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23C-080 (3) f 42 BLISS ST BP-2000-0929 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C-080 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: Above ground pool BUILDING PERMIT Permit# BP-2000-0929 Project# JS-2000-1715 Est. Cost: $800.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sg.ft.): 17685.36 Owner: ROBERTS JEANETTE Zoning:URA Applicant: ROBERTS JEANETTE AT. 42 BLISS ST Applicant Address: Phone: Insurance: 6 PINE VALLEY RD (413) 586-0494 () FLORENCEMA01062 ISSUED ON:4/28/00 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 24' ABOVE GROUND POOL 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: 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 Occuaancy Signature: Fee Type• Receipt No: Date Paid: Check No: Amount: Building 4/28/00 0:00:00 2018 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo File#BP-2000-0929 APPLICANT/CONTACT PERSON ROBERTS JEANETTE ADDRESS/PHONE 6 PINE VALLEY RD (413)586-0494 Q PROPERTY LOCATION 42 BLISS ST MAP 23C PARCEL 080 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: INSTALL 2T ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets 9f Plans/Plot Plan THELOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Conservati ommission Permit from CB Architec a Committee Loo 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. �1 LJ __r_ • --�------- LA �� S � n `' `,w.7 s3 +1y1,.�4� `�f •��• �' �+�Er� 's int �'^, ,� tirA ,�.: .r "s;''1•fl� l'�`�y, ,'S�"�?c .`j,:. ! �r P �# ; �� �-, .a r �+,■j � �C'y t� •r7a 3 ' ,d r'"� �"�"�:••" ,�` ' Yea' - ' a tt�. �s .G- * <' i �� t, -�'y r'' }� ^+,rpp{ •d� RS- sr�r e_��'J�,i�')z.�< r y. ��". „� + ''�Y, i'ter t�: a p.: ... � .,, �. ��re,�."Yt �+ .r�� �.. 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D ; Department use only i �tharnpton Status of Permit: 4 it I epartment Curb Cut/Driveway Permit AR Z 1 ain Street Sewer/Septic Availability Ro ' 100 Water/Well Availability ftiORTHkMF'7Q DEPT THAM �' N Ng &Mp n, MA 01060 Two Sets of Structural Plans phone 0 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: This section to be completed by office Jl Map_ Lot Unit / iu ..tJl J-6-f-0 G�014C t I -7� Zone __% ' Overlay District �f' Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (,> ,A;,' ✓x1 _t C Y ne(Pri Current Mailing Address: Telephone SignaturQ 2.2 Authorized Agent: Name(Print) Current Mailing Address: C Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (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) QD. Check Number D/ _7 This Section For Official Use Only R11ilding Permit Number: Date Issued: Signature: oa B i ding Comm issioner%Inspector of Buildings Date ' i 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 Department Lot Size Frontage Setbacks Front Side L: R: L: VO R:1,f Rear Building Height 3�7 cporO Bldg. Square Footage 7 % s�Ip Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ✓ DON'T 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 DON'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 ✓ IF YES, describe size, type and location: D. Ar Pere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: TION 5- DESCRIPTION OF PROPOSED WORK check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 1:1 Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Otherg Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ • Sheet❑ 6a. If New house and or addion to existing housing, complete the following: 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 Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1 as Owner/Authorized Agent her declare that the statements and information on the foregoing application are true and accurate, to the best of my k ledge and belief. igned under the pains and penalties of perjury. n a e i ure of Owner/Age Date crr,TION 8 -CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone Registered Home Improvement Contractor: ,r; 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 affidavit will result in the denial of the issuance of the building permit. ned Affidavit Attached Yes....... ❑ No...... ❑ 11. - Home Owner Exemption 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 responsibility for compliance with the State Building Code,City of Northampton Ordinanc ;and Local Zoning Laws and tate of Massachusetts General Laws Annotated. VA omeowner Signature o��ttn>•r�To (riff of 'No fllautpfoil B � E �Ettasanchnsctta DEPARTMENT OP DUILD0\1G INSPECTIONS 212 Alain Street ' Municipal Building ' Northampton, Mass. 010GO WOR14;R'S COMTENSATION INSURANCE AF t AVIT p�txus.;.Jpernti ttcc) with a principal place of business/residence at: ------ �/ (strc--Uci ty/stair'zip) do hereby certify, under the pains and penalties of pcgury, '112-1 ( ) I iding the following, \ti,orker's compensation cove,ge for my an an empio�rer prov employees wori ing on tills job'. Onsunyn(-- Comp, ny) (Po!ic;Nura}r_r) ---- (Expiration Disc) ( ) I am a sole proprietor, general contractor or homeovvoer (circle one) a-rid have hired the contractors hsied below vyLo have the foilovyug worker's co©Densation policies: (Name of Conimaor) (Insuranc: Coni,)3,1y/Pot1Ci Ntunbc:) ( xptrauon Datc) (Name of Contractor) -- (Insuranc: Company/Pohm, Numccr) (—txpiraaon Date) (Name of Connector) (Insluancc Compuy/PoGcy Numba- ) (Exp rauoa Date) (Name of Contractor) (Insuran(--Company/Policy Number) (Expiration Date) (aa>ch addrtioml sbcct if nooaz�to atcUtrc4 infixz .pati:ing to all ooa7acon) ( ) I am a sole proprietor and have no one work-ng for me. I am a home owner perfortning all the work myself. NOTE:plc=tc be awzrt that whilo hotncowocn wbo catploy pa-om to do m.m+. morn=aioo cr rrpaa work ou a d.vCI1M9 of no(rnocc then throo Unita in which the bomoowucr rc ida oc oa the gounds apptrrunsmi thecto art oo(gcowWy,ocordertd to be employm under tho wack=As -lira Act(GLt52,n 1(5)�apprimcioo by a bomoowvc for a bccax or pa-Mil may evid—the legal"Abu of an omployar under tiro Wockoea Coapoo atioa Aa- I undcrctaad dui a oopy of thio cbatemaat may.ba focw.,-,W to the Dopartwooa of lo&u ai Aoca&-&Offioa of 4rsuiooa for the coverr�e vrriLesioa and that L-iJure to&a covcrtso Under sociion 25A of MOL 152 Can lmd to the impozitioa of cr'a1'O-d Peaalua comistiug of a fine of up to S1,500.00 m&or inpri3camocai of up to ooc ytw tnd civil penahio it,the focm of.Stop Wort(Order and a rim O(:S 100-00 a day agaia4 tor-- For dcqutmn:;�uic only Pcrmit Numbxr Mapes _ Lot n qi;6.,�,fL,-,-_,,e;c/PcrTnjUcc