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17A-260 (2) E E Fy A �i` AUG - 1 ; �1 - � 0 �O 44 k, ..'�. r„.TAM K S 1 S TI n Q DES?OF B J DktG..1 ECTICNS �.�� .� � �• e� 01060 �,r p- �-^ �( f �. L.- T `.ON I1'Nvols (T(-A�(kry `' o t � I i le oc jL �2^,x P.1 . .........__._..,..,...._........._.__..._.�.._._.w_.W...... - — :� .L Y S � S ��'15.x+ 4x � Pr Ll VIII. ZONING PLAN EXAMINERS NOTES DISTRICT I\ ' P) 9 6r USE I FRONT YARD AUG 2001 SIDE YARD DE NORTHAMPTON,MA 01060 REAR YARD NOTES IX. SITE OR PLOT PLAN — For Applicant Use ly�r rs A..¢ '# �r� t~.'".#-.Tm s'SK..-e t d d o-q #+ { r8 r t to 7 r� '-r 4 r d J'V � 4­q r ->=r s -r t t# t - r t 444 -s-r- a-s.`� .r .'.r...�' '' a 1 .I - f v c - ' y ��r e i-€'- 4 14 .{.,rvt^.°-4 < 4 "{ t b'.�.T.t r a€ ° z t t aS y { a r y. F-. t }-t t r Y 44"} -4 i 'r � i 4 �.f.y r j P .t.} 4 l.t e}, }..,.�q i � k} - k j y -; j •f `'Z�.' t7,1 a f f �i s tj ai r t �L ' ?f 7 041} ITI t e X11"7 -i T a z 'rg r t ski ; s s ��� y yea " 4 I - i 4 { i r ; Y°( d •t°T��` C�-z> f r � "" t�+ #� e ,`� a�+}.y F P �'f TG�' ; '$ i t gg� t x t 1�s+ E {} a �b¢r .�€..;:'ti. BOCA FORM APESP — 669 C1969 BUILDING OFFICIALS & CODE ADMINISTRATORS INTERNATIONAL, INC. Z0 Oy R e GiN Of Norfi1aillpf o11 B H �asaachnsctta _— DEPARTMENT OF BUILDD\'G INSPECTIONS 212 Main Street ' Municipal Building 'a Northampton, Mass. 01060 WORKER'S COMPENSATION INSURA-NCE AFMI AVIT Jr- (li ,pc�miticc} • with a principal place of business/resideaceat`. (phone!,') (st1>Nt/ci ty/staicia p) 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 thus job: (Insurance Company) (Polio Number) (Expimtion Dale) ( ) 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) (Insvrancc Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance C0MDauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Pot;cy Number) (Expiration Date) (Name of Contractor) (1asttrance Compary/Policy Number) (Expiration Date) (an-A additioml shoes ifnoccnuy to include infocrosrioo pertairang wall oomrnco�) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plcsse be awzne that vrhi.lo homeowmn who emplay pcxsons w do�r,,im,acc o=zrk. too ar repair work on a dwelling of not moon than throe tilts in which the bomoowner maiden or oc the you rppurteaam.thccto arc cot gencally ooc=dcrod to be employm under the wockn's coavc sslioa Art(GL152,z3 l(5)�application by a homeowna for a license or pa-mil may evidm the legal etsIIu of an employer uoder die Wockoea Compomation Act I undcntaad that a oopy of thu rtocmm2 may bo forwarded to tho Dopartmcat of Indiu;rid Aoct&ate OlSoo of Iawri for the coverage verification and that failure to cccunc coverage under suction 25A of MOL 152 can lead to the imposihion of aiminsl pcaaltics oom6ling of a fine of up to S 1.500.00 and/or imprison of up to one year and civil penaliia in the form ore Stop Work Order and a find of 5100.00 a day agnima me �f For dc{ia-tax&_-1 use only permit Number Ma � Lot R Sigaaturc of Lic,=s6 JPcrmittce Uate f 7 SECTION 8,-G,ONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder r *Azj!� License Number vas �_:a "� � r _ , JCl .�.�'f'�`A f///9 /oJ Address Expiration Da et Signature Telephone Y Not Applicable ❑ i 1ov/,1 L7 Zz 2 Company Name Registration Number /d elo� Address Explration Date Telephone SECTION 14 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,;§25C(0) 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 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 tl a 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 '$ DESCRIPTION OF PROPOSEQ O}�K c eck all a livable ,v; 'Zbo m ph New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes?—No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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 SECTION 7a QWNER AUTHORIZATION O SEONIPLE�TED,)N�HEN GYVN2S1GNT "p 171ft APF'�,ll*S FOlIl:rr Sc as Owner of the subject property hereby authorize J4L r c `{ to act on my behalf, in all matters relative to work authorized b this building permit application. Signature of Owner Date l k as Owner/Authorized Agent herebrdeciare-fh-at,$Fe,4tdtempfits,And information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed un r the pains nd penalties of perjury. x 4ne n r Print 1< r I Signature of Owne Ag n Date r• 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 /O 00'Loa) Frontage Setbacks Front p7 C Side L:_ R: /(c ` L: R: Rear S9n,.>i Ar U a�7 Sys rs7- . Building Height Bldg. Square Footage ' % Open Space Footage % 6-61(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 -'r — 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 f` 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 there any proposed changes to or additions of signs intended for the property ?YES— No IF YES, describe size, type and location: Northampton � B I g Department rail, - 1 2001 Main Street R om 100 DEPT Of 8'll ING INSP am ton, MA 01062 - 87-1 40 Fax 413-587.1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTLON 1 sSITE INFORMATION �. "fh�s s li3e feted 4fr � 1.1 Property Address: � � -'��L1nit g i S if Yoh AW SECTION 2-.PROPERTY OWN ERSHIP/AUTHORIZEb AGENT 2.1 Owner of Record:,� / ? L�C d Al 4' Name(Print) Curren ling Acdr � 3 Telephone Signature 2.2 Authorized Agent: Name(Print) L _ Current Mailing Address: ,Z Signature Telephone _ jECT10N��f=S�"IlVli4ryi"E��CON5?RtCT`ION C�5'I"S Item Estimated Cost(D�alicant o be Official Use Only com leted b erm Building (a) Building Permit Fee" 2. Electrical (b)Eated TOtaf Cot:af" stim > , Constructic ,frofri .i6 3. Plumbing 'Builcfmg'Permit-Fee. 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) {'Z 5-00 C_he6k` lumber his.5ec#ion For.Official Use.,'Only Bui[dirtg Permit"Nurriber: 'Date,Issued Signature: 8dingGorntniss,,ionerJlnspee#prof Bui1C{ings , " Date ,'. File#BP-2002-0123 APPLICANT/CONTACT PERSON LOUIS MONTGOMERY ADDRESS/PHONE P O BOX 1013 (413)625-6953 PROPERTY LOCATION 89 OAK ST MAP 17A PARCEL 260 001 ZONE URB 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: CONSTRUCT 3 SEASON ROOM ON TOP OF EXISTING DECK New Construction Non Structural interior renovations Addition to Existinp, Accessory Structure Building Plans Included• Owner/Statement or License 013471 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: �/ 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 Commission $`-dt-0 Signature of Building O cial 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. r'. 1 w , i S f # pg r , a _ , 'd 9 e t. pas VAIN IFNI I* VA Too 511 A oil ZERO? 1 ,f i 89 OAK ST BP-2002-0123 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma:Block: 17A-260 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:ADDITION BUILDING PERMIT Permit# BP-2002-0123 Project# JS-2002-0179 Est.Cost: $12500.00 Fee: $62.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: LOUIS MONTGOMERY 013471 Lot Size(sq,ft.): 10890.00 Owner: GRAHAM ANNE&SCOTT Zoning.URB Applicant. LOUIS MONTGOMERY AT $9'OAK ST Applicant Address: Phone: Insurance: P O BOX 1013 (413) 625-6953 BUCKLANDMA01 338-1 01 3 ISSUED ON:8131010:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 3 SEASON ROOM ON TOP OF EXISTING DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: �'t�(�l�,,a House# Foundation: Final: Final: I WO, pe Rough Frame:®I( ��f Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation:— Final: Smoke: Final: 0 It q -40-© ( THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/3/010:00:00 1315 $62.00 212 Main Street,Phone(4L -1240,Fax:(413)587-1272 Building CommL "nthony Patillo