17D-021 (9) SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑, I
Name of License Holder: RObE rp`I :K1 K-� 13 C b _I nC�"t t
License Number
Address Expiration Date
y I3 bt3�} i ao-4
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
tBoBErzr C. ELK-MAN
Company Name Registration Number
Address Expiration D to
TelephonA/5- s�34' wq
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...... ❑ C EP-r I
11. - Home Owner Exemption
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
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
El
New House ❑ Addition ❑ Replacement Windows Alteration(s) y Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding[❑] Other[❑]
Brief Description of Proposed
Work: `REMOI)E1,, ()ti& a T r�Di� n9k EAljt Any ( DOLL , Pf1N,TrZF-6Ll5H oU2S
Alteration of existing bedroom _Yes No Adding new bedroom Yes _ X No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheep
6a.If New house and or addition to existing housing, complete the following:
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 FOR BUILDING PERMIT
I, �C)T F VE as Owner of the subject
property
hereby authorize 503 N
to 5pLQn rn behalf in all matters relative to work authorized by this building permit application.
Signature of Owner Date NOR
I, 13o C3 RF_L(Ll wf , 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.
X03 REc_LMMJ
Print Name
1 �llU1
Signature of Owner/Agent 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 NO f Q bT FK f Mr CPZ U 5 t
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 0 DONT KNOW � YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW n YES 0
IF YES: enter Book Page and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained I , 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 0 NO
IF YES, describe size, type and location:
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 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
a II
� I
Department use only
r (� J060
Northampton Status of Permit:
`� g Department Curb Cut/Driveway Permit
Main Street Sewer/SepticAvailabilitoom 100 Water/Well Availability
pton, MA 01060' Two Sets of Structural Plans
240 Fax 413-5 7-1272 Plot/Site Plans
Other Specify
PLICATION TO CONSTRUCT,ALTER,REPAIR,gENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:: This section to be completed by office
U SrrAk) UI Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�-rc V r R ir a 0'A t4 i I ( �&I f- L5 STYE/q F(&C-N /
Na rint) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
13U+3 RVV A N :3(o S£2 U�C� ITE�-rI�O+��f} W1PrON
Name(Print) Current Mailing Address:
6
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)II'Ito be Official Use Only
completed by ermit applicant
1. Building °[ (a)Building Permit Fee
2. Electrical t (b)Estimated Total Cost of
3
CDb Construction from 6
3. Plumbing Building Permit Fee
(G 000
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number 0
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
ICI
Building Commissioner/Inspector of Buildings Date
File#BP-2005-0300
APPLICANT/CONTACT PERSON Robert Reckman
ADDRESS/PHONE 36 Service Center-Unit 2 NORTHAMPTON (413)584-1224
PROPERTY LOCATION 105 STRAW AVE
MAP 17D PARCEL 021 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLIC&TION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL BATH ADD BATH DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessoa Structure
Building Plans Included:
Owner/Statement or License 009498
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
�/Approved Additional permits required(see be�ow)
PLANNING BOARD PERMIT REQUIRED UiNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/Old Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Doieds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
I
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
O Z/
Signature of Buil ' g Officidf 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 mleet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
- W—AVE BP-2005-0300
105$TRA
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map BIoc�C 17D_021 CITY OF NORTHAMPTON
Lot: -001 PERSONS CON RACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
: BUILDING PERMIT
Cate ga ry
Permit# BP-2005-0300
Project# IS-2005-0395
Est. Cost: $54500.00
Fee: $207.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Robert Reckmal 009498
Lot Size(sa.ft.): 9583.20 Owner: CAHIL LANE STEPHEN P&RITA M
Zoning:URB Applicant: Rob rt Reckman
AT: 105 STRA L AVE
Applicant Address: Phone: Insurance:
36 Service Center Unit 2 (Al -' 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON 2IA5104 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATH, ADD BATH & DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring P.P.W. Building Inspector
I
Underground: Service: Meter:
Footings:
Rough: Rough: Mouse# 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: Receipt No: Date%Paid: Check No: Amount:
Building 9/15/04 0:00:00 10977 $207.00
212 Main Street,Phon (413)587-1240,Fax: (413)587-1272
Building Cossioner-Anthony Patillo
BP-2005-0300
105 STRAW AVE
COMMONWEALTH OF MASSACHUSETTS
GIs#: CITY OF NORTHAMPTON
MV-Block: 17D-021
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTOR
Lot -001 DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Permit: BUildlny
B UILDING PERMIT
Category:
Permit# BP-2005-0300
Protect# IS-2005-0395
Est Cost: $54500.00
Fee o PERMISSION IS HEREBY GRANTED T
Contractor: License:
Cons t.Class: 009498
I J se_ Group- Robert Reckman
r of 4ize(sa ft.): 9583.20 Owner: CAHILLANE STEPHEN P&RITA M
7onin _,URB A licant: Robert Reckman
AT 105 Insurance:
Phone: Workers
APP1 cant Address: 413 584-1224
36 Service Center - Unit 2
Com ensation
NORTHAMPTONMA01060 ISSUE �RK:REMODEL BATH, ADD BATH & DOOR
TO PERFORM THE FOLLOWING
POST THIS CARD SO IT IS VISIBLE FROM D.P.W.
STREET Building Inspector
Inspector of Plumbing Inspector of Wiring
Service: Meter:
Underground: / Footings:
Rough: �,y Rough: (� // 1'
House# Foundation:
�� "� /�" �l'� Driveway Final:
Final: 1�l t r 4fU'`1q6J3 Final-,7 �,b Rough Frame:
Gas:
Fireplace/Chimney:
Fire Department
Insulation: (9 j4x
Final: 6 K ) g- a0 d q
Final: Smoke:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI
OF
ANY OF ITS RULES AND REGULATIONS. '`"
Si nature:
Certificate of Occu anc Date Paid: Check No: Amount:
Feel e: Recei
9/15/04 0:00:00
10977 $207.00
Building
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Conunissioner-Anthony Patillo