The URL can be used to link to this page

17B-006 (10) i 4 u a�..� ',. __. , , . .; � F i �+ � � r. _„ ,.. .„ r, / �� tom,- J �� _ .. _ ;- _ � ,, - �, ,- �' a -� � - -� �, ,.r <" ..-�� - ...,, ,, - -- .� �� y �� .� , ._ r ,; .. .- � _ r,. k�. _. v � ,� _ � . .�--�- - - � �� `� _..�. h nt r�u��21 Q 1 } �; .- ,i i I ,_ 'i �, � � -- �,, �,- � _ �r ,. . ,/._] -hjul,Mb�a �..�. j � �_s r' .. .. _._ t / � - _ f i� E-Z W A N F 7J .WIN� 7/�O/(94A�F- ----------- JJI i i - 1 ; _ t ' i r V�- 7- 7 Aq4-f �. _t <:'� /, ,,�,, . . �I .;r�_ ,�.�. _.'.? 7'7 2'1 0 ,_ r ° 11'7 24'3 �� e ose UP -- 5'2 iM 2'4 tV close '4 Ln j 4�1tAMP�O o�o— o y Jaf wart 11aillpta t e �R+csaxrhasccta DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORTCER'S COMPENSATION INSURANCE All t AVTT i Yze--J LA? r\ 'C with a principal place of business/residence at: 0 L=- �� (phone#) (street/ci ty/statf/2i p) do hereby certify, under the pains and penalties of pegury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Daze) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insmrance Cornpany/Policy Number) (E)piration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Dale) (Name of Contractor) (Insmance Company/Poky Number) (Expiration Dale) (attach ad3itioaal shecl ifnecen-uy to include infomutioo pertaining to all coa> tor,) O I wn a sole proprietor and have no one working for me. (1/�l am a home owner performing all the work myself. NOTE:picaec be aware that while hoarowncra who employ persom to do mjrAc • c�c rsiructioa or repair"Torte on a dwelling of not 020ec than thrro units in which the homooavcr residcs oc oo tic pounds apptutcnant thrcto arc not g=crally ooasidcrcd to be rniploycra under the worker's coQrpcasation Ad(GL152,ss 1(5)),application by a homcow na for a l cease oc permit may evidcaoe the legal tutus of an employer under tic Workeez Compomatiozr AcL I under: d fiat a copy of thix ctntrmcai may be forwarded to tho Dctxirtmcoi of Indzutri d Acrid—&015oe of inauanco for the cov=ge verification and that failure to scc=covetrtgo under sxrica 25A of MGL 152 can lead to tha imposition of criminal penalties comisdug of a fine of up to S1,500.00 aadlor impr isonnrsti of up to ow year aOd civil pca,It c3 in the form of a stop Work Ord and a fi m of S 100.00 a day tgaiwl me For dcpat—W—oaty permit Number Napa Lot# gnature of Liccnsec/pernu e POW, 4.06 TRUCtION SERVICES 8.1 Licensed Construction SSuup'ervisor: Not Applicable ❑ Name of License Holder : f_A�l"T[� L+ License Number D n 4- Address Expiration Date Signature Te ephone :, en�ie�1 Contractor 1,ffiffi PP Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone S,ECT10 X10-.WO.RKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.1. c. 152, §25G(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)familie 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 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(: 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, Sta and Local Zoning Lai s State of Massachusetts General Laws Annotated. Homeowner Signature SECTION`5' DES�CR�PTI��OF�PROPOaSED�I►�ORKt ch s allay licable New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ ew S' s ] Decks [ ] -ding[ ] the Brief Description of Proposed Work: 0 t-4*' 25 v J,— G Alteration of existing hedroom Yes—Z No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 6 If Neva tiousE yin l oir "ddifift',461,a cMUM hou�sW CO lete�tlie.fotlow{I':�: 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? h. Type of construction ,'�� i. Is construction within 100 ft. of wetlands? Yes /No. Is construction within 100 yr. floodplain Yes j. Depth of basement or cellar floor below finished grade 4- _ k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTI,ON'7a „OWNER AUTHORIZATION-TO BE COMPLETED WHEN 01NNERS',AGENT,MR= ' NTRACTOk,0PLIES f=OR: JILDING PERMIT as Owner of the subject proper hereby authorize to ac my beha , in all matter ative to ork uthorized by this building permit application. d Signa ure of Owner 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 and penalties of perjury. 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 This column to be filled in by Building Department Lot Size '—47 A�Cv,,O S A M E Frontage 2 Gc) + S &f.L Setbacks Front Side L: 19 R: _ L: R: Rear Building Height Bldg. Square Footage , 5-S O % 1 Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (� y� volume&Location I ` G)`t L: A. Has a Special Permit/Variance/Findin 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 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 b 212 Main Street Room 100 ' Northampton, MA 01060 phone 413-587-1240 Fax 413.587.1272 Plotz,Sl APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMO_LISH A ONE OR TWO FAMILY DWELLING SECTION'1- SITE INFORMATION This section4to be completed byoffrce 1.1 Property Address: � s Map Lot F n� ;x q s�j s4 Y l' D oll,Zone Overlay Districts f Elm St. District CB Distr�c't SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (� -4-7o l U "C'.1 � 97) *nnt) Current Mai A dress• Telephone 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 com leted by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of _Z o Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number D This Section For Official Use'Onl Building Permit Number:_ U" L Date'lssued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2002-0140 APPLICANT/CONTACT PERSON PAYNE ANDREW&LORETTA ADDRESS/PHONE 470 BRIDGE RD (413)584-1686 Q PROPERTY LOCATION 470 BRIDGE RD MAP 17B PARCEL 006 001 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: CONSTRUCT DORMER TO EXPAND ATTIC SPACE FOR BEDROOM/BATH New Construction Non Structural interior renovations Addition to Existiny- Accesso Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOL19WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN19JU4ATION PRESENTED: Approved Denied PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan OR Special Permit and Site Plan Major Project: Site Plan OR Special Permit and 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 Z&�� Signature of Building Wicial 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. f » BP-2002-0140 G1S#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: alteration-addition BUILDING PERMIT Permit# BP-2002-0140 Project# JS-2002-0230 Est. Cost: $13600.00 Fee: $70.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq. ft.): 74052.00 Owner: PAYNE ANDREW&LORETTA Zoning:RR Applicant: PAYNE ANDREW & LORETTA AT.- 470 BRIDGE RD Applicant Address: Phone: Insurance: 470 BRIDGE RD (413) 584-1686 O FLORENCEMA01062 ISSUED ON:819101 0:00:00 TO PERFORM THE FOLLOWING WORK.CONSTRUCT DORMER TO EXPAND ATTIC SPACE FOR BEDROOM/BATH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 8/9/010:00:00 130 $70.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo