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06-001 (6) �1 hx�`' QIVC'r g CD LH 1 Li 9 i C.� D ,tv ' r ucluej sewou i 4� lPTO � afl �x Xlf 'NUrtjla111ptoll B �a3E AClln6ftt5 c m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKE,R'S COMPENSATION INSURANCE Ar, t AVTT (li ce11 ser./pe7nv nee) ,,with a principal place of business/residencc at: (phonei�) (stmct/ci ty/statrhn p) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: (Insu c—_ Company) (Policy Number) (F—,'piration 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/Policy Numbcr) (Expiraboa Date) f (Name of Contractor) (Insurance Company/Policy Number) (Expiranoa Date) (Name of Contractor) (assurance Compan y/Policy Number) (F\Tp mt on Date) (Name of Contractor) (Insurance Company/Policy Number) (Expi,v.tion Date) (attach add:`,ioaal r!xr;if ncccsz.ry to inc}udc infocmati oa pertaining to all radon) O I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be aware that whilo homcoAn=who employ paTons to do mxii+,-.,•nn ca:-.7uon or rtpaUµark,on a dwelling of not more than throe units in wi di the hortseow ncr resides or oa the groua6 zppurtenani thereto arc oot gcacr211y ooasidard to be employers under the work&%cart =r4on Act(GL152,ss 1(5)),applintion by a homconvcr for a I CcWc a pclmd may ev'denoc tho lesil,tame o£an employor under the Wo koes Componsation ALt I uaaae a=d that a copy of this rtatcmcnt may be foawnrded to tho Dqt tax of Indust-d Acad-&OEoe of 1-1& o for ttm covmgc venfieadoo and that failure to scatre covecago under soctioa 25A of MGL 152 can load to the imposition of mm'W pcoaltics oanistirq of a fine of up to S1,500.00 and/or unprisoamcat of up to one year and civil PCD Wcs in the form of a Stop Work Ord--and a faro of 5100.00 a day rtg&inst mw r') For dgnrtm'-�al use only — Permit Number Lot 4 Signature of Litx:n, t'.rmittcn SECTION.8'-:CONSTRUCTION SERVICES ' 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone ,�c RegisteredH'orrielriprovement`Contractor " f Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 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 affic will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ �H=ome�O�w�rier�EXemp`��on The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act 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 them 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-vear 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 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 W. SECTION '_DESCRIPTIOI`f VPROPOSEDINORK=(check alll:applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ J Other [ ] Brief Description of Proposed Work: 0060- 43 se-oiull "J� TO X""3 FL.[1n2 Apr - Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative O Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 60 IfiNew.house and or;`addition to exi!§tin`g=hou"sing, comp']ete-the following: 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 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, as Owner of the subject prope hereby authorize to ac my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 Date Signature of Owner/Agent 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 30 Frontage 1 b➢ r Setbacks Front Side L: R:. L: R: Rear Building Height Bldg. Square Footage �q p % Open Space Footage 0 % (Lot area minus bldg&paved �G7 a3 parking) 1 #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 V 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. V!ehere any proposed changes to or additions of signs intended for the property ?YES _ No IF YES, describe size, type and location: e- x t� - as i y of Northampton Sta _s� f�Per: t ilding Department curb Gut/ e rint, �. f 12 Main Street SawerlSeptc= a i V -7 9001 _ Room 100 Wa�e �Wel�Ava ab f : Nort ampton MA 01060 Two Sets oftr c tlr Phan ° � ��` DEPT OF 9uliDING1t1�";n�'T1(8 913 87.1240 Fax 413.587 1272 PIotlSite Plans R $# �d1 N!?RtNAh+PTON, A 01060 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 Map LotUnit �� ���, Zone * "`� Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERS IP/AUTHORIZED AGENT 2.1 Owner of Record: _' mAJ 7 Fe4oTv�✓ G icy M y0-e" yr��E AO_ - Name(Print) Curreent�Ma/ilin Address: Telephone T 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 complete by ermit applicant _ 1. Building Q � pp (a) Building Permit Fee 2. Electrical ff (b) Estimated Total Cost of Construction from 6 3. Plumbing T Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building Permit Number: --� Date Issued: Signature: - ; Building Commissioner/Inspector of Buildings Date File#BP-2002-0357 APPLICANT/CONTACT PERSON FENTON THOMAS ADDRESS/PHONE 670 HAYDENVILLE RD (413)584-8486 Q PROPERTY LOCATION 670 HAYDENVILLE RD MAP 06 PARCEL 001 001 ZONE SR 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: INSTALL DOOR&STAIRS AS 2ND EGRESS TO 2ND FLR APARTMENT New Construction Non Structural interior renovations Addition to Existing AccessM 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: _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 Comm' ion © 2- �b f Signature of Building Of icial 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. qy x x l� X t. � i _ '� i . } g 4 A }�.. }'� "'t�, , ��, bT - - � T"�, " ,�,�11_ �,­__�,',,, _�5---I—— ,"': f ." l - —P �, W�Q,,,�- —,- , m - , I � ", - ­�, � ''� � �, I �,�IV , � ,7i,, , , ,t f t? : � 5 1 `� 3.t 2 Y - s , � " ra„ ��,v x 4 5 �r�� � r * gists �'s" ,--s s � .� `"' "" �J ,S. - I 11 �:11�, , 11 4 , � � - nq" 42'�'�"",�,,,�,,-,,��,,.,�"",--,�,,:��,,,i��,,��,�,�-�','�,��",--�-7�',���,4,1��-,,�t",-�,p , --- W-MA ­'�',';�,,��­__'!'�� low"; �01 S- t r 7 ,� t x ' t. �„ "' R wi> sx� 1101.026 s � I a. ` ,; r n i s a , �r + �, u, - ��,{` t,� s t ^n x -. st f 4 E :-T w 1 <'e t x . x is z h -' � b '­.. vt - zr " t s f 2 3,.".,', Kf cx - fit... z l „_ + t z '" ,,t + 1 `.v 'u � ''"11'' ice` t yrn' r x, t a a�` "r € u Za t„rf';��`" k " kz � $ i , l SO oi - �"� t n%,' A - Y _'! �� I � , till;!!!!!! I , ­,,�,� � , �� ­ 11 1 -, > 'r r 4 x '',-,k 4 s c s C I� t i t` Y'- 5 Own VAN,' a. �: ti ' t .�, r '�d 4 ' b. � f. y # ° 3 f �..: s malty " ""::, !!!it :1­�,� ," �,��, - , �"`A'V�_111 16,� - "', , ,", , , , aS5 k, 22 s 4 ' , �` rr t 5 : t z f t @"` say �^.s t rr , �' ,,.� t } 4 Fdm. , i i iS x x f .�,ss ":4z s `s> f, ``.�` .r,t• �, iti -t5 "� c WW ° k "; ,4 3.t�`�aa�.�`�� � �I '� + ss .s`v�� r,� �„ f��{. a� Yi `� ss. ? 3'`Sy+ k - t, d t�. 7' �'x „�§'. r rc `;� , �°A i t" � w y$ Yf' t 2. :i �`� fiy, r'R , f zp, `k, �t .. 4s#� 7t �" aa.,+cSrir �iK� '=s� y, r7 0 #" �. �, p ^�`'" " _ ,. _ c a r ,'k § r ��`-+",� `yam'. `"� .' .f a-n + { a 7>,S a"5I a '�" x � . +� + , i r 9 x $w fix ' wr = w .. a � w LY r at" `a - J :AAYDENVILLE RD BP-20024M7 �• #: COMMONWEALTH OF MASSACHUS MgZBlock:06-001 CITY OF NORTHAMPTON Lot:-001 Permit: Buildtnq Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0357 Project# JS-2002-0536 Est.Cost:$900.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: Lot Size(sci.ft.): 612889.20 Owner: FENTON THOMAS Zoning:sR Applicant: FENTON THOMAS AT. 670 HAYDENVILLE RD Applicant Address: Phone: Insurance: 670 HAYDENVILLE RD (413) 584-8486 O LEEDSMA01053 ISSUED ON.10 121010:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL DOOR& STAIRS AS 2ND EGRESS TO 2ND FLR APARTMENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET =Spector of Plumbing Inspector of Wiring D.P.W. Building Inspector nderground: Service: Meter: Footings: .� Rough: Rough: House# Foundation: HILL S Driveway Final: ••�� Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:OK -3' y~oa -1�`wJ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON'VIOLATION' ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: '004W Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/2/010:00:00 1828 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 , Oak Building Commissioner-Anthony Patillo '°'`f 4-1 a,