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23D-113 (4) 200 FEDERAL ST BP-2003-0835 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 113 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2003-0835 Project# JS-2003-1116 Est. Cost: $11950.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Quinlan Builders 101707 Lot Size(sq. ft.): 85377.60 Owner: COMEAU JEANNE Zoning:URB Applicant: Quinlan Builders AT: 200 FEDERAL ST Applicant Address: Phone: Insurance: 5 Hillside Dr (413) 585-0949 HADLEYMA01035 ISSUED ON:4/7/03 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 4/7/03 0:00:00 3524 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo trVcr eat, City of E;flt s� trcAatlabt ttyir .. APR — 7 2003 Room 100 WUtcr/4,� 1IAvat��bsltty .. t, Northampton, MA 01060 T o got of Str turaA anws, phone 413-587-121-0 Fax 413.587.1272 Piotit Of orSpecrfy,.: 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 $A 00 Ot °+—a U Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Cur • Telephone Signat� 2.2 Authorized Agent: _ To G?,, let frl 1411 (5 'de ,d%, Had(eelName:rin;f4.....12 Current Mailing Address: S — y '7 y _ 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 2 Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) ( �� Check Number 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 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 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW Y 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 A 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: sSECTIONtS DES IPTIONIOF PROPOSEDIWORK(check all applicable), { ti.t .S Td"W s 'MI? i++tliv+G+kMM3:%'Yk +Hkbd'M^N•R mV 4 . f 1 New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing Or Doors 0 Accessory Bldg. 0 Demolition❑ !!JJ New Signs [ ] Dlecks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 5i-t eo0 f 5f-u t SO5 r fc i. Kc� ,4rck• Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet❑ 071fINVW/frolirefairdtaradition to ezi' tin housing "comple'teltlie foiMitt: 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 PWNER!AUTHORIZATION -TO BE COMPLETED WHEN OWNERSAGENTORR,CONTRACTOR APPLIES"FOR BUILDING PERMIT I , as Owner of the subject property soiraffroramminammi hereby authorize Vt to act on my behalf, in all mat - -a. ive to work authorized by this building permit application. Signature •lie "ner Date I, To OA Oe'vf 4 (ct , 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 Nj x e • Signature of 0 ner/Agent Date SECTION-8 xCONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : /O" 6UI\'1 lu C/ 5, ©S 3(6 7 License Number )4et <51 ( e 5( i d3 Address Expiration Date ti—S OLLAI 5'4 9 r- c4"-i 'l Signature Telephone "terstered °o me mprovement.Gontracton � Not Applicable ❑ Towle avol l a pi 10 ul or-7 Company Name Registration Number 6. J 6 M aililei 60a i(0L( Address Expirafion Date iri I'l 1 5 Gte 94, Telephone 5LI q Jtri t i 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 1 : .` p OM.' ® ° iris ,-. :,exn.e L1 ;11 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 hi who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3, 1. Definition of Homeowner: Person(s)who own a pares'[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 Brie home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the BuildingOfficial,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed ugder the building permit. As acting Constr Su ervisor yourptesence on the job site will be required from time to time,during and upon completion of th work which this permit is issued. Also be advised that with refs ce to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting Bath)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 • �tt1AM•PjO . . =O �p ,t• a fl (rear of Northampton 1 _ 6 Alcsaachnsetta' :m DEPARTMENT OF BUILDING INSPECTIONS _il=f 212 Main Street ' Municipal Building Northampton, Mass. 01060 r' WORKER'S COMPENSATION INSURANCE AFFIDAVIT TOM (licr nsedpermittec) — — with a principal place of business/residence at: -- (phone=) — --- — (strce-licity/statdzip) do hereby certify, under the pains and penalties of perjury, tha . - ( ) 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 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) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Ex;-,:ration Date) (Name of Contractor) (Insurance Comr='iy/Policy Number) (Expiration Date) (atuch additions)sheet if neecasr:to iachs&infornurion pertaining,to all cc ) I am a sole proprietor and have no one worlang for me. ( ) I am a hon-ic owner performing all the work myself NOTE:plc:ac tic aW2rC that ubile bocncooay-xa who ctnplay pa:3a to do mair�cnanrc,arr r:al o Cr rcp a r work ca t 'call 1 of not morn thin throe units in«iadt the bo-no,wna rc ida or on the Er-O±3 cp rurtenain tharto arc n-x caxrally coc3id'rtt'•:o be calploya3 under the worker.cer pa saber An (GL152l.a 1(5)),applinntion by a homeowner fora 1kt:we or perm?,ray the; legal status of an employer under the,Worlwr'a Compemation Ad• I undessttnd that a copy of Oita chat: eat may be for-wit/lied to the Department of Inchodsil Aocide ts'Offtw of Iiourana,for taw coverage verification and that failure to e- ire coverage under section 25A of MOt,152 can lad to the,imposition of criminal penalties coosisimg of a rmo of up to S I.500.00 and/or imprisoarnc i of up to one year and civil paaIlia in the form of a Stop Werk Quin and a film o(S100.o0 it day against ttr_ For dq-attxxreal use only (J Permit Numb es ! Map;, Lot i • Signal of Lice v ec/Permittc' -- - — D i t' --