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17C-260 (6) E C E E FEB 2 3 2001 DEPT OF BUILDING INSPECTIONS NQRTiiAMvTQN,MA 01060 rv8' 7 � 1Jf g � 0 �r'✓w y �jqlj,s" J I �ra�p� �rlrvu rnd/Y yl r/t; .S L?�' v� ^� s'�•c� �,''?��` ?�{ op . *rbl.tnww rQ' dz,b OS6 s ofbw��s �► ,�n� e hs hF/p a $!9 a StHnp �£ SJ OQ,'Ct�PTO s e Grit� of U g � �aSf$C!(trSCttf DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licensec/permittee) with a prirlcipal,,place of business/residence at: b4 oyoV hone# c (� ) ( city/stafrizzp) do hereby certify, under the pains and penalties of perjury, that: O I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoLiicy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (artad,additional sheet ifnearsary to include infocm,rioa pe ta;aing to all eoatradors) (� I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homeowoefa who employ pcnoas to do mahitcoaace,suction or repair work on s dwelling of not mace than throe units is which the homeowner re=dw or on the grounds appurtenant ihaccto an not generally ooandercd to be employers under the w m+ces compeas4m Ad(GL152,ss 1(5)),application by a homeowner for a license or permit tray evidence tho legal status of an employer under the Workees Componseion Act I undez s d dmd a copy of this rWemcnt may be forwarded to the Dcpsrft. n of Industrial A=dm&Offioo of rnsrasnoe for the ooveragc vetificadoo and tho failure to secure coverage tinder section 25A of MGL 152 can lead to the imposition of criminal penalties comisting of a fine of up to 11,500.00 and/or of up to one year and civil penalties in the form of a Stop Worst Order and a Sno of S 100.00 a day against tne. For depxrt mw use only Permit Number Map#{ Lot# Si of Li etmittee e 3.1 Licensed Construction S rvi or: Not Applicable ❑ Name of License Holder: /t',4i,.T 7 15` License N b Addres Expir6tioK bate 6�5/0 Signat Telephone Not Applicable ❑ Company Name Registration Number Address Expiration Date /. &eA;b Alle'- C))OS Telephone J 6�-�� SEidN it1 YIIGRKEiS'CCIMPENSAT11N INSIftANCE:A�l:1DAY1T(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...... ❑ 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 persons) 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 New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other KI Brief Description of Proposed Work: 0wo.,,ee Alteration of existing bedroom Yes_/No Adding new bedroom Yes No Attached Narrative o Renovating unfinished basement Yes No Plans Attached Roll❑. Sheets 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? 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 . 1. Septic Tank City Sewer Private well City water Supply . pi OI 7 ` s �T��yr 'IY/ �4 i�4w �t�ili.b[I ��ItNIIY A F. _, as Owner of the subject property � /(1AJ 7ii�-� hereby authorize p.;,, �� to act on my behalf, in all matters rela ' e to work Authorized by this building permit application. ko r Signature of Owner Date as Owner/Authorized Agent hereby declare that We stateme9Ks 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. I i y Print Name Signature o wner/A D 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 for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation 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. Are there any proposed changes to or additions of signs intended for the property ?YES_ No IF YES, describe size, type and location: -A , n re VY L6 City thampton AVild epartment FEB 2 3 21 a n Street I 00 100 DEPT OF BUILDING $npto , MA 01060 N Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 71 1.1 Property Address: �€;� `� ��, ww4nw, "pllsll .. PROP R WNE"Ir��A�TH4�ED 2.1 Owner of Re rd: iliA fr / /5l�►f"r u +� Name(Print) Current Mailing Address: /I Telephone ✓ S ghature ��S �d 2.2 Authorized Agent: Name(Prin Current Mailing Address: Signature Telephone 3-' Estimated Cost(Dollars)Item ( rs)to be �t� 1at ,5�UYtl�r c m leted by ermit applicant f 1. Building �,,-�y, p,o� (a Buling trtn 'Fee, � lk 0 2. Electrical =( EttirnAted T6fai CosC f Cori tructanr.fli< ...�3 3. Plumbing Bulldln °Permit.F 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 + 3 +4+ 5) 7�0• cX> Check l rntxer ieri or try at I u Shat re 3 `D File#BP-2001-0700 APPLICANT/CONTACT PERSON Craig Mamey ADDRESS/PHONE P O Box 128 (413)586-5512 PROPERTY LOCATION 72 NORTH MAIN ST MAP 17C PARCEL 260 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: INSTALL NEW CABINETS&COUNTERTOPS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 057159 3 sets of Plans/Plot Plan THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Commissio Permit from CB Architecture Committee Signature of Building Officia 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. 72 NORTH MAIN ST BP-2001-0700 G1S#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 17C-260 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0700 Project# JS-2001-1309 Est.Cost: $7000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Craig Marney 057159 Lot Size sq.8.Z 12066.12 Owner: ANTIN EARL J Zoning: RB Applicant. Craig Marney AT. 72 NORTH MAIN ST Applicant Address: Phone: Insurance: P O Box 128 (413)586-5512 LEEDSMA01053 ISSUED ON:2126101 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL NEW CABINETS & COUNTERTOPS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Devartment 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 2/26/010:00:00 2713 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo