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E A R A
DER! BUILDING INSPECTIONS
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Do or
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This Col— to be filled in
by the Banding D�pnrtment
Required I
Existing Proposed By Zoning
Lot size O y O -Prl f �y 0 2—
Frontage 66
6 G
Setbacks o ��t t U r S 3LO
a'r 'c'^ l !/
- side L: R: Y� L: R:
U1' rpe✓
- rear
Building height 2 r 3 S
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of 'Parking spaces aT /2eS7- G e C1\� �(„A
_ CB,/ rin
of Loading Docks
Fill:
volume--& location) CA
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: =_ &(01 APPLICANT's SIGNATURE
NOTE: tasuanoa of a zoning permit does not relieve an applioant's burden to oomply Wmi-all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE if
Fi1e No.
ZONING PERMIT APPLICATION (§I0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION /
1. Name of Applicant: k a ✓0'0` TO V - O
Address: 4'x "5 a we., Ncw11,o.,,/r .Telephone: 7- �6'6'T � 3 ,7 -666,j-
2. Owner of Property: 4A,T'r-Vx�-X�
Address: 2 ( W/A4 o�V--4— Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: ( v✓t�-p T�✓�i 0��.2
Parcel Id: Zoning Map# �C- Parcel# District(s): t-1A 1
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
(DU_✓'_aOro�i'n?an odd 2 ,3;�-a Ohe S7a✓v / �'T e� �oc�� von.✓;
� t.o
or.i!i�.2 SAS Sl�o
7. Attached Plans: _A Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. 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#
9. 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:
(FORM CONTINUES ON OTHER SIDE)
SUBJECT PHOTOGRAPH
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idress, mwkfex
CitY: Florence CountY: Hampshire-_- State: MA Zip Code: olo-62--
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORIMR'S COMPENSATION INSURANCE AFFIDAVIT
2 1 S
�— (lio n- permittee)
with a principal place of business/residence at:
(strest/city/statelap)
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 this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) 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 Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(aiIach additioml shed ifnxcsuy to include information pertaining to all oownwton)
( ) am a sole proprietor and have no one working for me.
( am a home owner performing all the work myself.
NOTE:please be aware that whilo homeowners who employ peace:to do m intend act,suction or repair work on a dwelling of
not more than three units is which the homeowner resides or oa the grouo6 appttrtenarri thereto arc not generally ooasidacd to be
employers under the worker's oompensation Act(GL152,vs 1(5)),application by a homeowner for a license or permit may evidence the
legal staters of an employer under the Worker's Compomation Act
I understand that a copy of this uatement may be forwarded to the Departera2 of Industrial Amdcc&O&oe of nsuraoce for the
coverage verificWoa and that failure to seatre coverage under section 25A of MOL 152 as lead to the impositioa of aiminal penalties ,;1.
consisting of a fine of up to 51,500.00 andfor imprison of up to one year and civil pmslties in the form of a stop Work Order dad a
fine of 3100.00 a der me
For departw4tal 1120 only
I�/
Permit Number
Ifl� J Lot#
' b SipatWe Licensee/Permittee
t
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z
." �k�9t r, x�t71i%�'g
4.,
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
I
Address Expiration Date
Signature Telephone
Not Applicable ❑
Company Name Registration Number
I
Address Expiration Date
Telephone f
SECTION 10="11YORKERV 00MpEN$ATlONT1NSUR INCE AfF1DAVIT(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 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.AAerson who constructs more than one home in a two-year shall not be considered a homeo_wnerwho constructs more than one home in a two-yearperiod 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 responsible for all such work performed under the buildin�permitunder the building permit.
As acting Construction 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"certif and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and cal oning La s an State of Massachusetts General Laws Annotated.
Homeowner Signature
• k
SE OM F X37
5 ;
ID'' Oiw F� C3P ti is !e
New House ❑ Addition ❑ Replacement Windows Alteration(s)❑ Roofing ❑
Or Doors ❑
Accessory Bids; .Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[✓f
,4/Z.4 -7— L/M/TE' K/TGNfN /2�-i ✓Ario.✓
Brief Description of Proposed Work: �E� `�E "! OP Es A/L4 Gam" Tyl4 T LoLl.//�s� ✓ �-J CiQ w,-"n /Z
fN0 u1 0 J eA#fT/✓lr Fovy' A7',06 V/ W ITAo- l-F— r-i •� <ayA c/ r!c/6�ir, SCr✓.41Z'C-
Alteration of existing bedroom Yes tVo Adding new bedroom Yes No Foor,4 e;'-
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet 0
a. Use of building: One Family Two Family Other c`
b. Number of rooms in each family unit: Number of Bathrooms i�r
'
c. Is there a garage attached? P G�` /./0-
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
SECT ON 7a i i? f O �TfO 7,'.0 LE,f l) WHEN
OWNERS AGENdoll� Ctif APILi) S bN iU1D1NG'pERM17
I�
as Owner of the subject property
hereby authorize A ✓�a G Up �— to act on
my behalf, in all matters re14/ive tp ork authorized this building permit application.
/1-1 -5-1&110
Signature of Owner Date If
F1, JIM,
, / r r , as Owner/Authorized Agent
hereby declare that the atements and information In the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
5� 7t 4. >a-r:7- s
Print Name //--
Signature of Owner/Agent Date
NyTc %h/5 APPS-iG.� t'rv,✓ /L��✓rsTS f'cr�-�� -�� ••,- � - .—�, - .
W��h✓r' G-r/q N/rte� �- �;���fUt� i rf�T Gc��cwt /�sc,� �r/L/✓�. T�,c� F�„�.4 �
02M 7)1,C" k l ✓Tc/L
� " %N� Sl�z-T`'� live `L' �c /2t3✓/Lj
S/✓oW �iT, �
• p AI t'�' J( �5T/^�ls' Fo v w Al) f yJ v v 3✓i�4 1,,6-
Section 4. 5 tm nom, 4 •� �5 �� /7F /Gri t'1 14 P19c/124 �r y oJ� SQL✓A/Lt
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning L�l. t� -)
r This column to be filled in by t
Building Department
Lot Size ¢ 4
p �
Frontage A 5 f a s Z
Setbacks Front
f a � Z L;
Side L: R: L: R:
Rear h} o
Building Height
Bldg. Square Footage �Q %
Open Space Footage
(Lot area minus bldg&paved 3 U�
parking) 0 `
#of Parking Spaces r
Fill: /-
volume&Location N / a
A. Has a Special Permit/Variance/Finding ver been issued for/on the site? ` y
NO DON'T KNOW YES 4' Z
� Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registr of Deeds?
NO DON'T KNOW YES h 3
IF YES: enter Book Page and/or Document # h ryl
B. Does the site contain a brook, body of water or wetlands. NO DON'T KNOW ri,
YES ` Li
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued: d
C. Do any signs exist on the property? YES NO 0 1
� l
IF YES, describe size, type and location: A
D. Are ere any proposed changes to or additions of signs intended for the property ?YES_ w
No aR
IF YES, describe size, type and location:
V,
ffig
Q ity of Northampton
uilding Department
'i
212 Main Street
+� MAY $ 2M1. Room 100
No thampton, MA 01060
S2
APPLICATION��e 413- 87.1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION'
1.1 Property Address: This sectionto be complet datj+,o#face
y,
2-T f.✓l�- P L G Map Lat Unit' r
m�
DlStriGtF
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SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Se,:c,t� 41 �✓o 2 s. etg Gnu Vy F�/�€�✓�
Name(Print) Current Mailing Address:
4. Telephone �jfj'(a� 2�/�0 ,K 13$ 4 S
Signature — 4g/(, ✓=//i - 5
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
5ECT ON 3-jtSTIMATED CONSTRUCTION C05TS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building D Do (a) Building Permit Fee"
2. Electrical p (b) Estimated Total"Cost of
Construction from 6
3. Plumbing v0 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4+ 5) lPv0 Check Number
This Section For Off icial"Us'ebh`l
B-itding Permit"Number.: Date Issued:
Signature: "
Building Commissioner/Inspector of Buildings Date
File#BP-2001-0897
APPLICANT/CONTACT PERSON SCOTT NORRIS
ADDRESS/PHONE 20 Wilder Place (as Of 05/15/2001)
PROPERTY LOCATION 20 WILDER PL
MAP 17C PARCEL 194 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiny,Permit Filled out _
Fee Paid
Typeof Construction: RE LA E GARACR THAT COLLAPASED UNDER WEIGHT OF WINTER SNOWS
TO BE PLACED ON EXISTING FOUNDATION SAME SIZE NO CHANGE TO EXISTING FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accesso_ry Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
M THE LLOWING 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 Architectur7Coittee
o
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.
R!PL BP-2001-0897
GIS#: COMMONWEALTH OF MASSACHUSETTS
,_ f lac- 194 CITY OF NORTHAMPTON
Lot:-001
Permit: BuildinA
Category: BUILDING PERMIT
Permit# BP-2001-0897
Project# JS-2001-1624
Est.Cost:$9000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 5967.72 Owner: SCOTT NORRIS
zoning:URB Applicant. SCOTT N O R R I S
AT. 20 WILDER PL
Applicant Address: Phone: Insurance:
20 Wilder Place (as Of 05/15/2001)
NORTHAM PTO NMA01060 ISSUED ON:5118101 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE GARAGE THAT COLLAPASED
UNDER WEIGHT OF WINTER SNOWS, TO BE PLACED ON EXISTING FOUNDATION SAME SIZE
NO CHANGE TO EXISTING FOOTPRINT
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: House# Foundation:
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:
Fee Tyne: Receipt No: Date Paid: Check No: Amount:
Building 5/18/010:00:00 174 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo