36-230 (4) 40 WINTERBERRY LN BP-2017-1435
GIS/1: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-230 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1435
Project# JS-2017-002388
Est.Cost:$3400.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK LANTZ 102169
Lot Size(sq.ft.): 117612.00 Owner: LISKER DONNA
Zoning: Applicant: MARK LANTZ
AT: 40 WINTERBERRY LN
Applicant Address: Phone: Insurance:
180 PLEASANT ST#200 (413) 529-0200 0 WC
EASTHAMPTONMA01027 ISSUED ON:6/8/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:AIRSEAL, 9" CELLULOSE IN ATTIC,
PROPAVENTS
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:
FeeType: Date Paid: Amount:
Building 6/8/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413) 587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1435
APPLICANT/CONTACT PERSON MARK LANTZ
ADDRESS/PHONE 180 PLEASANT ST#200 EASTHAMPTON (413)529-0200 0
PROPERTY LOCATION 40 WINTERBERRY LN
MAP 36 PARCEL 230 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT ('
Fee Paid 1r)
Building Permit Filled out II�JI,
Fee Paid
Typeof Construction: AIRSEAL,9" CELLULO TIC, PROPAVENTS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102169
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
/....-1Epproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/ORSpecial 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 Commission Permit DPW Storm Water Management
Demolition Del.y
Sign. . o :ui ging O`tcial 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 40k Contact Office of
Planning&Development for more information.
_ 1 -
Department use only
411
a.VAI City Jf N rthampton Status of Permit:
�N — 1 'guilds QQg epartment Curb Cut/Driveway Permit
'r7/ 212'Jvlai Street Sewer/Septic Availability
'il �Villf - �f2�A100 WaterPNell Availability
-., -, - Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: LL L7 `fjThis section to be completedzplby office
H W 0 I nit of J2 ( f,� Gt t\14 Map 3(e Lot N Unit
1 ,ac-C Zone Overlay District
Elm St.District CB District
iECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
L1 Owner of Record: /� Qi
a b
O
noN1.;A., 'L isk-Q,r (' �%�\vAactt1 Lw nar-f ,u mA
Jame(Punt) Current Mailing Address /
l ' Telephone 0110i_Li co _ s -). _
,gnature
!.2 Authorized Aent:
o1oa1
m f \--9\ -4-\ \% p1t0. t, sit .RS\Nr Q{,1-' MIDI
/
Jame(P // / Current Mailing Address:
sign ure e'4/(1 it Telephone
SECTION 3-ESTIMATED CONSTR TION COSTS
lem Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
Building (a)Building Permit Fee
. Electrical (b)Estimated Total Cost of
Construction from(6)
i. Plumbing Building Permit Fee
. Mechanical (HVAC)
. Fire Protection C
I. Total=(1 +2+3+4+5) �/ LI 0 0 Check Number /VV9' w
This Section For Official Use Only
3uilding Permit Number: Date
Issued'
signature:
Building Commissioner/Inspector of Buildings Date
Ihasbrouck @ northamptonma.gov
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 8-CONSTRUCTION SERVICES
B.1 Licensed Construction Supervisor: \ a
Not Applicable 0 /�
Name of License Holder: MAP\ Le, \ 2 C SSi -. -7N ,
License Number
. 4i\ � -* /' cti1')\6`eNe r\A (.1�i0 j/�
4tltlres Expiratio Date
/ a ay 3 - s 9 i ,
Signature elephone
idealetered Home Improvement Contractor: Not Applicable 0
039 1. mR
jtrccv„ r ( Q lod � 7
2
Company Name Registration Number
\'a Q\ eOxsost- S� cFS�I�Pcs-V" mp yjs1 (
Address Expir tion Date
1/
Telephone 113-sal-04,00
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 (Tid No 0
11. - Home Owner Exemption
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,p vided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 10835.1.
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 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
;ECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
sew House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors C
\ccessory Bldg. ❑ Demolition ❑ New Signs [Eg Decks:�� Siding L] Other{�'g
13V1n�'i
3rief Descriptionf Proposed r,� `\
Nork: f..Nc1h �N\(t 3'0)b �1i�r.-1 °t" c,.WV L ,-c iNQik L) 0S 9. j0,,�r'-s
4
Uteration of existing bedroom Yes No Adding new bedroom Yes CI'�\ No
qtached Narrative Renovating unfinished basement Yea No
'lens Attached Roll -Sheet
la.If New house and or addition to existing housing, complete the following:
I. Use of building : One Family Two Family Other
Number of rooms in each family unit: Number of Bathrooms
Is there a garage attached?
I. Proposed Square footage of new construction. Dimensions
Number of stories?
. Method of heating? Fireplaces or Woodstoves Number of each
I. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
I. Type of construction
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
.. Will building conform to the Building and Zoning regulations? Yes No
Septic Tank City Sewer Private well City water Supply
iECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
)WNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
h L-1 AC e I- ,as Owner of the subject
property , 1
iereby authorize CO 2� I')J' y' {( �,u rY.A`f\(/
o act on my behalf, in all matt rs re ative to work authorized by this building permit application.
��—• c,
s ) �)
signature off� \O\ww\ner \y Date
`c.r� --_O,I\ \ Z ,as Owner/Authorized
gent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
Ind belief
signed under the pains and penal es of perjury.
NC(' Q$'\ "
'riot Na e ,
/"../-'7": C 5
ti atur of Owner/Age Date
The Commonwealth of Massachusetts