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17C-184 (6) a 6r1 1) of art 11alIIp o I I 6 1155 AC fill 6(t 1)1:1F�RTl�Ll ) 01' BUILDING IN.SII-( 11 1.S 212 Main Street ' Municipal Buildinj, — Northampton, Mass. 01060 WORT ET'S COMTENT SA`I'ION INSURANC)" ,tl+'FIDAVIT �;-ith �. principal place of businesslresidel�ee at — fit I :_111 3I1 1p!O)'Ci (I 1I1� tI1C IO110��'IIIS, ','.i)Ir; S co11)1 C,1 V eluployccs ',l,.oI ins, 1" i�Ii lob: (lncnra�,c:r t'orsl:.����1 (Pc.�c,Nnalbcr) - _ ( ,,r.r uon Datc) I �±Iil �i SOIC l?rODilCI01, ?CIIE:.dl COIILT3CIOr Ui 1?G�?�O�VIIe; tC:rC:C 0[le) 2I]C Fi"d�'� I11SCCl 0-,I- ContIactm-s liste , PI 1Io /i'vho hav-, the loi1c,"v" t -- Q,iLj_me o1 Date) (N:Iac of (.o; 2nlr..nc 'Nan1r�, �ly'1II f t_l)ii,.1., . (s.t:.i� 1. ccil t•-.--_!-- .. -.., _ .r... i__:Kl::.:i cr.h_. .. .,-.:_..._.. <_�p:r-111fll ._:Id have nt� oue .,u:� u;:; for ine.. :'.ill _ I:Oi7 O:',.. - ?.O I I,:plc--a, tY r:?t atctc t}n❑li::x u::iti c:t�i:.c;t:hc i�._:a»•.,2,_r rc�i�'<�cr cx�!`.w-�.���:.ii z::�.:r;c:�iu t!u�-R:.•.:<«-<[-a-r:i1-, o.0:_i=::':a tom. c_�plcyc:5 un::r t}u,�ti1.trl'�r,�, _.._..cn i',c:(GL152,.31(Sl),nl<<.a_ic._,:n t ;:vo•.�-rr.�. i�:.c -,. .. _ c c:-_ ]cgil cl2trlc of a_n�:q?loyoc und<r ilm LV o,lc.h t.,o;ntmzxtion AcL I undc:auid Xc may 1 o f01�i',—I{ j to tiio U<tK.r tnr,i:of Iixiilstn�l Ac�i��'n'i Ofliro of I:.:,.0 u>_c for lim covcn;c vC T1C d tt t fail c to s trc bvrtabo ur r cc icn 25A cd` O1,152 can Ic_d to t1x im1»zaian c; ::i�l�, In Oani tmg of a lv to S 1.: J.!�J nay'cX ir::Ilris�yvnk:,of up to on.}ra:r.�j civil lxiul!icl in:;�t al.,o(a Lra of Sl(�.(?OEa,'dsy�s;r.iti•.t r.,. _ - /- FCC cSq;aiVtr_:nl u.a <,1y )ctrnit Tluni ra - t i E Jif, �turc of i.fcc �-lPr., t�,'.trr r r SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ��`.rl�1�� �, �tiTT __ _ G-`�- C9.7L i w License Number ILI Address C•\' �a� Expiration ate Si nature Telephone Reitered`Nornef�rriprov �� ��� ' Not Applicable ❑ Company Narne Registration Number Address Expirati n Date YV\.YAI fit 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 affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 11� I0 0 l-B0x e §40ri The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)faniiiies 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 borne in a (wo-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 buildino permit. As acting Construction Supervisor your presence on the jot) site will he required from time to tune, during and upon completion of the work fCr which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Lmployees 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' DE SCRIPTION;OF PRO POSED.WORK-(check allsapalicable V% "Iu New House ❑ Addition ❑ Replacemen indo Alteration ❑ Roof g Or Doors Accessory Bldg. ❑ Demolition❑ New Signs Siding Other [ ] Brief Description of Proposed Work: tom' `-SVt�+ .i1! � i1.., Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes i,_No Plans Attached Roll ❑ - Sheet❑ 6a. 1f=New hduse,'and'.or.'addition to`existin�Choiising, complete=tlie';followin;r: 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 SECTION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ­---ee,, C Z �S' as Owner of the subject property hereby authorize _ �t`i k-L iIN M to ac..; or my behalf, in all matters relative to work authorized by this building permit �pplicatinn. Signature of Owner Date 2ff —i.a -- ----- --_---, as Owner%Authorized Agent hereby declare te state ents 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. C' k{ c 13 -� ---------- - - ------- Print Name Signature of Owner/Agen Da e 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued,ffoor/on the site? NO DON'T KNOW YES _V Q,--EP IF YES, date issued:---A-'NW -;.m IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES !/ 9Z IF YES: enter Book _ ��- Page ?�j _ and/or Document # B. Does the site c:'.)ntain a brook, body of water or wetlands? NO _ V/ GON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservat on 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. Aref there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: _ _ XQQ City of Northampton S atusv Per t r Bil'din Department CurbCuf/,D vv , e 212 Main Street S rZSeptcA eb ` Room 100 Wa erlWe l Avaua,wi}r U '+� ' y� a ,gar .''$ �Y mpton, ''MA 01060 Two Sets offStr e ttra a�i p Fax 413-587-1272 Pl %Slte Plans �d?ie A-587-1240 Other Specify � � T .Y.,, APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Proms Address: �This section to be completed,by,office Map F fe Lot Unit Zone Overlay.District EIm St. District CS District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) C:rrert M-it na Address — �-- �– -- e,ephone - Signature — — 2.2 Authorized Agent: Name(Print) Current tvlaihng Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item stimated Cost (Dollars) to be Official Use Only completed bvermit applicant _ 1. Building (a) Building Permit Fee !b timated Total Cost of Construction from b 3. Plumbing Building Permit Fee j .+- Mechanical (f-IJf'.r�; 5. Fire Protection I 6. Total = (I , 2 3 + 4 Number ThisSeglion For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings. Date File#BP-2003-0998 APPLICANT/CONTACT PERSON WILLIAM PICHETTE ADDRESS/PHONE P O BOX 454 (413)628-4787 PROPERTY LOCATION 53 CHESTNUT ST MAP 17C PARCEL 184 001 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 Typeof Construction: RESUPPORT EXISTING PORCHES NEW FLOORING REPLACEMENT WINDOWS& SIDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 071053 3 sets of Plans/Plot Plan THE FgKILOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With 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 Ehn Street Co ssion "�_/wx 1.20e2 Signature of Building Official Date x 11 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. BP-2003-0998 GIs#: COMMONWEALTH OF MASSACHUSETTS .� '` CITY OF NORTHAMPTON Lot: -001 Permit: Buiidim Category: BUILDING PERMIT Permit# BP-2003-0998 Project# JS-2003-1598 Est. Cost: $30000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM PICHETTE 071053 Lot Size(sg. ft.): 9016.92 Owner: BOULEY ERIC S&MICHELLE Zoning:URB Applicant: WILLIAM PICHETTE AT: 53 CHESTNUT ST Applicant Address: Phone: Insurance: P 0 BOX 454 (413) 628-4787 ASHFIELDMA01330 ISSUED ON.5 115103 0:00:00 TO PERFORM THE FOLLOWING WORK:RESUPPORT EXISTING PORCHES, NEW FLOORING, REPLACEMENT WINDOWS & SIDING 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: FeeType: Receipt No: Date Paid: Check No: Amount: Building 5/15/03 0:00:00 1412 $150.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo