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17C-126 (2) t . � -T C. (°r }i} \ 1 _.._�,......®.�....�.. ._v.,.«.�w��...�...-.u.,....,,.,. ...-a..,...ew.�r.....�.,......,.......:,.. ,:a,..a.,_...,m._ ...-:...._r,....v� .sue::» i �,lGr 4y� _ ._�_.Y..,,_�-- 0.'C• y•-- w L! f1 � CIA JN, r ---- -- -- - -A c- L llrll loss k P'I G 7P4 P >.D ow t JN• °.»� �,r mow......,.+ -::=..� x — s—x• 1-4- t�y\7 V�'l`��/" ��� ;ar �� prt }. �-"3. .,. r.[•�k JN... •'' Fx: *.. +.��? `�'ms, c i 1 t?-Cam/gym. ; . t19 i °l x4, FTzt;' . g i is f } it S w ', C c 1 f i �5 Yom,.' t.� ...-.�.... e.m.,...,......i,.... f T , 4 eL 5 r Ty V- 1 �� 1 F SEP R=20 2001 DEPT Of BUILDING INSPECTIONS N4RTHAmMON. 01060 �7-3 -(ttA1-!P�. �04Oa g $ Crz �rfaz- Ilttiri�tnll ai3EACllttS[ttE DEPARTMENT OF BUILDD\TG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WO -iR'S COMPENSATION INSURANCE AFITMAVIT I , (li�tlxrJpcm]i flee) with a principal place of businesslresidence at: CIO hereby certify, under the pains and penalties of perjtlry, that: O I am an employer providing the following -,vorker's compensation coverage for my employees working on this job: ------------------- - (Ins=can Corup2ny) (Polio Ne nbcr) (Expiration Date) l ) i am a sole proprietor, general contractor or homeowner circle one) and have hired the contractors listed below who have the fonowLQg workel's compensation policies, (Name of Contractor) (Insurance Coinpany,Poliq Number) (Expimtion Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Lnsuranc,� Coiupany/Pofi(-y Number) (xpiratioa Date) (Name of Contractor) (Insurance Comj=y/Poliicy Numb-:r) (Expiration Date) (nttadi additicciil thcct ifneccizuy to inclu&-infocuutiou perta a rig to all 0cttractors) i I ail' a sole proprietor and have no one working for me. O I am a home owner performing all the work myself. NOTE:pica-se tic aware that while hocnco A-Lx '.i6o employ pazonz to cL.zszr-C iorr cr repair woe on a d,Yelliog of not more than thrco units in ub cfi the ho-rouncr ra des oc oa t5e pou.d zpp utcna thc.-d rc noe gc n.ly corm icrcd to be employers under the wort ees ccapcasatjon Act(GL152�-1(5)),applization by a homcow ncr for a liccws cc permit may evidence the 1<gil ctztria of an employes under ttin Woe Icc1a Compensation Act I undcrstnnd thxi a copy of thin ctat.cmcai may bo forwwe iod to tho Dcparta a of In�al A.&.&Offioo of InsZUwoa for the coverage vcrifiication and that failure to sccun oovcrngo undcr SW-ioa 25A of b1GL 152 can lead to the imposition of criminal pcna hcs consiuiag of a fine of up to S1,300.00 and/or imprisonment of up to one yc-tr and civil perialtia in tt`form of m Stop Work Ord=mod a fino of 5100.00 a day agrtirb mC. ///✓ For dcpvtxn—t�l uao only s permit Number ivlap;t Lot tt Sigel tture of Liccn ermitlee --L� e SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: a, - Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 6. g teredHome�I r rroveinerit Cont ractor 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.... \0 No...... ❑ 11:- Home ®wner i,,M—bit' 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 _ SECTION 5- DESCRIPTION°OF'PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes 4� _ No Attached Narrative❑ Renovating unfinished basement Yes } No Plans Attached Roll ❑ - Sheet"N7 6a. If New Muse arid or addition to existing,housing, complete-.the following: a. Use of building : One Family 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 �'� _�t i. Is construction within 100 ft. of wetlands? Yes y 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 4 _ SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property i I hereby authorize Klk, ON 4e Sc to act on my behalf, in all matteaeive to work authorized by this building permit application. Signature of er 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 k 75 Frontage 'r Setbacks Front ! r- Side L: 1 R: L: L— IfF Rear _ { u a Building Height Bldg. Square Footage �� t' % Open Space Footage % r7 �� (Lot area minus bld<�& axed f `—� arkine) 5J #of Parking Spaces 2- Fill: volume&Location)Y 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 # S 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 I sued: 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: 1� T epa " - jl ` . . �n I orthampton StatB�of Pe� ' V r' i Department 2 a i n Street Sewer/Septic atlatt t y m 100 Wa VWell Av I SEP 2 Murth mp on, MA 01060 Two Sets of Ste c u a(''laris phone 4 7 12 0 Fax 413-587-12 72 Plot/Sete Plans �� r DEPT Of 8U1101NGINSPEC110NS Other Specify MA 01060 TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This sectionAo be completed by office Map Lot ' ' Unit fi 1 d �. Zone Overlay District Elm'St.`District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1rOwner_of Record: I-- tL IV`s ��oa,y14� Z �-e - -- �-k 11,t V--._ - - - - - Name (Print) Current Malting Address Si✓Y gnature--- ` ---- -- -- 2.2 Auth ri ed A ent: , 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 i 1. Building /, "' (a) Building Permit Fee ,4 2. Electrical (b) Estimated Total Cost of Construction from 6 _ 3. Plumbing r Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 + 3 + 4 + 5) Check Number 1 T is Section For Official Use Only Building Permit Number: Q Date Issued; Signature: Building Commissioner/Inspector of Buildings Date File#BP-2002-0318 APPLICANT/CONTACT PERSON Kim Rescia ADDRESS/PHONE 311 Locust St (413)584-5816 PROPERTY LOCATION 67 NORTH MAPLE ST MAP 17C PARCEL 126 001 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: ATID SPACE TO MUDRROM AREA&RENOVATE KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 022464 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO YMATION PRESENTED: k'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 Commiss' �j ©D 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. _ _ z Y 1, ONO Loaf {� b It 67 NORTH MAPLE ST BP-2002-0318 GIS#: COMMONWEALTH OF MASSACHUSETTS MgW.Block: 17C- 126 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:alteration-addition BUILDING PERMIT Permit# BP-2002-0318 Project# JS-2002-0486 Est.Cost:$20200.00 Fee:$75.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor. License: Use Group: Kim Rescia 022464 Lot size(sq,ft.): 12632.40 Owner: STENSON ERIK L&JANE R zoning URB Applicant: Kim Rescia AT: 67 NORTH MAPLE ST ApplicantAddress: Phone: Insurance: 311 Locust St (413) 584-5816 FLORENCEMA01062 ISSUED ON.-l0/I/010:00:00 TO PERFORM THE FOLLOWING WORK.-ADD SPACE TO MUDRROM AREA & RENOVATE KITCHEN 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:����6� Aqo House# Foundation: �L S 6'K le Driveway Final: Final: Final: ' ,7� 1-4>1 t Rough Frame: O k j/- /G-p j Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: C� Final: Smoke: Final: Q K THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/1/010:00:00 460 $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo