Loading...
23D-113 200A FEDERAL ST BP-2003.0541 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 113 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2003-0541 Project# JS-2003.0799 Est. Cost: $37255.00 Fee: $186.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DALE HAWLEY 055048 Lot Size(sq. ft.): 85377.60 Owner: COMEAU JEANNE Zoning:UR Aj'nlicant: DALE HAWLEY AT: 200A FEDERAL ST Applicant Address: Phone: Insurance: P O BOX 273 (413) 667-3149 HUNTINGTONMA01050 ISSUED ON:12/4/02 0:00:00 TO PERFORM THE FOLLOWING WORK:FOUNDATION SILLS, CENTER BEAMS REPLACED, STRUCTURAL REPAIRS, FOOTINGS, LOLLY COLUMNS 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:O r -/a -05 4 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATION Certificate of Occu anc e' Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/4/02 0:00:00 5548/5566 $186.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2003-0541 APPLICANT/CONTACT PERSON DALE HAWLEY ADDRESS/PHONE P 0 BOX 273 (413)667-3149 PROPERTY LOCATION 200A FEDERAL ST MAP 23D PARCEL 113 001 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 `559rSaioa 1.7b — Typeof Construction: FOUNDATION SILLS,CENTER BEAMS REPLACED, STRUCTURAL REPAIRS, FOOTINGS,LOLLY COLUMNS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 055048 3 sets of Plans/Plot Plan THE F 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 Co 'ssion 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. - 1 City of Northampton S u o Per •�{ Building Department � 212 Main Street Room l 00 Northampton, MA 01060 gWatere s�of Strl cb alPgya"ns w� •F y„ . "'.� tip+• Yi'+'�V'P_$' d�,� p'ti' d� y phone 413-587.1240 Fax 413-587-1272 Plo 1SIte Plans " � ' � �* SthgerSpefr ' 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 by office ad O Fe) e,r A, S k . Map Lot Unit F 1 D e C-2. 1 „�„ n • Zone Overlay District 1 rv� Elm St. District CB District SECTION 2 - PROPERTY OWNER.Skit-1-AU-T-H61tt2E�AGENT 2.1 Owner of Record: (Te YEN Co ry . -eo—O S ore_f J - Nor-OAArvt1"s cO, YI'44 Name(Print) Current Mailing Address: iNk3 - ' c - 3� yti � loc�� Telephone Signature 2.2 Authorized Agent: c\\• � \A 8 opp Qurst1t ,�� eyrie—di rliP Name(Print) Curren ailing Address: 0105C Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee STPvc# .\ 101)'e .eazr'S 3� 'a SS , 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 2 � SI 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) Check Number .This Section For Official Use Only Building Permit Number: Date Issued: /26 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 x 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 IF:'YES, describe size, type and location: SECTION 5 DESCRIPTION OFPROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other(] % Brief Description of Proposed Work: Fc on)dA-4j c2rJ 5f n S Ce,J-e✓-- 6PAYv1S r eplcice 5-1-r Uc-'-uok\ Alteration of existing bedroom Yes No Adding new bedroom Yes )( No Rtis.ftl r S Attached Narrative❑ Renovating unfinished basement Yes X No Feel- /14.9". Plans Attached Roll ❑ Sheet❑ /o l� CoLinA sa:t1Newlh it se andie raatlditfon o:ezi ting=hou"sing,-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 l C c wl_'e o..0 , as Owner of the subject property hereby authorize o`�� P Net-to I er( to act on my behalf, in all ers r ive to work authorized by this building permit ap licatio SigrdEure of caner Date 1)0 \ 140,-Lt.)\e , as Own Authorized Age t hereby declare that the statements and informati n the foregoing application are true and accurate, to the y knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner Agent Date • SECTION 8,CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: `'Z- p`t�\Q y C, S o 5s d y Q License Number _ 0 Viisst qv\ 01050 06 q_0( / oo Address Expiration ate -. yt3 -u-ur z- Signature Telephone Reg 5 le t e ent..Corit 1actor, � t �' u ; ° k � '' Not Applicable 0 . (N e\S S��n1��d`�\'` C Registration c Numbera Company Name c�p���r S US S e\� r� , �u.�� �Nq�d� Y1,1N , o lose Q I O 9 .moo Address \ Expiration pate Telephone IA -CR(.9-1/- '31 \ 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 No 0 o o � �0DTA 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 (Liabi'ity 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 • l- of to t1iant wt`ac �j t _ (Bcsaachnsctta _' DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street Municipal Building Northampton, Mass. 01060 "s. WORKER'S COMPENSATION INSURANCE A1,TF DAVTT W4_(-tATerl (licensed 'wee) with a principal place of business/residence at: 0 /050 ci f PQy- Yus5f 1( ,yam- (phone#) 13 *to -3 /4 (btleet/ci /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 Date) ( ) I am a proprietor,general contractor or homeowner (circle one) and have hired the contractors—llste�elow who have the following worker's compensation policies: en) `S LOo tom, 'Zur-ic�. -•vs R, cr�• wc3s SIR IIa 3/2.s/ © 3 (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) (attach additional sleet if ne -es.ry to include inffnnitoa pertaining to ell contractors) ( ) I 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 whilo homeowners who employ pc-sont to do maintenance,construction or repair work on a dwelling of not more than throe units in which the homeowner resides or on the grounds appurtenant thereto ere not generally considered to be employers under the worker's.compensation Act(GL152,ss 1(5)),application by a homeowner for a liren+r or permit nay evidence the legal status of an employer under the Worker's Compensation Act. I understand that a copy of this rt,tem,*st may bo forwarded to the Deparimcot of Industrial Accid i.OEhoo of Inwrsnoo for tho coverage verification and that failure to sxure coverago under section 25A of MOL 152 can lead to tbd imposition of criminal penalties oomisting of a fine'of up to S 1,500.00 and/or imprisoamcat of up to one year and civil penalties in the form of a Stop Work Order and a . • fine of S 100.00 a day against me. • • For depsrtmental use caty . et-C %, O a Mapil t Number Lot# Signature of Liccnsce/Permittec MOM/CM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC • HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ROGER BUTLER INS AGENCY INC ALTER THE COVERAGE AFFORDED BY THE POLICES BEL 5 COURT ST _ COMPANIES AFFORDING COVERAGE • WESTFIELD MA 01085 COMPANY A ZURICH INSURANCE CO TOURED COMPANY B DALE R HAWLEY COMPANY P O BOX 273 C HUNTINGTON MA 01050 COMPANY D ;OVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTFD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLLCY EFFECTIVE ',POLICY EXPIRATION UNITS TR DATE DUADDIYY) DATE SMNARYTY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LWlLTTY PRODUCTS-COMP/OP AGG II PERSONAL&ADV INJURY $ � o, 1 CLAIMS MADE L..., ..... 00CUR OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ _ MAE DAMAGE(Any ono**N) $ i Mm EXP(Any on•pawn) II AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ I ANY AUTO ALL OWNED AUTOS BODILY INJURY S _ SCHEDULED AUTOS (Peg parson) HIRED AUTOS I _ BODILY INJURY i NON-OWNED AUTOS (Pm a0okl1Ik} PROPERTY DAMAGE $ GARAGE UABRITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER'fl AN AUTO ONLY: EACH ACCIDENT E AGGREGATE $ EXCESS LIABILITY EACH OCCURACE i I.. UMBRELLA FORM ±AGGREGATE __..+ _--. OTHER THAN UMBRELLA FORM $ ANt I WORKERS COMPENSAn0N AND W C 3 8 5 7 2112 3/2 5/0 2 ! 3/2 5/0 3 X I BTATUTORV Loom EMPLOYERS'LIABILITY 1 0 0 R EACH ACCIDENTt THE PROPRIETOR: DISEASE-POLICY LAST d 500, PAR TNERS/EXECUTIV E --'"' tt OFFICERS ARE: i MOM I DISEASE•EACH BIIPLOYEEI$ 10 0 I OTTER I IESCRIPTION OF OPERATIONSA_OCATIONSNEHICL.ESSPECIAL ITEMS CONFIRMATION OF WORKERS' COMPENSATION COVERAGE. :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO N 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LI BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABU OF ANY KID UPON TIE C PANY, ITS A REPRESENT AUTHORQED REPRESENTATIVE� ,r,{ ., Pauline A Duzrfiewski ( P WORD 2541 (3193) ca ACORD CORPORATION