22-014 61 SPRUCE HILL AVE BP-2000-0841
GIS#: COMMONWEALTH OF MASSACHUSETTS
ap:Block:22-014 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: windows replaced BUILDING PERMIT
Permit# BP-2000-0841
Project# JS-2000-1 582
Est.Cost: $2200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 10001
Lot Size(sq. ft.): 26658.72 Owner: BERTRAND FRANK R&VIOLA R
Zoning: URA Applicant: THE JUBB CO I N C
AT: 61 SPRUCE HILL AVE
Applicant Address: Phone: Insurance:
P 0 Box 429 (413) 772-6217 Workers
Compensation
GREENFIELDMA01 302 ISSUED ON:4/4/00 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
ispector 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:
uilding 4/4/00 0:00:00 4152 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
. t .
r� n Department use only
1 U 1----- of Northampton Status of Permit:
Illding Department Curb Cut/Driveway Permit
�� MAR 3 0 2 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
} — 1`r3tsthampton, MA 01062 Two Sets of Structural Plans
t__ -- phone 413=587.1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
MapThis section to be completed by office
�/�- Lot / Unit
'.ol Spruce Hill gv -
F to r n c of M G i 0 6, l Zone � `e j L Overlay District
6C Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mr 11(5 . iGnt: B ✓-i-rcncL (2f Spruce, / / r / Ave-- Florence..,
Name(Print) Current Mailing Address: S$ti , �53
Telephone 7
Signature
2.2 Authorized Agent: �'/' �J
eke—1 uJ Gryp=j , nC C . P Q 201. 9' (T� lC' 67,30,E--
Name(Print) �/ Current Mailing Address:
�� o 11/3 ' STY -37I (a
ignature f Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 4,9aoo O 0 (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) a do ,() 6 Check Number 7,j� -- ;41j
/G/ This Section For Official Use Only
Building Permit Number: WPC f7( 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
Building Department
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&Location)
A. Has a Speci Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the per it 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. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
:CTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition ❑ Replacement Bows Alteration(s) 0 Roofing 0
Or Doors
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: D N- Rep 14remen-f Cut✓1 d_oLu j
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll . Sheet D
6a. If New house and or additionsto,existing:housing. complete'the followita
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
g. 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
, 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
, 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 P\ r-
I' � ///4 L /'� Date a/ O/o6
igna na e of Owner/Agent
SECTION 8-CONSTRUCTION SERVICES
I. Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: LQ C r b 3 r. O s S 3 3 3
License Number
a_jjaoc
Address Expiration ate
ignature elephone
Applicable liable 0
/ OOG0
Company Name Registration Number
(40 /066
Address G)3a� / Expiration Date
Telephon y' 37/b
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 oft uilding permit.
"'gned Affidavit Attached Yes 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
4
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DEPARTMENT OP BUILDING INSPECTIONSTs_
212 Main Street • Municipal Building
Northampton, Mass. 01060 r"•,
WORKER'S COM]?ENSATION INSURANCE AFFIDAVIT
I, Qt,vrt.nC2,
(liccuse Jpermittec)
with a principal place of business/residence at:
—1 -euer1S ' PO 83I (la?' (Phone#)
I d . 1-4 6-- el3G)--- (s Ucity/stalciap)
do ereby certify, undere pains and penalties of perjury, that
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
C-o , 5-7 qy
Company) olio Num
ber) (F1 iratio516
Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurancc Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Conn-actor) (Insurance.Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shect if nooma y to include infonnatioo pertaining to all co:e amors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcsc be aware that while homeowners who employ persom to do creirla-o,orr construction or repair work,oo a dwelling of
not more than throe touts in which the homeowner resides or on the grounds appurtenant thcttn arc oo(generally oocsidamd to be
employers under the worke?s mavens:dim Act(GL157 n 1(5)),application by a homeowvc for a license or permit may evidence the
legal,tonic of an omployor under the Worlcds Compeoaatioa Act,
I understand that a Dopy of this earaaroem may be forwarded to tbo Depertmcoa of Laths-raid Aeodaorf Otiioe of Imtuwoa for the
coverage vcrif c iioo and that failure to Locum coverage tinder section 25A of MOL 152 can Ind to the imposition of criminal penalties
ooasisting of a fine of up to S 1,500.00 and/or imprianamcat of up to one year and cavil penalties in the form of a Stop Work Order and a
rim of S 100.00 a day against me.
For departmental use only
(4?
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