23D-141 (5) r �
106 HINCKLEY ST BP-2002-0426
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 141 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: roofing BUILDING PERMIT
Permit# BP-2002-0426
Project# JS-2002-0648
Est. Cost: $4500.00
Fee: $25.00 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
FLORENCEMA01062 ISSUED ON:10/19/01 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & INSTALL VINYL
SIDING
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 10/19/01 0:00:00 3521 $25.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
S
• 2 City of Northampton Status of Pei
j1 5 Department
Curb 1Cut/Drivewa�,'e i
J 212Iding Main Street Sewer/SepticAvailabUity_` _
Room 100 Water/Well Availability
OCT 9 2001 •� hampton, MA 01060 Two Se is cif Structural Plans
phone A 13-537.1240 Fax 413-587-1272 Plot/Site Plan . __
DEPT OF BUILDING INSPECTIONS iUtherSpecify
No IAAJIDTCN,Mk fft660
APPLICATION TO GUNJ i rtUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY D'Wi=LLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
/ /04, // , dCleI- C-7 Tr---- MapLot Unit
✓ ri-o Q C--l C_C—l "1 r 0i0G oU Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
E 2-i 2- 0-14- -1--)i- S. dilThiJ 6/. .
Name(Print) Current Mailing Address:
Signature --"i"---e-4"------4*--.."—ijTelephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
com feted by permit applicant
/1. Building If ° (a) Building Permit Fee
9 cal
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee -
4. Mechanical (HVAC)
Fire Protection
'' 6. Total =(1 + 2 + 3 + 4 + 5) >i q-1 r 0 0 Check Number SJ_a_ / p-5--'
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 Fr t
ide L: R: L: R:
Rear
Building ight
Bldg.S are Footage
Open S ace Footage
(Lot are inus 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 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 there any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing X
Or Doors ❑
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding is Other [ ]
Brief Description of Proposed Work: S/ rJ i^J 4"-- £ C (Sr-iifoci_ OL-e1 QooR- .Siafijv til
il.c. i_n-c—67)
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 U . Sheet 0
"elfi ew house and o add it on` to!ezlst n tiousln =corn:`Tete' theToflowin_:
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
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, , 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 Na
i.L..d.i.....e...—__j iopq /0,
‘ignature Dat
•
of Owner/Agent
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
• 1 • :•v-men AL„•1 t;,_-tal, x,dot4:1:4,1,4.4P c Not A licable 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.
Signed Affidavit Attached Yes 0 No 0
u yam•0'E e"'e ti em e ti n
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 St e of Massachusetts General Laws Annotated.
iplomeowner Signature
olttAMpi.
o
9 4 i±t Jai Thri11anpfon __1� �944% 6 asaarhnsrta =Mifilii_
'�W}:1' DEPARTMENT OP BUILDING INSPECTIONS __�_`=
212 Main Street ' Municipal Building
Northampton, Mass. 01060 r'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
-e—I L am/ S . Ni) C I
clipermittee)
with a principal place of business/residence at:
/(44:. •
/D t; dA) LPL C.-.--. J S . . &N,Q. c--A✓u (ph #) 171/3— S 47/ -- c/S,0
(b ti tSt/Cl t}'/St a3P./n 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)
4,
(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 additioail sbect ifne -miry to include information pertaining to all ooatredor3)
( ) 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 vehilo homeowners who employ persons to do wins.-nw- corntructioa or repair work on a dwelling of
not more than throe units in which the homeowner resides or oa the grounds appurtenant thereto arc not generally considered to be
employers under the worker's coop asatioa Act(GL152,ss 1(5)),application by a homeowner for a license cc permit may evidence the
legal stoma of an employer under tho Worker's Compmaation Act_
I understand that a copy of this statement may be forwarded to the Department of Industrial Accident,'Offioo of Inaurence for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine'of up to S 1,500.00 and/or 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 tux.
For depsat use only
Permit Number
Map;# Lot#
Signa-tture of Li�P1C44_,..,_c_j
Late