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23D-141 (3) 5ECEilVEn o2377-J4/ n, DEC 3 - 2001 ILdi /6 ikiyMer 51— OENOPT BUILDING INSF'AP01060NS O CO / LA_Chi✓ Pi_ nec_c__"- 77' - ,��� / . e u is r-vrt_ . 106 HINCKLEY ST BP-2002-0470 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 141 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: ADDITION BUILDING PERMIT Permit# BP-2002.0470 Project# JS-2002-0715 Est. Cost: $8000.00 Fee: $52.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq. ft.): 11717.64 Owner: HUANCA EUGENIO& ELIZABETH S Zoning: URB Applicant: HUANCA EUGENIO & ELIZABETH S AT: 106 HINCKLEY ST Applicant Address: Phone: Insurance: 106 HINCKLEY ST (413) 584-4590 () FLORENCEMA01062 ISSUED ON:11/1/01 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 24 X 22 DET GARAGE 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 11/1/01 0:00:00 3523 $52.80 212 Main Street, Phone(413) 587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-0470 APPLICANT/CONTACT PERSON HUANCA EUGENIO&ELIZABETH S ADDRESS/PHONE 106 HINCKLEY ST (413)584-4590 Q PROPERTY LOCATION 106 HINCKLEY ST MAP 23D PARCEL 141 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out `3 Fee Paid itt�J/mod, 11-0 Typeof Construction: CONSTRUCT 24 X 22 DET GARAGE 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Denied PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan OR Special Permit and Site Plan Major Project: Site Plan OR Special Permit and 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 ' ion ////_crry 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 only City of Northampton Status of Permit: RD tll I Department Curb Cut/Driveway Permit- 2i_2 ain Street Sewer/Septic Availability R dm 100 Water/Well Availability OCT 3 1 2Nrth ton, MA 01060 Two Sets of Structural Plans phone 413-5 -1240 Fax 413-587-1272 Plot/Site Plans D(P?or°JJILDINC OISPECTICNS Other Specify APPLItAi ilkri 14h UCT,-ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: fi /17 �✓ G 1C sT--- Map C b Lot if Unit �L t� C C Zone �j� Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A-11 Ai v / ?.., I 1-1-7 AIG,KL C—y Sr—le- oRC-,ice--�i�� Name Print / Current Mailing Address: di O 6,2_/ /1�,1^ 1 1 3 - y —its •'! � �✓ Telephone 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 G 2. Electrical (b) Estimated Total Cost of 6 , , Construction from (6) 3. Plumbing f Building Permit Fee 4. Mechanical (HVAC) / 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) v v Check Number y ,23 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 47 Lot Size #940 ( /®1 I,6' 7-B 0 0 Frontage F 3 f 13. s 75"- Setbacks Front g`1? GI Is Side L: c R: 7O L: 3 R: 671 Rear SD S U Building Height /:3 )-4) �o Bldg. Square Footage 6.- -3 Open Space Footage (Lot area minus bldg&paved ?t70/ ?0 e/SC1-0 5-6parking) #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 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(here any proposed changes to or additions of signs intended for the property ?YES No " IF YES, describe size, type and location: - w to �� �,<✓inf- a-rr-y Ft 4.,✓410t.- - � 6i+1—c.li 11- C—o 4or. s� 9 SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ / Or Doors El Accessory Bldg. If Demolition❑ w igns [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: ? a a y Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes 4.---110 Plans Attached Roll o - Sheet❑ } ]�3t.= .. : 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 LnUr v 9` 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 v a a t— > '' �"'�� � UY- 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. r U c—r J //t!f—xl (A- A Z, 4-f7h- Print Name l 1 v/j+/ 0/ Signature of Own r gent Date • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : License Number Address Expiration Date Signature Telephone m .r fl ��.« � � � i� , €c�s.tt�fi,..➢@ � v tlE f ,1,1&S",1.14 ��1 � iu313 "3,1 za. .I:.X•....t J ji ,a317K:W0i, 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 ofthe building permit. Signed Affidavit Attached Yes Q' No ❑ 1. 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 Lo al Zoning Laws and State of Massachusetts General ws Annotated. Homeowner Signature (/�yliLG�� 0. &A HP2. :° eMeots Oy ( j of No rtlytinpioi _ _g �►�� E�� _ 9��ctt ` rB =v :aaa rinsetfa� (l {9— DEPARTMENT OF BUILDING INSPECTIONS 4 __��= • • 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 up' WORKER'S COMPENSATION INSURANCE AFFIDAVIT 1, (licensee/permittee) with a principal place of business/residence at: • (phone#) (btu eet/city/state/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) if (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 ifne +.ry to include information pertaining to all eoatrndot) ( ) JAM. a sole proprietor and have no one working for me. ( a home owner performing all the work myself. NOTE:please be aware the while l a *iwuera who employ persons to do rrea(nrrnarur,construction or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurtenant thereto arc not Malty masidered to be employers under the worker's giros ettat Act(GL152,s3 1(5)),application by a homeowner for a Gecase a permit may evidence the legal status of an employer under the Worker's Compensation Act I understand that a copy of this aaateme t may be forwarded ded to the Department of Industrial Acadeastr Office of Insurance for the coverage verification and that failure to secure coverage tinder section 25A of MOL 152 can lead to the imposition of criminal penalties ootuisti g of a fine of up to 51,500.00 andkor imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a firm of 5100.00 a day against me. For departmental u.n only �/ /v 1/0/ Permit Number ("11-41.1.4.. ..) 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II 1111111111 II EMI 11111 i _•„. . I MIIIIIPPEE iiiim 111 I IIII rill 11 "Li I III vIsI ' ..... IIIII I 1 11 Iii IIIII IhS Oil NEW ' 1 Obi ' Noma -. - .... • IlliESSIBE EIZEOMEIMMEI 111111111 —NU I L— THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. ol a— TO: BANK UNITED OF TEXAS , F. S . B. & OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA—AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY u 250167 SURVEYOR: • -NOTE- THIS THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY / `� OF M -MORTGAGE LOAN INSPECTION PLAT- RM4AII \, NORTHAMPTON, MASSACHUSETTS is 1 tZER PREPARED FOR m3m032 EUGENIO & ELIZABETH S . HUANCA SCALE: 1 "=30 ' FEBRUARY 25 , 1993 1,MO:� HAROLD L. EATON AND ASSOCIATES, INC. �r-.. REGISTERED PROFESSIONAL LAND SURVEYORS C. .�-�r\ 235 RUSSELL STREET - HADLEY - MASSACHUSETTS