Loading...
06-042 (3) [TM4*6359 `t-` _ l BP-2002- . max J3 2©O&0$$" P :Cmrsgeutio a l J 7eQMEBv t)7 1 1 54.&8 ,,tt{ FRi�K 9V S iox fi Id ps ..pT x - . ..:,.,. eco fkftMl4trfery 2 . I -rift RD (41315115448i0(1 f110f ‘f ,Y t_ra !'JF-. -�Za.•� .nil - $i 4 BUGLE I QOF st "t - Soya,i Rea¢t"Frame: L ( - : "FcepleeetChinuy: 'T�a6tYm:.. "nes 4?/0$`/70/d 1 1tV� Y f3E ` r OF I ORTHAMPTON UPON VIOLA N OF -t2t3[ r; :, ' 3 I a 1 t38 $25.00 2121 I, e4 t1w!c(4y3)3b1-t24O,Fair,(413)589-4272 `_< . , ` .Ba'316m8 i3#ituMt-AItny Patfto' I City of Northampton 71 . Iriif7dr Building Department cPrfiniPkfPi a$, 212 Main Street Room 100 u +r .fiiisF __-_ - Northampton, MA 01060 ^ r' it dtTEd % it ....,...3 w' phone 413.587.1240 Fax 413.587.1272 Pmt/Sltee .tet APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This section to be completed.+b f ce 1.1�P--rr/operty Address: � ?V rar + X d d 9 (T&OQYlQ\t tC Zoctck Map } K s �p Zone R Oq rlayaDiitnpta./ot Elm St. District CB District - . Xy SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: �`:,{ e ! 1pV C)nter' / Name(Priil) ' - Current Mailing Address: .,ala ' tALII Signature ' Telephone SECTIO 3 S IMATD CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building FJ G 80o (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 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 Depafmcnt Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage 4'0 Open Space Footage (Lot area minus bldg&paved parking) N of Parking Spaces Fill: _ _......... ._. I (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW V/ 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 k B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Y.. .._— YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issue?, C. Do any signs exist on the property? YES NO V IF YES, describe size, type and location: D. Ar here any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: _ ,i Q s 'Er at POSED' 1 e Sa llc.. maw.. .. .sp* rn a W ,,, ssni.. e :• . � _ New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. 0 Demoiition6 New Signs [ ] Decks [ ] Siding[ ) Other[ Brief Description of Proposed Work: S+ i rt LcveeJ Przeka, f � dr- { a 't' Les,/at',. J J Alteration of existing bedroom Yes V No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes /lo Plans Attached Roll 0 • Sheet❑ $Itt447' , r 2."CLdhilUSHH]t]5SltO°-. •In1 St. N 14catics r.L:eRftea 6HOW]flg: a. Use of building:One FamilyTwo 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. Mascheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands?......... Yes No. Is construction within 100 yr. floodplainYes 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 OWNER`S AAGENTOR CONTRACTOR APPLIES FOR St 8LDING PERMIT _ , as Owner of the subject probe hereby authorize _ _ to a 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 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. Print Name Signature of Owner/Agent Date ( SEO II "CONSTRUCTION;SERVICES 8.1 Licensed Construction Supervisor: �p Not Applicable 0 Name of License Holder : Nei e -4- 6`-� -nerd CS Q7 /'ry1 o J BVI Livens Number Li(Q CO( E E . -BoreVic c ( . 1p2 of c Addr ss p,� p� 9 Ex it tion D to I''I f'. ���Ol—O l U a Signa to �, Telephone AGtif7i,ttat141a u: r i s3ii1FivitS&€ -i.. ;F. ,,,...;.,-,-..A--' :--4,A.'s'skim Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 affic will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 ( a P0 ei1 " C. -= . 3 vg € iit1"...... The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act. 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 then 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 Oficial, 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 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 ppt _ PTO —a+se•\ t "y afi `G lilt 0:f-fl r of Northampton * . `� 44 8 atazsna4nsatia• ft c — 9 =. DEPARTMENT OF BUI[D7fyC INSPECTIONS _ 212 Main Street ' Municipal Building '-. — ` ".E> Northampton, Mass. 01060 WORKER'S COMPENSATION INSLURANCB, AFFIDAVIT (ii setJpermittec) with a principal place of business/residence at: • 9(0 Ock.k . S\-- .0-crevice ill, 010C2(phone{0 5 , ie) (strecdciiy/statrinp) 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: - (Lmunnce Company) (Psalm,Number) (Expiration Date) () I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following wakens compensation policies: (Name of Contractor) (Lnsarrance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comnany/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Ea1>aanea Date) Name of Contractor) .....(Insurance Company/Policy Number) (Expiration Date) (aux§ Idtam-ssm vl thcct if i-r-, 4 L-S andw ,rt p. ins m.u ..n . ndon) (Y) 1 alai a sole proprietor and have no one working for me. () I am a home owner performing all the work myself • NOTE:pinv tc emut that w�.�c M#rrmoth War copier' se:n:nvtteenseroth'othe co thee rood or adhrvtlinlo m r thee barn than earn is wF d the honmuvs resides or ad tbt growth tpWeieaud ibmta en ort a.0 Jty at'4Ctd to to employer,under the v./other th .vm ft (GL152-t I On-ANT-thou by hoamwm fm n licmz or Foram:ra+y nih..er the nun thaw of en employeeunder-the works'.Ccoopennstioo At I uohmand that:they of this neathear.may be ranmMN re the De yr of Tethered Accent e Offix of'mw.ce fro We dc'Nun'uv¢i6liar ani th4tf.ib',tto zccurc cnvmSo=St Nether 24A of Ma 152 can lad to t&ittearairiortrerAtothl 4coJic thee-oink;ofafine of up toS1}OO.oO mdy,v tmprhocmrcn ofup te ee ycy uric:hi]pmltiv in Ce form of a Story Wed Orth rads fire o(SLOO.00 t thy appimt me __— For d{mo-oarnuse thy 41 = Pccmit Number One.. l ',i.retp', nrap'+_.. LO44 Sty I. o it..'+Jli ••erinitfrr . Dote • PR• a• : L T�a•a. Jesse C.Montgomery - nh JCM Home Improvement C ""'' 46 Oak Street „v Florence,MA01062 kall1111111111 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: • .. • .• • "• ARCHITECT meg, } 3�yy iiisa. _ _ .a'• , 4€wx-a '^.�n..rd ...'Ys . , ,i.:dx,�.bx^, _.�tx.;� ..,.�. . s,a�iwu�; F .� >:�x.�e .`&€y��. ra:.a'k '�+a +d �vi� R''�aaMi ''i,M ""i'",s gt' ,mss 3 ha 2 �'i�-: ` 1tag a ari'` fid^. a. ",�y,su na£4=`S�c,_.+.�9 5 a4 -. e tt:;;; .*~ .i _ 06Z...1 :v'� �i..��Wk5 ;37N4 Jia k1&.x 1 #L' v..�`r ase s:a;, '*. i -k ,s eek"".".arzi w'i=t,;yfE :;iz' nn. .i: ` tr..4. ^ -.me - -.4I. : •i°A as' f� >a, � 3Tt *fr •et wqh ,`- tabents*as • �; .-- 9 • • - ' S� wo ..- { en. 3 i ••6 o/ i • .. RespectfullyRespectfullyaubmgMa 1.' • "�1<rwri. • • My alkntln ti,Mit Tam auvw • : e s!a mak R •s>NF Ar. wa be wu ld m�/,en wan aNvr,wMlt nmeasye Pert4 �iYYeV�� 4 �. O 1 i Note—This proposal may be w the awn aby us if not accepted within 2' days. t .xYex � Date // 3G/G / signature ICAdeknsNC 3818-60 PROPOSAL s ry f i