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05-048 (15)
�-r lin/-r nT p S e 6Ity) Of f11a111}�t011 J E Achntrl(a' ' o DEPARTMENT OP BUILDMIG INSPECT101JS 212 Alain Strcct ' Municipal DUIldinp Northampton, Mass. 01060 «'(RICER'S C061fPENSATION r�STRA.T,CE .4.I7T�J):+.�,�1;' I G-O7J G �O N ---------- ___ (liccnsxJper�nittct> �1.�tL a plvncipal plat.- of business/residencc at: so-'-/7--Y ST. Ilula' WSAVX,4- ne'} z-6 C- 93 Z? (sit/city/s[a.tcrti p) do hereby cerdi,, under tic pates and penalties of pellur-y, ?hal (✓'I am an employer providing the following %vor,&S cotnncnSZ:-,G, cove age Ior Iny etuplovecs wor-..�bng on lltis job. A-9,5e l AW &PGnW w6c stp�98bof zw5 /2-to -0'6 r-� Conn cv) (Pelic: Nu-naiy-r) -- (�:piraoon Dztc) ( ) I am a sole proprietor, general contractor or homeowner (ci:cie one) and Lave nixed the cone actor's listed below wbo have the following workers cot-oenszLon policies: +nrilC Oi CO^.'^Oio") (1nsurancr CoInp3,i)'1PGUCf NlllII'r:l (Name of Contractor) -- Onsura.ncc Compaayi?oUm- (—Expir.:tion Date) (Name of Conn-amo,-) (Imsurane Compan)-/PoUq- Numbs) (Expirtion Date) (2`tamc of Contractor) (Insurancz Comcauy/Pobcy Numbir) (Expiration Daic) (artazb:dpi:;ocal r'-xQ ifncc n.to mcu6r informjaoa pcta.iai to*.0 ( ) I am a sole proprietor and have no one worL-ing for me. ( ) I am,a home owner performing all the work rnyseif. NOTE:pl=x be ewxle Lt.!MUC b•C�GO'.4aCT]N,uo flay perLcm to S:) c-rgau.•-oric oo.d•.cll^C of not mote thia L---—j in%I-b cb the boc�raid..or oa the p-oun.6 zppurtc —tbc—D_c nx aUy mG:dmi to tc c-iployca tio'— lbc..a{r•:ate,, ca Act(GL152-01(5)) applinzoa by a bomco—=far:b _�a permit Mn y czd�x k Icg�d rt,^„of en—:PIOyx under din Works -,CoeipomaLiou Act I uodasia:ld dhd a Dopy of tiva cotrmcw t y bo f'.c--i d to tho Dcgonta a ofl—i.,,id Ac daatY ofG—of trzzira000 for the oovcabe tmreaioa n-•1d thal L•iltac to t.ocurz tovcrxse talet socxioa 25A of hMOL 151 can IcLd to the im xis6oc of eimiwd pcn.+lb- ooasir,m;of a tint of up to S 13oo.00 az,Nor rspriyo®�of up to one yesr end 6N_j pmittia in ibc roan or a Stop Wort tc.od a f1m of 5100.00 a d_y Lpl=t1x !J' rc:rm =—�— umt�_ Lot Signaturt of Lic=z,,-/Pc,,,i tuc,- SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / y Not Applicable ❑ Name of License Holder: o/r!4F---s 00 License Number CsU-y r4 CT-- t;(l l&&I/1 ► #3 U 124- /2-'s Address Expiration Date Ai� 2.6t 3z3 Signature Telephone 9.RealsCered Nome:lr ri uemeptCrf krs for n,=„'. �EJ ;,i Not Applicable ❑ Company Name Registration Number 2& S6V S i. 6 -/?- - Address Expiration Date W 1 L'f'l 5 � - Telephone �9-V 32-'5 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L.c.162,§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...... ❑ w tia 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 SECTION 5-;DESCRIPTION-OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Q Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding[O] Other[D] Brief Description of Propose /,, � Work: /ce V U�� /�S �JGC1`Zl � / 'ea!/ rleyl c'Y &glk' e%M ma i 1v6 Alteration of existing bedroom Yes V No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa:If.New lhouse iii d vc.addit on to'i( ilia hcru `ffrct:' arri( a thimlliwina 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 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Cby4V 01)4— as Owner of the subject property hereby authorize JA-Kr,,FY to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date JA-In E�� as Owner/Authorized e ereby 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 r1u Q/1 6 -2-1 -4 Signature of Owner/Agen Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by m -( Building Department Lot Size __ " .. _. _.__._..� .w....... Fronta e Setbacks Front Side L: ... ._; R. . L: _m .,� R L....._ _ dl Rear ... __ _.._ _..,.. Building Height ? Bldg.Square Footage °""""" "`' ON Open Space Footage % (Lot area minus bldg&paved _ i ! .. FA parking) #of Parking Spaces Fill: F volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES IF YES: enter Book Page. _..._._._-... ' and/or Document# _....._ — B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q 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 ............................... IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. l! In i of Northampton uding Department JUN 2 1 2006 !,..2'12 Main Street oom 100 :#orthal pton, MA 01060 olite13-587-1240 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 section to be completed by office S q Map Lot unit .C.. .1-0 zone: overlay Distract... EIm'S# ©Istria ce Dlitrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C/eW �a�`,(�l 12eQ Name(Print) -� Current Mailing Address: Telephone �� Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: u" I/ 26e-932-3 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �/ 6 6-1) (a)Building Permit Fee 2. Electrical q (b)Estimated Total Cost of Construction from 6 3. Plumbing Z i l3 t7 Building Permit Fee 4. Mechanical(HVAC) d 5. Fire Protection 6. Total=0 +2+3+4+5) Q f/0 S' Check Number r This Section For Official Use Only Building Permit Number. Date Issued: ..;. Signature: Building Commissioner/Inspector of Buildings Date File#BP-2006-1391 APPLICANT/CONTACT PERSON James Locke ADDRESS/PHONE 26 South Street WILLIAMSBURG (413)268-9323 PROPERTY LOCATION 324 AUDUBON RD MAP 05 PARCEL 048 001 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: REMODEL 2ND FLR BATH&ELIMINATE TUB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 001992 3 sets of Plans/Plot Plan THE FPLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 1 ATION 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 Pe t from Elm et Commission 2L 2od� 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. BP-2006-1391 324 AUDUBON RD GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 05 -048 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1391 Project# JS-2006-2060 Est. Cost: $19650.00 Fee:Cost: $ PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: James Locke 001992 Lot Sizes . it. : 388119.60 Owner: SPERRY CHARLES.R&CLAUDIA Zoning: R12. Applicant: Jaynes Locke Applicant At1d ess: Phony: insurance: 26 South Street _ 413) 268-9323 _ Workers Compensation WILLIAMSBURGMA01096-9726 ISSUED ON.612312006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL 2ND FLR BATH & ELIMINATE TUB POST THIS CARD SO IT 1S 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: �3 �Q (� 'final: Rough Frame: G It9/o{ (.out,, Gas: Fire Department Fireplace/Chimney: Final: Smoke: Final: 6K o�(40o L'Oat% THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON` UPON VIOLATION OF ANY OF ITS RULES AND REGUL TIONS. OX00' Certificate of Occupant_ Signature: _ -- FeeT e: Date aic Amount: Building 6/23/2006 0:00:00 $83,0014545 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commis;ions-Anthony Patillo