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23D-037 (16) 11 ORMOND DR BP-2004-0252 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-037 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0252 v.�a Project# JS-2004-0372 Est. Cost: $0.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DIVERSIFIED CONSTRUCTION SERVICES LLC 030787 Lot Size(sq. ft.): 7535.88 Owner: YEH WARREN&WELLI YEH Zonine: URB Applicant: DIVERSIFIED CONSTRICTION SERVICES LLC AT: 11 ORMOND DR Applicant Address: Phone: Insurance: P 0 Box 168 (413) 253-2798 Workers Compensation BELCHERTOWNMA01007 ISSUED ON:9/17/03 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD 8 X 24' ADDTION TO HOUSE TO EXPAND 2 EXISTING BEDROOMS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Undergroun e5 x ,d�'� j Service: Meter: 2 Footings: Rough: ,,,_as,,j)fj><`�y Rough: /2/ s 3 House# Foundation: CvUs Driveway Final: Final:/,.15.c 44 Final:; J Vt0 � s`Y 3i/°3 . '" Rough Frame:Vk- 1 j` '3 -`oy �/ ryi Gas: Fire Department Fireplace/Chimney: Rough: Oil: lnsulation:0 A. 12--g-63 J.. ) Final: Smoke: Final: ern" I `?a•O y THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. / _ Certificate of Occupancy anc / / �� Signature: -- -'.*'''fr''Zf(iFeeType: Receipt No: Date Paid: Check No: Amount: Building 9/17/03 0:00:00 2292 $80.00 212 Main Street,Phone(113) 587-1240,Fax: (413)587-1272 i Building Commissioner-Anthony Patillo nun /( ilo City of Northampton BUILDING INSPECTION LABEL Arit, PPRQVEID y °° Inspector / a/ 7 d -(51-t4 -84 F 4.‘-74, if„, -nags' ��' File#BP-2004-0252 APPLICANT/CONTACT PERSON DIVERSIFIED CONSTRUCTION SERVICES LLC ADDRESS/PHONE P 0 Box 168 (413)253-2798 PROPERTY LOCATION 11 ORMOND DR MAP 23D PARCEL 037 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST Ei., LOSED REQUIRED DATE' ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 7a- a fa • Fee Paid Typeof Construction: ADD 8 X 24'ADDTION TO HOUSF.TO EXPAND 2 EXISTING BEDROOMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 030787 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN 0' ' `PPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see belov\ PLANNING BOARD PERMIT REQUIRED UNJL. 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 UNDI Finding Special Permit Variance* Received&Recorded at Registry of Deeds 1 )f Enclosed Other Permits Required: Curb Cut from DPW Water t1. Sewer Availability Septic Approval Board of Health ;1 Water Potability Board of Health Permit from Conservation Commission rmit from CB Architecture Committee Permit from Elm Street Commission Signs of Building O ficial Da e Note: Issuance of a Zoning permit does not relieve a appi;r: , „urden to comply with all zoning requirements and obtain all required permits from Bo:.. dth,Conservation Commission,Department of public works and other applicable permit granting *Variances are granted only to those applicants who meet t standards of MGL 40A.Contact Office of Planning&Development for more information. 4. • Cityof Northampton S: atus oP 1t1 _• •'f p ^s�� , YJ z,3J y � , • Building Department Curbieut/aD vewa �� 212 Main Street Sewer/Seo �c�•�.tab t =�' Room 100 Wa erllNetl= vat abt a u Northampton, MA 01060 woof c Tat, �uxr phone 413-587-1240 Fax 413-587-1272 �PIotIS t P anss Other S eci � 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 byAoffice !� n-19/lQn `? 4;- Map Lot Unit ' y(/,./Z�qz L' Zone_° Overlay District 443n Elm St_District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:Ye.X. / Gl /1 /! Orin€ ie-/ ( /---4/erc AC)/D,<2 Name(Print Current Mailing Address•'72 p ,�. Telephone Signature 2.2--A�uthorized Agent: JJ Mgr /t? A. cr. C CJ k /6 F e/c Ji-er ywa.rib4 Na e(Print) Current Mailing Address: M � S'3 -27 9'S .- Telephone SECTION3 -'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) -4 3d, 000 ^ Check Number This Section For Official Use Only Building Permit Number: 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 O. O _ _Frontage _ Setbacks Front 36 S4 ' a cJ Side L:''' R: 2 a L: (6 R: d '� Rear f 6 S4�e V Building Height s�u� Set rn .6,lc/ Bldg. Square Footage % zod -. Open Space Footage (Lot area minus bldg&paved 61) 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 1 Replacement Windows Alteration(s) 0 Roofing 0 Or Doors 0 Accessory Bldg. ❑ Demolition❑ New Signs [ J Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Go(e-C 8 y4ei S CCovI•S� ,4, -e.veha[ 2 ,P.x.s�.it� 4Irvomr Alteration of existing bedroom Yes No Adding new bedroom Yes No V Attached Narrative❑ - Renovating unfinished basement Yes No 6 Plans Attached Roll -Sheet C 6-if- f"New:house.and.or_"additionteaisting housing com-ptefe l e ardriving: 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? ye 5 d. Proposed Square footage of new construction. Z cif:" Dimensions 'X 2t e. Number of stories? / f. Method of heating? U/ S /J / A `t`_ 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 I R l _ I ,e - , as Owner of the subject property hereby authorize h2r-S 1 fi c eoASV to act on my behal in all mat r relative work authorized by this building permit application. Sign ture of Owner Date r. s. t N^'L a f;` -t�?'x�i� z�.: .:f++3�"�'.KF. �Y'•�h4;. I. v ' '" v. eis/-:( eel -51 , as Owner/Authorized Agent hereby declare that the state en 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. 6. /''I r1 e / Print • g - re of Own- •_ Date SECTION 8 CONSTRUCTION SERVICES _ 8.1 Licensed Construction Supervisor: � Not Applicable 0 Name of License Holder : 0, /nog'. ! j/ ©.3c 93-7 / License Number �p /2oA- /68 �� Aer-i-- -en /4-_ o/ 7 7`/o—OS-- Address i 1 Expiration Date A /27 7 ? Sire Telephone Rem re f. om tirm• .•vemen Cen r. •7 __ fi-..,LL'r tE4lif Not Applicable 0 Ye. 't /a7 Co ns /a 7 Qy • Company Name Registration Number Addr s Expiration Date Telephone --.277 ,SECTIO 11O 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 building permit. Signed Affidavit Attached Yes No 0 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 fur 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 r A 1 r-ommonwealth of.Wasachusens Type er r n legibly. lt‘tlopamnent of Industrial Ac_iaents _ 01/7cc of!mr'sfgatloas q :;�' 600 Washington Streer 4 ;,. Boston. Mass. 921': ' -- 'A/ricers' ::amoensation :nsu;nnce Ai davit om. ;. ' - .�,t.-;,-2_,_,,. - ;„ _ , lame: location: r, art a tomeowner :erforzntr.z. ail vror_Cvs-... — . .m a sole :r-2cne:or and .a` ::.0 :?:t-Rr: ; n 311' :::ac:— a. �... , . - .. .^! . "..'�"'r'rlf".'4.#!'.',wti.',TM "•'t.."",.MC iW,'�.:�+�+�.'"_ys.:'�• �r..:... --.. ,-Y" -^u..""'.' ^ `:.4i.f;,.�S am an ::nutoyer :r.via: s ':,rcr:Cora :3'Ce.sat:on .or=7 tr-.:: 2 ,:k on -us;co.� company lame: G 1 ye/`�', -Z. .,� ^. ✓ .2 57 �e t'i0" - address:J O /� z �' .% city /,�vcri et-- T ;,.... '! 7nnne 41'3 - 2-.S' - ' 7v7 t . �- ` Itsnranct :,) -- S SG' �,' -. � • 4/ . _,-f .ntCr : _ -•7 (-4" '1 /:. 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'o..' : ,:an.eau o tie mammon at:rmtnal oenatnes )1.; 'ine so :0 =i..:'O.u) tnaror one years'imorsonment as'veil as,::vti aenzenesm::e form $i i_:C'' CRX :RDE3 :no:: :Inc ti 5100.00 a :ov against ae. : Jnaeraanu liar a :00v if ails statement may ae tt)ryaroet:o me I& if:avnganons If:tie.1.IA:or:Overage verification. do hereby ce " • --to pains Ina a ctataer.i leriur:liar:tie!lriorrranon 3roviaed above.'s:rue anti cor.s illianatureA M mate e :iS~4.l ?^tit: e f ffv:-.10{:in=t° 'hone= 2i 2 --.2-7 IP 1 azsztrzam otTiclat use )tav so,too :e n ^u.roc✓:e:omotetea jv ::r, tr:own HHTic:ai city or town: _ — -'.�^ .. -y aermrulicense f i�Bwiding Department e a •:� neck'.f immeuiate-- p snonse , -- utrrti y y -et: 4%1/.te4-Z193 :I =lx: 41.11 3.:1Zdri! .r contact person: 711011e =: 1, rrn.cv:lot PIA I nJr Q 11 . 1J C.- a' Q ci h O 0) i D rb L I v N. ! 0 0 , , C r N ‘t. A 1 ►._ L - - - - ,- - 1 Q ` h j � �