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43-052 (4)
41 • i 516 WESTHAMPTON RD BP-2001-0614 GIS#: COMMO WEALTH OF MASSACHUSETTS MV:Block:43-052 CITY OF NORTHAMPTON Lot:-001 1 Permit: Buildinq Category:Non structural interior renovations T T iJ ILDING PERMIT Permit# BP-2001-0614 Project# JS-2001-1094 Est.Cost:$2000.00 Fee:$50.00 PERMISSION I HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Group: *. Lot Size(sq.ft.): 40772.16 Owner: STOKES TIM ANN LEWIS. Zoning: SR Applicant: STOKES TIM & AKIN LEWIS AT: 516 WESTHA PION RD Applicant Address: Phone: Insurance: 516 WESTHAMPTON RD 413 582-0474 FLORENCEMA01062 ISSUED ON:118/010 00:00 �,TO PERFORM THE FOLLOWING WORK: EPAIR EXISTING SLAB & FRAMING IN ATTACHED SHED POST THIS CARD SO IT IS VISIBLE FROM THE TREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footin Rough: Rough:'3'15141 X"0---House# Foundation: Final: Final: CV-611, 3 fot Rough Frame:6!ki Gas Fire Department Fireplace/Chimney: Rough: JiI: Inau�rt: Final: Smoke: Final: Q'K THIS PERMIT MAY BE REVOKED BY THE CITY ORTHAMPTON UPON VIOLATION O ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc si nature: Fee Type: Receiat No: Date Paid: Check No: Amount: Building 1/8/01 0:00:00 1163 $50.00 i 212 Main Street,Phone(413)58'4240,Fax:(413)587-1272 Building Commission Anthony Patilla 1 ,ec47� 4"YW Ala ao ,F_ 516 WESTHAMPTON RD BP-2001-0614 GIS#: COMMONWEALTH OF MASSACHUSETTS "`"Ian:Block:43 -052 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category'Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0614 Project# JS-2001-1094 Est. Cost: $2000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sg. ft.): 40772.16 Owner: STOKES TIM&ANN LEWIS Zoning SR Applicant.• STOKES 'TIM & ANN LEWIS AT. 516 WESTHAMPTON RD Applicant Address: Phone: Insurance: 516 WESTHAMPTON RD (413) 582-0474 () FLORENCEMA01062 ISSUED ON.1/8/01 0:00:00 TO PERFORM THE FOLLOWING WORK."REPAIR EXISTING SLAB & FRAMING IN ATTACHED SHED 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 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/8/01 0:00;00 1163 $50.00 212 Main Street,Phone(413),587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2001-0614 APPLICANT/CONTACT PERSON STOKES TIM&ANN LEWIS ADDRESS/PHONE 516 WESTHAMPTON RD (413)582-0474 Q PROPERTY LOCATION 516 WESTHAMPTON RD MAP 43 PARCEL 052 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATIQN CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: REPAIR EXISTING SLAB&FRAMING IN ATTACHED SHED New Construction Non Structural interior renovations Addition to Existing AccessoKy Structure Buildine Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FRLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: pproved 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 ofDeeds 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 Commi 'o Permit from CB Architecture Committee Signature of Building Offici-ar 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. orthampton BuilDepartment 4--a l 2 lain Street Rom 100 nEPT Df 8KDING p n, MA 01060 0 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION` This section to be completed 1.1 Property Address: by office TIC w 61T14l�'�IC TJi� 2(� , Map: dot unit eij �reriay District r y lm$tSYiC# 48.©Istric# SECTION 2 -;PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I;>". <t(I WnnVR-' l it _ fI-osicit(c 0 icxz Name(Print) Current Mailing Address: T Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Z0 (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 =(1 + 2 + 3 + 4 + 5) Check Number Q -•" This Section ForOfficial Use 0nl Building Permit Number:_ .y bate Issued: Signature: Building Commissioner/]nspector,of Buildings , pate � � . . , � \ \r � \ � � � 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 let!; � 8 P Side L: R: L: R: Rear i UOQ Building Height /17 1 Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved parking) (7 #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_ No7X- IF YES, describe size, type and location: CTfON 5- DESCRIPTION OF PROPOSED WORK check all aplicabte) New House ❑ Addition ❑ Replacement Windows Alteration(s)'o Roofing ❑ Or Doors 1:7 Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[[ ] Other [ ] Brief Description of Proposed Work: 'WN� . vQ&MfLru!�k- I Alteration of existing bedroom Yes No Adding new bedroom Yes _X No Attached Narrative ❑ Renovating unfinished basement Yes >CNo Plans Attached Roll ❑ - Sheet 6 U5-ti' O fn 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 �04g. 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 . I. Septic Tank City Sewer Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE'COMPLETEDHEN' OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING P RMIT 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 as Owner/Authorized Agent hereby declare that tstatements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. igned under the pains and penalties of perjury. Print N Signs re of wner/Agent Date Y # ECTION$-CONSTRUCTION SERVICES .1 Licensed C�Holder ction Supervisor: Not Applicable ❑ Name of License License Number Address Expiration Date Signature Telephone ,::i e ;.,. .<v�ps .gii:• ?",s3 F -:: Yom' lit ' .p...`l Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C{ ?) 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. igned Affidavit Attached Yes....... ❑ No...... 1441, 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 hople 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 an r7onir Laws and State of Massachusetts General Laws Annotated. Homeowner Signature _ - O a. Grit� of 'Nart4alliptIIIt U 1Q g 6 DEPARTMENT OF BUILDING INSPECTIONS 212 Main. Street ' Municipal Building ' Northampton, Mass. 01060 WORE ER'S COMPENSATION INSURANCE AFFIDAVIT I, t �V (liceuser/pernlittee} with a principal place of business/reside'nce at: M j�- (JJ&.(phone#)Sgz-6 .� --r �tstreet/',cityls�;a�i�p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (insurance Company) (Policy Number) (Expiration Dale) ( ) 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 Cpmparry/Policy Number) (Expiration Daze) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shad if neceniLry to inchxle inform on portnitcing to all contractors) ( ) I am a sole proprietor and have no one working for me. ,01ZI am a home owner performing all the work myself. NOTE:ple w be aware that while homww=3 who employ pcmns to do aDc,_construction or mpair work on a dwelling of not more than throe units in which the homeowner murder or on the goo,o amt teuant tbado are not gsucrally oo=drnd to be employ=under the worker's compensation Ad(GLI 52,m 1(5))�application by a homeowner for a license or permit may evidence tho legal statua of an employer under the Wmkoe'a Compensation AcL I understand.that x copy of this#atemad may be forwarded to the Dgmrtaxo2 of Ir>davitrial Aoadec&Office of lnsursnce for the as* coverage verificadoo sad that failure to segue coverage under soctioa 25A of MGL 152 an lead to tba imposition of criminal penMWes consisting of a fine of up to S1,500.00 atudlor impriso�of up to one ytar and civil penalties in the form of at Stop Worst order and a fico of 5100.00 a day against ttyc For depatment1l use only permit Number Mao- Lot# 4&gnature of LicensectPetmittee