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17A-059 (3) nT �O id of Poa.-iljumplolt V = = Q E �ta:IsAchnccI16, _ W o OEPARTME14T OP ©U(LDP\,C INSPECTIO1:S — 212 Main Street ' Municipal Building Northampton, Afays. 01060 WOMCER'S COi'VENSATION LNSUR CE AJIFLDAVi7' (li ccusu/pern�i flee) \with a principal plat.- of businessfresidefce al: (scrUci ty/slaicf-P) do hereby ccaA;, under the pains and penalLieS of penury, ?hai ( ) I :man employer providing the following worker's colnncnsa:Jo , covc,2^c for Ins employccs worJ�ing on this job (Lnn:n,2c-- (PQLIC-; N yaixr) -- ;oir uor Dzl^) ( ) I am a sole propnetor, general c000-actor or homeowner (cl-cic one) and hzve hired the contractors listed below v,-ho hzve the foUo%VU* g woFker`s cow en non pokiest (i+am: of Co^.:�.clo�l — - (In�nnc:. Comoan)•lt"'cuc, Ntun'�-=;) �r:>:;tiny::oa Datc). of Contra.-tor) --- (lns,tranc:. Comoa-ay/Po!icv \uc��rr) ,ir;ion Date) (Name of Connacio,) Cmsuranc;. Compao)-RoUc). Numbtif) (Ex pir.-ion Dare) (T`alne of Coon,ctor) (Lasuranc-- Comc-a- yIpohcy Numbs) (Ex�iJalion D'ac) (n�c 1 i ocil t'.kC !o<ci,y to n u �(o ry oa pctaains .1J ( ) I am a sole proprietor and have no one working for me ( ) I am a home o\vner perforTning all the work myself. NOTE:plcsc be—a rc tr,,,�1 Jc bcmroµvm ubo ccaplay pcz- n t.o clo M.=+, acr, win c rruv..oric d..cil_z of not most for Linn--v=i'a in ubi the 6C c�Avcr rcvdc o<oa the v-ound,2pputtcn_r=tbc,en LT ox c��_Jlv ,o t- cnvloy,n unr-the.jai. I -lino Art(GLI52_n 1(5)�zpplic bon try e hoatcoava far:L=a:c u permn n`y ono tbti Irgzl rL,n of—cz,loycr under d-Wok—,,Co�n M_- 1 un.dcM. d dw x oopy of thi.-r cm oa..y bo foc-mvdod to tbo Dc'portmco2 of Off,—of I,u,r•000 for dm covrrxSc vv1[caboo a.'td Llu L•iltac to sccztrt l-ovcrMsc under section 21A of MOL 157 can lad to the imposition o(crimio.tl pcnnll.i- oomLs,, g of►fi«orup to S 1-500.00-ndlac imfztsaouxni o(up to ooe ycur end OtiiJ pca hio in be form o(.Stop Wort Order and s fire of 5100.00 dsy cFpinA me For dcpY-iJ u.c only pernut Num cs I Lot Si of crmittcc —63Ee j � h SECTION,$ CONS�'RI�iCTION S�RYiCES 8.1 Licensed Construction Supervisor: Not Applicable►❑ Name of License Holder � Qs� to�v License Number LP Address Expiration Date SignaGT Telephone 9..` •,° r. .ri � "r r � ��.. F Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTIOR,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....... ❑ No...... ❑ �.1. ��arne�Ow;ner��xemph©n 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 Massaohusetts 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 i S ION 5-...D SC. T N OF PROPOSED WORK(check alLsippficabije : New Rouse ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding j ] Other[ ) Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll o- Sheet 0 s, ,. #-(v . E `use a`n8'or:ad`ditio :_fo e" isfrn .h°au in com l'e a #hb fo lowin lt a. Use of building: One Fan 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 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, c 11 A&CF5 4 44 rcAV, - icy!f L Z , as Owner of the subject property hereby autho ze C V � �0PU S l d'2aC-TL(��f to act on my b0i.alf ' all matters relative to work authorized by this building permit application. // O i of Owner Date i I 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. Signed under the pains and penalties of perjury. Print Name "'\I Signature of OwneslAgent Date a 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 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 212 Main Street - m Room 100 Northampton, MA 01060 t .� phol1C 413-587-1240 Fax 413-587.1272 Po: Site 1, ns. �. APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING b SECTION 1-SITE INFORMATION yTh►s sectron to be completed tay office 1.1 Property Address: Map, Lot unit Zone O'veriay Di trict b E!m St:District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ Name int Curreat&ling ss:Z Telephone Si 2.2 Authorized Agent: rod (Print) Current Mailing Address: — — -�T Si Telephone SE_ CTI66 ESTIMATED CONS UCTION COSTS ys' Item Estimated Cost (Dollars) to be off Zal Us- y = 6-ompleted by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing' s � _ guildingPe rmit Fee s:a, 4. Mechani+`(HVAC) 5. Fire Protection I 6. Total (1+ 2+ 3+4 + 5) 1 Check Number —' j fhis Section ;or Official Use Only i Building F ,rmit Number Date Issued: .-,% h �� ' St nture # ; g BUitdln" CO" 1 Date B. [1fiR1 finer/lnspe�.br of Buildings-, 3 >` File#BP-2002-0352 APPLICANT/CONTACT PERSON CDT CONSTRUCTION ADDRESS/PHONE 158 NORTH MAPLE ST (413)585-8677 PROPERTY LOCATION 204 NORTH MAPLE ST MAP 17A PARCEL 059 001 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 Tvpeof Construction: NEW KITCHEN/BATH(EXISTING) COVER PATIO W/WOOD&REPLACE EXT DOOR New Construction Non Structural interior renovations Addition to Existing AccessoKy Structure Building Plans Included: Owner/Statement or License 003666 3 sets of Plans/Plot Plan THE FO 'LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O ATION 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 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. .E i r f t Or t� t *4 � 204 NORTH MAPLE ST . - BP-2002-0352 Gis#: CQN WEALTH OF MASSACHUSETTS MR:Block: 17A-059 '"ITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations .) ILDING PERMIT Permit# BP-2002-0352 Project# JS-2002-0530 Est.Cost: $18000.00 Fee:$90.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CDT CONSTRUCTION 003666 Lot Size(sq.ft.): 7230.96 Owner: MCCARTHY CHARLES E III&KATHY Zoning:URB Applicant: CDT CONSTRUCTION _ AT. 204 NORTH MAPLE ST Applicant Address: Phone: Insurance: 158 NORTH MAPLE ST (413) 585-8677 Workers Compensation FLORENCEMA01062 ISSUED ON:1011101 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW KITCHEN/BATH (EXISTING), COVER PATIO W/WOOD & REPLACE EXT DOOR 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:fi'/,'b��r � 'i's3 Rough: ! House# Foundation: Driveway Final: Final: L?� �� Final: 81131b2 ~ Rough Frame:Qk //" /�•©/✓�' Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: FinaL6 K g-0-706..g THIS PERMIT MAYBE REVOKED BY THE CITY OFN - HAMPTON UPON VIOLA ON OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc urLs Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/1/010:00:00 4054 $90.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo