31A-236 (2) --` Order Number: 144286
Page: Page 2 of 2
Customer P.O.Number:
Order Date: 8/14/15
Scheduled Delivery Date:
216 West Road(Route 83) Est.Customer Pickup Date:
Ellington,CT 06029 PO#: Customer Pickup Status: NA
860-871-1048 (Fax)860-871-1117 Order Date: Doors On: TBD
www.kloterfarms.com Due Date: Salesperson: KIM M.
Customer agrees with this order as written and assumes full Delivery Charge $0.00
responsibility for their property during delivery.NO CHANGES CAN BE Subtotal $29,265.10
MADE TO THIS ORDER ONCE A DELIVERY DATE IS SET. (initial: Sales Tax-MA $1,829.08
Customer Letter $0.00
Wide Load Permits $0.00
CUSTOMER APPROVAL TOTAL $31,094.18
Deposit 8/14/2015 VISA-YARD $-250.00
Stock- $250 deposit will hold stock unit for 4 days after which a nonrefundable 50% Balance Due $30,844.18
deposit is due or the product will be returned to stock. Orders-$250 deposit will lock Deposit
in sale price for 30 days, after which 50% deposit is due to hold price for up to 6 Balance Due
months. Construction will not begin until 50%deposit is received&delivery date has Deposit
been set. Kloter Farms will issue a credit slip on any canceled order less a re-stocking Balance Due
fee. Deposit
Balance Due
*LINF,ITEMS MARKED TBD(To Be Determined)MUST BE Deposit
Family Owned & Operated
SATISFACTION GUARANTEED We Appreciate Balance Due
SINCE 1980 Your Business! Payment Info: POD
Printed on: 8/28/2015 4:21:17PM By:Joe S
Order Number: 144286
' Page: Page 1 of 2
j✓ Customer P.O.Number:
Order Date: 8/14/15
Ri Scheduled Delivery Date:
216 We Road(Route 83) Est.Customer Pickup Date:
Ellington,CT 06029 PO#: Customer Pickup Status: NA
860-871-1048 (Fax)860-871-1117 Order Date: Doors On: TBD
www.kloterfarms.com Due Date: Salesperson: KIM M.
Deliver To: Penny Remsen Mailing Address: (If Different)
35 Kensington Ave
Northampton,MA 01060
Phone (000)000-0000 Ext.0000 Phone (000)000-0000 Ext.0000 Phone 0-Ext.
Qty Description Unit Price Discount Extended Price
1 16'x 20'SmartSide Garden Elite Cape Storage Build $24,574.00 $4,914.80 $19,659.20
320 Standard Heavy Duty 2x6 12"On Center Floor
1 Red Painted Siding
1 Red Trim
1 Red Doors
2 Red Shutters(Pair)
1 TBD Arch.Shingle Color-Delivery Date Pending metal roof
2 'R'Windows(Brown)30x36 Aluminum
1 Extra'R'30x36 Aluminum Window(s)(Brown) $125.00 $25.00 $100.00
4 Extra'T'Aluminum Transom Window(s)(Brown)ABOVE DD DOOR ON GABL $95.00 $76.00 $304.00
2 Miratec Shutters(extra pair)40"&larger $75.00 $30.00 $120.00
4 Upgrade window choice to insulated(white)BROWN BROWN BROWN $160.00 $128.00 $512.00
1 Standard Door options
1 No Standard door(credit) -$325.00 -$65.00 -$260.00
1 3'Single Door(s)Location? $195.00 $39.00 $156.00
1 Extra'T'Aluminum Transom Window(s)(Brown)
1 8'6"Double Door*Cape Only* $790.00 $158.00 $632.00
2 Smartside Mini Shed Dormer(2 transoms inc)OF MINI SHED DORMER $1,635.00 $654.00 $2,616.00
4 Add extra transom window(s)for longer mini shed do $95.00 $76.00 $304.00
1 30"Vinyl Garden Cupola w/Copper Roof $1,140.00 $228.00 $912.00
1 Garden Series Window Cupola with Straight Trim
1 Clear Coat Cupola Copper Roof $70.00 $14.00 $56.00
320 Insulated Floor-double foil w/bubbles R1.5 $1.00 $64.00 $256.00
320 Tar Paper Under Shingles NO TAR PAPER
16 Elite Ridge Vent(per linear foot) $12.00 $38.40 $153.60
40 Ice&Water Shield Specify LF $2.25 $18.00 $72.00
72 House wrap under siding Specify PF $3.00 $43.20 $172.80
1 Special Option 3/4 Fire treated floor T&Gl $1,000.00 $304.00 $696.00
1 Special Option METAL ROOF $2,000.00 $720.00 $1,280.00
1 "Labor Day Sale"(8/17/15-9/7/15)
1 Note:Floor$870-20%=$696.00
1 3/4"Crushed Stone Pad(includes up to 6"of leveling) $1,175.00 $1,175.00
1 560P Labrador Retriever Polished W/301 Ext $348.50 $348.50
TOTALS: $7,465.40 $29,265.10
8'�I&14ifI!�h�i:f'1D
dormer - NOTES:
_ m _
9�u
R Stair p R
s
dormer'
q T
'i:."T&G FireTreated floor
TYPICAL ROOF CON5TKUCTION
CONTINUOUS RIDGE VENT OPTIONAL
MIN.30 YR,ARCHITECTURAL A5PHALT 5HINGLE5
OVER 15N ROOFING FELT
1/2"CDX ROOF SHEATHING
2 X 8 5PF M2 RIDGE PLATE BUILDER:
12 2 X G 5PF k2 RAFTER5 @ 1 G"O.C.
12v KLOTER FARM5
2 1 G WE5T ROAD
LOFT ELLINGTON, CT 06029
PHONE: 5GO-871-1048
KF3A IIUKKICANE"IE5 @ tA.KAPTEK
PROJECT:
5/8"PLW✓OOD 5UBFLOOK TYPICAL ROOF SAVE
10"0.H.W/SOFFIT
9 1.12'81140 FLOOR JOIST @ 1 G"O.C. I X G PTO FASCIA
v 5/8"DUKA-TEMP OK TITLE: I G' WIDE
- GARDEN 1/2"COX PLY&OOU SHEATHING
5
W)VINYL
H E D OF LP LAP ISIDING
2 X 4 STUD WALL @ !G"O.C.
DATE:
2-23-15
APPROX.GRAN APPROX.GRADE
rmlcAl FLOOR caNSrrucnoN
DRAWN 5Y:
374"P.T.TaG PLYWOOD
E.S.
2 X 6 P.T.FLOOR JOIST @ 12"O.C.
OVER 4 X 4 P.T.[3A5E MAX,SPACING @ 5'-0"O.C.
t 5'CRUSHED STONE
SCALE:
A5 NOTED
SECTION DETAIL "All-
5CALE: 311 G"=1'-0" 511EET:
I OF i
D177-15
LOAD DESIGN:
DRAFTING CONCEPT5 LLC
•SNOW L''-VE- 50 P5F ARCHITECTURAL OWTING
-WIND 90 MPH A-
JOHN FLOOK LOAD=60 P;F CSH 7:7.442.505°
VbANS : No D(MeNS 0-Ns
FcoorZ(AS j)0(NN) w-fL-1. NaT MEET
TYPICAL ROOF CONSTRUCTION
CobE iFon L � p V6iE CONTIN UOUS
RIDGE VENT OPTIONAL
/// MIN.30 YR.ARCHTECTURAL ASPHALT SHINGLES
70114-t ' ^�� Q` ?' C F^'L (WwPA OVER X R POF SHEATHING
G FELT
W 11. t �1 /'1 1` 112"CDX ROOF SHEATHING
2 X 8 5PF#2 RIDGE PLATE BUILDER:
-
12 2 X 6 5PP#2 RAFTERS @ I G O.C.-T Roo R m4f I2V 2 1 6 G W FARMS
2 1ES T ROAD
LOFT ELLINGTON, CT 00029
PHONE: 800-871-1048
Kf3A HUKKICANE`IE5 @ CA.KAF(CK
PROJECT:
TYPICAL ROOF SAVE
5/8°P1.WtOOD SUBFLOOK O O.H.W/SOFFIT
9 112°61.140 FLOOR J015T @ I G-O.C. X 6 PTD FASCIA
DUKA-TrMP OK TITLE: I G' WIDE
GARDEN 52"+CDX PLYWOOD SHCATHING
W1 VINYL 51DING
SHED OP.LP LAPP SIDING
2 X 4 STUD WALL @ I G"O.C.
DATE:
2-23-15
APPKOX.GRADF APPKOX.GRADE
TYPICAL FLOOR CONSTRUCTION DRAWN BY:
3/4"P.T.T4G PLYWOOD
E.S.
2 X 6 P.T.FLOOR JO15T @ 12"O.C.
OVER 4 X 4 P.T.BASE MAX,SPACING @ 5'-0"O.C.
4 5"CRUSHED STONE
SCALE:
AS NOTED
SECTION DETAIL "A"
SCALE: 3/1 G"= 1'-0" 9FiEET.
I OF I
D177-15
LOAD DESIGN:
DRAFTING CONCEPTS LLC
-SNOW L:VC ' 50 PSF ARCHITECTURAL ORAfTING
-WIND -90 MPIi
FLOOK LOAD=GO P5F I
JOHN 05H ?;7.442.5053
SEED �E 1� R PANS No DtMENS (,TNS
�a �Af fZ Tt�s °rz_ vwc. 2('b �-c
F Loo tz(As D2 4WN� w«(_ WIT AA66
Cob(- Fo rz- CZ A RA 60E TYPICAL ROOF CONSTRUCTION
CONTINUOU5 RIDGE VENT OPTIONAL
�dlN l `
MIN.30 YK.ARCtTECTUR
AL ASPHALT SHINGLIE5
OVER ROOFING FELT
L,043 Of FAIL (IPWPA 1!2"CDX ROOF SHEATHING
2 X B 5PF k2 RIDGE PLATE BUILDER:
12 2 X 6 5PF#2 RAFTERS @ I G"O.C.
�A�nL FLOQ R �l� 12� 2 1 G WI FARMS
LOFT 2 16 WEST ROAD
PHONTON, Cr 1-10
PHONE: 860-87 I-1 048
Ki3A HUKKICANE TIE5 @ tA.KAFiEK
5/8°PLYWOOD 5Ut3FLOOK TYPICAL ROOF SAVE PROJ ECT:
10"O.H.W!SOFFIT
9
112'B1140 FLOOR J015T @ 16"O.C. I X 6 FTD FASCIA
GARDEN 5/8"DURA-TEMP OK TITLE: 16' WIDE
12"COX PLYWOOD SHEATHING
W/VINYL SIDING
SHED OR LP LAP 51DING
'f–X 4 STUD WALL @ 16"O.C.
DATE:
2-23-15
APPROX.GRADE APPROX.GRADE
TYPICAL FLOOR CONSTRUCTION
DRAWN BY:
3/4"P.T.T*G PLYWOOD E rJ
2 X 6 P.T.FLOOR J015T @ 12"O.C.
OVER 4 X 4 P.T.BASE MAX.SPACING @ 5'-0'O.C.
t 5 CRUSHED STONE
SCALE:
A5 NOTED
SECTION DETAIL "AII
SCALE: 3/1 6"=P-0" SHEET:
I OF I
D177-15
LOAD DESIGN:
DRAFTING CONCEPT5 LLC
-SNOW LVE= 50 P5F ARCHITECTURAL DRAFTING
-WIND =90 MPIi A - i
-i-LOOR LOAD=60 PSF
JOHN 1511 7;7-4425053 H
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 021 16
Home Improvement Contractor Registration
Registration: 127530
Type: Private Corporation
Expiration: 11/9/2016 Tr# 259303
KLOTER FARMS INC
JASON KLOTER
216 WEST ROAD
ELLINGTON, CT 06029
Update Address and return card.Niark reason for change.
Address ReneIsa[ Emplocment Lost Card
__ -- 0fficc of('onsumer'lrftir,& 111"ine"Re�j_u1 rtion License or registration valid for individul use onIN
=jHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
3 Office of Consumer Affairs and Business Ree,ulation
Registration: 127530 Type: h
l Expiration: 111912016 Private Corporatio 10 Park Plaza-Suite 5170
-- Boston,MA 02116
KLOTER FARMS INC
JASON KLOTER
216 WEST ROAD
ELLING TON CT 06029 l ndir,iucrar, \ot xali«d xcithout signature
KLOTE-2 OP ID. CA
�--1 ----
A��°r'`' CERTIFICATE OF LIABILITY INSURANCE
1010712014
THIS CERTIFICATE IS ISSUED AS A. MATTER OF INFORiv1ATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIR6iATIVELY OF NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
EELO: ' THIS CERTIFICATE OF INSURANCE DOES NOT C&NSTITUTE A CONTRACT BETWEEN' THE ISSU;NG INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IiaPORTANT: If Inc certificate holder is an ADDITIONAL INSURED, the policy(ies) must be cndnrsed. If SUEROGA-110N IS bN AIVED, suejoct to
the terms and conditions of the policy, certain policies may require an endorsenrent. A statement on this certii.cate does net ccntcr rights to the i
Certificate hoi(jer in lieu of such endorsement(s).
— cor+racr
Duc�R Phone: EGC-875-2523 t AaE
\.ding, Moriarty& Dimock Inc rHOtiE FAX
Unior,Street Fax.: 860-875-0921 PHO
E-MAIL.
:)ckville, CT 06056 ADCrESS: —
� COIL.-+ L4SUF,ER(S)F,FF-CFDItJG COVERAGE NATO+"
INSURER A:LIBERTY MUTUAL
--- ---------
uREe Kloter Farms, Inc. I^JSURER O: — -__ ---- — ----.1-- ---__--
Country Warehouse,LLC ATIMA INSUFFRC_
216 West Road — __------------ ---- ___.-- — -__
Ellington, CT 06029 INSURER D:
IN S U R ER E: ---- ----'--- --- -- --�---------
INSUREF.F
OVERAGES CERTIFICATE NUM REVISION NUMEER:
THIS I TO CE -Y THAT THE POLICIES OF INSURANCE LI ST FD BELO',V HAVE BEEN ISSUED TO THE INSURED N aED SE JVE FC F THE POLICY' PERIOD
DIGh tD NO V,'IT IA STAN DING ANY REQIJIF.EP.'LNT, TERM OR CCNCITIOIv OF ANY CONTRACT OR, OTHER DOCUI I b-11 H R TCT TO `:VPI y T 'C
E=:il ,E MAY F ISSUED CF' h""Y' f RT IV THE INSURANCE AFFORDED BY I PO'ICIES DE F °ED HEREIN SU3_rCT TO /-LL THE P?
�<CLU !CNN A" D COQ N,DI T IONS OF SUCH POLICIES LIM:TS SHOWN MAY HAVE BEEN REDUCED BY FAID CLAHOS
R- CDDLSL'Rh POLICY Lrr-1 POL��Y EX' LIMITS
P 1YPL-CF INSURANCE I es tl•�Dl PO'ICY hUMDER I(Po M.ODf:'(Y fI I ;41;DD'Y Yl Y1 _
GEr RA_ LIABILITY I I EACH OCCURRENCE I 1,000,0001
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--.—I ICSP3013948 10/24 .i 10/24 PE\. Sr i 100,0001
�X co"'INI'Ep'c GENE 4L VAEILITY I —
_.� 2014 2C 15 e S;oaa
EXP L41.t
I C _F.1ADE OCCUR —_
PER50NAL .4DV INjur,Y s 1,000,000
— I r 2,000,000
C,EN-tic3 L� E ulll A FUES Ftr a�cu'Ir.T co-I,vnr A s 2,000,000
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---
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500,000
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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: 35 KE�N1SI#'j 'CatJ Aq[=
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant g;-111J
Date ign-ature of Permit Applicant
City of Northampton '
Massachusetts
I ! DEPARTIMNT OF BUILDING INSPECTIONS x.
212 Main Street • Municipal Building
Northampton, MA 01060 ss w:.y
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 inspec ' s ar made
understand the above.
( own /r ident's signature requesting exemption)
I
vi II to sch d le all required building inspections necessary for the building permit issued to me.
Date / S�
Address of work location
• The Commonwealth oflMlassachusetts
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/IndividuaI): t�2
Address:
City/State/Zip: 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 part-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 g. Demolition
working for mein any capacity. employees and have workers'
4. ❑Building addition
[No workers' comp, insurance comp. insurance.$
required.] 5. We area corporation and its 10.0 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.❑ 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: e�
Polic y#or Self-ins.Lic. #: . � ? � Expi'ration 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.
Signature: Date:
Phone#:
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:
License Number
Address Expiration Date
Signature Telephone
9 Registered:.Home Unprovemenf Contractor _._ _._,- Not Applicable £
-- /� 73
CombabyName Registration ber
Address 'Expiration Date J
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...... £
7,7 Z7
11.`. 1H Owner_Egempt on'
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 ndersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
N hampton Ordinances, State and Lo al Zoning aw a d State of Massachusetts General Laws Annotated.
Homeowner Signature.
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition Replacement Windows Alterations) ❑ Roofing ❑
Or Doors El
Accessory Bldg, E2__'*� Demolition ❑ New Signs [C]] Decks [M Siding [❑] Other[❑]
Brief Description of Proposed
Work: �4 .fta I L_ 0<--- 915H4>11 t0c, TLg0
✓No Adding new bedroom Yes �Cgtra"n�
Alteration of existing bedroom Yes g ✓No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
sa if New house and or.adcI. ion-,fo ex sfina f ousina._complete the followlna:
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 TOR.BUILDING PERMIT
L �- 1t-�(`.�1 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
1 as Owner/Authorized
Agent hereby declare 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.
Prinf ame
l `
Signat of wner/A nt D e
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 i�4 by E
Building Department Y
Lot Size
Frontage I —�^ ''-- —----- -- — --1
Setbacks Front
Side L: 4• L:i2# ii R: - - {
Rear --
Building Height ?
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved i
parking)
#of Parking Spaces f
Fill: r1
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES Q
r
IF YES, date issued:]
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW ei/ YES Q
IF YES: enter Book { Page, —__ and/or Document# i
B. Does the site contain a brook, body of water or wetlands? NO � DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained , 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 O NO
IF YES, describe size, type and location: j
E. Will the construction activity disturb(clearing, grading, excavoon, 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.
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMA TION
This sectiortto be completed byoffice
1.1 Property Address,
Map Lot Unit
,
N D we_J_- A.*j �� t-1A 01040
Zones Overlay Distr►ct
`EIm,St District CB District s
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-?V%j.jNy L, g4QL-ts1123.21 35 K627.IISI#J4-rarJ tl
Name(Pri t) Current ailing Address:
Telepho6-
Signat
2. thorized A ent:
Name(Print) 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 DDD. o� (a)Building Permit Fee
2. Electrical DQ . •o (b)Estimated TotaI Cost of
S ' Construction`from 6
3. Plumbing _ Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(u1 +2 +3+4+5) 3 OOO, °a Check Number
This Section For OfficW Use'Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'ef Buildings Date
File#BP-2016-0197
APPLICANT/CONTACT PERSON REMSEN PENNY L P
ADDRESS/PHONE 35 KENSINGTON AVE NORTHAMPTON01060(413)992-7197()
PROPERTY LOCATION 35 KENSINGTON AVE
MAP 31A PARCEL 236 001 ZONE URB(100)/ 0A
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE 111
ZONING FORM FILLED OUT
Fee Paid 'A /
Building Permit Filled out
Fee Paid U
Typeof Construction: CONSTRUCT 16 X 20DETACHED GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 ets of Plans/Plot Plan
t
THE VOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
proved 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
Demolition Delay
S `Zs I S
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.
35 KENSINGTON AVE I BP-2016-0197
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-236 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2016-0197
Project# JS-2016-000339
Est. Cost: $35000.00
Fee: $64.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: Homeowner as Contractor
Lot Size(sq.ft.): 4965.84 Owner: REMSEN PENNY L
zoning: URB(100)/ Applicant: REMSEN PENNY L
AT. 35 KENSINGTON AVE
Applicant Address: Phone: Insurance:
35 KENSINGTON AVE (413) 992-7197 O
NORTHAMPTONMA01060 ISSUED ON:91912015 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 20 DETACHED GARAGE
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:
FeeTyge• Date Paid: Amount:
Building 9/9/2015 0:00:00 $64.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner