a sealed instrument this /10? day of December, 2007. Wi es 06IE K. EBBELING COMMONWEALTH OF MASSACHUSETTS COUNTY OF HAMPSHIRE December 1,4- , 2007 Before me, the undersigned notary public, personally appeared the above named MARJORIE K. EBBELING, and proved to me through satisfactory evidence of identification, which was a Driver's License to be the person whose name is signed on the preceding document, and acknowledged to me that she signed it voluntarily for its stated purpose. OFFICIAL SEAL .JOHN J.MORIARTY Joh J. M iarty, Public NOTARY pUSLIC ommi Sion Expires:6 9/2012 a p�F p M dw+ � 20 My k. ';• 'Yx.;c t y' t. s .; r `�;, • s6ra'iei , Y' , r i:i"�t�Y:'SMI •*'- �,� _ �w "� ;�tt t „i,:. j � y# 9R�1.,� tt'1�1#:&� '■ y � 4 R i 9 a:, YF Fill.�"(,'^n� n r. �"{4iF� �` r` if j �� :�°WI� �•: �• a- �t i w AT At. i y r }:t r e■ r r z . s v ■ "lR:, W a.:—a a�,rr M• Lz- r', f� y m, % r+lY*� iF rs c{�lrt� t k 1 tt a" ■a i Up F;tr. Eli r i. -` rtk c^hp'ilr,�i+ilj�"-l�ln Y�"}M,a�y t�wa� ■ ■ r �� M..rat�� yll a * w#i r t Wy .. `■ �# Ti , ��. iy �� `. '11[ dd lt!- i �at.�yl,•xl� ' •" •� :. �r r ■•Y •• ��0poi ii ,.'�'�+ z ■. :. R _ .i roc`� s � ,irl ts,ry^� r Ills ■ rsYS ` t . r:: a .• t fElr�'� ■ a t?yt ■•'3 ''Yr.a,�`I i►�-. > t r•} •■ !" ,rte ' .�{ aiE �:y y,4r`.iY t r f • s`dr is ■c a Y # r'xrsi niY 7rli4 mod{ iif a r R`i • i i rw aI"b r# ■ � :` • :• Wo. a pF L >~ �' rn -ash iY Y ■ - f! 91....■ �-_ : Y 'Ytl� -��s# ■i: � Y �r YwF m' y�i`<'�t Y {{P {rt ^r'r r •. -:■ # , * V r `.' • f�. M :��ta...,R�r R-..m�ASW a Pik, ,� M r r' • ::.r :: ■ ■ -: y r a.�'r i- }�,�• i 1 fir?.' � i t ■ .-r! ,r # • a r • •` a a ti i""V rd s Y e'"Mfit�. a• ti' l • r.', ■" 0• •a: i<■ * ■" k* 'R r l mm. M'tn i +nt}.rlr� 'Ifr-• a ? x f �.a r� •a rwaraf*. ■ • i ':�r �' yWyMrt ly"�1 ■ R r: r ■ r` a -!'a # w - ilf wtYi ���'Yc "Wt rya ,{rt r�� • sw r •• r:s •f •a Y r■' s A■- s o r t 'M _ua� • �'i '* • j s • f :: r i3Y • r i. r r: • Y ■ a r ■ ■ # tiiFy kt y aw rw A* # ! ar i':: "■ ti• ■ r; r. ra '� Al y r • ••'. a" rr rY ■# r yA w■ �r "�►� ■?YI "� ■r'. -:•■ •�� "� .y ■ aw {: ■"_ iryy t'-l■tyiY�, tlwj6A :dw . 'rt'[a • .r•�. i t •; ',#± RR �� ** .y'•: k= #: itiMy'1r.1'Y'1!I*�Y kl'w4f}t i �+r y� X40■ lea+ '` ■- '. TM t r •� ■•w w*. r■ tr • '`: ■' s r� �V����1'nik ra����'r,4�1�*"�yta a'■,�'tt_�1��� ■r# '■�' �j*a# `' #•■ ■a.■ •`"!■* ■'"r�. � 4k' �"Ir�nlyii ;ylry r•■�" .s' ------------- • . r • +er " . yr.t r■ kYa •Y ar "` s ■ l... r .:f i�i .: i r: r rs tv -.R •i. ,f■ ��. • .* "r'; • .■*_. 11��ta!`��■t�y"�ti.,*�" M r.Yth s -:a► r*:. .: #�: ■ -i; rr ,: r {t � ,is a�^�n it • • :. f- R ■. • • a # rt - # t F`t b�I sw i",} Y t E ■, i Sy► Rr '■" -:.a r: ■ r r = a ■ * ,• R, '4a l ea''` 'i+ i't` ■ - • • - rA�16L# * ■ • r •■ ift, l�lkll}Ila�l��tutl�rt Vyyti�. t� t• " r r.' • } f � t ali1Y}i,fib ilk yll �P.nt! ".- r r :._. ■• ',�■ ■''1 •�,. Y:■ a 4. ,.." �.M [t l,teaa+qM�'�"+Yr�J`a-r■,Y '�'�fkr ■r .:;R r : r. .s ■!.: ■# ■;! ♦" r r�'. ; " ilFt`�. i �"r?i` � IM ■• it■ ■:w .:. .r. a s ■ L ,. t ..'d� �1:ir w■ r r' r• r!� ■ 9 �; ■ ■ > ■ r rr i rijl IYert �aM • # r • • a M , r '. r a: • ." rr.;, • r #���rti��5�i��''V" a`fi '��� ■# yr ■• � ■ f #y #w )' • ]A • t f w a• � • ..�. M.y r• M w " t r r• . r i •R.': ■ t1F�4 l i�a.k#r 'y■� 1i■ i#■ i w�. rM IY��" "�� ■# :....Rr R W ■ '-: ■ �..., r' 'i1i; t� • r ,�s 411 L-E-P.°_-72�,-E-NT OF BUILDfj�G UI;SPE=I 0-,VS 212llvlain Street 0 Municipal Euildirg NSPECTOR Norrb.Unpum, MA 01060 Y-Tt-VX Ir-n rNAITNTUID The State of Massachusetts allows the homeowner the right under 780CMR 108.3).4 to 101-3-4 to act as lhisIer construction The s*(.a7L-- defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structurtur es. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building-department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construci- o"n ssupervis.-l-, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before back-fill). sonotube holes (before oour). a rouzh building inmection (before work is conce.41ST). insulation insiaection (if required) and-aTinal-buildinginspection. The building department requires these inspections before the*work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occul3ancv until the work-can be insp-ecte:d- If the hc-m eowner hires other trades to perform work(electrical, plumbing& .as) the homeowner will be responsible to make sure that the trades hired secure their proper pe=ts in conjunction to the buildinc,permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DEIAY the project until such time as the proper permits and inspections are made L understand the above_ (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of lfassachusetts --! IleparvnentofInd»-stria.,: ccidents w Oiace o.f Invesrig a.*ions 600 Washin91on Street Boston, _L-1 02111 www.mass a ov/dia Workers" Compensation Insurance Affidati-rt: Builders"Contractors/flectricians/Plumbers policant Information Please Print Legibly Name(Business/Or,-anizadon/individual): ©(JAS �0[--71J. C"�/lJ 7A/c ?address: 14oZ TAa UI S AUG-. City/StateZip: OC Me tVA Phone.-­: Y/2 � ,3 96-2, Are von an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 13 4- ❑ I am a aeneml contractor and I employees(full and/or part-tine). have kited the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling I ship a--d have no e=1oyees These sub-conrrctors have 8 DT. FJ emolifon world for me in any capacity. employees and have workers' 9. Buildinz addition NO w^Terw_=L= nce COME).=nrdn^e.* required-] 5• ❑ We are a corporation and its I0.❑Elect<ical repairs or additions oEcers have exercised,then =.❑ I am a homeowner doing a.II work 11.0 Pluumbin4 repairs or additions myself jNo workers'comp. right of exemption per MGL 12 Roof repairs insurance required_]t C. 152,§1(4),and we have no employees.[-No workers' 13-0 Other Con3p.insurance required-] r�nv aqp scan nert5 oox iF1 nest ago 1W out me se=on 5ERO-W-showing their won='coamensauon policy mformanon -- --- r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contra ots must submit a new affidavit indiraLan such. Contractors tha check this box tnust.at ached as additional sheet showing the name of the sub-cons actors and s=whethc or not those eatiaes have employees. If the sub-conaactors have=npiove-s,they must provide the workers'corm.policy number. I am an employer that is providing workers'compensadorz insurance for my employees. Below is the policy and job site taformadon. r'1 I3- 534.52413 Insurance Company Name: �A 0- I lS IJu -7-5 3 kk Q YY Ain T)-,t J s 1-16 LYeV 8r AA ire)ci U o 1 6a r�.�►�Ms- Policy#or Self-ins.Lic.#: A. I. M . M aTUA L I k& CO. Expiration Date: // r'/ Job Sire Address:_f !;T. n'► , City/State�7ip:- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sec'm-coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1 500-00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK QRDER and a Erne of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Otice of Investi=ations of the DIA for=,,rance coverage vm-mcanon I do here under azns and penalties of perju the information provided above is true and correcL �gnature date: Phone r: f LOther e only_ %,o not x rtte to th..s area,to be completed by cuv ur town of�eiaL wa: —Permit/Lic ense thority(circle one): f Health 2.Building Department .?. Citv/Town Clerk 4.Elec ical Inspector S.Plumbing Inspector r son: Phone.. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder�_4—_T LC7_a / C1 / 9 License Number 149, 190 o l Jo t A*bjw I � . o q`0e AO Exp�n Dat Signature Telephone 9.Registered Horne Improvement Contractor: Not Applicable ❑ Company Name Registration Number 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...... ❑ 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 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-vear 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Vgndows Alterations) Roofing �{ Or Doors 0 Accessory Bldg. ❑ Demolition FA New Signs [0] Decks Siding [V Other[p] Brief D scription of Pro osed Work: h v ,1r W -14 I P J217,11". Alteration of existing bedroom Yes�No Adding new bedroom Yes _�No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete 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. Masscheck Energy Compliance form attached? h. 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. 1. 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, A A�, ��� \ '� 5� V", as Owner of the subject property ` `I (y� ► heleby,althorize to a o my behalf, in all afters relative to work authorized by this building permit apple tion. Signature of Owner Date LJ I N oao--5-0 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. S21mfi w!tiT jLVSh l- ame i Sign-lure-of ner/Agent Date Section 4. ZONING I All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L:J S_. R:A-A L: `.,..' R:_ Rear I O J f / Building Height Bldg. Square Footage 6 cl`? Open Space Footage (Lot area minus bldg&paved narking) #of Parking Spaces Fill: (volume&Location) _.,__ _..... _..,..,. . A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW (2� YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (Rill' YES 0 IF YES: enter Book Page', and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q Date Issued: pC3 .Up'j I)L -17 C. Do any signs exist on the property? YES l NO G( IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the constRK'tinn antivity disturh(clearing, grading, ex9evation, or fillinq)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then-a-Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: t, .Building Department Curb Cut/Driveway Permit ' 21 Main Street Sewer/Septic Availability ( � Rbom 100 Water/Well Availability ' Nof#ha on, MA 01060 Two Sets of Structural Plans phone 411,3--W7-1240 Fax 413.587-1272 Plot/Site Plans' Other Specify APPiCI�ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION -SITE-INFORMATION This section to be completed by office 1.1 Property Address: j �� � ���✓ � � Map Lot Unit Zone Overlay District. Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JAi205 Ad& /-/Q&A,4/13 Name(Print) Current Mailing Address: f..` 411J J�Ll Telephone Signature 2.2 Authorized Agent: 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 �� L'�'U (a)Building<Permit'Fee 2. Electrical ��D�L', (b)Estimated Total Cost of Construction from 6 3. Plumbing `� °yr Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3+4 + 5) LSGb Check Number V ONMO This Section For Official Use Only Date Building Permit Number: Issued: Signature: ------ - -- ---------— Buildmg Commissioner/Inspector orBw mgs - Date File#BP-2008-1035 APPLICANT/CONTACT PERSON ROBINSON ANN ADDRESS/PHONE 142 JARVIS AVE HOLYOKE (413) 534-9734 Q PROPERTY LOCATION 182 MAIN ST MAP l OD PARCEL 033 001 ZONE URB 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: REFRAME WALLS REPAIR FOUNDATION,FRAME NEW ROOF New Constriction Non Structural interior renovations Addition to Existing Accessory Stricture Building Plans Included• Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 Demolition Delay osloler f 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. BP-2008-1035 GIs #. COMMONWEALTH OF MASSACHUSETTS � ��.. CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS pvrn,it: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2008-1035 Project# JS-2008-001141 Est. Cost: $27000.00 Fee: $320.00 PERMISSION IS HEREBY GRANTED, TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 8886.24 Owner: ROBINSON ANN Zoning:URB Applicant: ROBINSON ANN AT. 182 MAIN ST Applicant Address: Phone: Insurance: 142 JARVIS AVE (413) 534-9734 O HOLYOKEMA01040 ISSUED ON.511912008 0:00:00 TO PERFORM THE FOLLOWING WORK.REFRAME WALLS, REPAIR FOUNDATION, FRAME NEW ROOF 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 5/19/2008 0:00:00 $320.006604 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo r 6 vV` ' `` Po�,y Vkf Q f3 AT Fl A14 L--- lS vl ,� -., I! 182 MAIN ST GIS #: COMMONWEALTh OF MASSACHUSETTS Ma :Block: l OD-033 CITY OF NORTHAMPTON L,ot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) cate(,ory: renovation BUILDIING PERMIT Perinit# BP-2008-1035 Project# JS-2008-001141 Est. Cost: $27000.00 Fee: $320.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: (ise Gi-ou : Homeowner as Contractor Lot Size(sq. ft.): 8886.24 Owner: ROBINSON ANN 7_onmg: URB Applicant: ROBINSON Al 162 MAIN S i Applicant Address: .Phone: Insurance: 142 JARVIS AVE (413) 534-9734 O HOLYOKEMA01040 ISSUED ON:511912008 0:00:00 TO PERFORM THE FOLLOWING WORK:REFRAME WALLS, REPAIR FOUNDATION, FRAME NEW ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plunihing Inspector of Wiring D.P.W. Building Inspector t"nder<ur(;uml: Service: Meter: Footings: Rough: (��ough: g louse# Foundation: `J v Driveway Final: Final:/ �a Final: �Z� -D'-Z_Q of Rough Frame: 6 6 6 P Ga; Fire Department T Fireplace/Chimney: Final: Smoke: F L FINAL- olLoq. 09 Lectcs THIS kE1`-%_ .,LI' MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF ANY O'', ITS RULES AND REGULATIONS. f Certificate of Occupancy - silInature: FeeType: Date Paid: Amount: Building 5/19/2008 0:00:00 $320.006604 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 It Building Commissioner-Anthony Patillo