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23D-129 (3) - , 18 WINSLOW AVE BP-2002-1026 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 129 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: ALTERATION BUILDING PERMIT Permit# BP-2002-1026 Project# JS-2000-0618 Est. Cost: $7100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sq. ft.): 11586.96 Owner: ARMER; .1 : _:rNli-A Zoning:URB Applicant: ROGOVIN REBECCA AT: 18 WINSLOW AVE Applicant Address: Phone: Insurance: 18 WINSLOW AVE. (413) 586-8594 O FLORENCEMA01062 ISSUED ON:5/29/02 0:00:00 TO PERFORM THE FOLLOWING WORK:FINISHING UNFINISHED ATTIC SPACE TO MAKE BEDROOM, PUTTING IN SPIRAL STAIRCASE 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 5/29/02 0:00:00 ??? $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-1026 APPLICANT/CONTACT PERSON REBECCA ROGOVIN ADDRESS/PHONE 18 WINSLOW AVE. (413)586-8594() PROPERTY LOCATION 18 WINSLOW AVE MAP 23D PARCEL 129 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ? U Building Permit Filled out C ti ? < S Fee Paid Typeof Construction: FINISHING UNFINISHED ATTIC SPACE TO MAKE BEDROOM,PUTTING IN SPIRAL STAIRCASE 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 F t LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF t ' 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 C ssion S L' LPL 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. w ' , Department use on Y r LI � Clo Northamptonerrr7it, Department 21 Curb Cut/Driveway Permit 2Main Street Sewe /Septic AvailabityAY 2 2 2002 i om 104 Water/Well Availabilty No> am ton, MA 01060 Two Sets of Structural Plans �-pion13,-587. 240 Fax 413.587.1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING -4" -5---rill; r 6 oc*t on 0" SECT ION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office £0 it ,cJoJ /1C: , Map 2 3`1) Lot I Z-9 Unit Zone U 1C 8 Overlay District 0rer&CP--, /7/2/9 Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: k'e be_cGa. k'D .1-1 je �i*is/' /tee, �� Narpe'(Print Y Current Mailing Ad e s: / Lii3- s 6 - 399 J �-� Telephone / nature 2.2 Authorized Agent_ So__ Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complyt d . .-rmit applicant 1. Building o` (a) Building Permit Fee '45 -a 2. Electrical # d °, - : " 4' (b) Estimated Total Cost of bi he. Cf/ G .. Construction from (6) 3. Plumbing ri Jpr Building Permit Fee 4. Mechanical (HVAC) - .Sd 5. Fire Protection —,50-totie ctdedao 6. Total = (1 + 2 + 3 + 4 + 5) 7l io0 Check Number This Section For Official Use Only Building Permit Number: e P- too 2- _(O 2-A 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 MAILS) Building Department Lot Size ta0 O C 2an Frontage / #\, 9 J / r,0 (,�aiCt Setbacks Front ),46.1 CA 0 Side '30 L: 13 R: 14?j L: R: Rear 8s.3 Building Height 1+-C h0 CHNr - Bldg. Square Footage mC ^7 % t f` 3 Open Space Footage (Lot area minus bldg&paved parking) `` � #of Parking Spaces V�,O C n tf Fill: (volume&Location) flo at?.1.-)ct A. Has a Special Permit/Variance/Finding ver been issued for/on the site? 1'1.tue 0vk./ NO DON'T KNOW YES rSiaJ 1 +n IF YES, date issued: kook S Se(tew4e, 2a0 I IF YES: Was the permit recorded at the Regist 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 t ere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: (IDS— on(i SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replaceme t Windows Alteration(s) ❑ Roofing 0 Or Doors Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] ,if afti S ,i i (e bed ,a r4i1 Brief Description of Proposed Work:'r'�v►.Sl� N iJ C ��, '� ' f'ppr,.f, �✓f/�� ,H S , C 71-41 rees 2e Alteration of existing bedroom Yes )( No Adding new bedroom > Yes No Attached Narrative❑ Renovating unfinished basement Yes )C No Plans Attached Roll D - Sheet 6a. If New house and or addition to existing housing, completesthe following: NIA_ 1 a. Use of building : One Family 7� Two FamilyOther b. Number of rooms in each family unit: 3 Number of Bathrooms ) c. Is there a garage attached? hJ 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 ,i` No. Is construction within 100 yr. floodplain Yes )t/ No j. Depth of basement or cellar floor below finished grade / k. Will building conform to the Building and Zoning regulations? X 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, , 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 Date I, , a Ow Authorized Agent hereby Clare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ains and penalties of perjury. ` Print Name ehiocc.a '€., 047_ Signatur: . ►,fir" / Date 457 2.o O SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicab l Name of License Holder : License Number Address Expiration Date Signature Telephone > � aek aiT'i1 e;.. . 1 lOr < ;,s, Not Applicable/6 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 issuan of the building permit. Signed Affidavit Attached Yes No ❑ 0 s xempti'On 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 y n er is permit. The undersigned"homeow r"certifie nd assumes res nsibili or compliance with the State Building Code,City of Northampton Ordinanc , State a o 1 Zoning La and S e of Massachusetts General Laws Annotated. Homeowner Signatu lvin)1pi � p4 • (tit NorfLaptun __fe m^�' ' aB4 err nsetts = ._ '".:: "`� DEPARTMENT OF BUILDING INSPECTIONS __�i= 212 Main Street ' Municipal Building _ Northampton, Mass. 01060 ' e y um".�- WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, ' ,ifea 11 c7 D✓I f1 -� (keens dpermittee) with a principal place of business/residence at: ! ,, (1/l1/s% //ge /Gl/ �<�.�- 0� 2 (phone#) '/ (d t i ee t/ci ty/stair/a p) 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 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) r. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach a.dditioail thcct ifner-,,.ry to include information pertaining to all contractors) ( I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. u,Aki I eitsItpvL - I.S 5L-lovtArtt4 t„i, ho(A- 1 NOTE:please be aware that while fern owners who employ persons to do malrrt.,,,or, construction or repair work on a dwelling ota not more than throe units in which the homeowner resides oc oa the grounds appurtenant thereto arc not gn.rlly comidcred to be C� s—41)(ft employers under the woriotr's cr-ovation Act(GL152,zs 1(5)),application by a homeowner for a license or permit may evidence the !' legal stairs of an employer under the Worker's Compensation Act- SAzS(A) . I understand that a copy of this s+. .ne.,t. t may be forwarded to the Deportment of Industrial Aocidecsie Office of Iasvrao 1 ea for the .t `1 VY coverage verification and that failure •secure coverage under section 25A of MDL 152 can kad to the imposition of criminal penalties r ••'• • • a f ne of up to S 1,5,r.a. .•..•or im �pthoss of up to one year and civil p nalti es in the form of a Stop Work Order and a r....ofS1Q0.±, a day against.. S/V\ `1/4 Cki . 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NORTHAM✓TON,MA 01060 • ` t . : ' -_ , ' ) , / . i IA ic+ Ak tIVO2 V`) /H, I , . ,' , 4./ • i 1( U'99 lureiv i Q k z_i. A r n 4 i1 i+ i < Ca05 ' 71 6-- 6'c — \ t \1t Je . '� 04? jX \ CAvSe k. / / : • 1 _ /' - / . --xi Z6,nd kh �..%zl l II-ile No. i iut3Zal rase obi Building Sketch $:{<'J - 'wet Clierd REBECCA ROGOVIN '- .pertyAddress 18 WINSLOW AVENUE • City NORTHAMPTON County HAMPSHIRE State MA Zip Code 01060 Lender FLORENCE SAVINGS BANK NOT TO SCALE LAYOUT APPROXIMATE DIMENSIONS ROUNDED /3-. i i2 7 I i Aeadir-fi Hi' timix24) , , a „. .„............... ip) ,i, irow.,..,:. * 44-rH 3 4, .1 0 4 Edn V 1 it)°pl. LI < Y' 46 i if ,VI 1 It 6 , /0 1111 - ��,,�� .< (s i� � ////__ air Form SKT.BidSld—"TOTAL 2000 for Windows"appraisal software by a la mode,Inc.—1-800-ALAMODE