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31A-024 (7) BSI fn,, z0 0 g ' E J3l c�nnchncctla — --- DEPARTMENT OP BUIL00\1C INSPECT1o1:S 212 Train Strcct ' Municipal Building Northampton, Mass. 01060 W O RICER'S C O I CP EN S A T I O N CN S URAN CE A FITED A NFIT (li ccusxJperrni ttcc> with a principal place of business/residence at: 1 / (phone.") (srrt-t/ci ty/SialcJzi P) do hereby cer i-�;, under utc pains and penalties of perjury, that ( ) I am an employer providing the following, worker's coinncrls-nuo;; cove.Sc for my eluplovecs working on tilis job. i YVA 7-71 S'A 11 JIG (lnsu-r-a Corur,Y) i (PoLic: Nu--,tir_i) --- - (T :pinion Data) ( ) I am a sole proprietor, general contractor or homeowner (6:6e one) and have hired the conuactors listed below who have the f000w- 9 worker's comoen non policies: (Nanic o-Conimcior) (Ir151,•,n Colnpar}v'c�c, ?gum Y,) it=�:pif�uon [�atc) (Name of Contractor) -- (insnrancc ComoazwPolic-v Numccr) (EaPift:uon Daic) (Name of Conn-actor) (Insurance Compan)•/POLCY Nllrmb f) (E\piraoo Date) (Name of Contractor) (Lasu aac-^ Comcaay/Pohcy Numb:.") Txpiradon Datc) (caadt�.ddi;;ocal c'xa ifnc .ry to a—ud�informirioa patninins to rill cca-r-_c;v�) ( ) I am a sole proprietor and have no one working for me ( ) I am a home owner performing all the work myself. NOTE:plc be&w-art Lc:lizJc bCu3oc,,T9 n Wbo employ Pc 10 r w 6D r. e ego o:rr air uo on a d- ctL^of ON most tti_,_,:Uro:=ri in wt=b the bo:mo•.•vcr raid,,ca the Vouneii zppurtcn:.r tbe-eo c.c ox C-x..Ly oeci:d-czi to be e„^Iplaye7 uric,'-,L--uo:i u's m_=p---•lioo Act(GL I 52-=1(5)),npplicZ6ce lry e 6om ,—fcr e b: ---e r-man—y—d—lLe Icg.]ct Luc of ca cr�loy�uodcc dw Woricdi CAmpum it,io Act I un 3—r d the>Dopy of thi,a-L- nl may bo few--dod to u-D cpauzwc o f 1<u4 atri eJ ne odoct� Off o0 of Ircu.000 for ttx s' --�c vcriG=ioc aad Uu L•iltae to eooim covcrn�tai&=waion 25A of MGL 152 an la_d to the i ion of aimiwj Peoaiti- oomismg of a Floc of up to S 1X00.00�ndfex aa{niy�x- of uP to ocr_year eaS 6 -jj pmJtia in d5 focm of e Stop WOrti Order end a (un of S 100.00 t d:y rpinsl©, ( Foe dq>..nrz>-=11 ur_only Permit Ntlmbcr 1,4.-1p;; I.ot SEGTION> °Cx . tliCTldN°SR15 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 1�' � 1/1,-- c.--"' e ( 0 J 17 0 )� License Number Address Expiration Date q Signature Telephone Not Applicable ❑ Company Name Registration�Iul"�ber Q y � l l b Address Expiration Date Telephone SEcTlorl _ ,ccl�Il��Ns�x�a>u FNSL11'AI+iCI AFI±1D1t1T fmM; sz,§256r 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 Icense,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 "ECTIflN S-DES IPTI NL'IF f+ flP S' ` 1MORK h k,- !l a t' a "1 New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ I Accessory Bldg. ❑ DemolitionO New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: k^ t—�^�`��� r ►Le t-► .ti X16^' 3 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes /No- Plans Attached Roll D - Sheet 0 a. Use of building: One Famil Y Two Famil Y Other b. Number of rooms in each family unit: Number of Bathrooms i ! c. Is there a garage attached? ! d. Proposed Square footage of new construction. Dimensions `fE e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? j Type of construction i i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes i�lo i i j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . i 1, Septic Tank City Sewer Private well City water Supply i SEA 1+e1�i tik ! 1� i3©R�YA�tV' Tfl B flfl �E>rS WHEN OWN T­ AGE 'ct C�lf "]"RACTO�t AtL}ES°>iI EtU 1NG PER1VI,i T as Owner of the subject property F hereby authorize D, -0- J S C to act on al f in all mat rs relative to work authorized by this building�ernnit application. Signatu o Owner Date I, 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. f 1 Signed under th pain and pena�ties of.perjury. ! Print Name l /4ci � Signature of Owner/Agent Date 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 A ��, �� ��l ut _ 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 'r 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: ..^� 1 �� �r i � iue k 1���. � ` _ . _� r � .....� �. ty of Northampton ��> I ��4a wilding Department " OCT k } �'z(� 212 Main Street Room 100 Ctr'No►umbing$ N rthampton, MA 01060 rtnam ton, ��� .587.1240 Fax 418.587.1272 x r•= tom? J APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECT[t?tV -SITE tNFORMAFtON 1.1 Property Address: r I SECTION2"-pRORf7TY OERSiffP/dl'Hf3RIZED AGEMT 2.1 Owner of Record: f Tva�,��Gt�+�, lr' rin Current Mailing Address: C7 e2,— Telephone u 2.2 Authorized Agent; (+ JQrv, cAL- Name(Print) Current Mailing Address: Signature Telephone I P SECTION 3 "" ESTtRV1aTED O+DI�ST��lTT?N"CiST " " Item Estimated Cost(Dollars)to be C f#tctai e Ony " completed by ermit applicant 1. Building /Jr , utlt a 'ermit IF Electrical (C11ttt d Tqt ! Gt�f Z / ctiora'€rczrrt « _j 3. Plumbing Ll ! Will :Permit 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total =(1 + 2+3 +4+ 5) Z ( Zao CheckYNctmber" I Building Permitf^Number.. .'Date Issued: i signature: Bu)Iding Date Camrrtissionerllnspectorof Buitc4tt�gs`= File#BP-2016-0474 APPLICANT/CONTACT PERSON OLIVER ISELIN ADDRESS/PHONE 36 Service Center NORTHAMPTON01060(413)584-1224 PROPERTY LOCATION 42 FRANKLIN ST MAP 31A PARCEL 024 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT JA 4a Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN&REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included• Owner/Statement or License 039073 3 sets of Plans/Plot Plan �C THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON NI MATION 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 Vd* fflicia y Si re jof B Date Note: Is suance 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. 42 FRANKLIN ST BP-2016-0474 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 A-024 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-2016-0474 Project# JS-2016-000784 Est. Cost: $21200.00 Fee: $138.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: OLIVER ISELIN 039073 Lot Size(sq. ft.): 17903.16 Owner: DANTON ERIC Zoning URB(100)/ Applicant: OLIVER ISELIN AT. 42 FRANKLIN ST Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:1011312015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & REPLACEMENT WINDOWS 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 10/13/2015 0:00:00 $138.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner