05-066 (7) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:— AVIrs eel f f Z
License Number
-'r, /z-5;--CS-
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
(9&t/4.WN l�f .� /'✓y/!�� /"Lai'
Company Name Registration Number
2e_ Se /o"Y1 �'T GthWltvt s z;U,le 6-/Z -06
Address Q Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings ofone(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
N
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Yl— Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ([] Siding[[3] Other(EI]
Brief Description 9fP�roopos id, e
Work:rejota f c� �Q + JXIPA WIn
Alteration of existing bedroom Yes K No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes be No
Plans Attached Roll -Sheet
sa. if New house and or addition to existing housing, complete 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. 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, Ne0 as Owner of the subject
property
hereby authorize N�7•'/� `—�y� i Lvv vL�'KJ� �,�Z� �y�L'�
to act on my be alf, in-all matters relative to work auth rized by this building permit application/,
Signature of caner Date
as Owner/A thorize
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my owledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Own /Agent V Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
hvv$t This column to be filled in by
C Building Department
Lot Size ��" '� NO cal`` 6—t
Frontage 3 9-8 3 �8
Setbacks Front f\r0
Side L: R: L: R:
Rear
Building Height pt uimm
Bldg.Square Footage 2-7-8-3 % tf0 CXft✓ (-
Open Space Footage
(Lot area minus bldg&paved Q
parking)
#of Parking Spaces N 0
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW V YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO l
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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
s Department use only
City of Northampton Status of Permit:
Building Department Gurb Cut/Driveway Permit
212 Main Street Sew6r Ayailability
-- Room 100 Water/Well Availability
I N,arthamptoh- MA 01060 - Tv�S�ts f Strudtur8I Plans
phone•f3- ? �24b; Fax 413-587-1272 PIoGt/SI Pans
Other Specify
APPLICATION TO O S'F UCT,6l14TER,REPAIR,RENOV¢TE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION I
--
""
1.1 Property Address: This section to be completed by office
,,/,. _ ``-°•°'
3-7 Z �wV Map Lot Unit
ku,4 4 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
I V I;,� Q + LA-P D L. <J y D D 3-72- A vd v6 tJx i 4eJ4-
Name(Print) Current Mailing Address:,—,,q
Telephone G
Signature
2.2 Authorized Agent:
it Al L-0� Z,l- SOV711 S'i l I
(,�IZl� AW9 13 VZ6—
Name(Print) Current Mailing Address:
'1/9a 768 - Q 3 7-3,
Signature V Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building 2 ' ENT D (a)Building Permit Fee ��S-Q
2. Electrical / 5D (b)Estimated Total Cost of -3 �-
/ Construction from 6 /
3. Plumbing 2, 001) Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 0
6. Total=(1 +2+3+4+5) -3!5/&5-D Check Number
This Section For Official Use Only
Building Permit Number: ZVOIK Date Issued:Issued: Zl 0
Signature: /0 -2-4
Building Commissioner/Inspector of Buildings Date
w< 372 AUDUBON RD BP-2006-0431
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:05-066 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0431
Project# JS-2006-0634
Est.Cost: $35650.00
Fee: $182.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: James Locke 001992
Lot Size(sg. ft.): 142876.80 Owner: JUDD EDGAR R JR&CAROL A
Zoniniz: RR/WSP/WP Applicant: JUDD EDGAR R JR & CAROL A
AT. 372 AUDUBON RD
Applicant Address: Phone: Insurance:
372 AUDUBON RD Workers Compensation
LEEDSMA01053 ISSUED ON.1012112005 0:00:00
TO PERFORM THE FOLLOWING WORK.-Replace Kitchen cabinets, doors and 1 window
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: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeType• Date Paid: Amount:
Building 10/21/2005 0:00:00 $182.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo