17C-150 (3) a
baa�ds_
wR��
ilk
_i
i E
1
�Q�� Irne,6= �osS�h!e sGr�v�rer S�t�lS
(w( �os,'� ale ShowP.r s .E! s
J
r
j
i
Zo
boa�c�t �
wall ,
J
n1 (( -
(y"
ck
VLOI
- 3
u
'a
�t
i
s
0t _ GuRPI"or r�A,T �R,�o M
i
-° ate_ (w os�'� �(e_ Shower_ s (t 5
w m
CD
3
4
i
4�ttAM p yO
g � ��aSS aC!Jtt5[ll5 v
DEPAR1-MENT OF BUILDING INSPECTIONS r
212 Main Street ' Municipal 13uilding
Nor thantptoil, Mass. 01060
'YOR7CER'S CONH ENT SAXION INSURANCE AFFMA IT
(llc�.1lscrJperm!tter)
v,,Ith a principal place of busnicss/residence at
2-o Lac
do hereby certify, under the pains and penalties of perJury, that:
( a
I = n employer providing the following workers colnpeilsation coverage for Iny
npleyees working on this job:
4 4
(Insurance Cornpmy) (relic,Number) (Expimtion Date)
; ) I am a sole proprietor, general contractor or honteowne: (ccreie one) and have hired
the contractors listed below who have the coLr,uensauon policies:
(Name of Contractor) (Insurance Cotnpany/Poli('y Number) (Expiration Date)
(Name of Contractor) (Insurance ContpaayiPolic,,Nimiber) (::Npimtion Date)
(N<nne of Contractor) (Inszuancti Col�pany/Polic�Numtxr) (> xpiradon Date)
(Name of Contractor) (Insurance Come ,yrPolicJ Numbu)) (Expiration Date)
(attadt uiditioarl ci�c�-t iFnocczur,:to in-luck iafocmi;ion pamulir_&to all cx iradnrs)
( ) I am a sole proprietor and have no one working for me.
O f am a borne owner performing all the v;ork myselr
NOTE:plcnsc be aware that whilc ho(➢COw1X_71«Nbo tr:ip!ay pcic:s to d ma lctuacS c . cr rr,air Nvvric on a d«ttling of
not ntocn th n tlssto units in t;fnc}s the ha o riiver rrsidn a on Ltic p oucx z zpputteneni thercio a c[)Cl(l cncrally Dori,kral to be
cniP!oyrr,under the worker's c xrrp z tion Act(GLl52rs 1(5)},application by a homeowner for a Eccase cc Permit may cridcnoc the
legal ctatuc of an emvloyer underthn Work'M's Corupeoz Lion ALt
I understand that:k copy of thin etatcm -A may bo fc cwarciod to tbi Dcparta_f of Lxix fri al Ac i&rn&oflioo of Isnurwce for the
coverage vcrific:mdon and that failure to accure covccago trod,-x scctioa 25A of MdL 152 can!r_d to the imposition of criminal pcn&Ibcs
oowistiug of a&nc'of tip to S1,500.00 and/cc u�cnt Of','?to one ytsr and civil paniti i in d,,focrn of a Stop Work.Ordtr and a
fires of S 100.00 a day again:.[me
Foc dcgutrrml�al u>,c only
Pcrmit Ntimbex
Map,, _ Lest ri
�� t tur�s6f LiccnscrlPernuttce �'
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holderd���� -
License Number
Address Expiration Dat
;7 61
Signatu e Telephone
S-166 F`Y�/
9.'Registe`red Home irriprovement Contractor Not Applicable ❑
1101� �-P� c.>L 1'► . .�.� � .
Com an Name Registration Number
�� �t,�� �' ��-e��u�l P--- 2c1` �att.5i'S�-
Address � 1 0le ki e _ �`/� Ex�ation Date ��—
Telephone �76 ( 1 .�
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 affidavit
will result in the denial of the issuance of the building permit.
Signed Atfidavit Attached Yes....... t No-.... ❑
11. , ine:NOwner Exemption
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-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(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 Alterations) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ Other [ ]
Brief Description of Proposed Work:_ 1 r ,� ,���ow�:,r�y.�6�___�, ,tia _1,1 i z per'
Alteration of existing bedroom Yes. 7c No Adding new bedroom Yes NIC No
Attached Narrative ❑ Renovating unfinished basement __Yes No
Plans Attached Roll u - Sheet '
6a. If New house and or addition to existing housing, completeAhe 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 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
I
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize v �� der ��S 1��1 ��I t� �� �� r to act on
ASignat half, in all a ters relative to work authorized this buildi g permit application.
J re of Ow er Da `
�� �� i (� as Owner/Authorized Agent
hereby declard 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
1 i 1
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
j� This column to be filled in by
Building Department
Lot Size �F 1 D�
Frontage 0
Setbacks Front 2-0
Side L:1 0 R: Z � L:
Rear
Building Height I r
Bldg. Square Footage l &00 2
Open Space Footage °%
(Lot area minus bldg&paved 5?0 0 �f
parking) e
#of Parking Spaces
Fill: 0
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO X 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:
III hamptontat °
Buildir, partment GurbCu�tlD � a a
- 12 r Street lSeptrc vai a. y
Room 100 WaerlVrelly. rt;y �
GFPT OF BUILDING I pton MA 01060 Two�Sets of Str c r ` arcs N W
3 A
( MW§04YS-5817.1240 Fax 413-587-1272 Plod%Site
Other Specify ,. .._ .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section.to,be completed by office
1.1 Property�Address: j
Map l .Lot _ -. Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2_1 Owner of Record:
i-1am (Print) Current ailinSAddress:
_ - -- I--- Z
Telephone
Signatur
2.2 Authorized Agent:
I Na rint)_ Current Mailing Address:
Signatur Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
j —
2. Electrical (b) Estimated Total Cost of c7
3(9 Construction from 6 ( � S
3. Plumbing 1 5Q Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection 0
6. Total = (1 + 2 + 3 + 4 + 5) Z5-0't'v. Check Number
This Section For Official Use Only
Building Permit Number: ` 01 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2002-0328
APPLICANT/CONTACT PERSON Skyline Design
ADDRESS/PHONE P O Box 142 (413)586-8491
PROPERTY LOCATION 106 HIGH ST
MAP 17C PARCEL 150 001 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
Tyneof Construction: REMOVE CLOSET&CHIMNEY 2ND FLR BATH&ADD SHOWER&NEW
WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 002722
3 sets of Plans/Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I MATION 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 Co ission l
, le�
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.
HIGH BP-2002-0328
Gls#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0328
Project# JS-2002-0501
Est.Cost: $14500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Skyline Design 002722
Lot Size(sq. ft.): 4704.48 Owner: KASPER MICHAEL F&MARY LUCE
Zoning.URB Applicant: Skyline Design
AT: 106 HIGH ST
Applicant Address: Phone: Insurance:
P O Box 142 (413) 586-8491 Workers
Compensation
FLORENCEMA01062 ISSUED ON:10121010:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE CLOSET & CHIMNEY 2ND FLR BATH
& ADD SHOWER & NEW 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 sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/2/010:00:00 8167 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
r
001 w
AWN
mm�"
i",�
�a f
WWI "m. Et ty j ys-r^ cr
S , 5
r r t,C` t c d € #€ ,✓.a A� iy 'h �~tk�css`�W-,' '` *- a r.a € t „ 'F
ti
NT
€<
ras
'^�"r*�.# .
{ r ewe x : ,
,r ��, x � � '"✓ y� � h t-r4.r �'t�1, � r ����' �3s�¢ �T° �'L - �e '>:'``,,�+c x�x �x� �i�F `f�
MAN
is i i ?
`3-4,t ,', x ''a a i'h r ` �E �z-wf `_. w,-3r a" � e "C` MUM,'v'�i ..
W-Mm
00
�' v
ijk
' '+ .' r``.: ✓,� :`" itv�
s', :. w„s
,X "` r r y,
§213, ^'�e•3=r 5 n" u L n =4 S ` ',v.X .K
w
W
' ow
w' x
th
a a `£€` OEM
r aka= `c y
S.
A t
rr
sow
p
5 aI :� aX t
�'��
Y xfix
51—
-nag WWI yww:
�tU 1
` ,e� asae "L
SKIN ,y
4 z
O
Kill,� 7� 3 >5: �
MEW
sa,
MQ
r r• ,. 5^�t-'"�P ' {t"'d stz r, tiU
M� .w 02 » ,
s _
61rIIST 8P-2002-0328
#:
COMMONWEALTH OF A. S C SETTS
h ;B: 17C- 150 CITY OF NORTHAMPTON
�- Ol
Permit: Builds
C* o :Non wiomW wrr.Qvations BUILDING ,EE T
Pan*# BE-, 002-0328
Project# J--29' 501
Est.Cs 514504.00
Fee:$50.00 PEIt1VIISSIONIS HEREBY GRANTED TO:
Const f�NS: Contractor: Denser
Use Group: Skyline Design 002722
Lot Si&tW ft)- 4704,48 Owner: KASPER WCHAEL F.&MARX LUCE
pan
A1'"c 106 NIGH ST _ - -
AW_&ant Address: Phan: Insurance:
R.0 Box 142
(413) 586-8491 "Workers
Cornpensat�on
FLORENCEMA01062 IS•S'UED ON:IQ/Z/QI t1.Ol1:Ol!
TU
PERM"`�1 THE F04LO07NG WORK.-REMOVE CLOSET & CHIMNEY 2lVD Fi.R BATH
&ADD SHOWER,& NEW WINDOW
T CARD SO I I VIS . EWA T S T
Inspeetor Otpionibini" -Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter
Footings:
ROUgh:/!.t d/ 5 f"1 Roughs Mouse# Foundation:
Driveway Fines:
Final:, +� ' Final:
Rough Frame:cPG'f-G� '- 3;
Gas: Fire Department Fireplace/Chimney:
Rough: Insulation:
F
Final: kee Final: j< ,..
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO
ANY OF ITS RULES AND REGULATIONS.
ifj ; f cu anc ture:
Fee Tytae: Receipt No; lla,�tc Paid: Cl __,Nu: Amount:
Building 10/2/010:00:00 8161 $50.00 ,
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patilio