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� DEPhIti?.6D T OF 13UILDrN1G INSPECTIONS
212 Main Strect ' Municipal Building
Northampton, Mass. 01060 �
��'OR]CLIZ'S CO'Nf NS�I�ION I1�SIJRANCI: AII�D�r1� IT
(1 i�u;c:Jl;crin)tire)
v"Ith a pillicipal place of-business/residence at
(saret/d t r 1Slalc.�z7 p)
do hereby cerciiy, tlndel the pa!ns gild penalties of perjilry,
I allI an CIhpiOYC7 providl1?;'_ dv1 Iollov"111P, 102 IIIV
t
�.III IlovCC°S wol KIIIS, OIl tI11S l(`h
- -- _-
(1nsu�n 0
1 L131 a Sole p ou tictoi, gC11ti al con I-?C;,ol Or C?0rI1C0`:'D C: (ci:"e Oils) llave nLt C 1
the cone-aciors Il>te!']i belOw vY hO h-Ve the 011 O`.Vii7Q '��OCI: C Ju?i)CI1SaaOi? DC�JC:PS.
cio.l --- (IF1A!Ianc::
(Name C�, \utnc-n) Dale)
(Name of Coalrac,or) (Insuranc Comhan}/Police Numtxr) (LxpirCio❑ Date)
(N2jnc of Conu2c,or) (Insuran(-- Compz [Pohcy Number) (L-xpiruon Date)
(aeach�ddiUoc:al z'.x<+fn<cc:ur:to c�cluw u:foc�tioo pat�.r,ni,to ell oo�-�.C4:'�)
( m a sole piopnetoi and have no one worming for me.
( ) I am a home owner performing all the work: myself.
NOTE:plcs be nvruc Ihzt�Icrlo hoarowncn who anplay pcz- s to do rr z ocr,cc rn' oo c rcpau w'orx oa d,,elling of
not Mort than tbruo uniU in t,l Ch the bomCowncr reside=or oa the pp rt.n , x-�a2 nor genes ally-- std w be
cmploym under the wo;iu's arlea Acl(GL152-"1(5)�awLica-000 by a bomco"T]Q far e bc=sc oc pcsmrt may c-d--thc
IcVj ctnn of m ;mployoc under tho worn ,Cooap--t;on AcL
Y 1 udcrztan.d thax i oopy of thii m y bo foc w—d.od to d-Dopnrtmmi ofLod r al Arad—&Ofo°or ltL"fDOO for tho
¢ covc"-gc wn6cilioo mad that L•iltzc to&«curt oovcrasc under sociioo 25A of 1 JGL 152 c3.n Irxd to tba impaz4loa of trim nsl pc° -
coasistiug of a Cone of up to S 1 500.00 and/or i${aisoon>� of up to one year and civo peniltio In(jc form of a Stop woti Order and a
fits o(:S 100.00&day t&uin me
For d�uvncS.'J uic oily
11crmit Number
M.3p� --- Lot R _
M
Si litre of LisexJl'etTr islet --- -- --
SECTION'8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: 1,^ Not Applicable ❑
Name of License Holder: V �ti ►LS/� 0 2;9as-a
License Number
Address Expiration Date
L eel s Y� fl-.
Sign4 Telephone
Not Applicable ❑
Company Name Registration Number
�bYrN rj de ST �9 )at� )bck
Address I �j Expiration Date
Lx-,J-5� - ` � Telephone �����
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§2SC(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 a building permit.
igned Affidavit Attached Yes....... No...... ❑
fthil., 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 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'"'
l4N'5 C� 10N OF'PROpGSET)WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition New Si _ [ ] ecks Vrl SidTn ] Other [�
Brief Description of Proposed Work: 5elreoDpd f d kV I y 0
Alteration of existing b room Yes�No Adding new bedroom Yes No
Attached Narrative existing unfinished basement Yes r/
Plans Attached Roll 0 - 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?
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
C4 �k�ICJJ as Owner of the subject property
hereby authorize O Y1 Q N S 9-1+ to act on
my behalf, in all matter r la ive to wor t orized by this building permit applicat' n.
f o0
Signature of Owner Date
J D kK �u KS /�_fi , 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.
igned under the pains and penalties of perjury.
J06K �u145 kq
Print Name
01��IL VJA�L
Signature of 0 er gent Date l
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 �i C�
Frontage
Setbacks Front L 00 'bb [fi�
Side L: I�S/R: L: 3.�- R: O , 0
Rear L4 Gtr
Building Height
Bldg.Square Footage 1 c %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special ermit/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 there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
City C rthampton €
A 5 M0Id ��,!Departrnent
21i'-K in Street
DEPT OF BIIILDIFIG INSFEI fij,a 0 100
NOR I PIPOS�TON a
..,�.- -.�.-,.�...r. ,►? �, n, MA 01060
phone 413-587.1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
Thts s.` Ion tube co�I�te€�r office
1.1 Property Address:
Map
b,,
b,, 6'
L s A Zone V+t i
��[ay DstrJrt
Elm St. District CI ,<2itrCr. T
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
W ` Current M ilin Address: M
t1J Telephone sc!$�— �Y�"�r
tiS 'S +1�►ac�C S
Name(Print Current Mailing Address:
AjL-eetrs !9'1
Signature Telephone S Lt- SSA
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
cornpl eted by ermit applicant
1. Building r�d I 6UU Ov (a) Building Permit Fee
2. Electrical + CC,& .CD (b) Estimated Total Cost of
1 Construction from 5
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =0 + 2 + 3 +4+ 5) l Coe' . db Check Number
This Section For Official Use Only
Building Permit Number: - Date Issued:
Signature:
Building Commissioner/inspector of Buildings Cate
File#BP-2001-0002
APPLICANT/CONTACT PERSON John Punska
ADDRESS/PHONE 5 Dimock St (413)584-5533
PROPERTY LOCATION 372 AUDUBON RD
MAP 05 PARCEL 066 ZONE RR/WSP/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out _
Fee Paid ,5
Typeof Construction: REMOVE EXISTING DECK&REPLACE W/SCREENED PORCH 14 X 20&OPEN
DECK 12 X 22
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 039852
3 sets of Plans/Plot Plan
THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § _w/ZONING BOARD OF APPEALS
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 Co ion Permit from CB Architecture Committee
1—IffZ41 ;
Signature of Building ial 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.
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372 AUDUBON RD BP-2001-0002
GIS#: CONWEALTH OF MASSACHUSETTS
MapBlock: 05-066 CITY OF NORTHAMPTON
• Lot:-001
Permit: Building
Category:Deck Addition BUILDING PERMIT
Permit# BP-2001-0002
Project# JS-2001-0008
Est.Cost: $21000.00
Fee: $105.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group John Punska 039852
Lot Size(sg.ft.): 142876.80 Owner: JUDD EDGAR R JR&CAROL A
Zonirl :RRNVSP/VIP Anulicantr John Pt�nska
AT. 372 AUDUBON RD
Applicant Address: Phone: Insurance:
5 Dimock St (413) 584-5533
LEEDSMA01053 ISSUED ON.716100 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE EXISTING DECK & REPL„ACE
W/SCREENED PORCH 14 X 20 & OPEN DECK 12 X 22
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Btilldings
Underground: Service: Meter:
Footings:
Rough: Rough: W of House# Foundation:
Final: Final:
Rough Frame: `0'C�.
Gas Fire Department Fireplace/Chimney'
Itqugh. 0,.. ___r .. Insulation_
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NO THAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/6/00 0:00:00 2465 $105.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building C ommigcinnPr- Anti,.,.,..D^+;11„