05-005 F;M
D 'PARTMENT G.' LUILDD G- INSPL-'C-r'j0tiS
1
212 MaLili Strcet Municipal Buil(jill
I CL'S.S 01060
NVORICER'S CONTPEINSATION ]_�SURANCE
x/
i) C C F i_11' 7
a[I D r 0 vi d Q
t= :'�.cyc ' "vor-Irw up, L.-Ils L)
j 0
L, Z 3-j AS c, q7c)/T 11-al1n&,
cLas-aran I Comp'-ay)
!:C!e Oct) Ind
L
'allic Of,Cont=.C.Lo')
mC 0,
D
of"Cori"mciclr)
�c�ai rivof axL'tapION—Un LLO
111—�vd L`���copy of U— f"'1_3 to f 1_� 015—.1
u' c.•<vcilictioa aid tLt C lure to co.
152 can 1—d to Lt.
of a f_u__of up to S I CI)
u
SECTION 8-CONSTRUCTION`SERVICES t
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name of License Holder
T— License Number
C,, '
Address Expiration D e
Signatur Telephone
Not Applicable ❑
3.-ReatsfereiJ'Home�mc►rov mer��on� a"�,
c5f t/dev Gc0frczCe Dr - — '�' �1
Company Name Registration-Num ------
Address Expiation Date—.T
�24 Telephone W/3 5SST-C%�i
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.
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-vear 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
r
r ,
f..
SECTION 5-DESCRIPTION>OF:PROPOSE D WORK(check all�applicable)
New House [] Addition [] Replacement Windows Alteration(s) Roofing
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[0]
Brief Description of,Proposed a r ,
Work: � � (`t Sl��=,�Pt (�E S �i t01 --E'' 7 ICiS � � �� ( L(/C\ 1
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa if`Nevw�hoaseand�or:��dtian�fa�xtstrng 6ouslng.�complete.tfa`eFoflout'r.ing:
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 BECOMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING'PERMIT-
LA__' as Owner of the subject
property.I,reby a Chi Y°1'1
to act on-rriy b alf, in lima relative to work authorized by this building permit ap lication.
u f wner Date
as Owner/Authorized
Agent hereby declare that the stat ments and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un er the pains an penalties of, erjury. '
E r-f �tv
Print Name
Signature of wner/Agent Date
^
'
Section 4. ZONING All Informati6h 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 t
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage F-7 010
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume,&Location)
A. Has a Special Perm it/Vuhanoe/Fi riding ever been issued for/on the site?
/�� �~�
NO v/-�.� DON7KNOVV �./ YES \~�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry ofDeeds?
NO �� mx vv ,DO NT U [S
k~�' m
IF YES: enter Book j Page, and/or Document# '
��
O. Does the site contain a brook, body uf water orwetlands? NO �_��r DON7KNOVV �_� YES
IF YES, has a permit been or need uu be obtained from the Conservation Commission?
-
Needs to be obtained ~��~� �-�Obtained �~� Date� ' �
C. Do any signs exist on the pnopart �� ��y? YES \~� NO �~�
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property
�y? YES 0O
0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre urinh part ofo common plan
that will disturb over 1 acre? YE8 � ) , NO � �
~~� / ^_/
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1 t,ty
of Northampton
- -� ilding Department
` " 1
3l2 Main Street
p.
r� - Room 100
vI -
Northam,pton; MA 01060
t
-phone 4;4-587-h 240 Fax 413-587-1272 �o `
Y 4
r, a peCl ci
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
w:;b 7 t Thts section to be completed by office
1.1 Property Address: a ��
"^'/] K / ' .� , ,a-l.lntt r
(( Yerlay'°Dtstctct
Cl.n$t�13 �' '1,tt' wi.'� Z .+rn "' ^B.L3tStr/a,t;� a+t ..••-
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nafrfe(P i t) f Current Mailing Address:
Telephone
e `J 55 i
2.2 Authorized Agent:
E-'f M A -
Name(Print) Current Mailing Address:
ignature Telephone
SECTION 3-ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 1 / ,(a)Building Permit Fee
2. Electrical (b)Estmated;-Total Cost of
Construction from 6
3. Plumbing Buiiding.Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) Check Number
This'Section FocOfficiaf Use Only
Date
Building Permit Number. Issued:
Signature:
i
Building Commissioner/Inspector of Buildings Date
BP-2006-1287
GIs#: COMMONWEALTH OF MASSACHUSETTS
- CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
�or v
Permit# BP-2006-1287
Project# JS-2006-1896
Est. Cost: $12000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KEITH HAMILTON 133811
Lot Size(sq.ft.): 78843.60 Owner: MORRIS LYNNE A&
zoniniz:RR Applicant: Keith Hamilton
AT. 717 KENNEDY RD
Applicant Address: Phone: Insurance:
27 Cahillane Terrace (413) 587-0763 O WC
FLORENCEMA01062 ISSUED ON.5/25/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 5/25/2006 0:00:00 $25.006204
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo