23D-144 (3) 11 WINSLOW AVE BP-2000-0864
GIS#: COMMONWEALTH OF MASSACHUSETTS
4ap:Block:23D- 144 CITY OF NORTHAMPTON
-ot:-001
Permit: Building
Category:shed BUILDING PERMIT
Permit# BP-2000-0864
Project# JS-2000-1610
Est. Cost: $1596.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 16639.92 Owner: PORTER ALAN H&JOYCE L
Zoning: URB Applicant: PORTER ALAN H & JOYCE L
AT: 11 WINSLOW AVE
Applicant Address: Phone: Insurance:
11 WINSLOW AVE (413) 584-8878 ()
FLORENCEMA01062 ISSUED ON:4/13/00 0:00:00
TO PERFORM THE FOLLOWING WORK:E R ECT 8 X 12 SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Jnderground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 4/13/00 0:00:00 1893 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2000-0864
APPLICANT/CONTACT PERSON PORTER ALAN H&JOYCE L
ADDRESS/PHONE 11 WINSLOW AVE (413)584-8878()
PROPERTY LOCATION 11 WINSLOW AVE
MAP 23D PARCEL 144 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 1f9�
Typeof Construction: ERECT 8 X 12 SHED
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 OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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 Comm' ion Permit from CB Architecture Committee
.
Signature of Building Offic a _.e_,Z---6/ /3/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.
M
-! 1Department use only
1\1___ City of NorthamptonStatus of Permit:
7200� Drivewa Permit
rim-1-
Building Department Curb Cut/ y
i_�.----s-- -.212 Main Street Sewer/Septic Availability
DEPT OF Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
Map Lot ?// J Unit
i I win�SLOW A UE
FLdil L=A/c 1/1/1
1 Zone Overlay District
_,,,b/ C)--
Elm St. District CB District____________
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/4C-ni tO1STTR lI w)lV,t.o► , ,9v( Fl-li'ENCe /V/ o)o6)-
^" me(Print)` _� /�- Current Mailing Address: 5 oy aY51-t l r-L� elti Telephone O
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
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 A79.3 577S--
This Section For Official Use Only
Building Permit Number: �p0-0 `"{ Date Issued:
Signature: 2ooa
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 d v X FO X p p Si rv--0
Frontage g 0 7fefri-
Setbacks Front
Side L: %-9 R: 7- S L: D R: E9
41.
Rear 1,2 3 97
Building Height
Bldg. Square Footage /4' 7/
Open Space Footage
(Lot area minus bldg&paved / if 96 /
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a pSpecial Permit/Variance/Finding ever been issued for/on the site?
NO V DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does )he site contain a brook, body of water or wetlands? NO DON'T KNOW
YES 1/
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:
;TION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition ❑ Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. ' Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work' iTORA 6E 5/ITb gx ( a—
Alteration of existing bedroom Yes I No Adding new bedroom Yes 4l No
Attached Narrative IDRenovating unfinished basement Yes V No
Plans Attached Roll ❑ - Sheet❑
ea.i New9 Buse ender addltien teekieling housing.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?
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
, 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.
Y V7/D0
Signature of Owner Date
Al-AV PORTER , 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.
.' ned under the pains and penalties of perjury.
AL AN' PO RTEN'
Print Name
eda,, 67z, Ybida
Signature of Owner/Agent Date
grr•,TION 8 - CONSTRUCTION SERVICES
Licensed Construction Supervisor: Not Applicable 0
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
Not Applicable 0
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 issuance of the building permit.
" —ned 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
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W"' — DEPARTMENT OP BUILDING INSPECTIONS , is 1
. 212 Main Street ' Municipal Buildings=_
Northampton, Mass. 01060
WORKER'S COM]?ENSA'IION INSURANCE AFFIDAVIT
✓ I, / s- ✓ PORrJ ,
(li ccnseeipermi tire)
with a principal place of business/residence at:
/l w 11V SLO1N AuE FLAIR E iCE (phone#) S I'/-$l 1 S
tr (stm..,i/city/stalr/ap)
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) (Expiration Date)
(attach additional sheet if nee>-,nary to inetudc informafioo pertaining to all ecarndo:s)
( ) 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 while he a woc,who employ pazom to der rruirt,+ry.ner construction or repair work on a dwelling of
not more than throe units in which the homoowoa reside or oa the ground,appurtenant thereto are cot&moodily considered to be
employed under the worker's oompeasaiion Act(GL152,331(5)),application by a homeowner for a license or permit may evidence the
legal ctatua of an employe(under the Worker''Compemaiioo Act
I understand that a Dopy of this awemmt may bo forwaeded to rho Dopartmcv2 of Industrial Accidents'Olhoo of Iaxuanoo for the
coverage verification and that failure to sectuc ooverago under section 25A of MOL 152 can lead to the' on of criminal penalties
consisting of a fine of up to S 1,500.00 and/or of up to one year and civil pemltia in the form fa Stop Work Order and a
fine 0(3100.00 a day against me.
For departmental use only
Permit Number
Map#_--- Lot#
Signature of Liccnsecfpermi.ttce Date
HTTrin-"- 1 ____.___________
APR - 7 2M0 .' --
DEPT OF SUIL(.!NG INSPECTIONS
NORTHi;Mn10% Mt,,0106u
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