07-024 (7) 077,
` re ` BP-2002-0265
Gist COMMONWEALTH OF MASSACHUSETTS
n . 7 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: AU eRATION BUILDING PERIVIIT
PermitBP-2Q02-0265
Project# JS-2002-0400
Est,Cost $700.OQ
Fee;$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 250034.40 Owner: ROTHENBERG BARRY C&AMY S WOL
Zoning:RR Applicant: ROTHENBERG BARRY C & AMY S WOL
AT: 489 NORTH FARMS RD
Applicant Address: Phone: Insurance:
489 NORTH FARMS RD (413) 586-4129 O
FLO RENCEM AO 1062 ISSUED ON:9III/010:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT DORMER TO REAR LOFT OF
BARN & REROOF
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: DA 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:
Budding 9/11/010:00:00 3265 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0265
APPLICANT/CONTACT PERSON ROTHENBERG BARRY C&AMY S WOL
ADDRESS/PHONE 489 NORTH FARMS RD (413)586-4129()
PROPERTY LOCATION 489 NORTH FARMS RD
MAP 07 PARCEL 024 001 ZONE R.R.
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building PermitFilted out 302
Fee Paid
Typeuf Consquction: CONSTRUCT DORMER TO REAR LOFT OF BARN&REROOF
New Construction
Non Structural interior renovations
_Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE F RING ACTION RAS BEEN TAKEN ON TRIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project Site Plan OR Special Permit and Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variances,,,,
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 Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
r I-7—Ol
Sig store of Y uild ci /..
al / 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 meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
, .
3
r— 3ity of Northampton
Building Department Dam7t k.d.0nY 1/Onnco .-
- - ?COI 212 Main Street s*.s4-r'., .FCS' tr'14F1�naEr
{ t Room 100 IO09PAIUNAlltrilb0
I n hUILMNIIINSPECTIONS No-thampton, MA 01060 ,Kr�fru`�t,>abrtx �
vaiii-Ctgi , 4111.587.1240 Fax 413587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION. I
het o ec
1.1 Property Address: , Trs lseion+tbomp etdd y t Ice:c ,
-`i
4/5, /IfFitms /Pc - Mapk " bekrk•Lot n aAss
*
';x ttom�,,AC 5^
Florence / f{. Z no sverl Dis f
i[rt? ,�yy ss `'Ry
Elm St. District t- • e'` CB iastrict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,,,±7728/7'yy kafr?Tcn3e, VI-9 ,14 Fa-44,.s-ts ,4? -
Name(Print)/ Current Mailing Address: 3-1-0 erL
j f Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
$EC •N3 - STI •TE* ON TRU ION OST
OST
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
I. Building #7o a •
(a) Building Permit Fee
2. Electrical D (h)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanic&(HVAC)
5. Fire Protection
6. Total=(1 + 2 + 3+4 +5) 700 - Check Number 450 "
This Section For Official Use Only
,3ulid(k$jeer IENDmber : a:: Date Issued; roS
{ E
n^ a l
.. EmP#tio&lCoFpmisiderfWsAactooP>_SutkYinBs p?. ben ,. - _
•
Section 4.
ALL INFORMATION MUST BE COMPLE PED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filed in by
[/ Budding Department
Lot Size rSo oV
Frontage Kra'
Setbacks Front _ .^
Side L: Po L: R:
Rear
Building Height ......... ....... _.. ,
Bldg.Square Footage °to
Open Space Footage
(Lot area minus bldg&paved
parking)
ff 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 _✓ DONT 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
IF YES, describe size, type and location:_
„BiritertAine. ED ki'd�'4` 1"apahcable7 �=
r•.x,. a-��tn�la�• n:.�.�n ......in �"~*ti a-0.army i'�*..-. . x.�y-w. .,._..
New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Cr Doors ❑
Accessory Bldg. CErDemolition0 New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: /ICtF Pf*/tfra, >n REA!( [CFT B H/1(Ll/ t �`t`(ZGtY= 77[?! Seen o/t/,
Alteration of existing bedroom _Yes_.L No Adding new bedroom Yes x No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll O- Sheet
the '•7s -`. .RBrsa'dda:n; o..•istin`_x°housin.' cont:IetValiM lifii ]n
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. _Mascheck Energy Compliance form attached?
h. Type of construction
Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes
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
."`i,EOT10ttgaa„,:4, , N64)4iTHOJNTATADN ' „O)BFOinp t.EfED WHEN
t9"/KERS, C'itNT:O,R CONT.RA`CTOR P ES$FOR 61HIAI$O PERMIT
I,W. , as Owner of the subject proper.
hereby authorize _ to act
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner /J , /7 Date
25 Avey /Q011yy..��]E-t.-i - ti- ..P' t{C '" -�as Owner/AuthorizedAent
hereby declare That the statements and information on the foregoing application areu'tf e and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
`BAelz( f2o 77170,0e6-
Print Name
Signature of Owner/Agent Date
8.1 Lin ensed C struction Supervisor: Not Applicable ❑
Name 0 Licenfc Holder: _
License Number
Address Expiration Date
Signature Telephone
dratzizinifuTiallin eve ." . i,Y:Hi83z ^f .a=awi w „^. • rrs_:• , Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone_
SECT)QN3107.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAJ.x. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application, Failure to provide this aflidt
will result in the denial of the issuance of the building permit. _
I Signed Affidavit Attached Yes 0 No_.,.. ❑
3ataisi�, ''il11ll tr izn
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)familie
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 180, 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 persons
you hire to perforin 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.
`c-Homeowner Signature %tot
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9A. - 41
`� DEPARTMENT OF BUILDING INSPECTIONS 1!- J
212 Main Street ' Municipal Building
Northampton, Macs, 01060
WORKER'S COMPENSATION INSURANCE A}i .IDMIT
I, r6R re y /' , G—
/
(licensee/permittee)
with a principal place of business/residence at:
VS9 4/ ? ` 5 Ar.. Flo?v-1.4.ie-s_(phone;t) 5-1--4. Y/a 9
(Street/city/state/zip) cif-rviuC
do hereby certify, under the pains and penalties of perjury, that
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
—.. (Insu.anoe Company) (Policy Number) —... (Expiration Date)
O 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 Comnany/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
:enact:a bowl act if notary to ieclede inforeabot Pe,mimv5 to all candor!)
O I am a sole proprietor and have no one vror6hng for me.
< I am a home owner performing all the work myself.
NOTE:plea tc near the al,hmxrvvan who aploy pawn la do maroon olacwoa or swan van.oo a dw<lag of
at wort titan Caro,routs in Wart the bomeoww ado or w doe taoa>W apgvimam lhaefo aro tet Gly maitk d to be
aplo)m uoar the wodce s ers im at(61.152a1(5)),appliapon by a hommwoe for a lio-the Cr prima maa trance the
legol anau of an aacioloy.r uodir Na Workarr Comp®.Lou Act
I uodcnand at>ropy ofthu mama may to farwwdd to the 0epeamem rin& lid AxidmS O&oa of karat for tbs.
wvalgevgific#iw sad thatf ib,mto spout mwtgo war sxsioa 2$A ofMOb 152 au Ind to t)n impala:ofcom:a pmnitin
eomitivg of a Ewe of up to SI-500.00andsgtat
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