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17A-244 (4)
P-Vi V= 0-j-N11 LOT` 121 N;S T R 11 < �e. A` < 0 Z k2 i-7 ............ .......................... ......................... ................ .......... -/........... .......... ............ .................. ...........5 4". ............... .......... ................ ............... ........................... ............... ............... .................... .............................. .......... ............-........... ............... ............................ ................- ............................................... ............. .............. .............. .......................... Me Propoor hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: J, h"J",do"-Azf dollars($ lyon,CIO —Paym, to be made as follows: '17 oe All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from above specifications Signature involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents necessary insurance Note:Thi p sal may be or delays beyond our control.Owner to carry fire,tornado and other n S , Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if noiKepted within days. Arreptaure of Frop09111 —The above prices,specifications c r nd a h�reby accepted. are re and conditions a satisfactory and are hereby accepted. You are authorized Signature. it m, s 0�� I be de a outlined to do the work as specified: Ppyment will be made as outlined above. Date:of Acceptance: Signature To Reorder. 800-2256380 or nabsoDrn O O Grzfy of Xorf4auipton L Z $ � �tassac}�usetfe DEPARTMENT OF BUILDING INSPECTIONS �. INSPECTOR 212 Main Street • Municipal Building ' Northampton, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup%:-„isor. The state defines "Homeowner” as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing&gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location OB E: 0 6 �1 zf tJ of i klr l l al pt tl l t � 6 �1�iSJftCI(liSCIIe m L%EPAR"I?fElrT OF LUILDI?�G INSPECTIONS 212 Main Street ' guaicipal Buildilig Northampton, Mass. 01060 j WORICER`S CONITENSATION 1NSUIZANCE A FIDANI.T (liens°J�•��miucc) %with a principal place of busiress/r,-_sidcnc-c lstrcetJci t}•is. :�:�-r�p) do hereby CCIi111'. Lllacl Lllc p L l5 ;''.iid pen',!"Ics 0: '\' I =r1, an employer- providing the iolo,vinc .:orr_ers compensation covelevc or my einployces working on dill job: G4zj . (,(-)- -N&L)c -�-G (In-Tj=cz Compam) c�;c;Nu-mbcr) r don Darc) ! ) I am a sole proprietor, general fJr hon eo N-Dcr (circle one) and l:a`,tc aut;ti the contractors listed be:ovv; ;,�t:o h2 „ the `oll ;;; -,� orkers co pensa on of ties: (Name of ConLmmr) (1nSll:--'1c MuT1bcr) iT?:' it.t1CP: Date) (Name of Contr<. o:) — (71lsJr,rice Con anIPG!ic, i�'tsntrr) X G 0 n Date) (Name. of Contractor) Jnst mule Co i :n;Polio; Nunit> r) x.:,-;LOa Date) (Name of Contractor) — - (Inst r nee Cemr �,Polite Numr r) (E:;:ni aion Date) l I iLTl i'. arc 1?1 Oj?11C Ji i'.ii'1 i1 ?V 110 oli .,'U?' 'iit for i11". all iii No'IT:please be awv zc tttz:-.,'._ire txt-�o"1r " ro r, pig ,�- n:: inch z:::cr r m of:c;;air• `;;_ _ •cl!i not lnoce tlin Limo uui's in%,i-.e't r=:,:=Cr ot; C--!p10yv^-3 u_tidcr dVr wcc}: _cc r^_:e:im tr.(FiL!5�� e!(51;,n,:;iic.:ion by a hncnco«-ncr`or a Gccu cr p:r;u:r._ ....tin c Ic811 status of an :mploya uo'-cr tLL Wocicc', oa; pion�_cL I ur dc.zr.nd the a cmy of tti,ctatc::cc cuy bo fot—n dcJ to tl�EYcj rt.% se oFIr LZricl M6r�ty LIfic�of;: ,r>?=a for Llx covcrase vaificlioo and that f.illt c to to r:coy r;ut c�.i ^25.0.of?.tG1.152 can lid to the impasifioa c:crr i_1 pawl:a —iztLng of a ftne of up to 51-S )-01)—:t i^fir:ux oIti to cr.:}t ..:.j civil p=u16,in d fcnn of n S!� 'c i'.0�1�ar.1 fire-of,'I OO.QO a dsy gnin:.t m.. - Fc,-tfrTwulr z!A.,k oily Jl ;z curt of i.icon,cJ('crm itt•.; r ir;__ SECTtON.8-CONSTR -naN SER1/IEES 8.1 Licensed Construction supervisor.—^ Not Applicable ❑ Name of license Holder: —J `+ - Ucense Number Address 0 Expiration Date Signature Telephone " Not Applicable ❑ _ A ite'° ec ifflre m"'T ve ie t of traeto , Jqz,P,L�� a1w -4-Company Name Registration um er n:ss Expifatiorf Date M Q 01ftPC J Telephones- ]6/o t�7 e SEC-n0N 10-:WORKERS'CONIPENS7 TfQN INS JtiJ tGE i E(lEfl lltT if Gam-c. €52, 25C(&3 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...... ❑ 11 --- _�ome��Qwiaer T�e�xl�if�l 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 10835.1. 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 shaIl not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that be/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 maav 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 SECT-TON 5-DESCR1PT1ON_OF>PROPOStakW.O-RKfcheclt_alf2POkab. New House [] Addition Q:. Replacement Windows Alterations) 0--]Roofing Or Doors El 1 4 Accessory Bldg. ❑ Demolition Q New Signs [Oj Decks [0 Siding[01 Other[Ca Brief Description of Proposed (� Work:. Y)Vfd (24ej- 1 1QAA P L� o(PQ✓ \Ct Alteration of wdsting bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet § Nevi useand-o"ddl idm,-" xE tnMt sinst;_cor tDiete ttoy ainct: a. lioa cf build;..ng:One Farnily - 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 W oodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. is construction within 104 ft.of wetlands? Yes No. Is construction within 100 yr. floodpiain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. 1. Septic Tank City Sewer Private well City water Supply 'SEGT ONxa_=OWNPRAALEiURt TJfJiC -a- E-COUP1 EtED 1fIF[E[+t OI�fNERS-RG1�'•O�`COEiTRI►�O�At?PE:IES F©L��Bt11L'tIING;E�!ERMt�. b ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, as Owner/Authorized Agent hereby declare that the statenfents and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Si ned under the pains and penalties of perjury. lobPrin me Signatu of erlAgent Date Section 4. ZONING All informatibit Must Be Completed.Permit Can Be Denied Due To Incomplete Itformation Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size { Frontage 3 { s Setbacks Front — t� - Side... L { R:{� L:a —' R:1 —' Rear �- Building Height �— z � Bldg.Square Footage % �� I F Open Space Footage % (Lot area minus bldg Bt paved f �-- #of Parking Spaces I Fill: r volume-&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book ( Page; and/or Document# ! Page,, B. Does the site contain a brook, body of water or wetlands? NO 0 DON-r KNOW 0 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 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: $ E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acne? YES Q NO Q t IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Depariei 4tse' -` r-, - City of Northampton StatuB"oi<Pemltt Building Department Gci Cutti)[iyeP� � lf 4 212 Main Street Smerlseptta�fiCvai v Room 100 iNertVlfell�lvada6 * - Northampton;MA 01060 Tiko Sets of StniciuraF Plante¢ `° �� NT phone 413-587-1240 Fax 413-587-1272 PtotlS�te Flans Outer Speedy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTtON:1 SITEI�iFOE2MA'�ION r Tflis sectiorE 6e c�iitnpt"eted56y office - 1.1 Property Address: - Lc# FteX1C.f' �v t n 2one f Overlayisfiicf ot� -;EIm3t`District - -- CB Dishict SECT(ON2=PIZOPERWOWNERSIII P/AC1TF10RtZEt1ELGEt't_ - 2.1 Owner of Record: Name(Print) Current Mailing Address: - --PI Telephone Signature 2.2 Authorized Agent JU K l P Na*(Print) Current Mailing Addresfj Signatwq Telephone SECTI 3=EST 0 FI3TRUC[IOK COQ Item Estimated Cost(Dollars)to be Official Use Only completed by perm it applicant 1. Building I / =_(a}:Buildmg=Permit Fee 2. Electrical _(b}Estimated Iota[Cost.of Gon stniction.frdr[ fi' 3. Plumbing Buitding PermitFee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number O' 'Cfii Secttoir or:E]iTi aaLuse;0 Buildirig�'PermitNumber--- ~ t Signature: Building-Commissioner/Inspector of Buildings Date File#BP-2007-0043 APPLICANT/CONTACT PERSON Cyrus Newman ADDRESS/PHONE 697 Bridge Road NORTHAMPTON (413)586-1093 PROPERTY LOCATION 82 LAKE ST MAP 17A PARCEL 244 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT F e Paid "Building Permit Filled out ee Paid 0 s3 01 17Z,'C10 Ty eof Construction: Reroof over 1 layer New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 Signature of Building fficial 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. 82 BP-2007-0043 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2007-0043 Project# JS-2007-0063 Est.Cost: $1800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Cyrus Newman Lot Size(sq. ft.): 16988.40 Owner: KATZ JOANNE G Zoning URB Applicant: Cyrus Newman AT: 82 LAKE ST Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 NORTHAMPTONMA01060 ISSUED ON:711212006 0:00:00 TO PERFORM THE FOLLOWING WORK:Reroof over 1 layer 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 7/12/2006 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo