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08-009 (6) 844 NORTH KING ST BP-2004-0774 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:08-009 CITY OF NORTHAMPTON Lot:-001 P_ERS_ONS COIYTBAEI ING WITH UNREGISTERED CONTRACTORS Permit: Building ;rIXT-tHI /EtiA* $S tO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2004-0774 .a L' 1 Project# 3S-2004-1145 Est.Cost:$10000.00 -- !NSr'ECIV rT r Fee: $72.50 FERMISSIaJfIS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 392040.00 Owner: DIMOS JAMES Zoninv: HB Annlicant__DIMOS JAMES AT: 844 NORTH KING ST Applicant Address: Phone: Insurance: 75 POMEROY TERR (413) 584-3320 () NORTHAMPTONMAO1060 ISSUED ON:2/5/04 0:00:00 TO PERFORM THE FOLLOWING WORK:ENLARGE EXISTING KITCHEN & REMODEL BATHROOM, AMENDED 3/19/04 ADD 2ND EGRESS TO UNIT #2 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: Receipt No: Date Paid: Check No: Amount: Building 2/5/04 0:00:00 203 $72.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo e 1 c_cd/d 2/10- Aleer `l ( i 4 a,,/ A 4f Avoid j > N—b trikr Aye q/( s C7 « 0 ^( 1:07 L. JUN 1 5 2004 L'—.,) DEs. .-p '.NccEG?VS File#BP-2004-0774 APPLICANT/CONTACT PERSON DIMOS JAMES ADDRESS/PHONE 75 POMEROY TERR NORTHAMPTON (413) 584-3320 O PROPERTY LOCATION 844 NORTH KING ST MAP 08 PARCEL 009 001 ZONE HB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 07/53 Sc'c5° Typeof Construction: ENLARGE EXISTING KITCHEN&REMODEL.BATHROOM 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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved_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/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 S et Commission ��/ Z.-yr 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. Feb 02 04 10: 54a P. 2 e a aia>? eFA.'> it City of Northampton ,M �, �- ""� + Building Department $„ +14 ��x� �' - 212Main Street Room 100 + "- 117;,...''".., Northampton, MA 01060 yam,""' �" Att . s phone 413-5871240 Fax 413-587-1272 "2- likfliet1.04:1- APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOYATEiOR DEMOtTeStl A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION J /Ue V k 0 o/4 n7Q ' ," SECTION:2-PROPERTY OWNERSHIP/AUTHORIZED ACETO. • 21 Oweer oT Recor : Al ,,��}} p- /�/5 ry� 0.N'1 PS /\• IU\'CM t71 7> � �✓C9y L�'vvll ' Name(Pnm) Current Mah',g Address: *Floors k ✓24,v,..z_ - Telephone Cir-) 6-4,1 7 5-023) 2-2 Authorized Pant �a vk e° Name Trot) Conant Mailmi Addres: 54gnaare Telephone SECTION 3-ESIIMATEDCDNSTRUCIIONCOSTS them Estimated Cost(Dollars)to be Official Use Only °omelette by Permit apizalcant 1. Budding &Cp° (a)BUAdeg Permit fee 2. EiecRrcal +PC " Ll l ✓ rte., (b)Estimated Total Cast of Constnictodfiom.(4) 3. Plumbing / 5- rd's., 5uUthing Permit Fee 4. Mechaniai(HVAC) / " {• 5.Are Protection 6. Total=(1+2+3+4+ 5) /C OW, Check Number /jO— jT This Section For Official Use Only Building Permit Number:,. ".77L/ Dale Issued: Signature: .tL .. Building Cannissiaer(lnspabr of Widnes Bete Feb U2 01 10: 54a p. 3 Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Fasting Proposed Required by Zoning The column 4 be[Mee in by Bonnie!Department y9 0 Lot Size ` ' Froumge a q3 Setbacks Rout S.& I Sae, L:51 R: 13 L: R: Rear Building Height fQ WI ( 7 e' Bldg.Square Foomge 540 C 5e S9 el! Open Space Footage i i ([a Dmndnus Nas&pane pei1 59 VII =nano) e of Paking Spacce b 0 Fill: , Iveum &[radon) �© ✓1 e n ^M N/4 A. Has a Spedal/Permit/Variance/Finding ever been issued for/on the site? NO,`' DONT KNOW YES_.. IF YES,date issued: IF YES: Was the permit re=rded at the Registry of Deeds? NO DONT KNOW YES ._ IF YES: enter Book Page and/or Document 4 B. Does the site=Main a hmok, 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: Are✓[f]e6any propusei charges to or addidms of signs intended for the property ?YES No IF YES,desalbe sent,type and kacation: __ Feb 02 04 10: 54a p.4 SECTION 5-DESCRIPTION OF PROPOSED WORK/chock affil 4kabkj New House 0 Addition 0 RePlacemeitt 4mration(s) ❑ Roofing 0 /� Windows Or Doors iv Accessory Bldg. ❑ Demolition New Signs [ j Decks L 1 Siding( 3 Other( 1 Brief Description of Proposed K'work `Air i ( W� Alteration of existing bedroom Yes J_No Adding new bedroom Yes No „ Attached Narrative❑ / rt iRenovating unfinished basement T Yes /'"' No Plans Attached Roll 0-Sheet O ' lkee 1'111dWf:lid.:tkf:8 "hOil&Il'GSYi #O Yfillo theti: a. Use of budding :One Family Iwo Family Other r�.I b. Number of rooms in each fatuity unit:: �J .._ Number of Bathrooms r-'\ C. Is there a garage attached? IA ( ` � d. Proposed Square footage of newewconstruction. y„„/ Dimensions e. Number d stories? ✓ . I I Method of heating? t� l.. _ �.' ) � Number of harti_ asa g. Energy Conservation Compliance. J \Mthheck Energy Com fiance form attached?- h. Type of construction wt24L_1j_ ( // i. Is construction within 106 ft,of wetlands?____Yes ii./No. rs construction within 100 yr. floodplain Yes�Ii,/ Na j. Depth of basement or cellar floor below finished glade .5 n k. Will building conform,r. e Building and Zoning regulations? 1...."< No. I. Septic Tank� City Sewer Private well ay waterSupply SECTION 7a-OWNER AUTHORIZATION-ID BE CONPXES,ED WHEN OWNERS AGENT OR CONTRACTOR APPLLiES FO+ , R,.8O,II.DING PENIA. I,. l /� 0.1— I " ` ( t� 'L al as Owner of the Subject property hereby authorize -3 ci Vet-e/ `l 01 W70,J to act on my beha4,in all matters relative to wart authorized by Urs Madding permit application. F A if Signature downer NI Mg-2-n...--1/4_ Date tj2" 0/ I,.. A it ✓ � � " A-- as Owner/Authorized Agent .+ declare that the Vatements and information on the foregoing application are tele and accwate,to the best of my knowledge mid belief. Signed under the pairs and penalties or perjury. n -3s t,•.tf r GG /�/ i 1, of • Pent Name - Feb 02 04 10: 55a P.5 rSignatureofWrnegAgea -Ziazee9C. 4±/ — arts a. .��8� SECTION 8-CONSTRUCTION SERVICES 81 r tronued Cc'to cutin Suonytsn: Not Applicable 0 NPSNAUSSIDININIM:_, tkense Number Address Expiration Date Signature telephone ti::k ' ' _.,T qs ---..'„ � . x:, °`* x...j..;t Noe Applicable ❑ ComnafY Name Registration Number Address Expiration trate Telephone_ SECTION 18-WOOERS'GOlsPEt6SATION-tN5NRAt aVIT:(N,G.l t84§-25C(4)) Workers Compensation Insurance affidavit must be Completed and submitted with this application. Failure to provide this affidavit will result in the denial ofthe issuarne of the building permit _ Signed Affidavit Attached Yes 0 No....,. ❑ tiN::liiiiiiaii0t4iiiiiittan The currant 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 wbich there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or fano structures.A person who eoRstruals more than one boon in*two-rear 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 fgr 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 Engtoyees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for persons) you hire to perform work for you under this permit. The tmdersigned"homeowner"certifies and assumes - .,a:(bilk for compliance with the State Building Code,City of Northampton Ordinances,Se.- id Local Z....I:Laa id State of Massachusetts General Laws Annotated T Homeowner Signature , L Feb 02 04 10: 55a P• 6 lx M 'y City of Northampton ' i. �w J .t •: ata...,a,,.,n, -i Feb 02 04 10: 55a p. 7 A yPac.-.3'.ar41 f Y}E�c (f.i2 of porfl)aiii0on Is - .0,be . 0' ,pl,».ahaeln.-• i ("EPA-RI-MEW( OF 8UUOINC INSPEC1101:$ 212 Main Stract ' Muoidpol Sodding — Northampton, lilacs, 010GO wOmcIII'S C0OeENSATTON CNSURAN E AI,I,U)A vtT DR -_/'A v i o� 1- 7. LL... @ccas«1{xmrincc ‘VILLI z pd ncipai place ofbar residence aC S PQ p� „ t, ei s?fr 1520 OtM�vca� /Y'✓ 9r/ -rs over) ..j (mr✓ckyteiatdSp) do hereby certify, under the pains and penaiues of penury, that ( ) I an an employer providing the following workers compenszdon cove.^_ge for illy , employees wortiug on This lob (Ws : un Coop ) <Polic:Numb_rl (Expirtion Date) ( ' I am a sale proprietor, general contractor i r homeowner ircie one) and have hired the fcoon-actors listed below who hive to foUot _ ••.rKeeS comoenszdor pohc;es. (Nome o;Con r..ao-f y (Insvmnce Coupes Relic(Nwntca r...'?+aopn Dn to) DltLO,, . Eftc (Name of Coarrnor) aosnroscoa Compa viPoticry vtm¢cr) (t.uir_aon MO 5• L• (Q A(, • R+..me of Counacta:) <Insufanc Comtun>/Policy-Nxmix:)^ (ESpi^-uoc Date) 1 Tawe of Coorractorl (Inmuanc Comcxnylaolicy Numb--r) (Espireuon Date). (ewA imal.ke leeon.rr w,eicu.b idnx.ina p..••i--x,a,.n a,..-,..a<:vl , ( ) t a Solt proprietor and have no one working for me ( I am a home owner performing all the work myself. 7 NOTE.yt-.-s..»ect the.flk bwlo'; nevi°,W-ww uete.:....n c=-.,eeme rQavwi w,dmfs:al M aNe II=Urre ova u+nmda Q betourr,cpu trim 0100th.rpiwys,cpamiiz I u:co Lv-..0V oc 6S 1u F. t oye> oo,-tte+.¢#vy ac v. *Cm Ac(GU 52a1(5n Kgliutian by•barnnwv res.4azw or l..+'^rcy 0-14 ike kg I4zan n r..e.epky....ada tbo WU4oe Cogno, ,g*o Az,- 1 40-a-muith#t.. Cluab.umEIDa.miry*alio warm wy befv.WaOb N.Dq.lmatla(IdunJ McGW O0`a.it/0w.twat. o>+.a:se.asficam adpul Qat w*nett exert-tate,miler latim ISA tor MOt 151 c.a kJuid.:arraim domain.t p aalle ooclz up or.fix.orupa$I)Cp.W alder mtpiwnmcm o(up box yw taxi call pas c,nf[1 dr Sbp Wwk QSb wd. co • .a <S tooS4.day spina ax. Fa< u.u<cosy Path 1':sib=�_ Ma p# Lot ,_ 1 , _cwt,..._,1 :._._. _.�...__ ,..�. __--- — 844 NORTH KING ST BP-2004-0774 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 08-009 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit If BP-2004-0774 Protect# 3S-2004-1145 Est.Cost: $10000.00 Fee:$72.50 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: v:e Group: Homeowner as Contractor Lot Size(sq.ft.): 392040.00 Owner: DIMOS JAMES Zoning: HB Applicant: DIMOS JAMES AT: 844 NORTH KING ST Applicant Address: Phone: Insurance: 75 POMEROY TERR (413) 584-3320 0 NORTHAMPTONMA01060 ISSUED ON:2/5/04 0:00:00 TO PERFORM THE FOLLOWING WORIGENLARGE EXISTING KITCHEN & REMODEL BATHROOM, AMENDED 3/19/04 ADD 2ND EGRESS TO UNIT #2 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: Receipt No: Date Paid: Check No: Amount: Building 2/5/04 0:00:00 203 $72.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo File#BP-2004-0774 APPLICANT/CONTACT PERSON DIMOS JAMES ADDRESS/PHONE 75 POMEROY TERR NORTHAMPTON (413) 584-3320 0 PROPERTY LOCATION 844 NORTH KING ST MAP 08 PARCEL 009 001 ZONE HB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid c9/02/02; 9 0r202''529 Typeof Construction: ENLARGE EXISTING KITCHEN&REMODEL BATHROOM,AMENDED 3/19/04 ADD 2ND EGRESS TO UNIT#2 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOXHATION PRESENTED: 'approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Pemtit 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 Co 'scion � / 0* l - Zoo 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. 844 NORTH KING ST MP-2004-0096 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON IGIS#: 78710 Map:__... 108 'Block: 009 -- ZONING PERMIT tot: '',001 Permit ZONING PERMIT APPLI APPLICATION PERMIT 'Category: Zoning Permit Penn;t# IMP-2004-0096 PERMISSION IS HEREBY GRANTED TO: .,Project# CJS-2004-1145 Contractor: License: Est.Cost: Fee: $15.00 -Homeowner as Contractor __ -r- #of Fixtures: Owner: DIMOS JAMES Applicant: DIMOS JAMES AT: 844 NORTH KING ST ISSUED ON: 0I-Mar-2004 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: ZPA-ADD 2ND EGRESS TO UNIT#2 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Zoning Permit Application REC-2004-002372 18-Feb-04 213 $15.00 212 Main Street,Phane:(413)587-1240,Fax:(413)587-1272 GeoTMS®2004 Des Lauriers Municipal Solutions inc. File No. Please type or print all information and return this form to the Building Inspector's Office with the $i.5 filing fee (check or money order)payable to the City of Northampton I. Name of Applicant: Thf al rp'f ......� i /fftOf ll /J d J Address: 7 Telephone: lir" 3010 2. Owner of Property: �9 / /! 'r C-'-^'� —...—.._ te ., L^ r - 3 . ,2Q Address: '7 7" � "�"\\�'�' �� ` Telephone: .) �/ 3. Status of Applicant: Owner (� I?i Contract Purchaser Lessee Other(explain) 4. Job Location: O 1-1L-1 ""o c w ' ` 5J& 5-rarer aiazatitsPrjzo_ parcel kk�o Na) t e:` �arce1As,.=. +l (S £ r 7Vg a .warret#' e 'Pxia. l5' 'rTq . .t "'°P:w°iTB :EfttED:iN'6Y�i7iE'sH131CA1Ni3EPAJ'41Ft�, st-- ,. -. ' :^.._ 5. Existing Use of Structure/Property:_..Per.,t L3"%-1 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 14. -2 FAar-c_+,cL 7. Attached Plans: Sketch Nan x Site Plan Engineered/Surveyed Plans 8. 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 DONT KNOW x ... YES IF YES: enter Book Page and/or Document It 9. Does the site contain a brook, body of water or wetlands? NO Y. 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: (Form Continues On Other Side) 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NO _ IF YES, describe size, type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUIRED BY ZONING Lot Size Frontage Setbacks Front Side L: R: L: R: C;.- R: Rear Building Height Building Square Footage % Open Space: (lot area minus building a paved parking - #of Parking Spaces #of Loading Docks Fill: (volume Et location) 12. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: Applicant's Signature NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. 000 pdf City of Northampton [ ;* --:,_65_ ,7,5L . Building Department �. a c-, 212 Main Street s Room 100 ,1, .— A Northampton, MA 01060 -- - phone 413-587-1240 Fax 413-587-1272 Ci--;-: .� _ . `� . a APPLICATION TO CONsTRUCr,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE ORTWO FAIi1IY DWELLING. MIR 1 BECKON I-SITE INFORMATION .* ThAsSsecgon zw 1.1 Property Address: S .�r"„ :.� : a„ c fpr �/yy U/m� �c�,�y � e w iV6Y ti kik)? �'q yrs... r�N cB�n1,hT�t -s` SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Recard: 37tVV °- /C . Diwial �� O ?Yvaer Na t) _ant__ �/ � Current Mailing Ad res: // 33d0 ''( Telephone arum 2.2 Authorized moot: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCrISNCOSTS Item Estimated Cost(Dollars)to be Official Only completed by permit applicant 1. Building ©©Q (a)-Bhilding Permit Fee 2. Electrical ( (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building.Permit Fee 4. Mechanical (HVAC) 5. Fre Protection 6. Total = (1 + 2 + 3 +4+ 5) y checkNumber ay/yfl� is Section For Official Use Only Building Permit Number: a I Date Issued: /'/ Signature: Building Commisionerfnspector of Buildings Date f 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 Depafnnnt 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&Lcin) A. Has a Special PermitNariance/Finding ever been issued for/on the site? NO 110 t 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT 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: • g; v. ate .N i OF:'P•OPOS a tR •i� ck 'lf ice, *` "' New House ❑ Addition ❑ Replacement Windows Alteration(s)❑ Roofing 0 Or Doors C Accessory Bldg. 0 Demolition❑ New Signs [ I Decks ( j Siding[ j Other[ j Brief Description of Proposed Work: Alteration of existing bedroom Yes_... No Adding new bedroom Yes No Attached Narrative O Renovating unfinished basement Yes No Plans Attached Roll O-Sheet 0 ara^ningwom—r;Na m :aiirEmt reaRt i tr '.ik: r`iTS e`•-;1ie fin"'pnW i : 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. .._... bimensions e. Number of stories? f. Method of heating? .. Fireplaces or Woadstoves— Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction L Is construction within 100 ft.of wetlands? _._Yes No. Is construction within 100 yr. floodplain__Yes`N- 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 SEO1 ipt.. t7 YP Ef4A[;TRIZATABN TO BE COIhPL7ED.,WHEN OWYX`itriV4GE ttit tg:CORYWACTOrtgAPPIAESIORttlittithiG PERMIT i, _, , as Owner of the subject property hereby authorize ,_,,,, ._to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date DatelnialS , 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 _ _ SECUO -(CONSTRUCT=ION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ^- Name of License Holder : License Number Address Expiration Date Signature Telephone Not Applicable H�— Company Name Registration Number Address Expiration Date Telephone SECT,OM '©--JiYQRKERS j OMPENSA'TION INSURANCE=AFFIDAVIT(MCI.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 oft wilding permit. Signed Affidavit Attached Yes No _ 2 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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 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 responsibi - for compliance with the State Building Code,City of Northampton Ordinances, St. an. Local Zoning Laws and : . of Massachusetts General Laws Annotated. Homeowner Signature • pottdoindoi . 20 l''Gt.'r�Uy s E Giiir of ttx tli�It�tpttin P - rn m';� OEICCRT :EM OF 6UILONG INS Pia.1IONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE A,PFIDAVIT .0( vyt to, t 0/ s^s?th.i principa�i�place o:business/vas:dance z!: 5-+ LIc = p) do 'cmeby certify, eadca the .., mid pen Ic; of penury! Char. O I am an employer providing the `ol1owino c OT Purrs eotnpcnsaoon cove r e ler my employees working on this job: (Innnanr Compan) (FOUL.Nitratr_r) (ErT'r9'on Date) ( ) 1 am a sole proonecer, nan_^RI c..iip'z or Gr honteoxvner (CiECle one) and }cava, ?tstd the 'coj trraC0.S listed below r .'':0 Mom I] .ULri% a..£,Pds CIJ J 'l3-=_O I:CaS_ ,,Sj"%-7 /luo /r iiamo of Contractor) ClosaNsiica Colnoan tict{ Nistrattcs1 (E a-ct Date) tike. (Name of Contractor) Ens-trance Cont- - ^'o!Ic+ Nunn (Il - o Date) (Name of Canaaci ) lintocanco CostintinitilIolior 1 f'ib_ ) , Examinn Date) (Name, of Contractor) illassnoact CoinconadIonchNumty ri tE . is Date) l J t 1 a sole I. i aloin IC one. 101. MC- C Iart id ironic rravilinttotti- :011'..ttloos=t ti t, nott eW more ticuL a'_C:.w n _ cst -_ .wlScc- E,Y.LLSV .a tv c:.,oyca un a _. — .fG ( ..a1cn I,4 hi cow,s fcr.11::::«c ry=Cr .r gal c.auc of ca Cc ln5'x.v.ier LL:n Wnkc'r t:,x_rt ue-i..ct It1 ritand LS*:a.Tv ofti. :.ie:'m v So.fm.. .:t};t.,r of ld.u.id r .ct4ogS(Ji1 =i'e. my cotgo vciCcita a^d ttm[f_.uc to::�_:ccot;r_ - c .....2iA MCI.152 cn Icd W the .m(JziljP-.rorCj'.'1 Pral::_t an;aC siol cfi:,<s up to Sl,C' cpr:> f_. to -.,5,-r.d c•nl xruPo m. :Ono of a i.<h:_erA e. ..m afaA'LC\:aGYr17,1"m. Cm-- I—C/-1; ttlYcta O ly mtN Lamro r ice :,cC/Pc t _.. r a y *_. a City of �dartk�ant}r#an � t14 $i....,hn,.us �I' ., i DEPARTMENT OF HUILDRyG INSPECTIONS dSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 • HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supe. 1sor. The state defines"Homeowner'as, "Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption,to act as their own construction supervisor,to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings(before backfill), sonotube holes(before pour),a rough building inspection(before work is concealed),insulation inspection (if required) and a fingl building inspection.The building department requires these inspections before the work is concealed, failure to ,secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing&gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are madeOf �//} /� i .I"'Gid'rL amn ,)t rk f �j'�' DtWIlunderstand the above. ome owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. / y Date"— Address ate ;Address of work ail, 7 i( `0©v / c 74' location _ dY 1 th7 torr n rip _... ..)ar1VH SVV4. 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