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23D-088 21 WARNER ST B I 0989 GIS#: COMMONWEALTH OF MASSACH, ACTS Map:Block: 23D-088 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDL`T PERMIT Permit# BP-2002-0989 • Project# JS-2002-1602 Est. Cost: $32700.00 Fee: $76.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: ' Use Group: JAMES RAPINCHUK 013498 Lot Size(sq. ft.): 12588.84 Owner: BEIN THOMAS&MARTHA E COONS Zoning: URB Applicant: JAMES RAPINCHUK AT: 21 WARNER ST Applicant Address: Phone: Insuranc 53 ASHFIELD R (413) 268-8216 WILLIAMSBURGMA01096 ISSUED ON: TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 12 FAMILY ROOM & RETROFIT BATH 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: On Rough: Rough: V1iC1 House# Foundation:o fc 7 5 AP-6/4 —TX Driveway Final: Final tir 9.A/eAlit' Final d1 ) %/L Rough Frame:© (i3-•(6,-0 Gas: Fire Department Fireplace/Chimney: oil: insulation: C3ic S•a a ` .7 Final: Smoke: Final: d K l - !7-O a THIS PERMIT MAY BE REVOKED BY THE CIT OF NOR MPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Fee Type: Receipt No: Date Paid: Check No. r Amount: • Building 5/15/02 0:00:00 785 $76.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Plumbing ❑ Building Lh" Electrical t,: r ��r City of Northampton `2'' BUILDING INSPECTION LABEL Fif D�}A"r PRO ED S9 Inspector Date -o 21 WARNER ST BP•2002.0989 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-088 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-0989 Project# JS-2002-1602 Est. Cost:$32700.00 Fee: $76.80 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES RAPINCHUK 013498 Lot Size(sq.ft.): 12588.84 Owner: REIN THOMAS&MARTHA E COONS Zoning:URB Applicant: JAMES RAPINCHUK AT: 21 WARNER ST Applicant Address: Phone: Insurance: 53 ASHFIELD R (413) 268-8216 WILLIAMSBURGMA01096 ISSUED ON: TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 12 FAMILY ROOM & RETROFIT BATH 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 NOR is 1PTON U ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No. Amount: Building 5/15/02 0:00:00 785 $76.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-0989 APPLICANT/CONTACT PERSON JAMES RAPINCHUK ADDRESS/PHONE 53 ASHFIELD R (413)268-8216 PROPERTY LOCATION 21 WARNER ST MAP 23D PARCEL 088 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Tvpeof Construction: CONSTRUCT 16 X 12 FAMILY ROOM&RETROFIT BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013498 3 sets of Plans/Plot Plan THE F LLOWING 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 Co ' on �/, 6 /5- 2c�0 L_ 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 City of Northampton Status of Permit: (, Building Department Curb Cut/Driveway Permit Et;p, 16 'y i ;2 1 2 Main Street Sewer/Septic Availability_____ Room 100 Water/Well Availability 1 Northampton, MA Structural 01060 Two Sets of Plans__..__�_ I* i AYphlor e N.587-•1 40 Fax 413-587-1272 Plot/Site Plans Other Specify - APPLICATION TO CONSTRUCT, f1LTER, 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 z i lati/P.R! I S - Map 073 Pj Lot 6kg Unit Zone Overlay District Elm St. District CB District_ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ToM ele•fed /MA ZI1-tom. cQONS 21 WA-a-N T— Name(Print) Current Mailing Address: —76 0 a707 / _ Telephone 2 I Z10 Signature 2.2 Authorized Agent: 1 c f 1ZkF'at viu< 53 ik {-WIEW Kc Name(Print) Current Mailing Address: ig ature Telephone ECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2 7 �p p co (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of t DQ O. U C7 Construction from (6) _ 3. Plumbing Building Permit Fee ' 000 . 00R 4. Mechanical (HVAC) 5. Fire Protection * ( 000 . 00 6. Total = (1 + 2 + 3 + 4 + 5) Check Number $ 76'7° i This SectionFor Official Use Only Building Permit Number: '!�f}.—� Date Issued: Signature: Building Commissioner/Inspector of Buildings Date I 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 '72 X ! -7 5 (J/ ir) Frontage 7 2 ' 7S Setbacks Front 1 0, 0 Side L: 20 R: 2 S L: R: /5- Rear O Building Height / ,r 35- Bldg.Square Footage $SZ I Open Space Footage % �"Q (Lot area minus bldg&paved /D�� �J 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 >4' YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW X. 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 x IF YES, describe size, type and location: SECTION'5- DESCRIPTION OF PROPOSED WORK check all applicable) New House 0 Addition [1' Replacement Windows Alteration(s) 0 Roofing ❑ Or Doors ❑ Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 12 X 1(0 51,44 4n toy s.17•e7. ) f n IT- -t 1 Alteration of existing bedroom Yes X No Adding new bedroom Yes 74, No Attached Narrative Li Renovating unfinished basement Yes 7r, No Plans Attached Roll Sheet Li 6a:'If"New douse antltor`faddition to'existing housing, completesthe ffollowing: 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? NO I d. Proposed Square footage of new construction. I 1 Z- Dimensions 142. X I (° e. Number of stories? f. Method of heating? G7? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction 1"100 P i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes Xs j. Depth of basement or cellar floor below finished grade L / q C rteWi .) CAN VD 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, 7 A ,a I, LOOAJ ' , as Owner of the subject property hereby authorize JA,1'j. P. ( P to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date /41J , 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. J< P' R ,Pinl L"k Pri me Sign ur of Owner/Agent/ Date • SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : ZA M P RAP 11 v-H(J,< O 1 3"t9 ap License Number S D t L.l-.I AP BU/ -1 / MA 10 I 31 z-oo 3 Address Expiration Date 'kw , 3_ ure Telephone Re lsfered i�bmeim rovement Co'n#r' � ' �' �°Emu A4 Not Applicable ❑ _ gtslt� ,Zs Company Name Registration Number Address 4413 Expiration Date -L�I i lAhit�j�3t}��1 r �/� Telephone Zoo'9 B L 1(a 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. Homeowner Signature b. • 9 ri r;, "0 6 lassachaartta =:• — -cfl— DEPARTMENT OF BUILDING INSPECTIONS __``= . 212 Main Street ' Municipal Building Northampton, Mass. 01060 r''s WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, TAMv-s P. ?APfrtc_fit',<. (Iipermi«ee) with a principal place of business/residence at: 5 3 A6I I !- ) RED. V.A u Acµz,gu/2 ,MA (phone#) yl-5 248 $/.l( (bIteet/City/state/zip) 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 Daze) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ,f. (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 additional shed ifner.- .ry to include informsaon pertaining to all ooatractors) ( am a sole proprietor and have no one worming for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ persons to do ma rr ,n.nn construction or repair work on a dwelling of not more than throe units in which the homeowner rcidc3 or on the grounds appurtenant thereto arc not gees,ally coasid«cd to be employers under the worker's compensation Act(GL152,ss 1(5)),application by a homeowner for a license a permit may evidence the legal status of an employer under the Worf er Compensation Act. I undrniand that a copy of this statemeet may be forwarded to the Department of Industrial Accidents'Office of Issuance for the coverage verification and that failure to seatre covet-age under section 25A of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 andlor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a firm of S 100.00 a day against me. For soda l trap col, Permit Number 5--(00-02. map#_______Lot# Si o ermittri- t dl\i,',:. MAY 1 5 2002 '' NERDY CONSERVATION APPLICATION FORM FOR LOW-R1 E RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS .- 780 pMR Appendix ){-effective .3/1/98) Applicant Name: Pc*tt gA u ir.I. cK Site Address: 2 t \ik/,4 4C Applicant Address: r3 A i-tWWI-U Kr) City/Town: — ----_ . sIlLNAM6eijkA1 Use Group: Date of Application: 5-/5-oa- Applioani Rhone: ZG8-82_►G Application Signatu��.y..�. Compitance Path(check aneX O Prescriptive Package(Limited to 1- or 2- family wood-frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2. lb): Heating Degree Days(HDD6s)from Table J5.2 la: (For items d. through i., fill in all values that apply from Table J5.2) a. Gross Wall Area sq. ft t. Walt R-Vatcrc RR: b. Glazing Areal _sq. ft g. Floor R-Value R- c. Glazing 96(100 x bra) % h. Basement wall R- d, Glazing 11-ya1_r U' i. Siam Perimeter k e. Ceiling R-value R• j. Heating AFuE 4 • Component Performance: "Manual Trade-Off" (Limited to wood or metal framed buildings only) Climate Zor►e(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade•Off W4orksheetfrom Appendix 1,(and HVAC Trade•OffWorksheet, if applicable) ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts. ❑ Systems Analysis OR D. Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall +Ceiling Area IZ sq. ft. b. Glazing Areal 3GP sq.ft. c_ Glazing a%(100 x b+a) ' % 50 ADDITION with Glazing%(c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value Minimum RA/attics -Fenestration_ Ceiling, Walt TFloor ;Basement Wall Slab Perimeter, Dept 0.39- R-37 , R-13 i R-19 R-10 . R-10,4 ft, ❑ `SUNROOM'addition(greater than 4096 glazing•to-wall and ceiling gross area) Attach 'Consumer Information Form"from 780 CMR Appendix 8. Official's Name: ""T/cr" i4-'61 Official's Signature: Application Approved g, Denied 0 Date of Approval/Denial: Reasons)for Denial: (provide additional details as needed on back side) 1 Glazing Area mew be f(her Ruage Opening or Unit Dimensions.