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24A-159
' Ctrl t of Torf( alts toil 4 Q tc-J aAcI)nccIIa — DEPARTMEWT OP BUILDING INSPECTIONS 212 Main Street ' Municipal 13u11d7ing Northampton, Mass. 010GO NN'O RIa- IZ'S C O YQ'EN S A'n O N CN S URA-N CE A FF M A VIT - %Vlth a principal place of business/residencc at: do hereby cerdi under the pains and penalties of pcgury, t1121 (✓f I am an employer providing the following worker's c0i1locns2Uon covcmSc for my etuployces worming on this job'. (]nsul a Corar ��) (Petit: N�rli> r) (t�:pir uon Datc) ( ) I aln a sole proprietor, genera3 contractor or homeowner (circle one) and have hired the coniTactors listed below wbo have-the fOLOV" S worker's coo?ens2non pchctes: --- — --- i -- .,;� '�ari'�_: �.. �(�-;:auaoon Datc) (Nome o�CoaL:-acro-) (ti_�;oncc Compare}r.cue, ) (Name of Contractor) --- (Ins --Dcec COMD"az-v/pobc�' Nunccr) (-Explr uorl Da[c) (Name of Contractor) (Insuranc: aropa-ayfPaUq N-wnb�,) (Ezpiraon Date) (Namc of Contractor) -- (Insumc-- Compauy[Policf Num s) (Espif-ion Bain) (aaa��i�ocil s'xC if❑cc�:i� to�nc?,yC;:infoc�i.'i oa pcttn�tin6 to nil ocV'r.-GA:�) ( ) I a sole proprietor and have no one working for me. ( ) I am a home owiicr perf6f=' a all the work myself NOTE'plc b aw a7c },,.-r )c bo zuplcry Pc OC o ua�• cam-c .Y c c c,u or o� d 1L=�of c.oc most tti4:...:t`..=r tmij in%I�,G the bomooava'n-aido o<oa Llt, vvjz.;.z�p�:tl.cn:r_'tbc:•cn LT o�:E-�c:Uv cccs:d-cd to LY c;:tployc�unr'.c t_hc.,�i;a's :loo Au(GL15�1(5)�:.ppltai�cn try e hoaicow:rs fc::Lc-�-r«perrnrt try n;d�x tiv IcS�l n-a.of an c=,loy.c uodc dw V1w4.o��Coos�•�son rest 1 unde^,m—d ds,d x oopy of liw z>tvami m.y bo D,,—,-o,of of G�%•a° f tl� ,'e' covmsc v�ilitrlioo aid Uu L•ilt�c co cc�trc covtYasc urtdcr waion 2 S A of htQL 152 c�1r�1�o the c .i°o of�°'1 pcnilrin oocniz•.ing of a firer of up Lo S 1}00.00 uxVcx¢I� of up W Oor year L,�j avil peasl•dO W tx fC�M of a Stop Word Order gad o fim of 5100.00.d:y cp nA ax For y. Pcnlvt Nur�bcJ l.ot ° --- Sil,n:lhuL of L.icznscc�t'cnniucc �------ l��e SE � 3t 8 �C�S'6FtT�S � �,. . 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number NJ 'F- / Address Expiration Date Signature Telephone 00 0 , Not Applicable ❑ J" /g ;L z� Company Name Registration Number R /L/ /e Address Expiration Date Telephone S;E+GTIQN 111 Ylt�IKERS'fil> � 1Ti©hl IN$i1RANCE1E311t111T3 jM G.L C 152,§2c( �56�).. 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...... ❑ 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 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 /�'O C",'J 6-t' S � [� i l i"�p1� 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: "ECTl. N 5=QES&R tfiTl F P R �SE O h.ck: lIca e New House ❑ Addition ❑ Replacement Windows Alteration(s)W, Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition[]jj New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: e a"" ( W, dv��I , iJl t'c-Ge C'�_�,.,e¢� Aleti M. Alteration of existing bedroom-Yes--/-- No Adding new bedroom Yes No w< It Attached Narrative❑ Renovating unfinished basement -Yes No Plans Attached Roll V- Sheet❑ ON 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? { i 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 . (� I. Septic Tank City Sewer Private well City water Supply I SEC71QN 7a,t bWI LR AUTNQRI IQ WHEN, 011HLtS AGI�IT" 1C01 R�►C"ft/ PL[ESR;BlllLl�l PERMIT I f C's c L, as Owner of the subject property hereby authori e �" S P �" to act on my behalf, in I matters re a to work authorized by this building permit application. Signature f ner Date I, as Owner/ uthoriz gent q hereby declare that the statements and information on the foregoing application are true and accurate,to the of my knowledge and belief. Signed under 7P,ns and penalties of perjury. J/ Ste -.; Print Name Signature of Owner/Agent Date FEWC-irdC,.j. EM W l� City of Northampton Building Department F� 212 Main Street Room 100 Plumbing&Gas Inspection orthampton, MA 01060 orthampton.MAD D60 3-587.1240 Fax 413.587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I I 'SE0 TC�+11 SITE INFORMA7lON � ff e �1.1 Property Addr - -. • �0 1-4- �. Ir V l i \ V t Q 5 -' �ty tK MR,, SEGTN PFfOPEftTY pYIfNERSH TN+ Rf2El AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: v)e �')r Telephone 01 7-1 2.2 Authorized Agent: el 6i� _Se /t in Sp�✓ CA N Name(Print) Current Mailing Address: Signature Telephone 57t+DN 3STIMAEDONSTt)CTIO N CdST , . - Item Estimated Cost(Dollars)to be Official Use Only, completed b ermit applicant 1. Building sv-o (a) Budding Permit Fee 2. Electrical fib) Est� ted Total Gf 3 ' on` uctiorfrr3m;� .. 3. Plumbing OutFcngerm�f'' .a 4. Mechanical (HVAC) 5. Fire Protection rT 6. Total =(I + 2 + 3 +4+ 5) Z`� �9z?_a Cf#ecl f Umber ly BIldcrg Perrrrtt Ntrrtber -Date Issued: i ildin :Corrtrr%i simW,l nspec'tor':df Buildlttps File#BP-2015-0826 APPLICANT/CONTACT PERSON OLIVER ISELIN ADDRESS/PHONE 36 Service Center NORTHAMPTON01060(413)584-1224 PROPERTY LOCATION 345 PROSPECT ST MAP 24A PARCEL 159 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: RENOVATE KITCHEN NEW BEAM&WINDOWS,NEW EXT WALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039073 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMTION 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 De 'tion Delay C,2 - /"�- i wAre@#�BuJ1KKg Of ial 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. 345 PROSPECT ST BP-2015-0826 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A- 159 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-0826 Project# JS-2015-001594 Est. Cost: $24500.00 Fee: $144.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: OLIVER ISELIN 039073 Lot Size(sq. ft.): 7143.84 Owner: MCLINDON JAMES B&JACQUELINE A SPAIN Zoning: URA(100)/ Applicant: OLIVER ISELIN AT. 345 PROSPECT ST Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:212712015 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE KITCHEN, NEW BEAM &WINDOWS, NEW EXT WALL 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: House# Foundation: Driveway Final: 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: FeeType: Date Paid: Amount: Building 2/27/2015 0:00:00 $144.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner