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23D-050 (7)
89 RIVERSIDE DR BP-2003-0637 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-050 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0637 Project# JS-2003-1047 Est. Cost: $50000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sq. ft.): 25003.44 Owner: KLEMER KATHERINE&LYNN CURRY Zoning' URB Applicant: KLEMER KATHERINE & LYNN CURRY AT: 89 RIVERSIDE DR Applicant Address: Phone: Insurance: 89 RIVERSIDE DR (413) 584-5037 O FLORENCEMA01062 ISSUED ON:1/22/03 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE PLASTER & INSULATE & SHEETROCK WHOLE HOUSE 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:y'/s/G; p A�House# Foundation: ✓ -�/� Driveway •Final: FinaL•�; �j�/.� �J% ,Final: i "��.7 _ `°"' � Rough Frame: • k ti..../7. 3 _k_kv Gas: „ Fire Department Fireplace/Chimney: Rough: Oil: Insulation: v K z-/,,©O E Final:p06-• �, Smoke: Final: 6 K' 1` aG- 0 --*t+ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO I ANY OF ITS RULES AND REGULATIONS. _ Certificate of Occupancy -- signature: Zz Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/22/03 0:00:00 543 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo File#BP-2003-0637 APPLICANT/CONTACT PERSON KLEMER KATHERINE&LYNN CURRY ADDRESS/PHONE 89 RIVERSIDE DR (413)584-5037() PROPERTY LOCATION 89 RIVERSIDE DR MAP 23D PARCEL 050 001 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 050 Typeof Construction: REMOVE PLASTER&INSULATE&SHEETROCK WHOLE HOUSE 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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: 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 mmission /i/DO 2—__ 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. *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 r-"""` (� i `tINorthampton Status of Permit o � } u -- kk g Department Curb`Cut/Driveway'?ermit ;��z�..4 SCE' 3,wA (Main Street Sewer/Septic Availability . S jAN 1 7 2003 �- ., `om 100 Water/Well Availability + � ' ' ' � Northam ton, MA 01060 TN,ro Sets of St-�ictural P,1a s*-- {�{ s- ,3,.5t7-1 40 Fax 413.587-1272 Plot/Site Plans 4'51 '� LJtN� ,` Other Specify. - r ,, —APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Propert Address: This section to be completed by office g9lV e/' J(de Map d� D Lot © Unit (ctCt Overlay District -_ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:tk CLO XM 444A_ ¢ 0(aA/sid ilLE e_ iy ' Nt tint) j Current Mai g d s: -6 7 li Telephone Signat re 2.2 Authorized Agent: LJWAI c14-VL ty q Name int) Current Mailing Address: h Signat e Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building �U (a) Building Permit Fee 02 , 2. Elecirical.xt 1t �,,,Cpr�,�„t,�J (b) atimated Total Cost of 1 Y"'`,"'Ur"� / jU Construction from (6) 3. Plumbing \1 i it 1(t, E./ Building Permit Fee 4. Mechanical (HVAC) //C7,-0 5. Fire Protection I/Ur " 6. Total =(1 + 2 + 3 + 4 + 5) 4 9'67TD Check Number ,fl/3 3—D ._... 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 t 5? /1I G Frontage Setbacks Front Side I,: 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 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 A 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 X 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 ❑ Replacement Windows Alteration(s) El Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolitioy ^ New ,eSigns [ ] Decks _[/] / Siding [ ] Other [ Brief Description of Proposed Work:! WtO'L4 -GlYe Alteration of existing bedroom Yes X. No Adding new bedroom Yes N No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 6a 'If'NeW.-tiouse;ai1daor-'addition to existing housing, complete the folloWing: a. Use of building : One Family )( Two Family Other b. Number of rooms in each family unit: R Number of Bathrooms c. Is there a garage attached? /� G f d. Proposed Square footage of new construction. Dimensions e. Number of stories? ,0 f. Method of heating? 4I *awl 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 1C No. Is construction within 100 yr. floodplain Yes No f j. Depth of basement or cellar floor below finished grade Q VV k. Will building conform to the Building and Zoning regulations? X Yes No . I. Septic Tank _ City Sewer X Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L 1 , 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 {S Date • I, t`//Ild auoit , 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 pain and penalties of perjury. Wil i ( Print e lit 1p 11746 Signatur of Ow err/Agent Date SECTION 8 --CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ,0 Name of License Holder : I License Number Address Expiration Date Signature Telephone 9-Zi egistered;:Ffome lmpr"oveme'nt'Confractor , M,; b, 3' ;.14,f:al Not Applicable i 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 O 11 Home 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"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, Stat nd Loc Zoi ing Laws and State of Massachusetts General Laws Annotated. Homeowner Signature -N a _ . ., BLt.Atkin!. t o �X� Jai Northampton i _*=3 �t4-sit (3t a tasaaclinartta `" = : � DEPARTMENT OP BUILDING INSPECTIONS * _`_``_ • 212 Main Street ' Municipal Building Northampton, Mass. 01060 ow"•� WORMER'S COMPENSATION INSURANCE. AFFIDAVIT _ It t- i/1 Cl.,tyyir (licevsee/pernlittec) with a principal place of business/residence at: • � °IU6�hone# t S — G,� (street/ci ty/sta t e is p) do hereby certify,under the pains and penalties of perjury, that. ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Darr) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers compensation policies: (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) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (math additional sheet ifner Riry to include information pertaining to all c adnrs) ( ) I am a sole proprietor and have no one working for me. X I am a home owner perfol ruing all the work myself NOTE:please be aware that while homeowners who,..euploy pcsom to do maintenance,corSn:e.ion or repair work on a dwelling of not more than throe units in%chiefs the homeowner resides or co the creitacit appurtenant thereto arc not gU illy considered to be employes under the worker's ocxnp=saticn Act(GL152,ss1(5)),applimtio.by a homoowna-for a license or permit may curt,err the legal statua of an employer under the Woriox'e Compensation Act. I undcrtu.nd that a copy of this rtatt,Nnt may bo forwarded to tbo Department of 1nrta,.triel Accident,'Office of lenuomce for the coverage verification and that failure to scarce coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties oornistiag of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil realties in the form ofa Stop Work Orda-and a fine of S100.00 a day against mc. For degutmedal W°only ' Permit Number l; ,- gyp;{ Lot� ri ig of Ltcensce/Permi ee na7I to