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25C-178 (15) 117 NORTH ST BP-2017-0246 GIS a: COMMONWEALTH OF MASSACHUSETTS Map-Block:25C- 178 CITY OF NORTHAMPTON Lot-001 Permit: Building Cateaorv: Skyhiht BUILDING PERMIT Permit# BP-2017-0246 Project# JS-2017-000421 Est.Cost: S1600.00 Fee:565.00 PERMISSION IS HEREBY GRANTED TO: Const.Class_ contractor: License: Use Group: Gerald A. Joyner Lot Size(sq. ft.): 9670.32 Owner: LASTOWSKI MARY L Zonln2: URCL9FZ Applicant: Gerald A. Joyner AT: 117 NORTH ST Applicant Address: Phone: Insurance: 20 College Park Lane (413) 562-5858 WESTFIELDMA01085 ISSUED U.N.•8/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK: Install one Velux A06 skylight between existing framing. 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: FeeTvae: Date Paid: Amount: Building 829/20160:00:00 565.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Louis Hasbrouck-Building Commissioner Aug 20 15 09.06a Joyner Custom Homes 413 p 1 Aug.19.2015 03:33 PM Always On Top 9782742570 PAGE. 1/ 1 Aug 20 15 08:13e a a r Custom Homes 413 P.2 !../ C7yof Nor8lempbn 80(IOlrigDepv(ment I - °' GU 212 MWn 3deef V Room 900 Nortnampton,MA 01060 ' phone 419.557.1240 Fe7r 413.587-1272 ,v. . .. S y' _ a IC =•4 8 �i APPLICATION TO CONSTRUCT,ALIISL WAIN.RBNOVAT!OR OIMIOLIBN A ONE OR TWOPAMLLY PW6LINO CRON 1-SITE XP'OR AT4ON • 1.1 TawNe6eeisa }t1 i;r ♦ l t 11 . .1 fp? Ah:ral ,ff, ::1,,,-__6• 7.”,-;:f..-:-",y.: )-::-.--2-1± .. _<ifick•plgi.1,..., AI• -41 ; on $IA0 (0a.0 ' „i,7:"--4.07--2-4)..L.214,2� . ' r eaCTCN 2.PROMM,OWr nRSNIIRAtli}IORIQp Agee / ill 1Jotrtti 5F. Nlomq apt/n/�rd of AJer4.6a,..s r1'on‘Ms O.IOUO thin x 5sretail=7704 (tea) lapilli . . oCof/ irk Imus._ • , ' e /dMA nrn.A S' AN .Tali Nas - _-.-,.2-” -., r — - . l4s Taoism DIPS .. I .ARCTae3• *tT JeyIQN cC Ta Ilam EI .e0mt01e1.n)toW , ollllri VllOnly mm two.TM.P.14TPt L elMing (UflSn,7 Peine F.. /, GoO 00 1I`,GS:oo 2 EtININiI (0)CafrNotintled T.L1 Cost e1 I ...-�-. Cemkue/en Pam Ta'Cost 1 3. Kurd p kWlelna PumN P.. / 1. IMMuNN1(HVAC) D � e Pln Pr aA a. TeN1=(t.2.344.$) t 1 /1400 : 00 ich.NlN,me.r 1 / QSROf 8Z3 • This Sween FerOR1emI Ia.a,IT OWN NemWr f Otle Wen . � C_ __ :ZOL • ,dime . emwfm.Rnlylaeref lurarot • ,c ON, ssai l : ._ fc . 2@Vert3ca. pn4 ••.._. Aug 20 15 09:O6a Joyner Custom Homes 413 p.2 SecCon 4. ZONIPIG I Ail Infer/nation Must ie Completed, Parr'[Can ee Dented Due TC IncampL=te Inform-at-Mr i E gs ng Pm.osed 'Required by Zoning as co:ira to..e CIMS j1 by Diann Depa'trent Lot Size I II; III I Frontage11' th iiil )l Setbacks Front I—� . F--; 3_ I Lr RL—Ir t: I I Rex L � P +I f I i---I 'ec_cicg Height J Bog. sours Footage r I ! I V° I [fl . Opo Spam Porzge % ;�er�-a oa„aas�parea !_—' i ) I C I-3 , I • R of FaridngSpaces I i I I I Fill: I (volume&Local ra TI_______ • A. Has a Specie! ?Permit/Variance/Fin Permit/Variance/Finding ever beer issued for/on the site? NO 0 DONT KNOW SLS' "ES 0 IF YES, date issued:I :F YES: Was the permit recorded at the Retstry.of needs? NO n CONT KNOW 0 YE 0 IF YES: enter Book fage� and/or Documentf;' i B. Ones the site contain a brook, body of waver or wetlands? .NO ® DON?KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Cate Issued:f ' C. Dc any signs exist on the property? YES 0 NC .® IF YES describe size, tyre and locator: I i D. Are there any proposed changes to or additions of signs interdec for the property ? YES 0 NO r IF YES, describe size, type and location: j t E. Will the constriction activity cisturb(ciearng, grading, excavation,or Kra)over I acre cr is it part pia com-nor plea that will disturb over I acre? YES 0 NC IF YES,then a Northampton Storm Water Management Permit from the CPA'is required. Aug 20 15 0906a Joyner Custom Homes 413 P.3 Aug.19.2016 03:27 PM Always On Top 9782742570 PAGE. 3/ 3 Aug 201E O6:13e Joyner Cuerorn Monis 413 p.3 8ECTUr IA DEgLgQidt OPkft0POORM TAMS tank ail egggegja New Nouse Cr I Atfldm 0 iRRAgaoam.n,{_Vats. I MNNNunl) © I Re.kng Q .. Aoaaonj an ldp.0 Oodd.n Q I New Signe (F] mem 8:1 gtdkaick Other ICA &w Ds.' N /wane rm 9 /}) dOG IA leer 5eer.i i in Yea N$ otpNfhp s tow,_Vu JC. No kaAmig mmbehoom_YAW_ 1. NC fia Plant ASmabetlkeA _Stoat • ON elbulRtp:ono Family" TVA Panpy Ott b Number groans M nal rawlyuni Numar a!&1Mde a a /A rale a wimp atkohwd?, d. Proposed Squarer o*.strut eaMNumb1 DImAARons A, NumNtof kaiak I, MAMAS dhottiklPra?hne of wand awe Number of NW� a Evenly Corwvn$rtConkeana.. MNNMGt EMrgYCoa.re nee Saran MuehAA? h. Typo of Catabugaat L la caueuata within 10011 of welbad.?_ ;AK NA. tatawmn:ga/RAMA 100 yr. teedpSn Yea ko L Dept of basement oro WAR ba Nbwdnl.Mdgmda k. WN biINMg oamam to to Sling and Zankq lepurNloM? _YAM No. 1. Rept TAM„_- city Saner PMuu watt, Oily war Supply S20110N Ta-ONNR AIRNORIZATIDN•TO DIA COMPLt1ID WHEN DYYNH 3 ARENT OR ODNTNRCTOR APPtJ88?OttBtALDDRi Mr /, r i Cr ,v. to i ata / / Nawner dew NOG PooPery batt OA i .Ma u �•. ■(/R/c�ataL. t A • I. 44441{//' Joycer aOWeetm, pad and YAM( mews to a.S.ff me enatbn a+the kneeing apeeseen ane rue endecoumu.lot.buil of my knavbdge Eignia ander the ptM end;AARON• 9e410y. _ aAn/d 4. . esr^ MA kw* •. »r' r..I//.. _ eh 49 b 4 aR:S ],r et an.G.Ad DM Aug 20 15 09:07a Joyner Custom Homes 413 4 P SECT 7Ck a.CONSTRUCTIOm SERVICES 8.1 Licensed Construcflcn Supervisor: Not Appithao e £ Name pt.,r..riHolder:... lcnt/d __,../?i 'or C5-(0t6o9Z © -® e ad- F. YdLne License Number 60e$1 74-;•c, , 6- _ 102/74fr7 AddressE, irniIor Date r Tetep-w e idistiv fY Rearster'Ra Nome lnnrt7vemsn{3apligc7n i e _ yj `.L i Nal Appp�,i+:able E. Company'ome Registration N:.mber a...e , le, . , . - 6VeSr� el ,�J1julic Address Ey 15 =xpl.. on Dais '4(3 e S2-55'81 _ SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25 Cie)) Workers Compensafior Insurance ahldav#must be completed and cub i ted wth this application.Failure:o provide this affidavit VII result Inthe denial of the issuance of the b;8idin9 pant L S geed Affidavit Atach=_d Yea £ N- C y r-.'; n. : xF SVekti .r crucify. �� �i�Lmt�3a 4BTWze� `�'a �air The trent exemption fa-'nnmeowts:re'was extended to=elude Owner-occupied Dwellin ypf one(I) or two(2'famines and to aline sash homeowner to engage az individual for hire who does not possess a license,provided that the owner acts u•enter . a' SBP. El It t ton Section 128.3.5.: Definition of Homeowner:Permed(s)who own a parcel of land on which husae resides or intends to reside,on which there is,cr is intxded to be,a one or two family dwelling,attached or 3eteched suucttces accessory to such use and/or fens. structures.A num a who constructs more than one home in a two-year period shall not be considered a homeowner. Such'homeowner'shall subrt to the Building Official,on a fore acceptable to the Building Oscal.that hoishe shall be responsible for en such work performed under the buildine 2srmi±. As acting Constriction Supervisor you:presence oz the job sine xi:be nanuired torn Moe to time,diming and opal comple`:on of the work for which this percit is issued. Also be advised fact with reference to Chapter 152(Workers'Compensation) and CTapter:53(Liability of Employers to Employees for injuries not resullt.g in Eeafn)of the Massachusetts General Laws Annotated,von may be liable for person(s) you hire to p.,f ren work foryou under this perm The underXpod vzonstonmer ce;i4Ees and a-mmareepersitnty>,r compliance with the State Binding Code,City sf Northampton Ordirencce,State add Local Zoning Caws and State of Massachusetts Genes:Lewd Annotated. i homeowner Signature _- _ Aug 20 15 09,07a Joyner Custom Homes 413 p.5 The Commonwealth ofMassuchusei =-P, ,g, Department of industrial Accidents ar2-7 . Office of Investigations y tN COO .Washington Street t Boston, MA 92111 Wo-=.>'' www.mass.gov/elia Workers' Ceit pemsattea Insurance Afilerrii: Bui9aders/Camractorsaiectricdams/Plurmbars Applicant Information Please Print Leassip Name fBusoestioroanizaticnitndiv'3ua1): .. / , e - _ i I: filiti'.a// Address: _....• 0 j- -- Ai L e , „ . _ .- �' / /4A 17 f,oft ri City/State/Zip: _ Poea Are you an employer?Check the appropriate box: Type of project(required): 4. ( S a a general contractor and S • 2.r' ear.aemplt oyerwith employees (fu':'•and/or put-true).* ' cavee hired the sub-cant=_cars ' 6. 1 New conn-uction 2.D I aa,a sole proprietor or partner- acted on the attached sheet, i 1 7. 0 R.emodeiitg asp and have no employees These sub-contactors have 8. C Demolition working for me in any-capacity. employees and have workers' *rsirznce.i 9. J Bn"ding addition .om [No woriars' camp. insurance ' P. requser:) S. D .We axe a corporation and its i '0.[]Elecni:al='epi"`or a3diticas 3.C I am a homeowner doing all work officers cave exercised their i_,[] Piut+abrng repairs or additions myself. No workers'comp. right of exm*,:ion per M3L ( 12[;Roof repairs insocatce required.] t c. 152, V(4), and we have no employees. [No workers' i 13.0-Other ,r, ! comp.insurancerequired.jf 1 , "Any applicant tat cheeks box#:must also a one to section bslow showing flatworkers'compensationpohry tforn:a[an. -Bo meownerwith s_bsitthis atSdmdtindicdag they the doingal work and tam hire outside conart a'm't sotthmt,a now affidavit sdthating such :^ovnaciors that check this box mist&tunbed an additions sheet thawing the nage of the sab.connadtos and strte whether r not r3.ee entlees have emp:oyecs. lithe subcontractors have=Onsets,they must provide their n'orkss'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below it the policy and job site information. insurance Company Name: Policy*or Self-ins. Lic.#: ' Exc_rai,on Date: ob Site Address' CitytStatelZip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date), Failure to secure coverage as:ecuired under Section 25A of MGL c. 152 can lead tc the imposition of crinins'peas//nes of a fine up to$1,500.00 and/or one-year imprisonment,as well as pistil penalties in the form of a STOP WC),RX ORDER and a fine of op to 5250.30 a day against the violator. Be advised that a copy of-Es;tatenent m=y be forwarded to the Office of Investigations of the DIA for ins"tutee coverage verfioaion. _....-- Ido hereby cent"under the pains and . ofperjury that:the information provided a5ove is true and correct Sitsire: _ — - - ''ri� / _ it/ Date:_ 5�16 Phone Ss: 110413- 5 �-/ - -1 C6�p 1 Official use only. Do not write in this area, to be completed by city or town officiaL �� City or Town: Permit/License# Issuing Authority(tb-ole one): 1, Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector II 6. Other _ u 1i Contact Person: ?hone#: Aug 20 15 09:07a Joyner Custom Homes 413 p 0 iga- .566e-it Ar Serer Con /�' t°r hir, ru9fie 1- (o (-cc rzg 5ub-conhnc71"oa5 5o,cen-iira.ukar, Jerry Car ev\-E d}aMM SPS 1-v 6u ra r2 ce +tjpt ( . LUor kgrs romp — vtoffe 5E5 s 0. 501 pp-� Pro pr`re. r 2 , l Lo-YJJ a IU/) n Street. /}meri eru 1 po,I L cy VIPL 174-81 Aug 20 15 09:07a Joyner Custom Homes 413 P.7 City o'Northampton 212 ?Mia Street, Notttamptcn, MA 01060 Solid Waste Disposal Anda-in In accordance of the previsions of MGL c 43, 354, I acknowledge that as - a condition of the bulding pefmit eel 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, 5 150A. Address cf the work: // 7 A/o h . 5-71 The debris will be transported by: v), Sa rtr-it i he debris will be received by: Cr?Vo yI C3 (40 M s 1 gr) Bui!din; permit number: Name cf Perm1t Applicant � e 1Dyher Date 1111Prgnature of Per,mit,T pplicant