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11A-031 i� i i' Lr � � � � ��I �, �, � �I _ � ri Mill. .hl C7 m uj 00 � � 00 VL+ pro )2, eA, 0 2-1 `� lop , .,� S 6,�- VA 4 5T" Z' f i ea �� Sl- ' I } E41 Hays-If cq I /#fte&.d-eL �P-CV2- eN f ; Q2 �c�Ua�� LV I-_ pp `e � rk ee�n� 9OU i O�2 City of Northamp ton Building Department Plan Review 212 Main Street r' Northampton, MA 01060 awe/( _ �- Fir 1 ,a CERTIFICATE OF LIABILITY INSURANCE DA 02/18/2015YI THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: David Jarry Neill&Neill Insurance Agency Inc - - --- 662 Riverdale Street PHONE 4137324137 No): West Springfield,MA 01089 ADDRESS: dj @neillins.com _ INSURER(S}.AFFORDING COVERAGE NAIC i1_ INSURER A: State Auto Insurance Companies STA INSURED Alliance Home Improvement Inc INSURER I: SAFETY INSURANCE COMPANY 39454 536 _. E.Main Street Chi copee, MA 01020 INSURER C: Acadia Insurance Company A0235 Chi INSURER D: INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP - - INSR - .TYPE OF INSURANCE_. -_ _.IAODLISUBR.. LTR POLICY NUMBER - MMIDDlYYYY MMlDOlYYW LIMITS A i GENERAL LIABILITY PBP2689283 03/12/2015 03112/20161 EACH OCCURRENCE $ 1,000,000 I ✓f COMMERCIAL GENERAL LIABILITY i i PREMISES S(RENTED 300,000 i 1 1 i I PREMISES(Ea occurrence) i $ CLAIMS-MADE OCCUR i MED EXP(Any one person) j$ 5,000 44 I' i PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ _ 2,000,000 GENi'L AGGRE IG._A_T_E_ LIMIT APPLIES PER: I I I I ` I PROD_U..C..TS-COMP/OP AGG..._ f $ _.. 2,000_.000 PRO- LG POLICY _ 12104/2015 1Eaaccident) _ i 1 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 6226463 12/04/2014',. ANY AUTO BODILY INJURY(Per person) $ 250,000 ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ 500,00 0 AUTOS AUTOS NON OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS (Per accident) $ 100,000 ,I I $ UMBRELLA UAB OCCUR 1 I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE 1 AGGREGATE _ $ DED RETENTION$ $ ANY PROPRIETORlPAARHTIN R EXECUTIVE YIN 1 2105/2 0 1 5 E L EACH ACCIDENT OFFICEOPRIETPR EXCLUDED? a 1 N/A' ! !TORY LIMITS_ ER $. 100,000 C WORKER COMPENSATION WC-20-20-000839-07 12/05/2014 WC STATU- OTH- (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below j E.L.DISEASE-POLICY LIMIT $ 100,000 � I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ALLIANCE HOME IMPROVEMENT INC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 536 E Main Street ACCORDANCE (TH THE POLICY PROVISIONS. Chicopee MA 01020 AUTHORIZED REP R S RATIVE ©1988-2010 ACORD CORP RATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Coprraetor Registration Registration: 154218 Type- Private Corporation Expiration: 2/20/2017 Tr# 261497 ALLIANCE HOME IMPROVEMENT, IM'C .r -.- - -----. - SERGIY SUPRUNCHUK 536 MAIN ST CHICOPEE, MA 01020 Update Address and return card.Mark reason for change. _ —� Employment ScA t %I 20M-0,111 Address �� Renewal �� p oyment �� Lost Card mfr: oia»rarrruarlt�r`! �y�crdJa��rrte/ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 154218 Type: Office of Consumer Affairs and Business Regulation xpiration: 2l2 +2Q17 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ALLIANCE HOME IMpRf-3V,,EM W,-INC SERGIY SUPRUNCHUK.4 536 EAST MAIN ST CHICOPEE,MA 01020 Undersecretary Not v id with t signature Massachusetts Department of Public Safety Board of Building Regulations and Standards t nn�tru4tiun Sutrtr�i+rrr ' License: CS-104327 SERGTY SUPRUN `H 148 BER1cSrriuir� w WESTFIELD 114201 14 01 g J..G+•��1'Jr_�G3c. ' , , Expiration Commissioner 1112912015 .z 00F UW All home improvement contractors and subcontractors engaged in home improvement contracting, duress specifically exempt from registration by Provisions of Chapter 142A of the general laws, -.10110hr V�DD� Y must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the AOiance Home f \ Director. Home Improvement Contract Registration, One Ashburton Place,Room 1301,Boston,MA 02108(617)727-8598 536 East Main St. i Chicopee,MA 01020 Phones:(413)883-3802 ` Fax or(413) a x413)3)331-4358 you can pay more,but you Can't buy berteYr MA Lic#154218 CT Lic#0635847 www.AllianceHomelnc.com SUE;MITTEDTO:, Xy-,, • V-V�-f- Phone: ✓ Cell: -" D Q Cl o l"CA CZ 0 S�e y1 k i—£pt L ou-el 5't� - Email: Q To ry--e 'ZC2 A UL' C o 1ti1 LeIffi S, 0 LC-` 53 t eby submit spofications and pstimates for work to be pert o ed an materials to be used: I L t '2- D(/ d idt v+` u 4> S n t, cc S art f a OL &-V- O k 1� SIDING Type: "Colo . © " S ct Wall Sheeting: O Insulation JXIiomeWrap U Strip Blocks&Dryer Vents Color: © ( Forset/Bloc s Color: ' Shutters Color: Gable Vent Avers)Color: E? `8t R Gutters ❑New utters Color: Soffit Fascia Vented YES NO Type Color: ocation: qo-LA Aluminum Trim V<Alliante Trim_} ❑Flat Coil PVC Coil ❑G8 Coil Color. f �S Corners C or: f umpster Location: ' ro.,-T Material Location: `--Ir XV pU Waste Disposal: u T p _ S , ter, e WORK SCHEDULE Pr Startlii ,?mpbTr05 ht a-The following schedule will be adhered to unless ci st4 the!a"gl s control arise: L 7! / Date when contractor will begin contracted work. _�� t/ Date when contracted work win be substantially completed Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired.The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but no limited to strikes,Acts of God,shortages of materials,accidents,and all other delays beyond its control,shall not be considered as violations of is Ag piment. WARRANTY 1r� All materials have C ,Warranty or as otherwise specified by manufacturer.Labor and workmanship have a warranty of one full year from the date of installation. All work to be completed in a workmanlike manner according to standard practices.Any alteration ordeviation from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. PAYMENTS We propose hereby to furnish material and labor-comp to in accordance with Payments to be made as follows: �,,,� abpve specification for the sut %($ i upon signing Contract; -mil 111 S a-X11(�� dollars WS upon dekvery of materials; ($ %($ upon jobcompletion; Name of Salesman %($ j 32 shall be made forthwith upon m ion work under&is contract. Authorized Signature The customer hereby understands and agrees to pay finance charge of 15%per month for annual percentage rate of 18%)on the outstanding balance not paid w' in 30 after completion of work.All payments received after 30 days after completion of work shall be applied first to unpaid finance charges and then to outstanding balances.In the event of default,customer herebVgnderstands and agrees to pay,in addition to the outstanding indebtedness,all costs associated with collection including reasonable attorneys fees. Acceptance of Proposal:I have read both sides of this document and accept the prices,specification and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do work as specified.Payments will be made as outlined above.You,the Buyer,may cancel this transaction at any time prior to midnight of the 3rd business day after the date of this transaction.Cancellation must be done in writing. DO NO IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature r Date Signature Date NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY bR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED.TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO:ALLIANCE HOME IMPROVEMENT,INC.,S36 EAST MAIN ST.,CHICOPEE,MA 01020 (Date.Sunday and holidays excluded) I HEREBY CANCEL THIS TRANSACTION (Buyers Signature) i i + I I E ! 4 jLCMG . City of Northampton 212 Main Street, Northampton, MA 01060 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. The debris will be transported by: �� W"-e red I (�j a .54e < <C The debris will be received by: I I.'1 Building permit number: Name of Permit Applicant `'�VV-k,2 l N Date Si o P it Applicant City of Northampton 4 ,= Massachusetts hti. � k,;r DEPARTMENT OF BUILDING INSPECTIONS � •+ w 212 Main Street • Municipal Building Northampton, MA 01060 ssw �L�a, 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 I• 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): ' toN\ cc �'}V &Cce Address: Eot- tt. � - City/State/Zip: ( C-op Cam...-- Phone#: Are you an employer? Check the appropriate box: Type of project (required): 1.[ I am a employer with 4. [] I am a general contractor and I employees(full and/or p time). * have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. R 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 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no (� employees. [No workers' 13.g 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. tContractors 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:' 0 l - �. Policy#or Self-ins. Lic. #: � Expiration' ' Date: Job Site Address: keo r'`L0."- >� City/State/Zip: S All"4.4 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 der t n nalties of perjury that the information provided above is tru and Corr ct. Signature: Date: Phone#: 3 C� 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 Su ervisor: Not Applicable £ Name of License Holder: ej � q e.5 /a License Number S. Address V Expiratio Date if/3 - g3 Sig Telephone 9 Re isq tared Homeam rovement.Contractor _ .__.. Not Applicable £ Company Name Registration Number �.A Address t' `� Expiratiol5 Date Q Telephone l l 3,g 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...... £ ll`. Home O wn er.Egempt10)i 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. J1 Mr SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors 11 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding Other[O] Brief Des iption of Proposed p c R I L( Q,t Work: IrUk-Aot �y ("cA:::., tl Alteration of existing bedroom Yes No Adding new bedroom Yes No �� x Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa If':New.a ouse`and-OraddJ.ion to'exlsting h"ousmQ complete the following" a. Use of building :One Family Y�, _ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached?__U4. © °� Z d. Proposed Square footage of new construction. � O d � Dimensions / e. Number of stories? I7 f. Method cf.heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. M aassscheck Energy Compliance form attached? h. Type of construction hW-Mk NeA) cV L ru i. Is construction within 100 ft. of wetlands? Yes __X_No. Is construction within 100 yr. floodpfain 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 l as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date d (L4 as Owner/Authorized Agent hereby declare that the statements and informati n 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 � Print Name ®47- Signature of Own gent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage ----- — ---� --- Setbacks Front Side L:'� R:E_—j L:L_..__; R:= Rear Building Height � � Bldg.Square Footage ] — % L (- 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 for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued:F�_�_ IF YES: Was the permit recorded at the Registry of Deeds? AM NO Q DONT KNOW YES Q IF YES: enter Book �I Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 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 Q IF YES, describe size, type and location: f 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. _ ape arfine use o I 4� f� C (� \` l C ty atus of'Permtt {n ' "' � of Northampton D Ilding Department t�rb Cur/privewa'y Perrni# � ' I 6 2015 `1 12 Main Street SewerlSepCleAvaila611rtjrt ' '� ' u I A Room 100 Water/VrCel�Rva�labtlity ort ampton, MA 01060 TwaiSet`safStructural Ptans , Plurr�'c r,� I. #;� - 7-1240 Fax 413-587-1272 P[of/SiYe Ptans ti_ °M y r r ' t ' t Electric. North:rptc. .. ,,,., �_ -, Other 5peclfy�" . APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION. ' Thissectiorrfo be completed by office 1.1 Property Address: M Map ' Lot ' Urnt lJ� vl 1 l r` Zone Qverlay pistir►ct EImSt Dlstrlct CB Dlstnct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record: '' P� ol Name(Print) rren ailing Ad es Q © r �94 ^2 ph ne f3 Signature 2.2 Authorized Agent: _ w�' 3,K tat S Name(Print) Cu nt M fling Address: cop Gp— Signature Te hone SECTION 3 ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use Only completed by ermit a licant 1. Building 90 � ® (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of ConstrOction'from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number L. This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date (I1(� File#BP-2016-0072 APPLICANT/CONTACT PERSON SERGIY SUPRUNCHUK ADDRESS/PHONE 536 EAST MAIN ST CHICOPEE01020(413)883-3802 PROPERTY LOCATION 11 LEONARD ST MAP l 1A PARCEL 031 001 ZONE URA000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT_ APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 12 X 15 3 SEASON ROOM&REPLACE VINYL SIDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 104327 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFZMATION 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 Elm Street Commission Permit DPW Storm Water Management molition Delay i Signature of Building 6fficia 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. 11 LEONARD ST BP-2016-0072 GIS#: 40mMONWEALTH OF MASSACHUSETTS Map:Block: I IA-031 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2016-0072 Project# JS-2016-000124 Est.Cost: $40000.00 Fee: $130.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SERGIY SUPRUNCHUK 104327 Lot Size(sq.ft.): 10367.28 Owner: ROSEN JEFFREY&PAMELA A TORRE Zoning: URA(100) Applicant: SERGIY SUPRUNCHUK AT: 11 LEONARD ST Applicant Address: Phone: Insurance: 536 EAST MAIN ST (413) 883-3802 WC CHICOPEEMA01020 ISSUED ON:712312015 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 12 X 15 3 SEASON ROOM & REPLACE VINYL 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 Signature: FeeTvpe: Date Paid: Amount: Building 7/23/2015 0:00:00 $130.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner