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05-027 (3) Mr.&Mrs.Richard C.PT•:c ?' 278 Audubon Rd. P.0.13cx Leeds,MA 01053-03,21 Pl C 4: MWY D1Ul'#VS0A1 ACK CC* A W 96 i SZ.OS 1pw MADPWay 7-U7 za - { r flol, AISLE A D 4' amq z Q .� g Pte `a.4s1 ACRM o CIO •^ i (� i N 73 Z AOVW OP FOQWAZY w �� b • ;�� -�� g 6 MZ P 46 haw OP faP&L-kL►- -, 1 V6 oZ rlawrM A! .977.3 ZAK44 ` 40"E ego �t�E X1.91 RESt At LM Tb BE CONVEYED TO S C3/6 Pas nr�a 4f0'4V lP�0 � 6 �lxsaxcllresrtta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE MIYIMAVIT (li cen-serJpermi ttee> with a principal place of business/residence at: (phone#) (st=Ucity/statr/ap) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach ad&6ccxz1 shod ifncces=y to include information pertaining to all vcahadors) ( ) I am a sole proprietor and have no one working for me- ( ) I am a home owner performing all the work myself. NOTE:plcmw be ague that whilo homcowncrs who employ persom to do muiut�comt,u oa or rrpair work on a dwelling of not mote than three units hn wbich the homeowner resides or oa the gourds appurtenant thacw arc not gracrally coandard to be cmploYrra under tho workers.compensation Act(GL152,�s l(5)�application by a homoowoir fora Uocnsc or permit may cvidcnoe the legsl ctatuo of an employer under the Workoes C,ompemation Act I understand dirt a copy of thin rEatemcat may be forwarded to the Dcput=cd of Dial Ac6deat Of too of Ink—for the coverage vMficaiion and that failure to secure coverage under section 25A of MOIL 152 can lead io the'imposition of criminal pcnatties nom icing of x five of up to S1,500.00 and/oc imp isos>rnctti of rip to one ytar and civil pcni ltha in die form of a Stop Work Order and a fmo of 5100.00 a day against ma For dgn:tmr�-sl urn only Permit Number gyp# Lot# Signature of Licensee/Permit tee e S�EGTOlB �CONSRUCTIQN 5ERYICES 3 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Re J' etl` tremen "m`'n . Not Applicable ❑ 6 I w�v=...E��r� Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS';COMPENSATIONANSURANCEAFFIDAVIT(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...... ❑ om+ ®� ..Mne a "_ 1 :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 buildinil 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 responsi for compli e with the State Building Code,City of Northampton Ordinanc , ate and Local ni g Laws and Stafle o /assac etts General Laws Annotated. Homeowner Signature SECTIO D- ROPOSE �ORK3c�ieckalla hcatle � WWI New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other Brief Description of Proposed Work: 1 Q 4) Alteration of existing bedroom Yes `/No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes V- No Plans Attached Roll ❑- Sheet o `� hf�N.' v �o s ' �ddit oin` to�ezi'stin ��housin ;com°W"°'lete�th��foTl,o�r`in : 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? 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 SECTION7a `OWNER AUTH30RIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT I, 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 A� 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 unde inslaAnd penalties of perjuMIC t�' lets Y4 C c �r I I Print Nam C7 , G r Signature of Owner/Agent Date 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 T4O 1 pf Frontage Setbacks Front Side L: R: L: R: Rear / Building Height ¢ U Bldg:Square Footage % l� Open Space Footage % �U (Lot area minus bldg&paved arkin #of Parking Spaces Fill: A/dA 6r- 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 ere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: ST 2001 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413.587.1240 Fax 413-587.1272tfie i APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION his sectionito beco pltedbtoff�ce rr a 1.1 Property ddre �� r � ` �q S c� � t7�1 O . 1 vU © MaFj Lo v # 3 z Zone Overlay is rt Elm St:District 2� VB D s r ct SECTION 2 - PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:(I � •�t�� ( d i0 r C ri t) Current Mailing Addre ' I elep onh e— Signature _ 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building q1Aa,0 0 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number r This Section For Official,Use Only, BuildmgPermit-Number:, - Date Issued: Sig nature : >a " Building Commissioner/Jnspector ot'Buil'inks' Date , .,_ File# BP-2002-0442 APPLICANT/CONTACT PERSON NICOLI RICHARD C&GERALDINE A ADDRESS/PHONE 278 AUDUBON RD (413)586-9696 Q PROPERTY LOCATION 278 AUDUBON RD MAP 05 PARCEL 027 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ERECT 20 X 12 SHED New Construction Non Structural interior renovations Addition to Existing Accessoa 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 INFQYWfATION PRESENTED: P 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 C mission /� 2 2c+o/ 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. BQN{RD BP-2002-0442 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category. shed BUILDING PERMIT Permit# BP-2002-0442 Project# JS-2002-0674 Est. Cost: $1800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq. ft.): 369388.80 Owner: NICOLI RICHARD C&GERALDINE A zoning: RR Applicant: NICOLI RICHARD C & GERALDINE A AT. 278 AUDUBON RD Applicant Address: Phone: Insurance: 278 AUDUBON RD (413) 586-9696 (� L E E D S M A01053 ISSUED ON.•10/25/01 0:00:00 TO PERFORM THE FOLLOWING WORK:E R E C T 20 X 12 S H E D 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/25/010:00:00 2538 $25.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo