The URL can be used to link to this page

17C-085 ¢ttW-f n�. F�° �`= °tip GAL) of 30Z tljaliiptoil 4 � E �145aA(Ilnc(tI0 __ © DEPARTME1,T OP BUtLDr)\G INSPECTIONS 212 Main Street "Municipal 13uilding Northampton, Mass. 01060 {liccusccJperrn)ttcc) ----- __. _ -- ��tl� a principal place of business residence at. (stTr...t/ci tylstaic�a p) do hereby certi_f);, under the pains and penalties of perjury, that ( ) i am an employer providing the follovvint� WorkCT'S comocnSLJo, cove:ayc for my etuployces wor:,ng on u11S)ob (Inns C-- C o M (Pohc-, Nu--airr) ---- (r:pirauor, Date) ( ) I am a sole proprietor, general contractor or homeowner (cucic oae) znd have hired the contractors listed below who have the follo�vinQ workers co yen aon pe!icies: (NIlmc of Coi1t::!c-,o:) (tnR1r371C Coinpa-nyii GtJC UITlY;) ?:i)li .ink D. tc) (N=C of Contractor) Ras-u cn c Company/Podcv NtDcrr) (Exp.r Lion Date) (Name of Conzracto,) (I.asurancc Compare}•/Police Number) (E\ptruon Date) (Name of Conu-r.Cwr) (Imumnc-- ComP,auy/Pohcy Numbz-0 (E,�i_l-aloon Darr) (taach arSdil;ecil cxcl if oc�..^;co�xtuc�iaforn�on perlainins W aL oaa7c G4;,j I am a sole propnetor and have no one worL-�ng for me. ( ) I am a home owner performing all UIC work r IDYSC . NOTE:plc- Lx e lc tL,,,kU,c bcc co mw-r-3 wuo cmplay pcsoo w 63 �z c -rte c rcuu-ork o-'d"e1L.z of oat mo(c tt a t t^utr w ulic`t the ta:u -ucr rc�&d or oa Lc pout c: zppurtct -t1> a c nx n :U:o ocrJ:G—d to b --1ploycs u Y^tb ..izid o pcclico Act a{ Ucaiiw by n bau�vvcr fct c l ou,c a permn n_y c,&-zoc t!`c Icgal ctna. of ea CMVIOY r under dv Wocic�g Comb miiip A. t- 1 t-n>evpy of tbii avemcm m y t»foew.vded to tbo of lr>dsu.•.ri eJ A dam'Otfioa of lrr---ror dm covmsc Vmfr_tioo n.�d llu L•ilv-rc to scauc covctasc uculcr scct�oo 21A of I.SoL f S7 can{ad to the i'z'�Q�oo o(�'v�n'1 Pca-itti° oomi3ln of a Cane of up to S1,300-00 andN-Lapri1o=),=t of up to one year ezd aril pca.Itia�o d)c fc m or n Stop Work Order end a fim o(S 109.00.day tpia-.1 t>Y For dcy�ttnr_'.�1 u.c only -- /O — Permit Number w� ---/L %G✓ i?/ 1 Z®a o i.�p;: Sirnatttn ccnsc lc muttcc —fie C' 1tN'. •CONS T RUGTICN SERVICES ` o.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder: 1whol �� 1 �7a Oro License Number Address Expiration Date ",,�2 W-3 �z?6 - yoos�- Signature Telephone Not Applicable ❑ 'j,11 Y1 zyr, i` U 20 rte, Company Name Registration Number Address Expiration Date QS 11-14 0 'J63 Telephone W5 SSG, 1,/doS' 5 C"fIQN 14,WORKERS'CCMI*EN T'ION INSURANCE AFFIDAVIT(M.G.L.c.152, ."5C(I;S} 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. 'gned Affidavit Attached Yes....... ❑ No...... ❑ 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 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 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing j Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: ST2!p 60n., A!=P A" 1.r0,72& zja Q546A& viva IF Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement - Yes No Plans Attached Roll ❑ • Sheet❑ 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 . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a r OWNER AUTHORIZATION -TO BE COMPLETED WHEN QWt�M FR4,AdW *,doNtRAcTok,APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 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. ned under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date r 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 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 k 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 4 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 k' 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: w a d ,F, " ' _ City of Northampton z` 86!iOng Department JUN 2 1 20M . ,,2 .2 Main Street =Room 100 ha pton, MA 01060 8; -1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SU"R 4-SfTE INFQRMATIt?N 1.1 Property Address: L 4 14)(1%q S7—/369/ Mgt �. MR Sir, Slwl TIQN 2'4fiOPERTY QWNERSHIp/AUTIiOiRI EQ AGENT 2.1 Owner of Record: ame(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone GTi N� 3 ESTIMATED N C" Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Tota[Cost,of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) Clee}"N#a�mber _ TNais Secti�rri`For OffNcNal Utid' 4,14d Permit Nurriber* ; . . "date"Issued: Signature: Bonding Cot6missiaherllnspector of Buildings Date 67 HIGH ST BP-2000-1169 GIs#: COMMONWEALTH OF MASSACHUSETTS iVlap:Block: 17C-085 CITY OF NORTHAMPTON Lot:-001 Permit: Building Categ_M:roofing BUILDING PERMIT Permit# BP-2000-1169 Proiect# JS-2000-2053 Est.Cost: $1440.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: William Turomsha 000515 . Lot Size(sq.1): 6403.32 Owner: LAWRENCE MAUREEN P Zoning.URB Applicant: William Turomsha AT: 67 HIGH ST Applicant Address: Phone: Insurance: P O Box 141 (413) 586-4005 LEEDSMA01053 ISSUED ON.6121100-0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE ROOF 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 6/21/00 0:00:00 10730 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo