23C-098 (4) 167 BAKER HILL RD BP-2000-0935
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23C-098 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: Deck Addition BUILDING PERMIT
Permit# BP-2000-0935
Project# JS-2000-1723
Est.Cost: $10000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD NELSON 061464
Lot Size(sq. ft.): 80586.00 Owner: COFFEY KEVIN F& SUZANNE F
Zoning:URB Applicant: RICHARD NELSON
AT: 167 BAKER HILL RD
Applicant Address: Phone: Insurance:
39 KINGSLEY AVE (413) 268-9335 Workers
Compensation
HAYDENVILLEMA01039 ISSUED ON:4/28/00 0:00:00
TO PERFORM THE FOLLOWING WORK:CO N STR U CT REAR DECK
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 Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/28/00 0:00:00 6305 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Gam`
File#BP-2000-0935
APPLICANT/CONTACT PERSON RICHARD NELSON
ADDRESS/PHONE 39 KINGSLEY AVE (413)268-9335
PROPERTY LOCATION 167 BAKER HILL RD
MAP 23C PARCEL 098 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid [OTio —
Typeof Construction: CONSTRUCT REAR DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 061464
3 sets of Plans/Plot Plan
THE LLOWING 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 Conservation Comm' n Permit from CB Architecture mmi e
zooa
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.
t
Department use only
T T p WCirr I Northampton 1usofPert:
0 • :ui s ;Department Curb Cut/Driveway Permit
ApR 2 61� Min Street Sewer/Septic Availability
__
' :o}1t 100 Water/Weil Availability
pton, MA 01060 Two Sets of Structural Plans
DEPT i8w- i"tP '� 1240 Fax 413 587 1272 Plot/Site Plans_______
{v0
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1
SECTION 1 - SITE INFORMATION
1.1 Property((��Ad��dress: ( This section to be completed by office
tog H Eek 1 LL 1"y Map 3 Lot 2te Unit
F i n pprI ce i R. 0106 D— Zone o Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
11a i Mir Rd-)4hritna7111P. d►ek
Name(Print) Currie/4 Mai ing Address:
J-- 13 5-Ru — vtRLI7
_Pit Tel hone
—5,-la e
2.2 Authorized Agent:
P I ,i\1. Elik c en
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building jr,pc. ) Der r: (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
J 'o Construction from (6)
3. Plumbing h® Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection )10
6. Total = (1 + 2 + 3 +4 + 5) Check Number l9 3b5"-----
7� This Section For Official Use Only
Building Permit Number: el/2)J�.35� Date Issued:
signature:
Building Commissioner/Inspector of Buildings Date
,
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
r Buildingng Department
Lot Size 11$ �99 r U
Frontage 4 -4, 7 5
Setbacks Front 6,3
--to Side L: R: L: /3 d R: /57
Rear //g3 a
Building HeightApc r r.
g Square U ( Footage 09 175 9 3/t1
Open Space Footage /4'5 7
(Lot area minus bldg&paved `J
parking)
#of Parking Spaces
Fill:
(volume&Location)
Has a Spec' I 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 'V DON'T KNOW
QES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
G Do any signs exist on the property? YES NO 1,
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:
:TION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ ] 44:10 N,,,K Siding[ ] Other [ ]
d
Brief Description of Proposed Work: ai
•
Alteration of existing bedroom Yes No Adding new bedroom Yes ✓No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
dditio to exrs s:t rig. complete the followingi Cte../K.
a. Use of building : One Family V Two Family Other
b. Number of rooms in each family unit: XAity Number of Bathrooms
c. Is there a garage attached? X t1Lt\.n cc
CXJ
d. Proposed Square footage of new construction.l 2ov c 1 Dimensions C)11Rpeper,' Gin
e. Number of stories? 1)-eCk �f1Q�. 11
f. Method of heating? t8."- " - Fireplaces or Woodstoves Number of each
ti
g. Energy Conservation Compliance. -.X i4c y Mascheck Energy Compliance form attached?
Type of constructionE' . Da—c‹.
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 tek('r
175
k. Will building conform to ther Building and Zoning regulations? Yes No .
I. Septic Tank Ci Sewer'u a j Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, &maa II t_ F. W , as Owner of the subject property
hereby authorize —fAltArt to act on
my behalf, in all matte s relative to work author.zed by this building permit application.
j CO "I l o2 k1100
Signature of Owner �� Date
I, & VU N P Co , a wne Authorized Agent
hereby declare thatithe statements and information on t foregoing application are true and accura e, to the best of my
knowledge and belief.
Q'nned under the pains and penalties of perjury.
S WI, F. Co- Cetj
Print Name
_____ iNNUAL a Co q I (,i, 100
Signature o ne Agent (J o1 Date
sFCTION 8 - CONSTRUCTION SERVICES
. Licensed Construction Supervisor: Not Applicable( `❑
Name of License Holder: \C.', L�a A• klelcianC S f%: 44
License Number
hrft ( 21/o,i
Address Expiratio1Date
? ( -I t3) a 2 —9335 ono
n ture Telephone
,WV,.RWZt � �E Not Applicable ❑
(i,(33
Dtm . ki,c(,tao_nr Atli tte.ijea-
Company Name Registration N mber
'fCt 1(1 r\54ei ibt #39(1610k) SA5 0 I
Address Expiration Dat
Telephone C. q�
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 issuanceof the building permit.
;ned Affidavit Attached Yes IDe/ No 0
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 Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
�-'C1Wf pT
`` (rtfi of �OLflla1ltpfali
•r�/For- �tateach nccfla
���fT— DEPARTMENT OP BUILDING INSPECTIONS teld1 —t
212 Main Street ' Municipal Building
Northampton, Mass. 01060 �tr'+
wORICER'S COMPENSATION INSURANCL A.FPWAVIT
K\C\lar'd .. Ne,150rL
(1iccnsixJ )
with a principal place of business/residence at: II,,
K 5 UU IV)`1e..,N (phonc;t) (413)a(o8% 9335
(suet t/eity/st3te'np)
do hereby certify, under the pains and penalties of perjury, that:
Nf I a m an employer providing the following worker's compensation coverage for my
employees worng on tlhis job:
6.1A.0 Z% J 6k� tit- `'Cd 53 A.6 d
_n= Company) (Polio:Number) irati Date)
(4 I am . ole proprietor general contractor or homeowner (circle one) and have hired
the contractors list- .elow who have the following worker's compensation policies:
Qom '"'
(N of Contactor) Insurance Companyi?ciic, Number (Exairauon Date)
(Name of Contractor) _ (Insurance Companti• cy Number) (Expiration Date)
(Name of Ccantra (lostranc: Compan}/P.0c). Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) , (Expiration Dale)
(anarla additional Meet if noccauy to meka4 iaforecaaoa pertaining to all coo:r a on) bb � ,n
lam a sole proprietor and have no one working for me. 6���", b
4,915-
( ) I am a home owner performing all the work myself.
NOTE:plmsc be awwrc that vebilo bomeowocn who employ pcsoas to do a-= cocotruCLiCO«repair work oo a dwening of
not mocc than three units in winch the bomoowncr rexidcs or oa the grounds appurtenant thccto arc not generally ooaridaal to be
employers under the worker's cu przssation Act(GL152ss l(5)),applimoo by s bomcowver for a Boat=or permit may evidence the
legal aaaaa of an employer under tho Workcea Compemation Act.
I understand that a copy of this ctatocoont may be forwardad to tho Dopertmeos of trv6'.rial Accidence OlLoo of In ut coo for tho
coverage verifcstioa and that failure to coatre coverage under suction 25A of MOL 152 csa Ind to Mc imposition of criminal penalties
co eei:ti n of a fax of up to S 1.500.00 and/or imprisianrocat of up to ooc year and civil posihia io the form of a Stop Work Order and a
fins of S100.00 a day against mc.
For cko.rcro, uac only
Permit Number
o a.
d Map:; Lot �
Si of Li
1
• * MAP SKETCH ADDENDUM ' .
Borrower/Client Coffey
""o rtY.'=cress i Biker H211 Rd.
City k• • • u i--. , County State ZipCode
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6 �� BUILDING SKETCH
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