17C-124 (3) 188 8" _
3 1t
152 4" 12"- 24"
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4.DISH-IQ R3633L
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67$" ( 12`x---2 it 4 " 36"
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All dimensions_size designations This is an original design and must Designed:2/12/2009
given are subject to verification on not be released or copied unless Printed:2/12/2009
job site and adjustment to fit job applicable fe as been paid ob
conditions. order plat
2050018.kit rE,13 Drawing#: 1
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w%J
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All dimensions_size designations This is an original design and must Designed:2/12/2009
given are subject to verification on not be released or copied unless Printed:2/12/2009
job site and adjustment to fit job appliicab fee has been paid or job
conditions. order�etl.
2050d01 S.kit El 12 Drawing#: 1
Corey&Rise Fox
68 Sheffield Lane
Florence,MA 01062 1371'
Kraftmaid Cabinetry 24" 9" 30" 18" 36" 18"
Door Style:Hayward Maple
Finish:Honey Spice „ 52 3-,
—
All Plywood Construction
Mounting Hiaght for Cabinets:90" 1 " 1
18" 3 1 v
11 12 Legend
13 1: BD12
q 14 a- BD12
w to 0-GA -R NGE 10= d 2: S(SB4 BUTT)
3: BF3
'e — (BF3)
Z;= 4: EZR3633L
- O (EZR3633L)
0 5: WCA1236L
at customers requeii tall y (WCA1236L)
fillers have been re i oved from 6: WA2436L
row of cabinets A (WA2436L)
7: BD18
installer to move gas line (BD18)
8: REP11/2.90(1-}
(REP 1 1/2.90(L))
9: REP11/2.90(R)
CO i (REP11/2.90(R))
10: BOBC18.FH
d cabinets,for i land need (BOBCIB.FH)
CO i -4 to be p stio ed far enoug — 00 11: 936L
ap away to 011o for counter to o �a (W936L)
overhan ani I leave at leas 12: X31018)
36"pass,thoagh from edge - 4
w 1 W 13: W1836L
36a w o handles o fridge (W1836L)
CSI 14: WR3618
'e ilestone yOur ter top will ne (WR3618)
sr � upport Huth a 12"overhang 15: WOC1836
(WOC1836)
16: B18L.FH
$ (B18L.FH)
installer o close opening 17: B018(13D18)
18: BD18
^h� (BD 18)
t`
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M V
47g -- --52 �J —387 —
76-91'
137W
All dimensions-size designations This is an original design and must Designed:2/12/2009
given are subject to verification on not be releasedAr copied ess Printed:2/12/2009
job site and adjustment to fit job applicable fee d r i.
conditions. order placed.
2050W18.kit Fp i Drawing#:1
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Massachusetts General Laws chapter 152 requires ail emplovers to provide worke s' compensation for their employees.
P: suant to,this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express orIimplied, oral or written."
An employer is defined as "an individual,partnership,association.corporation or other legal entity, or any two or note
of the foregoing en gaged in a)omt enterprise, and including the leg representatives ofa deceased employer,or the
receive:or trustee of an individual,partnership, association or other legal entity, employing employees. However the
owner of a dweLtina house having not more than three apartments and who resides therein, or the occupant of the
iweIIing house of another who employs persons to do maintenance, construction or repair work on such dwelling house
?r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
1GL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or
°newal of a license or permit to operate a business or to construct buildings in the commonwealth for anv
:)plicant who has not produced acceptable evidence of compliance with the insurance coverage required."
dditionaily,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall
.ter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
luirements of this chapter have been presented to the contracting authority."
,plicants
ase fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
essary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
trance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP_)with no employees other than the
fibers or partners,are not required to c workers'co
quiz airy compensation insurance. If an LLC or LLP does have
Ioyees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
idents for confirmation of insurance coverage.. Also be silre to sign and date the affidavit. 'The affidavit should
-rurned to the city or town that the application for the permit or license is beins requested,not the Department of
strial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
)ensation policy,please call the Department at the number listed below. Sells insured companies should enter their
nsurance license number on the appropriate line.
or Tows. Officials
be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
be sure to fill in the permit/Iicense number which will be used as a reference number. In addition,an applicant
ust submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current
information.(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
fit as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filed out each
here a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
oz license or permit to burn Ieaves etc_)said person is NOT required to complete this affidavit.
'ice of Investigations would like to thank you in advance for your cooperation and should you have any questions, '
o not hesitate to give us a call.
ar=ent's address, telephone and fax number:
The Commonwealth of Massachusetts
D,_-partnenat of Industrial Accidents
office of Investigations
6600 `'v'ashinaton Street
Boston, Mr 0-1111
Tel. - 6_7-722 7-_'*0I e,�: ,i06 OF 1477-�,'(:^S>ci r
J_ Fax_# 61 i-/')-:f=tq
.L:
T T
he Commonwealth of!Ylassachirse s
rn- Department of Inaitsarial Acc dents
-- `- - Office oflnvesti-arioj:s
` 600 I�ashin Lon Street
Boston,lkl--1 02III
_ r www.rnnss.aoi/tdia
Workers' Compensation Insurance Aflidai-it: BuildersiContractors,,Electricians/PIL bers
Dr)licant Information Please Print Lesibly
Naine(Businessor?ani2a^on/Individualj: T�
.ddress: Al
City/StateiZip:( (4 A 0 1 Phone
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I ate:a employer with *• ❑ I am a general contractor anal I
* have hired the sub-contractors 6. ❑New construction
�Ioyees (foil and/or part-time). � _/
Z I am a sole proprietor or partner- listed on the attached sheet. 7. emodeliiig
Erayself hi and have no'employees These sub-contractors have S. ❑Demolition
lno for me in any capacity. employees and have workers' 9 ❑Building addition
workers' comp.insurance comp. insurance.*
red.] 5. ❑ We are a corporation and its 10.❑EIectricaI repairs or additions
homeowner doing all work officers have exercised their I L Plumbing repairs or additions
- o workers' co right of exemption per MGL
_ 12_D.Roofrepairs nce required.] t c. 152, S 1(4), and we have no
employees. [-No workers' 13.❑ Other
to=.ine z ce required.]
*Any applicant that checks box'I rmst also 5111 out the section below showing their workers'compe nsanon policy information.
Homeowners who subrn t this affidavii indicating they are doing all won.:and then hire outside cont:actors ust subrit a new afrdavit indicating suc .
Conner=ors that check this box must attached an additional sheet snowing the name of the sub-con=tor and state whether or not tlsose e:�rities nave
cnmloyees. If the sub-contractors have e:rrployees,they rmst provide their workers'ccrrp.policy number_
I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site
information.
Insurance Cotrpany Name:
Policy#or Self-ins.Lic. ;r: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 2f'A of MGL c. 152 can lead to the imposition of criminal penalties of a
Er--up to $1;500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
I vestigations of the DL- for ins=anrce coverage verification.
I do liereby certi�fv under thepains and penalties of perjury thar the information pro-iided above is true and correci
S;_ma Date J
�;1rcral rose or.! . Do,nor write i:n this area, ro be compered by car✓or town a fzciaL
i
i
City or Town: Per-mit'License
Issuin-Authority(circle one):
1.Board of Health 2. a ld:n g Depart:tent 3. CI-L;/Town Cler'K -.EIectrical inspector =. P:ul:bang Inspector
i
5. Oz per
Phone
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �.. . �_ G S a
License Number
2,Z 75 N1 O"'Q S1- ,5 2609
Address Expiration Date
�.-•� �___S r_- s� 4113 . 2.Z►- -7141A
Signature Telephone
9.Registered Home Improvement Contractor: Not^Applicable ❑
&I (-.�; v
Company Name Registration Number
Address �f Z -r T Expiration Date
2cf0 K&W ST..• QS Jm Telephone X13'22i��41q
--r
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152,§26C(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-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 buildine 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 awlicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CJ Siding[t-3] Other[a
Brief Description of Proposed p,C�s
W ork: k' t7l t'R'm- A Ar'CIr G 64 t ET s $ CT U1 UMV s yP�.B-Y 0 w►+l a_ 2
Alteration of existing bedroom Yes V"'-No Adding new bedroom Yes No � /
Attached Narrative Renovating unfinished basement _ Yes _�ryo
Plans Attached Roll -Sheet
Ba.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.
I. 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, 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.
Si nature 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. ZONING 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: 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 ® DONT KNOW ® YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW ® YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'f KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ® , Date Issued:
C. Do any signs exist on the property? YES 0 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 o
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 ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
rSpecr
APPLICATION TO CONSTRUCT,ALTER,REPAIR;RENOVATEOR-EkMbLdH A°ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION i 2 7 2009
1.1 Provertv Address: This section to be completed by office
J
�D 8 Shesietd� Map _ L It Unit
(l(,r D6 2Z Zone ��Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Core 4 -Po X E L V
Name(Pri Current Mailing Address:
,�... �-�►l � - �'�lo�3550
Telephone
Signature
2.2 AuthorizedApent:
• G��R.rt'� 2'Z 3 ba An N S. . Limos N A
Na� Current Mailing Address:
"13 - 2Z1 - -7 LA I)
Signature Telephone
SECTION 3-E§TIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building c�( ` �-� r/'0 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing �y 4wu9p, Building Permit:Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2009-0716
APPLICANT/CONTACT PERSON KAREN CARTER
ADDRESS/PHONE 223 Main Street Leeds (413)221-7419 Q
PROPERTY LOCATION 68 SHEFFIELD LN
MAP 17C PARCEL 124 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction:_UPDATE KITCHEN CABINETS/COUNTERS&FRAME 2 DOORWAYS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 070008
3 sets of Plans/Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
Demoli ' n Delay
20d
Signature o 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.
Slii�r LE BP-2009-0716
Gls ,
COMMONWEALTH OF MASSACHUSETTS
:. CITY OF NORTHAMPTON
Lot: ! PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pern„, Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cttc,, BUILDING PERMIT
Pc:,,I: BP-2009-0716
Proic JS-2009-001060
Est. C S10000.00
Fee: o PERMISSION IS HEREBY GRANTED TO:
Const ;s: Contractor: License:
Use ( KAREN CARTER 070008
Lot 1, 1. ft.): 25003.44 Owner: FOX COREY A
zol ii. 1,B 100 / Applicant: KAREN CARTER
AT. 68 SHEFFIELD LN
ALL)/, it Achlress: Phone: Insurance:
223 11 Street (413) 221-7419 O
Leec A01053 ISSUED ON:31412009 0:00:00
:' :RFORM THE FOLLOWING WORK.-UPDATE KITCHEN CABINETS/COUNTERS &
FF?A 2 DOORWAYS
PO JIIS CARD SO IT IS VISIBLE FROM THE STREET
Ltspc of Plumbing Inspector of Wiring D.P.W. Building Inspector
ulidk� end: Service: Meter:
Footings:
Rc ,• Rough: House# Foundation:
Driveway Final:
F;, Final:
Rough Frame:
Go,: Fire Department Fireplace/Chimney:
Row- Insulation:
Fi,;,,; Smoke:. Final:
T1: : :RAIIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
Af N ITS RULES AND REGULATIONS.
Cc ie o OCCupancy Signature:
Fvc , Date Paid: Amount:
Bi 3/4/2009 0:00:00 $60.002118
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo