23D-051 (2) 77 RIVERSIDE DR BP-2001-0324
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-051 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0324
Project# JS-2001-0537
Est. Cost:$8000.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq. ft.): 1 1543.40 Owner: BRACHMAN GERALD R
Zoning:URB Applicant: BRACHMAN GERALD R
AT: 77 RIVERSIDE DR
Applicant Address: Phone: Insurance:
77 RIVERSIDE DR (413) 584-3264 ()
FLORENCEMA01062 ISSUED ON:10/3/00 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE 2ND FLR BATHROOM,
SHEETROCK WALLS, REPLACEMENT WINDOWS & CARPETING
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 10/3/00 0:00:00 1521 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2001-0324
APPLICANT/CONTACT PERSON BRACHMAN GERALD R
ADDRESS/PHONE 77 RIVERSIDE DR (413)584-3264 O
PROPERTY LOCATION 77 RIVERSIDE DR
MAP 23D PARCEL 051 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 /52/ c'rYD
T_ypeof Construction: RENOVATE 2ND FLR BATHROOM,SHEETROCK WALLS,REPLACEMENT
WINDOWS&CARPETING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THFjF6LLOWING 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 C ission Permit from CB Architectur onunittee
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.
Department use only
• ^t l V , t' City of Northampton Status of Permit:
�`� VW Building Department Curb Cut/Driveway Permit -
SEp 2 B 212 Main Street Sewer/Septic Availability
tl Room 100 Water/Well Availability
NEi`fnpton, MA 01060 Two'Sets of Structural Plans
DEp10F hone 41 1-240 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: p This section to be completed by office
11 R1ie�S �o'`'e 1) r1V� Map 1(✓ Lot Unit
'j 0 t H..\a vti1 ft0 t•\.) Mo..__ 0 ( 0 C, ..1._ Zone 144%" Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1 `�
Ge r-�,�d\ 1.- c IA `� /�] l I lier S totse V- t v-£
Name(Prin Current Mailing A�rrs:4, _3 a 6, t-
/
Telephone �
Sig ture
2.2 Authorized Agent: {� n
6 e r-0 1�CJt l.�C`�c-- k w ec r\ ") 7 ?1'lI C-r` d�S L Y 1 +'1 v't
Name(Print Current Mailing Address:
S.-g4---- a64-
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant _
1. Building / 00 (a) Building Permit Fee
2. Electrical (� (b) Estimated Total Cost of
Construction from (6)
3. Plumbing It c� O 0 D Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) 4 8 0 0 0 Check Number ,�a f 050 -
This Section For Official Use Only
Building Permit Number: ,p)/ 3)</' 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 Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW I 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 0 Addition 0 Replacement Windows Alteration(s).EK Roofing 0
Or Doors
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 5ke ck ("OtS iJew W 1 S)Ref 4ce C,al ( .1 �stil iu 414f
fir 7014
Alteration of existing bedroom Yes iX No Adding new bedroom Yes X No
Attached Narrative❑ Renovating unfinished basement Yes -}C No
Plans Attached Roll ❑- Sheet n
a. If New house and or addition 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
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
, 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 Nam
Signature o Owner/Agent ~ Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
i. , ,1 ig iml J i( alwz,d. MIP,.w d.* , .. 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. Rome Owner xemption
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"ce ifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, Stat d al Zoning Laws and State of Massachusetts General Laws Annotated.
omeowner Signature
.part t.,, 3:c.b 04. ��
A, �`b vIi�J of ictri1i ]11}1f011 1
t. `��1ic 4 —
A 0 1 e Alauenclincctta —
.�1 ll' {
i't:= DEPARTMENT OP BUILDING INSPECTIONS —
212 Main Street ' Municipal Building
Northampton, Mass. 01060 im
WORKER'S CONEPENSATION INSURANCE, AFFIDAVIT
•
A--, -- — — — -- ._..-._ _. __.
Qi ccnsocJpermi ttec)
with a principal place of business/residence at: /
/ -- (phone)
(st-G.t/city/stat.clzlp)
do hereby certify, under the pains and penalties of perjury, that .
•
( ) I am an employer providing the following worker's compensation coverage for Iny
employees working on this job:
' (Insuranc Company) (Policy Number) (Expiration 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 coelpensation policies:
(Name of Cont^,lcior) (Insrranc: Cornoany/Potic; Num c ) (F.zpirauon Date)
(Name of Contractor) (insurance CompanyfPolicy Number) (E oimtion Date)
(Name of Contractor) (Insw-anc; Company/Policy Number) (Expiration Date)
(Name of Contractor) (Losurance Company/Policy Number) (Expiration Date).
(much sdditional thcct if mamas).to incud:infortnsnoo pertaining to.11 codrneevn)
( ) I am a sole proprietor and have no one working for me.
5,4 I am.a home owner performing all the work myself.
NOTE:plrx be avrsrc that wtoLlo homeowners wbo employ pc-sons to do cr.t-t,-„m c -^,:coo m repair work au a dwcclliag of
not more than throe trait"in which the bomoowocr rcticks or co the Bounds appurtcasni tbcdo e t ax(.w+ny oeeridood to be
cznPlnYal no.cr tie was m.tpr-,<•tion Act(GL152.s3 1(5)),appliabon by a bomeowvc fora licease ct permit may evid:ncc the
legal rtanu of as er pIoyoc under duo Wortcof.Compomatioa Ad
1 uo4Qstand dada copy of tbi.,co.tcmaat may ba forwarded to tbo pepartaxaa of ladus'-rid Aacdo is Offioo of I.ruraoee for the
covmtgc vrri6euioo and qua Lilt=to scoot boveragc under soc tioa 25A of 1.iOL 152 ma lead to tie imposition of criminal pC6'lba
consisting of a fuse of up to S I.)00.00 andtor irprisoannem of up to ore yesr Lod civil pmaltio io the form of a Stop Work Order and a
rim 0(5100.00 a day icaiasi me-
For dcp.runr_,,-' we only 1
/ _,....-- Pc nit Number f
ivf pa __ Lot ~ ___�_-
.gnature of LiccnseeJPcrmiucc Late _-