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23D-149 (33)
121 HINCKLEY ST BP-2002-0430 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 149 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: chimney rebuild BUILDING PERMIT Permit# BP-2002-0430 Project# JS-2002-0638 Est. Cost: $2800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Andrew Church 104480 Lot Size(sq. ft.): 54450.00 Owner: GOODIN ADELARD J JR& SANDRA L Zoning: URB Applicant: Andrew Church AT: 121 HINCKLEY ST Applicant Address: Phone: Insurance: 174 Spring St (413) 586-0918 F L O R E N C E M A 010 6 2 ISSUED ON:10/23/01 0:00:00 TO PERFORM THE FOLLOWING WORK:TEAR CHIMNEY TO ROOF & LINE CHIMNEY 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: ®K /0 -23'0/ THIS PERMIT MAY BE REVOKED BY THE CITY F NORTHAMPTON UPON VIOLA N OF ANY OF ITS RULES AND REGULATIONS. 0, . .10" .4..:t15..,°7-.°'-zt.,ide Certificate of Occupancy Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/23/01 0:00:00 1950 $25.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo City of Northampton • Building Department 212_Main Street Room..100- Northampton, MA 01062 phone 4I 3,5874240- Fax 413.5&7-•1272 ; APPLICATION TO CONSTRUCT,ALTER;REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING litirMiilYatt1 ...t . iI lIl�iBrt ai,,,,i ri 1.1 .,-, 1,�`r fi t :-ay }'fir 4 u jt"i � /4 / �,,vc 4 - 5 T y ) I ` 4.3 E ,/`ii Y'`! tli Rl,,4-44,,,,,," -[: N - 17/n i--T h .1t7111,7;14.1 ,-.A-- --..- ay - 1:', A;- I CI¢ -112d'ie;_ qatn are, CCd0 f64 i / 7'/,4,/4 .S / 14, r1 (P Curr6nt Mailing address-_ Telephone igrug? 4 ,/�22Ao � (?'< Yc . /7 .q 5/ /-//, 3 / .i- /.,-,.4,c e_ Name 1PrMt) Cement UsiJink Address:... �/ i II(72d2144) _5-- -o gig . Signature Telephone Item Est mated Cost(Dollars)to be ::Offileiili( Mskr.. care tctuebY Peer t fF t i1t .i .N gr+ • ' ~-. R :;* '1!e I. Build fa3 W Ptie : .:..f 2, Elec FCaI - t#�.. Irj ` : . :: 3. Plumbing -..,r - . 4. Mechanical(HVAC). .! _ - ;•i :_.: • ••= _t 5. Fire Protection C/ Imo..:.._ .__1-.R'.'.el'_:�'!rl�, �1:I.'>4'A4'.., - . _ .. 6. Total= I +2+3+4+5J �"I ttrr .. , 4 v .yJ / �,��-. .�.!Ain.. � 4.. • . y' •n w ' a L d k µ •}7 . 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved Pang) #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 X YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO A/ 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 X 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: t �" is i'I e1 nl t d+ p y rt • New House 0 Addition 0 Replacement Windows Alteration(s)0 Roofing 0 Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs gn [ ] Decks [ ] Siding[ ] Oth� /tn/k, Brief Description of Proposed Work: i9/- (h T� Aye f'-t /,ni'e cm/h'/1/7 7 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll D-Sheet C� 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 $fli = 1��l � ' 1. fide 4 id - , as Owner of the subject property hereby authorize T/11�Ci'C'.�,� CI a{/' L ' L to act on my behalf, in all matters relative to wor authorized by this building permit application. Signature of Owner Dade I, 4. Fe�J C 14 K. , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ins and penaltie of perjury. fi ' Print Name ` Signat e o Owner/Agent Date • • • 8.1 Licensed Con tructintl Supervisor: Not Applicable Cl Nom of License Holder: Andrew Church DBA Chimney Saver 040943 License Number 174 Spring St Florence Ma 01062 I 1rj 0-?l10? _ .—.__-.. Address Expiration Date 413-586-0918 Signs Tatephone --- Not Apptrcabte Andrew Church DBA Chimney Saver 104480 .pmprl11 a Nam@_ Registration Number 174 Spring-St Florence Ma 01062 7-1-2002 Address Expiratioir Date telephone 413-586-0918 = a Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 5C No l7 I _ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 7110. Sixth Edition Section 108.3.5.1. Definition at Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use andlor farm structures. 4 person who constructs moreJhsfn one home in a two-year period Shall not be consider$homeowner. Such"homeowner"shalt submit to the Building Official,on a form acceptable to the Building Official,that h©lshe shall responstlble for all such work performed under the banditti 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 ass►anes 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 • �S1tANp2, &�o• tt.ai oyfl (rite of .Narf1j&mptan el! �assac4asitla L�yy DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, Mass. 01060 WORKERS COMPENSATION INSURANCE AFFIDAVIT Andrew Chirch (licenser/pernvttee) with a principal place of business/residence at: 174 Spring St Florence Ma 01062 (phone#) 413-586-0918 (street city/stall ip) 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) (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) (Etiration Date) (attach additional Moot if necessary to include ioformenoa pertaining to all oorstrea s (1 I am a sole proprietor and have no one wort ing for me. ( ) I am a home owner performing all the work myself. NOTE:phrase be await that whale bomcowocra who employ pcsom to do m'anca oomyvaien as repair work on a dwelling of not mar than three units in which the bomoowner resides or m the grounds appurtenant thereto us oot generally oomiderod to be enaPloysn under the work.a's oanpensalion Act(GL152-ia l(5)).application by a homeowner far a tic ax or permit may evidence the legal name ant employer under the W orkda Compeneation Act. [understand that a copy of this ctstenues may be forwarded6 to the Department of ln .siai Aoodeod1 Moe of Insurance for e coverage vcn8c iioo and that failure to accuse coverage under sonioa SSA of MOL 152 an lad to the imposition of criminal pcaallies oo mistcfg of a fitted up In S t y00.o0 and/or imprisonment of up to one year and civil paania in the form of a Stop Work Ordc and fin of 5100.00 a day apical me For depero wand tun mly Permit Number Map# Lot A ignaturt of Licoasee/Permiuee • Date