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17A-199 (3) �Jr� GA-Nl F S�6 rf' LE"1�n/ longirialge woodworking 2- lab A ,/ 01A4,2- �f/3. re'V- /s'}Z i k j i f - ' i UL7/ i P . O . Box 88 - Belchertown , MA 01007 - 0088 - ( 413 ) 323 - 8977 www . longridgewoodworking . com MA Lic . 07 666 1 4'CtU►b1P�. O O g� "e Gztlr of Xort4alupton z Z �833ACt�l13ttt3 - DEPARTMENT OF BUILDITjG 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 l:is/her construction supc-.;sor. 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 fl�7 of r\lT1't�Jt1111 ft111 6 �S�Y S S At 11116 fit 9 - {y f r DLPARTMEi.T OF EUILDDJ G INSPECTIONS 212 Alain Street ' Municipal Duilcling Northampton, Mass. 01060 WORICER'S COMI TENSATION INSURANCE /I FIDAN.T - ti:ritl) a principal place of businessh,esidencc ,310 04-6 SO.c�.�+�Gr�-Zf> Jv;f)"o s"TCCUcit ,:",:t^.z_t,) CIO Hereby Ccf—L l • UI1Ccr UIC h Ii1S ano that O I am an empioyer providing the ollo,.vinc .;orr_cr's Compensation coves c nor :ny eltlploveen RJOI'Brig on t?lis job: (lnsiranG Cotap?m) ( c c,Nu abet) (F�pit non Daic) ( j I am a sole proprietor, en°ral conk er homeo ou (cycle one) Pod I ve tired the contractors lIsted be10w %a` the 'bi r ,:rin!r, v;Oi np,`5 CO-, -O 1 sa,ioil Contactor) 'InsJ�ncc Ccrre.:n-;,Tclicf Nurn>xr) fix.; r;: o-:Datcl (Name of Contnci3Or) com, ;IvRc-!,C1' I t i fir) :.:t10 D2iC) rni3me Of Contr3clor) (I71sJ I1C^ COm,;:? 'i/i�01iC: fvllSIll'r r� J-S.. 1%aIe) (Name of Contactor) —- (Ins,1rwlc:, COLIIT)'/Policy Numbrfr) y - (I::;i :iin Date) (..".ILl Cl12b'�li]CY:1l S_KCL;!;;!r<-t t.^::�:•r_?.�'.�:.•:�Y:Ca::Ci:rr�._.... � Ali::.._.-.._...+1 ( I am a sole prol)rletol 110 011;, Vori:.ills' fo,- illy. *70 rfi:please be Im-:Uc L1.:-wLi]c h"<r4v,5lr_-3'5 ,3 C-npl�r;*.. c ;n:: :_� ': nc�a.-:n m Cr::,:alt not uxcc than throo unite in t:i idt;.t res:L�=u a1 c�ploya3 u_r cs thr 1vc;i:f-cc x• icn,r (Gtl`,2-::-1(5)1•r,:;Ii_--;ic:1 by hotn:o:ln-,for n Lcc c ct Itsal rtaw;of an cnployof uou' tLo wcvkcl,Com-;er- uon?.Cy_ 1 undt.^ctand nisi a copy of tlx,i clstc: rt c:.y bo forwnrcivl to t1»IYt-taunt of Iod� lri_1 Ac i6-='Y Ciao of:: u. -a for tlxc nova- &c vaif eafioo atu:that f-durn to un3:;.cLtir?25A of?,(C-L,152 Can Ic_d to the intpDsifi n cfr ir:!PC[-,!:- Misting of a fine of up to S I_x00.00 n:s�,'rt ir:;1r,.:r r^ of up to crn-}-z_r e:.1 civil ezullin in d o fc rin r•f a Std, :+ -0�=t:-A= Lr>r of S I M.00 a d-y i fain:1 m.. . rcX drx,uur>`'stsl u.c ocily '� perrnit Numb.:r ----------------- F 5,gnaturc of;.icon�JI'crmtttcc _-__ . S�CT�ON'8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder : gl4c - 2-0/V& L //-->CrC— G✓Uo�� ��N License Number r o o x- /4 - /v MX / CD DS Address _ Expiration D to /3 . 323.. Signature Telephone Reg se:e Mm" =m—T 'ent on#ractc� � � Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION A WORKERS' COMFENSATIONaaNSURANCE.AFFIDAVIT(M:G:L...c. 152, 6,2..: v 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...... ❑ fig 3 �Y 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"homeowmer"shall submit to the Building Official,on a form acecptable 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 f ti i I01 0FFROPOSED WORKA checldal }a IIcable ' WIM EMS New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: A-6W 0 Z. `'` �`�Dle- /3.9�►-//LUV�'7 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D- Sheetf;[ 6a: e. of d or a .itlon t7c xisting hots rn omp�;eee fi-e fi011owing: 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 Nc 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 SEC7 � AUTORIZATION TO BE COMPLETED WHEN OWNEfS�AE#N �ONTRACTOR'APPLIES FOR BUILDING PERMIT 1, 4A 7---��- as Owner of the subject property hereby authorize _j�/lscr L�N�-77?./DG � to act. or my behalf, in all matters relative to work authorized by his building permit application. CeQJeuLCI �-- Signature of Owner Date r—�— 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 under the pains and penalties of perjury. Print Name C 11 Signature of Owner/Agent Date f 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 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 _X___ 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 _ X NO IF YES, describe size, type and location: S�tcT S/fiy v� GF �✓v. �-+�D. Are re there any proposed changes to or additions of signs intended for the property ?YES _ No IF°YES, describe size, type and location: f � , fw�of�rthampton rra r`r -J�Inj3bppartment 212 Mai' Street E , ��,Rodrriy,100 'OrMampton, N(IA 01060 phone 413-587-1240 F'x 413-587 1272 t APPLICATION O C©NSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMA-,' ION Thisasecta'on` o° b «com°' ed by ffic rt x 1.1 Property Address: /7- c7A°T� �.�✓'G Map L It o �. EImSt District CB Des rct SECTION 2- PROPERTY'OWNERSHIP./AUTHORIZED-AGENT. 2.1 Owner of Record: G-C--e)nJ (h<o��3� /�f/ /r/o.� X1,60 S;, hO r��` cE, 1164 Name(Print) Curren Mailing Ad ress: Telephone Signature 2.2 Authorized Agent: PO dGX �� Ts'�<H �'✓� tiz� oo vu tz Name Print) Current Mailing Address: �f/3 . .3 Z 3 . �- Signature Telephone SECTI0N.;3�- ESTIMATED CONSTRUC'PIO.N COSTS Item Estimated Cost (Dollars) to be Official Use°Only completed by ermit applicant 1. Building O d v0 (a) Building Permit`Fee 2. Electrical ��. OU (b) Estimated Total-Cost of Construction from 6 3. Plumbing / � U .00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) U(I . D0 Check Number J` This Section For Official Use Only Building Permit Number: Date•Issued: 5�gnature: ' Building Commissioner/inspector of Buildings. Date T File#BP-2004-0884 APPLICANT/CONTACT PERSON BILL LONGRIDGE ADDRESS/PHONE P O BOX 88 BELCHERTOWN (413)323-8977 O PROPERTY LOCATION 141 NORTH MAPLE ST MAP 17A PARCEL 199 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid 61— O Typeof Construction: RENOVATE 2ND FLR BATHROOM New Construction Non Structural interior renovations Addition to Existing_ Accesso1y Structure Buildine Plans Included: Owner/Statement or License 076661 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF904ATION 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 Pern-lit 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 s� Z 00� 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. longridg e- woodworking z,0--j ve-l",Z,/ 0 P . O . B o x 8 8 B e t c h e r t o w n , MA 0 1 0 0 7 - 0 0 8 8 4 1 3 3 2 3 - 8 9 7 7 www . longridgewoodworking . com MA Lic . 076661 � � �sssachusette - of Wart4amptan r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building INSPECTOR Northampton,MA 01060 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(::-,,;sor. 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 i 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 1, 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 (1,xftT of Narfllztlt ptolt - 6 fiLisaxcflttsctta � _ - A DhP/u2 wE% ,"I OF LUILDIl G INSPECTIONS 212 Main Street Municipal Building Northampton, Mass. 01060 Wop,ICER'S COiY1TENi SATION INSURANCE AFFIDAVIT �:itll a principal place of busMeSSJrCSid ,IICC t: 3 d 6-L--6 f,vd— C O 11eICUy Cerill)', Ufl,, �r dl ) IIJS ;'hid pCi]?ltl (�i 7C;rlllt�/ illii:- I am tail employer pr'OVIding file 10110`, iRL"':OI'tr:C�S C01tl�C115 UOn GOVe:'Ct C 7011 illy e111plovees working on t is job: (Inszrana Cotaram') (?c-c;Numbcr) ---- (r�pir ti^n Date) ( ) I cam a sole protic tor, general c nsac c; hor eo.yner 'C'Cie one) and 1:ave hired t.11e Contractors listed belo'v',i'i]0 iii 'lac `O11 ,. v Or kerS GJi Je l$3 i0it ;'0!i0'.cS: (1`T=-- Of COnU<tctor) (1nS �.`1C I CIT ;.i;l'GI1C j Nurnt-- i�?: :.i's0': Date) (Na-= Of conn.c"or-) — (7115U �inC OI uc IV�O!lCi' Ni=- bar) (EXT:)l:'3tlo.).',late) (Name of Coatnctor) (Ins r�sle� Cots _c.;rPolicc. Ntuilh--r) - (Name of Contractor) — (Itis Inc Conlr }' Polio ivtumrter) (;F:;:ri-::io Da�e)- i ( I <Lll <i :;Ole ;?raprl( "u 2il`1 hu 110 OIl'0 '.,'C;rl^:iii t; t01 I ;?iIl Ia home 0�','I1Cr ii CI.C``I:lli'�: all NOTE::plczsc be a:rarc tt:st ;r- cr:;;air ,;i_a_J:cl!i c: not m0rc thshrr> n to unite {f t-'ysa11Y ca1p10yc.3 uaz tlr hotncowncs`cr a bcc ct l�gzl et�tua of an cnplo)w under tLn"VC kc"t l=ath;w-tion!ct. I ur>de-stand thL a cry of this etatcs�l assay ho foaw,vtiod to tlr>IYtnrtja e of Izdus riel Ar6"- s f Cilicw of i::::-v>?_a for tta covcrasc vaif'ir-lion aad that(_iltuc to 2;A of MC'L.152 can 1'--d to tlxi IRl uilc c;cr i I pct:al;:= comisting of a fur_of up to S 1-�04.00 a:�.'r i ::,11.._11 tti:!o f up to or.:}: r.-.j Civil pczultia in }.c(than OF S!�+ ;0 u t:.d a fit~oC S I CO.00 a day [cr dc{;::u:>�rnl urc c1il y i ` Pcrrnit N # �!`;DnttIfC T':� O 7.ICCr7';C:" F i SECTION 8..='CONSTRUCTiION SERVICES 8.1 Licensed Constructions Supervisor: Not Applicable ❑ Name of License Holder : �1L� Ltd N ��'/ &g7 444 'D-T 4�6 p License Number Address Expiratio Date -7 f 3 2- Signa ure Telephone g. E P u'�,..ewHU._ °, Applicable ❑ �9Fte iTs'tere =�brne�lm royement Contractor- � � .��,,.� __ . ��4�..< Not Company Name Registration Number Address Expiration Date Telephone SEGTION 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-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official,on a form acecptable 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 .eference 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 _ SECTIOI�5.. ES8rP�TlONOF RROPOSED WORK[check all applJcable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ Other [ ) Brief Description of Proposed Work: Alteration of existing bedroom Yes_X__ No Adding new bedroom - Yes X No Attached Narrative 0 Renovating unfinished basement Yes �C No Plans Attached Roll 0 • Sheet 6a lMle'-w=6as v nd o Add:ition.zto-,ezisfingaiowsing�cat plefe the follawi 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 -SEGTlOP17aOWNER§AUTHORIZATION TO BE COMPLETED ::WHEN OWNERS tAGENT�ORCONTRACTO APPL(`ES FOR BU R LDING PERMIT ... , as Owner of the subject property hereby authorize GL�. -j6-< ItUt to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date'T 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 under the pains and penalties of perjury. &ret._ Z--,* Pr Name -Tx. _— 4//Ab Signature of Ow er/Ag nt 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 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—', DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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: S T S`� e dp 4/&fl r)41- t2.1 AA, Af47'`E D. Ar there any proposed changes to or additions of signs intended for the property?YES_ No � IF YES, describe size, type and location: l W,Of Northampton `V? ilci Department _'-----=---- .21IMain Street R$om 100 APR - rtha`rripiQn, MA 01060 phone 413-587-1210 Fax 413-587-1272 APPLICATION TO CONSTRUCT,AL ER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION ThES secfion to be co L ed by afce 1.1 Prooeft Address: 5 to Zone ►etlay D�stnct k u SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED,AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: O/06 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: � 3 323 - el - h Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b);Estimated_Total Cost of s�v •'v Construction from 6 3. Plumbing / In VD Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2+3 +4+5) ,- /I'V, r'D Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0884 APPLICANT/CONTACT PERSON BILL LONGRIDGE ADDRESS/PHONE P O BOX 88 BELCHERTOWN (413)323-8977 Q PROPERTY LOCATION 141 NORTH MAPLE ST MAP 17A PARCEL 199 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid T_vneof Construction: RENOVATE 2ND FLR BATHROOM,4/6/04-CONVERT PANTRY TO BATH W/SHOWER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 076661 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 ommission 1,110D 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. 141 NORTH MAPLE ST BP-2004-0884 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 199 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buj ding DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-0884 Project# IS-2004-1319 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BILL LONGRIDGE 076661 Lot Size(sq. ft.): 7535.88 Owner: HOLUB CELENA A 7onin :U B Applicant: BILL LONGRIDGE AT. 141 NORTH MAPLE ST Applicant Address: Phone: Insurance: P O BOX 88 (413) 323-897Z-0 BELCH ERTOWN MAO 1007 ISSUED ON:3123104 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM, 4/6/04 - CONVERT PANTRY TO BATH W/SHOWER 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:: - ' :., j Rough: �t7�0 House# Foundation: Driveway Final: Final:��jf�/ .° tX Final:/;// 7 / 1/0 1 W Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Ic Final: Smoke: Final:C x` —,9 O `G� THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPO7z;- F ANY OF ITS RULES AND REGULATION Certificate of Occu anc Signature: FeeT_ype: Receipt No: Date Paid: Check No: Amount: Building 3/23/04 0:00:00 1051 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo