23C-084 (3) 1� 4
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2015 00010096
Bk: 11964Pg: 148 Page: 1 of 1 RESTRICTIVE COVENANT
Recorded: 06)0912015 10:21 AM —*
KNOW ALL MEN BY THESE PRESE
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�) J%C C-CAC-n
1
That Ann Knickerbocker and Charles Tarlton, owners of the real estate at 68 B
d Street, Florence (Northhampton) Massachusetts, 01062, more particularly shown as
Deed Description, bounded and described as follows:
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Commencing at the Southwesterly corner of said tract on said Bridge Street (now
known as Bliss Street) the same being the Northwesterly corner of land now or
formerly of Michael Curran;
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Thence running Northerly on said street 4 rods to land now or formerly of Edward
Connell;
ZThence running Easterly along land of said Connell 13 rods to land formerly of
Thomas Wallace;
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Thence running Southerly along the line of land now or formerly of said Wallace 4
rods to land now or formerly of said Curran;
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ti°t Thence Westerly along land now or formerly of said Curran 13 rods to the point of
beginning.
-r Deed Date 11/14/2014 10:34 AM
m
Book and Page 11800 3-nf-3'a1q
Hereby Covenant and Agree that
The Backyard Barn space at 68 Bliss Street, Florence (Northampton), Massachusetts
01062 will be used as an artist's studio and storage space. It will not be used as a
sleeping space.
Executed as a sealed instrument this (date)
Ann Knickerbocker, signature rles Tarlton, Signature
1 AMY A KEHR
Nol�ry Pibk Cm um"of Mundoft
Mir OommiNion Faq�i►N Apq�!pA21
&WMT. HA.M.PS
MARY LBFRD.
1 .
No. 220924
Florence Savings Bank 53-7168 12118
85 Main St., Florence MA 01062 DATE May 29, 2015
MONEY ORDER
PAY TO THE
ORDER OF $ 100.00
One Hundred and 00/100******************************************* DOLLARS
MEMO 5-4 NOT VALID OVER$1000.00
NON-NEGOTIABLE
Customer Copy DRAWER/REMITTER
ADDRESS
ADDRESS
Florence Savings Ba No. 220925
nk 537188(2118
85 Main St., Florence MA 01062 DATE May 29, 2015
MONEY ORDER
PAY TO THE
ORDER OF $ 150.00
One Hundred Fifty and 00/100*************************************
DOLLARS
MEMO i T ,Q, ,` { ,���Q ;_ NOT VALID OVER$1000.00
�� NON-NEGOTIABLE
Customer Copy DRAWER/REMITTER
ADDRESS
ADDRESS
MPORTANT FEE NOTICE: CHANGE IN LAW ABOLISHES CSL's HIC REGISTRATION FEE
:XEMPTION. As a result of a recent change in the law(Section 80 of Chapter 27 of the Acts of 2009),the holders
,f Construction Supervisors Licenses are no longer exempt from the HIC Registration fee. CONSEQUENTLY,ALL
'ONTRACTORS,INCLUDING CSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A_
WGISTRATION,EEE OF$150.00,AND A GUARANTY FUND FEE. (See instructions for Guaranty Fund
ee schedule.)
16. REGISTRATION FEE ENCLOSED:S 16 io GUARANTY FUND FEE ENCLOSED: IM)")"010
PLEASE INCLUDE TWO(21 SEPARATE CERTIFIED CHECKS OR MONEY ORDERS,ONE MARKED
"REGISTRATION FEE"AND ONE MARKED"GUARANTY FUND."ONLY CERTIFIED CHECKS OR MONEY
ORDERS CAN BE ACCEPTED.ANY OTHER FORM OF PAYMENT,INCLUDING BUT NOT LIM[T ED TO
PERSONAL OR BUSINESS CHECKS,WILL BE RETURNED AS INELIGIBLE.MAKE BOTH CHECKS PAYABLE
TO"COMMONWEALTH OF MASSACHUSETTS."
I hereby swear, under the pains and penalties of perjury, that all information set fortli on this
application and submitted in support hereof is true and accurate to the best of my knowledge.
Further,I certify under G.L. G 62C, §49A, that I am in conwliance with all laws of the
Commonwealth relating to trues, reporting of employees and contractors, and withholding
and remitting of child support
I &If, . ,.�. - - '
Signatur of Applicant If a corporation or partnership, position held. Date
11.LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,AND MAJOR OWNERS(10%OR GREATER OF
OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR CORPORATION,BELOW.USE ADDITIONAL PAPER IF
NECESSARY AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS).PLEASE INDICATE BY AN"X"IN THE
LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D.
CARDS.USE ADDITIONAL SHEETS IF NECESSARY.
FULL NAME TITLE % OWNER ADDRESS SUPP.CARD
12. (a)HAVE YOU BEEN REGISTERED PREVIOUSLY AS A HOME IMPROVEMENT CONTRACTOR?. YES NO
(b) IF YES,PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER UNDER WHICH YOU WERE
PREVIOUSLY REGISTERED:
NAME: R.66-r p— Y•6 L,4k1-< C_ HIC REGISTRATION#:
13.(a) ARE YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER,PARTNER,OR CO-VENTURER OF AN
APPLICANT WHO PREVIOUSLY APPLIED FOR OR HELD A HOME IMPROVEMENT CONTRACTOR
REGISTRATION? YES v� No
(b) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANT/REGISTRANT AND THE REGISTRATION
NUMBER:
NAME: HIC REGISTRATION#:
14. (a) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT
FOR REGISTRATION AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN?
YES VNo
(b) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANTMEGISTRANT AND THE REGISTRATION
NUMBER:
NAME: HIC REGISTRATION#:
15. (a)HAVE THERE EVER BEEN ANY FORMAL COMPLAINTS AGAINST YOU WHERE DISCIPLINARY ACTION WAS
TAKEN BY THE DEPT.OF PUBLIC SAFETY OR CONSUMER AFFAIRS,OR ANY COURT JUDGMENTS OR
ARBITRATION AWARDS ISSUED AGAINST YOU?
YES c/No
(b)DO YOU OWE MONEY TO THE GUARANTY FUND?
YES v1 NO
IF YES TO EITHER,PLEASE IDENTIFY BY DATE,CASE NUMBER,OR DOCKET NUMBER:
THE COMMONWEALTH OF MASSACHUSETTS For OCABR Use Only.
OFFICE OF CONSUMER AFFAIRS AND
of*6 BUSINESS REGULATION Registration No:
10 Park Plaza, Suite 5170
Boston , MA 0 2 1 1 6 Effective Date:
Application for Reeistration as a Home Improvement
Contractor or Sub-Contractor Expiration Date:
(MGL c. 142A;201 CMR 18.00)
1. NAME OF APPLICANT: � � 6—�� �. C 1 494,
(MUST BE EHIIER AN INDWIDU U CORPORATION,LLC,LLP,TRUST,OR OTHERLEGALENTiM
2. NUMBER OF EMPLOYEES: 19
3. APPLICANT TYPE: p/INDIVIDUAL _CORPORATION _PARTNERSHIP _TRUST
(CHECK ONE—MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN#1)
4. SOCIAL SECURITY# 68—'10--3j10 FEDERAL TAX m#:-16 t 7 f 6 as
5. APPLICANT PHONE#: APPLICANT EMAIL ADDRESS:
6. MAILING ADDRESS: ��0: i)6)< 3 t E L s __y'4 o1(J s—
STREET CITY STATE ZIP
7. PERMANENT ADDRESS: A.3 Y!P Fi[X I .A I J 0 C=A
STREET CITY STATE ZIP
PLEASE NOTE TIL4T A P.O.BOX IS NOT ACCEPTABLE FOR PERNIANENT ADDRESS. YOU MUST LIST A STREET ADDRESS.
8. IF THE APPLLCCANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL
SECURITY#AND TITLE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE
TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Instructions before answering this question):
LAST FIRST SOCIAL SECURITY# TITLE
9. IF APPLICANT IS DOING BUSINESS UNDER A D/B/A,PLEASE STATE THAT D/BIA,AND ATTACH A COPY OF THE
FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK:
DBA NAME:
10. (a)DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION-RELATED STATE,
CITY OR TOWN LICENSES OR REGISTRATIONS?J/YES NO
(b)IF YES,PLEASE FILL IN INFORMATION BELOW.ATTACH ADDITIONAL SHEETS IF NECESSARY.
LICENSE TYPE ISSUED BY LICENSE/REG.# EXP.DATE LICENSEE NAME
J
City of Northampton 212 Main Street, Northampton, MA 01 060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: l i s S+. ')ocert '
The debris will be transported by: v, 'e GIrC
The debris will be received by: ►, i f (ee V (,>x e c v
Building permit number:
Name of Permit ApplicantU
Date Signature of Permit Applicant
City of Northampton .�
S�5 sj
r � Massachusetts
DEPARTIUENT OF BUILDING INSPECTIONS t
9: ti
1' 212 Main Street • Municipal Building
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill) sonotube holes (before pour), a rough building inspection
(before work is concealed) insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
1, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone M
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F-1 I am a general contractor and I
6. E] New construction
employees (full and/or part-time).* have hired the sub-contractors
2.2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.F1 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Sim ature: � Date:
Phone#• 'Y1 .-3 3 �--
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: {�~� let d a 13 J "
License Number
0 � L -mss , ofQ6.� T
Address _T Expiration D eat f,",
Signa ut re Telephone
Not Applicable £
9 Registered Home Imaovement ,.... M `., . PP
Company Name Registration Number
Address Expiration Date
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...VE No...... £
11 Home W ner 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-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.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑i/r Roofing ❑
Or Doors ❑
Accessory Bldg. Demolition ❑ New Signs [[J] Decks [❑ Siding[O] Other[0]
Brief Description of Proposed ''
Work: h S v/ C G t`i u, ,Os 2y t S
Alteration of existing bedroom Yes No Adding new bedroom Yes '✓ No
Attached Narrative Renovating unfinished basement Yes s,� No
Plans Attached Roll -Sheet
sa:1f New house and'or=adait on-to ezistina housing; complete the followlng:
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
�- In r t In f C k A D oc as Owner of the subject
property
hereby authorize (C r .
to act on my behalf, in all matters relative to work o ed his building permit application.
Or" � S Izq 11,5
Signature of Owner Date
to c r a ,asQwReF/Authorized
Agent hereby d clare 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.
A 17
ed
Print Name
Signat of O er/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Wormation
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage _
Setbacks Front GE ,
Side L:� R:-7 L:I Tt R:
Rear
PO
Building Height
Bldg.Square Footage
-
Open Space Footage %
(Lot area minus bldg&pavedwsW
parking)
#of Parking Spaces ! --�--
Fill: {
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES Q
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book I PageL � and/or Document#j` `—
i—
B. Does the site contain a brook, body of water or wetlands? NO (0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location: f
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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_ pmll Department use only
3 City 4 NorthamptonfatusolPermd s r " „3; y ,
?��� Buildi g Department Gr 01"M Perrrtl#' '
, 5
ain Street SewerlSep
Electric, om 100 UVater/Vetf.Avalla611ity 4 '1
i r u.
Northampton MA 01060 Twa ets>�fstructr,rai Plar}s
HiE
4
phone 413-587-1240 Fax 413-587-1272 PIo1/Site Plan"s `� r ' k
tate 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: r
6�� S� � T, Map Lot Unit
Zone Overlay District
EIm St Distncf QB;,Distrrcti
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1
�-�'-oule_ i-Ann k4 ,e: f/et' b ke�t` i• s t
Name(Print) Current Mailing Address: L5 �r1
f� Telephone
Signature
2.2 Authorized Agent:
Name(Printf Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building p } (a)Building Permit Fee
�� �c.
2. Electrical (b) Estimated Total Cost of
Construction'from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) 0 44rJ Check Number
This Section For Official Use Only
Date
Building Permit Number: - Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
cok
File#BP-2015-1214 �/ ON
Ir
APPLICANT/CONTACT PERSON ROGER CLARK 2 �6IC 91
ADDRESS/PHONE P O Box 34 LEEDS01053 (413)586-1491
PROPERTY LOCATION 68 BLISS ST (/ e
MAP 23C PARCEL 084 001 ZONE URA(100)/WSP(100)/ i
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: CONVERT SHED TO ARTIST WORK SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 021310
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
(/ pproved 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 Elm Street Commission Permit DPW Storm Water Management
De i e
-1a 000
Signat B i fficial 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.
68 BLISS ST BP-2015-1214
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23C-084 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2015-1214
Project# JS-2015-002294
Est. Cost: $20000.00
Fee: $120.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROGER CLARK 021310
Lot Size(sq. ft.): 14157.00 Owner: KNICKERBOCKER ANN
Zoning: URA(100)/WSP(100)/ Applicant: ROGER CLARK
AT. 68 BLISS ST
Applicant Address: Phone: Insurance:
P O Box 34 (413) 586-1491 O
LEEDSMA01053 ISSUED ON.611012015 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT SHED TO ARTIST WORK SPACE
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 6/10/2015 0:00:00 $120.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner