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23A-093 t ;:;,'gs1" BP-2004-0001 GIs#: -..... COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category. BUILDING PERMIT Permit a BP-2004-0001 Protect# JS-2004-0001 Est.Cost: $15000.00 Fee:875.00 PERMISSION IS HEREBY GRANTED TO: Const.Class Contractor: License: Use crone: Heartwood Construction 043443 Lot Size(sq.ft 1: 13242.2 Owner: SHAW EMLrNDA&MEG MERRIGAN Zoning.CRSApplicant: Heartwood Construction AT: 17 FAIRFIELD AVE Applicant Address: Phone: Insurance: P O Box 993 (413)268-7484 (0 WILLIAMSBURGMA01096 ISSUED ON:7/3/03 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BEDRM INTO BATHROOM & CLOSETS 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: Rouse# 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: FeeType: Receipt No: Date Paid: Check No: Amount: Building 7/3/03 0:00:00 331 575.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo File#BP-2004-0001 APPLICANT/CONTACT PERSON Heartwood Construction ADDRESS/PHONE P O Box 993 (413)268-7484 0 PROPERTY LOCATION 17 FAIRFIELD AVE MAP 23A PARCEL 093 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out QQ Fee Paid cw/ L �/ Tvpeof Construction: REMODEL BEDRM INTO BATHROOM&CLOSETS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 043443 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,WVIATION PRESENTED: (/Approved Additional pennits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* 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 ssion tes-•16" "7//70_3 Signature of Building Official 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. cti1 BIR4C ;',,f user l ar.or Cltyo r N� ' , impto❑ N 9tas of Rti.Asa n ¢ ,` -'•� _ 4nl ne I) nrt Ment Curb Cut/D IvewayPer It" - }} LS ,P t_i, tl -c41 fc Y2 fi1; � `;treef S vcrisep 'c abal t 4t aJ r— /,, I yor r 10C Water/Wel Availability T• :: y^�r• : L; f[o n ILIMFtOINADIDERD Two Sets OEStNetuiral EJa, a �a tis LI h 1,1;712 1, 2 r, i aF 413-5 + Plot/Site Hans AY< °r ax/r iOthcr ..lq .;; SpfrClt}` r QH-C7 1.4' Tq CQN,$4f RUC L` AIRIER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I SECTION 1 - SITE INFORMATION 1 Tins section to be completed by office 1.1 PrcL cry :dzres;; 17 .F.N.RE DE +y -, M P _ Lot ...Unit— -_.... �Fml � r r Zone -.- Overlay District �..Jsl2E/ A"*A�+ Elm SL District CB District SECTIO 4 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record: - MCli >Ntufaifl1144 i3t4EDa . isx €-Y,1.11\k- 01°35 rrrt4 (3 S S a 22uthorized Agent - - SECTION 3 _ESTIMATED CONSTRUCTION COSTS c , , .'v.^. "DoIar :HtIse Only 1 rete: r1 I `� Jt. 5nll'F,_ _. 0M, • Per,,, ES00 , Budding it Fee - I wu N _ /�� _ Yis Section For Official Use Only _ _ Building Permit Number �^ Date Ie suad. I Signature- _ Build ,I r nisson rsp ctor of n l 'ngs ca,� 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 011cd in b: nuilding Department Lot Size Frontage Setbacks Front Side I. Id: L'. R: Rear Building Height Bldg. Square Footage ,o Open Space Footage (Lot area minus bldg K paved parking) it 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 Documentni B. Does the site captain a brook, body of water or wetlands? NO V/ LON'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 V/- IF 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:_ _ _ _ SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg ❑ Demolition❑ New Signs [ ] Decks ( ] Siding[ J Other [ ] Brie Description of Proposed WorkljtMGbf L_r)O 1INff LZsJ2,MRPX„ 11•11A3.11111{(764-1\ 6-C1-i:1SECS Alteration of existing bedroom ✓ Yes No Adding nes bedroom Yes / No Attached Narrative Renovating unfinished basement _ Yes le No Plans Attached Roll U Sheet V 6a. If Newhouse and or addition to existing housing, complete the following, a. Use of building, One ; amity T 'roily _ . . Other b. Number or rooms in each family u'.e'. Number of Eathrooms. Is there a garage attached' d. Proposed Square footage of new construction._ Dimensions _. e. Number of stories' f_ Method 0' heating. Fireplaces or Woodstoves Number of each g_ Lnergy Conservation Compliai ice M,ascheck. Energy Compliance Toro anachedr h. Type of construction I. Is construction srthin 100 ft of set finds'_ Yes No. Is construction within ICC yi. f ov al: _ _'es Sc Depth of basement or cellar floor be ow finished grade 1k. Will building conform to the Rifs_ad Zoning regulations” Yes No . I. Septic Tank City Sewer =rrvate well City water Suppiy . . SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Nt_4�x' R�,ti Ct.ne f oe subject pronto, hereby authorize A- Stu trneelk`)( 1O eOPs(S110fs(i to du: ui my behalf in all matte s relatrve ryThd authr z en by the nolo rci per t t. to Signature of Owner Date as csner,Sumonzed Agent hereby declare that the statements and Infor n-ation on the foregoing application 2re true and ace trare. to the best of my knowledge and belief Signed under the pains and penalties of perjury_ Print Name - - - Signature of Onner/Agan: Dn.e SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:1 �T �q) Not Applicable El Name of License Holder C'-- v ' 5I ��- 101 NH54€ PITC AD l/cense Number —1>,Ocx qq3{{{ 4)i tc&1 I'4k. 0_ loq� Adc ss - Expiation Date • Signature Telephone 14.1CReeisteredlNome`Improvetnent Contrailbr: x ,...., atl,r ,. -;d'='x.. a Not Applicable ❑ \n om Q5 N4511-tncTUtit Company Name Registration Number TO :BOK kn3tuaAms sae t Mk .Oto% Address -y,1of� Expiration Date //[Gr Telephone 13 'U'O' ! '1511 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 affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes / No ❑ 11z 7tom"ee t w'ner.. -xempt on' 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/or farm structures_ A person who constructs more than one home in a two-year period shall not he considered a homeowner. Such"homeowner" shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall he responsible for all such work performed under the building permit. As acting Construction Su pervisnr 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 I.iabitity of Employers to Employees for injuries not resulting in Death) of the Massachusetts General I aws Annotated, you may be liable for person(s) you hire to perfo nn 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 _ __ iLLTI 1 rJ C.0I ,.r- . 7...11-1,>j Ir C_i-mac,bc, . J. 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