17C-119 (4) - - -- - -- -
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29" 212" _
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270 12 - 422-
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_ 337"
29" 96" 772.. - / 24" 44" r 24" 42"' =
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New 8'patio slider door 1636 1636 1636 1536 CR 2436
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85" 48" i__ 462"'
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85" ! 46="
All dimensions_size designations given are This is an original design and must not be Over Designed: 05/22/2001
subject to verification on job site and ecMNOioGIE, released or copied unless applicable fee Fp 1 Printed: 07/25/2001
adjustment to fit job conditions. has been paid or job order placed. Drawing#: 1
- --
Scale : 0 1/4" = F
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_ 85" 48" / 462"
- 1792"
85" _ 46 _
All I
subject to verification on job designations t givden are TECHNOLOGIES LOGES released orocopied unless applicable able fee e Over
1r Printed: 07//25/200101
adjustment to fit job conditions. has been paid or job order placed. Drawing#. 1 C
Scale : 0 1/4" = 1'
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B B JR asa itch 115Ctta'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATTON INSURANCE AFM' A.VTT
I, �y L4 vk lie e.
(li censerJpermi flee)
with a principal place of business/residence at:
3 S EWL, t c_L C T�? /V6r7`4a.n . ate x'14, (phonell) S'$y-/off`•��{
(s tr eet/ci ty/scat e/u P)
do hereby certify, under the pauis and penalties of pefjuly, that:
X I am an employer providing the following worker's compensation coverage for my
employees work--ng on this job:
ceniva 'A G w d. ht✓ �yA3yg,1oo ? zo0z
(Insurance Company) (Policy Number) (Expiratfon Date)
(� I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below w o have the following worker's compensation policies:
WA A aVae I-nv c e-
690- AYM k14-9 4111 e SSA 9 y oz
(Name of Contractor) (Insurance Company/Policy Number) (Expirrttioa Date)
6,2
(Name of Contractor) (Insurance CompanyRolicy Number) (Expiration Date)
(Name of Contractor) (Imsurantx Compauy/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(snag additioml 1hcct if noocm.ry to iacludc infocmatioa pcx�to all omtrnctors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo bomcowncn who employ per:om to do maim m=cc,mastuctioa or ripair work on a dwelling of
not morn thin throe units:in which the homoowner resides or on the p Quads apptutenant tbado an Dot gwcrally oomidcrod to be
cavloycrs uty5cr the wmikez comp=s4ca Act(GL152,=1(5)�application by a homoowwr for a tioc=oc permit may evidcaoe the
legsl rtahrs of an employe<under the Workeet C.ompomaiion A L
I undcremnd the a copy of this etatemcni Dray be forwarded to the Depertoxn2 of Indzishial Aoci&n&t?ffioe of Imus*nce for the
oovcrago unification and that failure to sw=coveaago undcr section 25A of MoL 132 an lead to the imposition of criminal pataltiea
oonsitt mg of a fine of up to$1,500-00 ntxt/or impris�of up to one year and civil p=16cs in the form of a Stop Work Order and a
find 01 5100.00 a day against me.
For&Pgnrtmt-W tsao only
permit Number
—_���,,�•� MaV/ Lot#
i•<. ;:: Signature of Li e
i
��ONST�RU�G7i0"NS1;R1%IC�S��� f�
8 1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 0 vi/Cl n La 1/a!/e e, C'S U 7h 19
License Number
3G ,Servrc� Ct,o, .3.24 - 20104
Address Expiration Date
xo" 2q
Signature Telephone
� ere_-,ff t5ontrwactom `' Not Applicable ❑
Company Name Registration Number
Co�s�ia C�rfo�., W aOG�wor �cN+�_ I PA04 5
Address Expiration Date
3G Service SIP. Jet tie ,d{oh Telephone SMf l P4f �! ` ;100,2
SECTION'10 WORKERS' C0MPENSATION.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 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)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'S DESCRIPTION OF�PR0P0SED WORK(chEeck all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) (( Roofing ❑
Or Doors X
Accessory Bldg. ❑ Demoliti-on❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: a rakc e. k1/' 4e n r,el d eta,- s G h c der 4 roroay S too/0
Alteration of existing bedroom__Yes X No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6awlf,.New.hou"se arid`,or:addition to existingjhou`sirig, compI6tetitheJ611 hk:
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
k. Will building conform to the Building and Zoning regulations? -Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION;?a OWNER AUTHORIZATION -.,TO BE COMPLETED WHEN
OWNERS;aAGENT O;R CON7RACTOR:APPI:IES FOR°BUILDING PERMIT
as Owner of the subject proper'.
hereby authorize to act
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Sfae V/'oo`e r as Owne Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to t e e
knowledge and belief.
Signed under the pains and penalties of perjury.
�,l
Print Name
Signature f Own r/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
N� 6h 7,43M we G'JO IeK a y 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 I
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 _ X YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO X 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:
E C E Q U E c)2 :1 f Northampton S s o Pier 'ft '
ng Department Curly ista#Ip e
JUL 3 0 2001 Main Street wer/se #,csA ai ail x
oom 100 Wa#er/Well �vaila �I
Ncrtharnpton, MA 01060 Two Se#s of _ r c ri a s
DEPT OFBUIL t 121IRCra -587 1240 Fax 413-587-1272 Plot/S to Plans
O�DI
NORTHAMPTON,MA 01060
OtJier Spec�fy_� .� �y
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION1
This section to be completed by office
1.1 Property Address: /
Gl L�4 n Map
Lots v� Um#
rlAre+r �e Zone Overlay District d
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _ �
ame(Print) Current Mailing Address:
Telephor ^ r j
Signature lam! 14
2.2 Authorized Agent:
.S-�a,• ,droolter �Y Sti���'ie/d Cti.• 2.
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 1?n 000 (a) Building Permit Fee
2. Electrical S', 000 (b) Estimated Total Cost of
Construction from 6
3. Plumbing I&3,o ea Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) , 000 Check Number 5
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner,linspector of Buildings Date
File#BP-2002-0115
APPLICANT/CONTACT PERSON ALAN LAVALLEE
ADDRESS/PHONE 36 SERVICE CENTER (413)584-1224 Q
PROPERTY LOCATION 24 SHEFFIELD LANE
MAP 17C PARCEL 119 001 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: RE O EL k'ITCHEN ADD REAR SLIDER&ENCLOSE_FRONT STOOP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077198
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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 PERMPC 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
Signature of Btading OffFtiat 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.
.a
_.
__ _._.�. .� e.
_:
x
F
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_. .._,. �`." _� :"�u?. . ". � '�".�_� _ ;err+.:� �.
24 SHEFFIELD LANE BP-2002-0115
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 119 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2002-0115
Project# JS-2002-0168
Est.Cost:$35000.00
Fee: $150.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group: ALAN LAVALLEE 077198
Lot Size(sq.ft.): 20778.12 Owner: DROOKER HAROLD&NINA
Zoning:URB Applicant. ALAN LAVALLEE
AT: 24 SHEFFIELD LANE
Applicant Address: Phone: Insurance:
36 SERVICE CENTER (413) 584-1224 O Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:71311010:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN, ADD REAR SLIDER &
ENCLOSE FRONT STOOP
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:
Ro Rougb: ' ,°w,i , j'=;j House# Foundation:
Final• 111 Final. ,
t>`Z• rZ04 >�ukgh rame;�C /3'G j • ��
. 7
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation d 3�(
Final: Smoke: Final: n•K 1-1
THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VI LATION OF
ANY OF ITS RULES AND (�ULATIO S.
Certificate of Occupancv sip nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/31/010:00:00 1848 $150.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272.
Building Commissioner-Anthony Patillo