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23D-045 (6) 119 RIVERSIDE DR BP-2002-0849 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-045 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: Above ground pool BUILDING PERMIT Permit# BP-2002-0849 Project# JS-2002-1410 Est.Cost: $1000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq. ft.): 12806.64 Owner: SILVA KATHLEEN E& Zoning:URB Applicant: SILVA KATHLEEN E & AT: 119 RIVERSIDE DR Applicant Address: Phone: Insurance: 119 RIVERSIDE DR (413) 585-8011 () FLORENCEMA01062 ISSUED ON:4/11/02 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 21' ABOVE GROUND POOL 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 4/11/02 0:00:00 1577 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-0849 APPLICANT/CONTACT PERSON SILVA KATHLEEN E& ADDRESS/PHONE 119 RIVERSIDE DR (413)585-8011 0 PROPERTY LOCATION 119 RIVERSIDE DR MAP 23D PARCEL 045 001 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 ,/5777 YlC Typeof Construction: INSTALL 21'ABOVE GROUND POOL 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 INTyORMATION PRESENTED: V 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 Street Co 'ssiioon�/ Signature of Buildin fficial 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. ,,,,_ Department use only � ��. .., , f� , �,.T ! ` i`fY'1 Northampton Q Status o` Permit: ll Build! Department Curb Cut/Driveway Permit - , 5 2CO2 ;;1 ain Street Sewer/Septic Availability_ '-'\., APR 0 m 100 Water/Well Availability_- _ Nortliamp on, MA 01060 Two Sets of Structural Plans - -Phone,4'13.5 7.12 0 Fax 413-587-1272 Plot/Site Plans oc.c. 1 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 >-3 1) Lot / S— Unit Cl a, 11I� rsic � '' .1,-. Map � . , S--i1 .\���CE - OrVL ()t bto a Zone '----e:t'd- Overlay District — Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Itc.+h tan e- Si\ ye. l\q 0;1 oe %1 d-e br. Name(Print) Current Mailing Address: ��`3 - 3 g-s - Fi 01 �� Telephone ign ture 2.2 Authorized Agent: 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 71. Building (a) Building Permit Fee 75a. 2. Electrical4 ('u 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) 4 / ppd — Check Number /5-)-7 AS.a— This Section For Official Use Only Building Permit Number: ge(6 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 `Q?/ 7 ° //a)/ 7 7 7 Frontage 3o �o / Setbacks Front Side L: R: L: aQ► 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 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. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other a,I Brief Description of Proposed Work: —ev j Ol. OLc? )t1 G at l c,s-.0\3661 Lc,O J- 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 h'ou"se ardoraddition"=to existing housing, complete.thie.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 g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. 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 1. > T -</ , 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. Si ne r the pains and penalties of perju y. Print ame Signature of Owner],gent Date • SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone = ,ed Nomelmprovement Cone al orF°15in7:'. 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. Signed Affidavit Attached Yes 0 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. 4.-Fomeowner Signature elltd ��� j ,t7iy,,,., s��k.....4 4 E Gal!. of NoxtIlaiilploil _**_� 9 Yip/ ((�B :saarfinsrtta _i _ — r DEPARTMENT OF BUILDING INSPECTIONS __!`= 212 Main Street ' Municipal Building Northampton, Mass. 01060 r'"‘� WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, (licensee/pe mitree) with a principal place of business/residence at: • • • (phone#) (h t1 tX.t/ci ty/state/II p) do hereby certify,under the pains and penalties of perjury, that- ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor homeowner circle one) and have hired the contractors listed below who have the following worker's compensation policies: ��-d0 �1-�t� SDP S' � Nain Contractor) (Insurance Company/Policy Number) iaa Date) r. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioaal sheet ifnoccsssr/to include information pertaining to all contractors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that wile bomcowoen who employ persons to do tra;rst.nsn.r,construction or repair work on a dwelling of not mote than throe units in which the homeowner resides or oa the grounds apputtemat thereto arc not generally considered to be employers under the worker's.oar pemstion Act(GL152,ss 1(5)),application by a homeowner fora license or permit may evidence the legal status of en employer under the Woricor's Corrtpomalioa Act.. . I understand that a copy of thin rrxt.m.nr may be forwarded to the Departa,cnt of Industrial Ae4drnts'Office of tmursnco for the coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 andfor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S 100.00 a day against me. • For dctactmcoisl use only Permit Number .---g---Z --.2(7_,-;'11--i .5 -t zi—e Mal4 Lot# tK:s:.:, signature of LiccnseelPermitice to _ . �� t. �k 0-1.7.1,•.1#,t.l_a_ 654 00. --I 1 i471 S"V c.k.. 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