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23D-080 (3)
"OP 1 77 WARNER ST BP-2001-0661 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-080 CITY OF NORTHAMPTON Lot: -001 Permit: Building. Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0661 Project# JS-2001-1 191 Est.Cost: $40000.00 Fee: $155.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Richard Constant 057246 Lot Size(sq. ft.): 19514.88 Owner: ROSEN ANNE B Zonin IIB9 xi nn!iz nt: Rich-,,a Ccr1!.t3rt AT: 77 WARNER ST Applicant Address: Phone: Insurance: 3 Blueberry Bend (413) 532-5654 SOUTH HADLEYMA01 075 ISSUED ON:1/30/01 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN,BATH,ENTRY WAY,CLOSET AREA POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: q.6)61 0-4---Meter: ,✓ Footings: Rough/ ('�T!'!Rough:3 V "\C\ `�2.2 House# Foundation: Final: moo677; Final: CPI X5i d l pail_ Rough Frame:Olt , i, ,®,,,A- Gas , ; :, Fire Department Fireplace/Chimney: Rough: Oil: Insulation: }// Final: Smoke: Final: 0 k 7-9.,-Q t .�L THIS PERMIT MAY BE REVOKED BY THE CITY OF ORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE S ,1:Z4fliei +444-d-c--4)14 Certificate of Occupancy IV si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/30/01 0:00:00 2665 $155.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2001-0661 APPLICANT/CONTACT PERSON Richard Constant ADDRESS/PHONE 3 Blueberry Bend (413)532-5654 PROPERTY LOCATION 77 WARNER ST MAP 23D PARCEL 080 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 �C Typeof Construction: REMODEL KITCHEN,BATH,ENTRY WAY,CLOSET AREA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 057246 3 sets of Plans/Plot Plan THE F OWING 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 Commission Permit from CB Architecture Committee Signature of Buildm fficial v Date 30 o 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. • w , w , J 1, Department use only f)'" �• C ._E [I V, E rampton Status of Permit: Buildin: artment Curb Cut/Driveway Permit - JAN 2 9 206112 1Street Sewer/Septic Availability Room 100 Water/Well Availability -- Eton, MA 01060 Two Sets of Structural Plans DE;sla^t e6Q 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 A/dd/ress: S.Z. This section to be completed by office 7 / a f-4 J-� Map 6_ _ Lot ,f0 Unit t�r' �fjC / I7-yrih1'I Zone A *�'"'' Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner f Record: ` . / /12(,(e • TO CIA ! ? lc-Jar-n et- kl Name(Print �— Current Mailing Address: Telephone .,.b.,atu e 2.2 Authorized Agent: /1 ,�j ,/� c X G cell I ( _ d hd h, 2 ,U lUl6l el- ern d S: N6�` Name rint) / J ( Current Mailing Address: y �D`4C' rile- 4. �� y,.� - s-202.1/45--"‘ s---y Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ..7 4 000 (a) Building Permit Fee 2. Electrical l/ (b) Estimated Total Cost of O Construction from (6) 3. Plumbing ,r,-- 0v Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Y", ) O o Check Number 02065 5-- This Section For Official Use Only Building Permit Number: Date Issued: _.o.iature: Building Commissioner/Inspector of Buildings Date w 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 /1/ /E( Side L: R: L: ': re the e Rear Building Height r 7 Bldg. Square Footage Open Space Footage 'o (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: • a :CTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I' Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: & r'` C r'' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative ol j� daO,- Renovating unfinished basement Yes JNo Plans Attached Roll Eel- Sheet n c 4 1S dd r�.ICS 64AIUNew 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? 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 d/` hereby authorize de i ez>ntj to act on my behalf, in all m ers lative to ork autlorized by this bull ing permit application. Signature of Owner Date ��Cj 6, ettrYdii , as Owner/Authorized Agent Y hereb declare that the statem nts 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. Xe;,— (art r Print Name fidOWA ��4� 6/7 y / Signature of Owner/Agent Date SECTION 8 - CONSTRUCTION SERVICES . Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : irC46/7 vlQ I nrkrile""/ License Number e/v e �P, s i c e S Address Expiration Date / y yid Signature Telephone " 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. " Ined 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 intend§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 „ ,,,,,,,, E Crzt gal Northampton 1 _. �1 9 ti. �t ”�' Aassacl(nsetle - DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ek*kkNorthampton, Mass. 01060 r'��y WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, (licensee/permittee) with a principal place of business/residence at: ? I iiirle� AP r5/l'a.e./,/x7 (phone#) .2(c - 5.---7 tstr-..t/city/staie/a do hereby certify, under the pains and penalties of pe , 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) (].Yam a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the fol,lowing worker's compensation policies: >//1 //cD aelt? ( g-oxreig—rier-r---4)-14)02/aL5:20) C/c7L0/ (dame of Contractor) (Insurance Company/Policy Number) (Expiration Date) T X-va -ffy? li'lpl�� Leo ame of Contractor) ce Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoat if ne—mry to include information pe taining to all ooatractors) ( 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 while homeowners who employ person:to do maintenarue com±ructioa or repair work on a dwelling of not more than throe units is which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be employers under the worker's compensation Ad(GL152,as 1(5)),application by a homeowner for a license cc permit may evidence the legal status of an employer under the Worker's Compensation Act I understand that a copy of this ctatemmt may be forwarded to the Department of Industrial Aocidmts'Offroo of Insurance for the coverage verification and that failure to secure coverage under section 25A of MUL 152 can lead to the imposition of criminal penalties consisting of a fine of up to 51,500.00 andlor impeisooment of up to one year and civil penalties in the form of a Stop Work Order sad a firm of S 100.00 a day against toe. 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