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�Q�c�� /�La�',ou�'I`{ !�� N o cz-c�•� M��L� 5�T• '�l o���+tic..�-
of 01:f 11allipfoil
(4 � E Rlasaxchncctla -
c� DEPAR-1-MiENT OP BUILDING INSPE'CTION'S
212 ?thin Strect Municipal Building
i torlha npton, Mass. 01060
«`ORICTR'S COMPENSATION INSURANCE AFFIDAN IT
I 2�� �.__ � . .�s-}-rte►-►_*-s�.
(11�.nS°:.I(xTTII1I1eL)
«r it11 a principal p!acr� of L�usii�es�/residency t=
ty/stale./zIp)
do hereby certify, under tic pains alld penalties o,L pcqury, :112T
121u �n CIl]pl0)'Ci p10�']d ln`. t�;; 1G�1 �':In S; '�v(J .ri C1�S COl11I) �`,2�lOIl COVe �C In( iW"
C111olovct;S wof0 _]C14{
/� l �'cam-v► _1 Eo Ica --*:,cLP +930Uq co-
7,jn on 1>al.,
(Lra ur.-ncti C c)Ea�_�I�) c!ic Shur
I aI71 SOIL tJiOL ictOi �: � ! CC T11 -C"01 Cr ho"',-,ccV,`I7E'i �C11Cc OLc) �u
the coI iacicFs IiS ell-,
(Name of Contractor) - -Ojisx-auc:: Numc-�-r) (i ir,IUOI D�tc)
(Name of COnIT<iClo ) (?nsurarc Coml�311)/pokc- ?vumixr) (L pirfio:l Dale)
(Tame of Contractor) (Insurance Com ' /Pohcy Number) (1.�p rayon Date)
(anal addfio¢al L'xci:f c<,cc:-s.i r,:to �cr_'u��:rvctci:i oo pctn:r_:n�w all w�a.r_o:�)
( ) I am a sole propnetoi and have no one worming for me.
O I am a home owner performin; all the work: myself.
NOTE:plc ix nw�ir tivr—hik bom�o �µto auplcy pcwnr to&cr ,cxn:j- oo cl mpac wori"oo c d.cur'&of
r,t mccc than throo maiti in uanch he bomcow rider oc oo the Emu s apputtcbeni the .r r, co=&md to be
employcn under the wu l:rs'm ccui> erd ccc,Art(GL152s l(5)�applica-non by e homeoavcr for a bccW<er permit may e.16cnee the
legal Vtnau of an amployx under df wociro t Coazpomc ?:I-
M„ I undessund diAt x copy of thi.cur—calm y bo foc-wurded to tho Doportmeni of Indzlxri nl AmdcuCf OfF oo of Irr�+ b for tba
coverzse vrrij'rcuioo and that f:ilt�c w surtrc wveTnge under wetion 23 A of htOL I S2 can lad to tho imposifio�of etimias!penalties
oominmg of a fine of up w S 1}00,00 arxl/or cr4ai�of up to one yrnr and cv,-1 pmihim o dx form of a Stop Work ordQ and a
fun o(S 100.00 a day t&uasi UK
/ / Foc dcpvn--a1 u —drily
!✓�— Permit Ntrn�ber
--- ---- -
`J '3�/
Signaturc of Liccnsccll'crtnittcc Ti e
t
;,SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
-/ //,0 1Z a i Z-
Address Expiration Date
Signature Telephone
cl� .. �al`
Wy:
� -
Not Applicable ❑
/Z5 �SFr0
Company Name _ _ Registration Number
Address /�` Expiration Date
/37 Telephone S$G/ - 7'70 0
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.
igned Affidavit Attached Yes....... OR"' 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
AOW-
TI OF P D WO I' lic
New House ❑ Addition ❑ Replacement Windows Alteration(s))< Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ Siding[ ] Other[ ]
Brief Description of Proposed Work:
Ucre FS Alteration of existing bedroom Yes No Adding new bedroaa�� �No
Attached Narrative❑ Renovating unfinish6d basem Yes ��No
Plans Attached Roll ❑ - Sheet❑
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?
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, H( UA42-1 (3, PIZA C e— as Owner of the subject property
hereby authorize �u�� I (/- �� 11--:� to act on
my behalf, in all matters relative to work authorized by this building permit application.
y� � Zoa o
Signature of Ovder ate
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.
igned under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
s '
1
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
�j Building Department
Lot Size
Frontage
Setbacks Front
r � / P o�
Side L: R: /,/V L: 14 R:
Rear
Building Height
Bloc g Square Footage 1392 % 4 39s cJ
Open Space Footage %
(Lot area minus bldg&paved s(�
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 V" 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 ere any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
ity of Northampton
$jilding Department
�� tr
a 12 Main Street
JUN 1 4 2000 s Room 100
hampton, MA 01060
^� F 3- 87-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This setibnb corseted by office
P y
kcLp I--c_ �i-Y-,CL-1-" Nla� 1.
l ;��lnIt
+�16Y-t°YlG`-C_ Zane Overlay CSur
t0 t CS DIstrl0
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
f-fI l a.sL, Pr►-C-r— ►°r`�- N�-!� �-ta.Q -cwt-. Ala ���
ame(Print) Current M 1'n Addres
aep Telephone
Signature
2.2 Authorized Agent:
)e I GI2c�-!C� T7 . 1'r V�-�S a-YYl 13�"
Name(Print) Current Mailing Address:
413 sS--(f-- �-+--oo
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit a licant
1. Building ��� 4 G 0 , po (a) Building Permit Fee
2. Electrical /� s0 a , v o (b)Estimated Total Cast of
Construction from 6
3. Plumbing Z �.o Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4+ 5) �!� D O O. a o Check Number ONO
This Section For Official: Use Only
Building Permit Number: A Date Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2000-1128
APPLICANT/CONTACT PERSON CASE HANDYMAN SERVICES INK BLACK,INC
ADDRESS/PHONE 137 DAMON RD SUITE C1 (413)584-7700
PROPERTY LOCATION 197 NORTH MAPLE ST
MAP 17A PARCEL 180 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 O-
ineof Construction: CONVERT 2ND FLR 1/2 BATH TO FULL&CONSTRUCT 16 X 16 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 009498
3 sets of Plans/Plot Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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
./� (o
Signature of Building Ggicial 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.
197 NORTH MAPLE ST BP-2000-1128
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 180 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:alteration-addition BUILDING PERMIT
Permit# BP-2000-1128
Project# JS-2000-2008
Est.Cost:$14000.00
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CASE HANDYMAN SERVICES INK BLACK, INC 009498
Lot Size(sg.ft.): 9583.20 Owner: PRICE HILARY
Zoning.URB Applicant. CASE HANDYMAN SERVICES INK BLACK, INC
AT: 197 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
137 DAMON RD SUITE C1 (413) 584-7700
Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:6115100 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT 2ND FLR 112 BATH TO FULL &
CONSTRUCT 16 X 16 DECK
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:
Rough: Rough: House# Foundation:
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:
Fee Tyne: Receipt No: Date Paid: Check No: Amount:
Building 6/15/00 0:00:00 240 $70.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo