23A-005 (3) 36 u - BP-2000-1163
Gls#: COMMONWEALTH OF MASSACHUSETTS.
�rap:slock:23A-005 CITY OFNORTI TON
Penin; Building
t:etCen+/:r1pl0i1eY / s \ G P RMIT
cos# SP-2
Pe1,183
Project# :JS,20 -.s , - -
Fat.Cost$2300.00
fen:625.00 PERMISSIONISHEREBYGRr4NT: TO:
cense ;leas: m 'a . , License:
104400
LotSizetsa,Li: 3402(.36 1 ` avENs BEMAN JR 4 HAMS L
loniii g URB . .'-. :Andrew Church
. 36 MEADOW 8r
Applicant Adi rens: Phoneb
174 Spring St M131516-09)1
FLORENCEMAO1062 Mai,0MGi2/00 0:00:00
TO PERFORM THEFOELOR?NG WORK:TEAR CHIMNEY TO ROOF & REBUILD a CINE
SUPERFLU
POST THIS CARD SO iT IS RI,E ThE STREE
Inspector olPiumbiog Inspector of rte' $F.W. FnepReternffWMiega
:'/Marl: Service: Morar:
"Rough: Plough; Boon#�
Flask F�ti
Rough Frame:
Gar F'kke`Hedecpaeet IfiCtrimuay:
Ron.: Pmu atiou:
Final:
THIS PERMIT MAY BERtVOKEH BY THE CITY 0 ORTHAMPTON UPON VIOLA t„" sF
ANY OF ITS RULES ANEIREG O
/..a �"Yd � as
Certificate of Occuoancv s�statel
Fee Tvoe: Receipt NP: DatePaid: A ount:
Building 626/000..0060 1689 $25.00
212 Main Street,Phone 1413)587.1240 But(413)557-1272
Building Commisnersio •
M
36 MEADOW ST BP-2000-1183
GIS#: COMMONWEALTH OF MASSACHUSETTS
/rsMap:Block:23A-005 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:chimney rebuild BUILDING PERMIT
Permit# BP-2000-1183
Project# JS-2000-2075
Est.Cost: $2300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Andrew Church 104480
Lot Size(sq.ft.): 34020.36 Owner: STEVENS HEMAN JR&MAVIS L
Zoning:URB Applicant: Andrew Church
AT: 36 MEADOW ST
Applicant Address: Phone: Insurance:
174 Spring St (413) 586-0918
FLO RENC EMA01062 ISSUED ON.:6/26/00 0:00:00
TO PERFORM THE FOLLOWING WORK TEAR CHIMNEY TO ROOF & REBUILD & LINE
SUPERFLU
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
ei' Jnspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
e 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 Time: Receipt No: Date Paid: Check No: Amount:
Building 6/26/00 0:00:00 1689 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
36 MEADOW ST BP-2000-1183
GIS#: COMMONWEALTH OF MASSACHUSETTS
tio•'r°Map:Block:23A-005 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2000-1183
Project# JS-2000-2075
Est.Cost:$2300.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use croup: Andrew Church 104480
Lot Size(se.ft.): 34020.36 Owner: STEVENS HEMAN JR&MAVIS L
Zoning: URB Applicant: Andrew Church
AT: 36 MEADOW ST
Applicant Address: Phone: Insurance:
174 Spring St (413) 586-0918
FLO RE N C E M A01062 ISSUED ON:6/26/00 0:00:00
TO PERFORM THE FOLLOWING WORK TEAR CHIMNEY TO ROOF & REBUILD & LINE
SUPERFLU
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
frakinspector of Numbing 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 6/26/00 0:00:00 1689 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
City of Northampton s s of � ''' 1114
:
Building Department 4
212 Main Street tf
Room 100
Northampton, MA 01062
phone 413.587.1240 Fax 413587-1272 -
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
1.1 Property Address: This section to be completed by office
?G 2X/ i. I 1�HCP. Map- Lot Unit
CJ Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: a
///9/9U;5 v-ravS 3C 2J7vnof r.)--c
Name(Print) Current Mailing Address
s v-s3ry
Telephone
Signature
2.2 Authorized Agent: -
4410/re C/U i- %7 y 2,,e 4.1. r/
Name(Print) Current Mai gA9lress;�
S f/ —0g/g
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
completed by permit applicant
1 Building (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 J.306-
6. Total =(1 + 2 + 3 +4+ 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings 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
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 DONT 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 [[-Ni
IF YES, describe size, type and location:
•
SEC7iON 5...DESCRIPTION OF PROPOSED WORK(ch k all agpf able)
{{4 New House 0 Addition 0 Replacement Windows Alteration(s)❑ Roofing 0
Or Doors ❑
Accessory Bldg. 0 Demolition❑ �,/; New Signs [ ] p Decks [ r
p] Siding f ] Othe
Brief Description of Proposed Work: -'71-40 4.tegngt, 7o el) •r/� t" /-11 -5r41%:-1-29-,124,— / A-te
Alteration of existing bedroom Yes `( No / Adding new bedroom Yes No
Attached Narrative- Renovating unfinished basement Yes No
Plans Attached Roll -. - Sheet L
6a. If New house antler addition to existitetatiusing, 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?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance tone attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
], 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
V_L
1, X a , .-r , as Owner of the subject property
hereby authorize Iningt✓-C-Ei to act on
my behalf, in all matters relative to work authorized by this building permit application.
x u i
Signature of Owner Date Co 4 . a°
If
I, °1.11,(1 w t-CYi/j ,as OwnerfAuthorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge arid belief.
Signed under the pains and penalties of perjury.
v�reCa (71 u roc
Print Nam
v _ / �. f�f
Signature of wneAgent Date i f.X>
SECHdiS•tcan RfCHOR'9ERYIGES
81 Licen;edcrostruction Supervisor: Net Applicable ❑
Name of License Holder: Andrew Church DBA Chimney Saver 040941
License Number
174 Serino St Florence Ma 01062 1-10-?Q02_ __-
Address Expiration Date
413-586-0918
signet " 7 Telephone
Vn 16 di etAJ
.ra^ "W4t`f Not Applicable Q
Andrew Murch DBA Chimney Saver 104480
ScpmRanV Name _. . _
Registration Number
174 Spring St Rorence Ma 01062 7-1-ZOG2
Address Expire-born Date
Telephone 413-586-0918
SECTICalaAletitetEltr EMPENSATIOSUIS hUreton AWT at;r.'i52$
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 Q4. Na O
n 4t . y9'y ; y..
Fy
The current exemption for"homeowners'was extended to include Owner-occupied Dwellings of one(I) 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`nr 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 Genera/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
i pS\LUIPTU ,1\•
AO"' d Crag of Taz'tham} ion
Itykisirreluvre. ilasaa.rgnaru: 7- rre:
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building aF(/'
Northampton, Mass_ 01060
WORKER'S COMPENSATION TNSURANC2 AFF1DAVTT
71
1, 1� .,Gr.L ..n<cayf�
(liccnsceincmvttx) _.......-_
with a principal place of huoinesssiiresidence at:
/ 7y et? 2<,uj r�-f' �G-c�u "27-)4. e/ phooeit) aft‘-(721/ .
(s aryheruJzip)
do hereby certify, under the pains and penalties of perjury, t!va
O 1 ane an employer providing the f"ollo.vins worker's compensation coverage in( my
employees working on this job.
(insurance^Comp'r.E (')Lcv N tat t) (Expinto_Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have kited
tic) contractors listed below who have the followiag worker's compensation policies.
(Name of Conuncwr) (Insurance Company/Police Numbxr) ('Espwuon Datc)
(Name of Coanzaor) Ors-anent ComoanyrPoticv Nm,ax) (E piation Date)
(Name of Contractor) (hegira=Cos aryfeaIicy Nandi (Forpeacnos Diane
(Name of Contractor) (Imutance Company/Polley Number) ('expiration Date)
(coca)addaro. tad vrnm«...-,an roc...&inormauoo peassiag w all Baa)
XI am a sole proprietor and have no one working for me
( ) 1 am a home owner performing all the work myself
NO1E:pimae be*wart thatawvle terfcronttcra uW anplvy hansom ucmt+wm'of rfixth .k ea dwctling of
as mwe than than,units in whit)the bamooaver raided oc CO We p,wrfa a'Tvt<vm Waco a.2 not BmdWly meridad tc lac
mgiloycn u is the worker's a a Intim AL (GLIS2n1(5)),wptiwtitm by a hommum fm a bcti c cc puma amy evidvnc the
1<yil tmma of ac apptoyer under the Woad.Co tion Act
041/4. tuadayand ibd afapya(:kit ctv:smx m.v to ixwadd to tto r),>6.(10.-26 ofUUW said AmdWt Offen of Ifanem f tIm
tevrat .afaioo anti gat ffikut to arc,-r cavaage w4a 5aerea 5Au MGL t52 on too to tea impatitice ofaimmal pfWda
xwoI ofa We°ftp to 31,500 00 ma1orimpcoowmrp of up bout ytar tad civil Manlvo w mc(of Slop Work C * ed.
Gm of 5100.00 a day againn me
'r
,� fc.deffuterarra uac any Permit Number _......._.
M:tp=___— _
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