31B-054 (2) AM/
ROOHAT / ROBERT50N BA5EMENT ENTRY AND LAUNDRY
relocate fridge and freezer
- - - - - - - - - - - - - - - - - - - - - I
' I pull down ironing bd. location tbd I I R F.
00
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rel sate shelves
I I relocate exis i g close pole etc.
Rochat/ Robertson Basement Entry 2-8
I 31 Langworthy I O new wall
Est cco block wall
I Northampton, lvla new smooth fireco4e 2-I3 Ooo
en paint existing wall mechanicals
Ives
Included: I fhw heat
Strip and re roof dormer roof and I new 112 wall dolly's to make up air tbd I I
ig remain
small overhang over back door. and handrail 2-8 soli core smooth ,
Dormer to have 5A}' new new carpet '
including stairs.
I I I work bench area i
I ` I Repairs to chimney rushing T5O I Camden 848; I ., I
Cloudland Canyon
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new walls
I Chair ' by owner
- - - - - — — — — - -- - - - - - - - - - - - - - - - - - - - -�
90210
t Coordinate Chair lift wiring and installation after stucco with Hudson
Seating and Mobility Chicopee. 866-321-4442 SL) ��
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RMti
City o.i Northampton 212 Main Street, Northampton, M_A 01060
Solid haste 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: i
The debris will be received by:
Building permit,number:
Name of Permit Applicant
Date Signature of Permit Applicant
SECTION 6-CONSTRUCTION SERVICES
8.1 Licensed Con structi�on+Supervisor: ` Not Applicable ❑
Name of License Holder: l\►°L` ��� ` ®tob�
License Number
Address Expiration Date
C113-5��1= s�z.
Signature Telephone
9Registefed Ha(alml2rovernent Contractor . Not Applicable ❑
Company Rafne Registration Number
Address Expiration Date
Telephone�� �'���Z
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25.C(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=nlptcon for`homeowners"was e;tended to include DwelE fn ys of one(I) or two(2)u i�ilies
and to allow such homeowner to engage an individual for bire who does not possess a license,Rrtrvided that the s viper acts
as m2erviser.CIVER 980, Sixth Edition Seebon 109.3.5.1.
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 gerson who constructs more than one Name in a two:rear period shall not be consieered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official. that keelsEve shall he
>respomsible for all such work performed harder the buNding rvermit.
As acting Construction Sutvenisor 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,yon tear 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
NTorthampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5.DESCRIPTION OF PROPOSED WORK(check ail applicable)
New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing F7
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks Siding[C7] Other[r:�
Brief Description of Proposed �Pr/;.+/2 •rv,'d/� 67Sd11G"�� �a oA—C-
Work:
,ol y o• Ilk
Alteration of existi g bedroom Yes �/f�o Adding new bedroom Yes !/ No
Attached Narrative Renovating unfinished lZasement Yes No tt
Plans Attached Roll -Sheet
6a.'If New and or addition:fb- xistih housin-9, 60nim 6 the 4XIEn :
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?_7V7P
d. Proposed Square footage of new donstruction. 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 PERNUT
!, l wu l p D �ip�C1Q..�c xl �.P,C�� �(Y�r��^-- _—,as Owner of the subject
property
hereby authorize&16%on
to act on my b all,in all matters rel-ti work aut_h r ed by this building permit application.
Signature of Owner Date
as OwnerlAuthorized
L1ctZt h�-a�-5 7 ' "^ ��^+i:-n rn±hQ t ra i C
_, daciare tha ie ct�iroE E a,« ,Etarr� . o ego nn alplication are true and accurate,to the best of my knowledge
'
and t)siiof.
Signed under the pains and penalties of perjury.
NeASari S ,S�\,-t�
Print ware
W cwjow
Sign aturEr of Owner/ nt DaLe
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::.-_ ._ ll ::..............: R:_.............
N
Rear '
Building Height _._..__...
Bldg. Square Footage w..._..._.,. ,,...- % ._.
Open Space Footage °
(Lot area minus bldg&paved
parking)
#of Parking Spaces ;..._...__.....
Fill:
volume&Location) _..__...:_..._---_.,..................._._... ......___._..�._._..__.-_---....._----.•-: ___._.____._---..._...
A. Has a Specia Permit/Variance/Finding ever been issued forlon. the site?
NO DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
X10 0. DOI47 KNOVd YES
IF YES: enter Book / Pages andlor Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW C) YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued
C. Do any signs exist on the property? YES NO
IF YES, describe size; type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
P. Will the construction activity disturb(dearing,gr tiding, excavation,or f€iiing)over acre or is it raE l of a common plan
that will disturb over 1 acre? YES 0 f,0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department-use only.
f Northampton S of Permit:
g Department Curb Cut/Driveway Permit
6 ^ t Main Street Sewer/Septic Availability
Qectr'c pig Q�s !`% Room 100 WaterMell Availability
r(1
At, �tha.,�pi o L ampton, MA 01060 Two"sets of Structural Plans
fps 87-1240 Fax 413-587-1272 Plot/Site Plans
Other:Specifyi.
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION .
1,1 Property Address: This section to be completed by office
Map Lot, Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
0Z4
Name(Print) Current Mailing A ess:
X 008
Telephone
Signature
2.2 Authorized Agent:
UAL A toocoa1 , ore�nce�-(cam 0�0�2,
Name(Printy Current Mailing Address:
Signature Telephone
SECT=3-ESTIMAT,ED CONSTRUCT50M COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building l S,0717 , (a)Building Permit Fee
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) Check Number 1
This Section For Of°sacial Use Only
i ^uildinp Permit Nu nber: Date
i 1 1S�u3II.
{ i �
I
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0361
APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC
ADDRESS/PHONE P O BOX 60627 FLORENCE01062(413)584-7522
PROPERTY LOCATION 31 LANGWORTHY RD
MAP 3 1 B PARCEL 054 001 ZONE URA(95)/URC(5)1
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:_FINISH BASEMENT(ENTRY&LAUNDRY),REROOF REAR HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 060300
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ION 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
r u rildirfO rfi cia 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.
31 LANGWORTHY RD BP-2016-0361
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 B-054 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-2016-0361
Project# JS-2016-000579
Est. Cost: $17500.00
Fee: $113.75 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 060300
Lot Size(sq. ft.): 6708.24 Owner: ROBERTSON CHARLES L&DENISE ROCHAT
Zoning. URA(95)/URC(5)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT. 31 LANGWORTHY RD
Applicant Address: Phone: Insurance:
P O BOX 60627 (413) 584-7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:911712015 0:00:00
TO PERFORM THE FOLLOWING WORK.FINISH BASEMENT (ENTRY & LAUNDRY),
REROOF REAR HOUSE
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 9/17/2015 0:00:00 $113.75
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner