23D-150 (3) 22 NONOTUCK ST BP-2005-0549
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 150 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0549
Project# JS-2005-0720
Est. Cost: $27660.00
Fee: $140.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BENOIT JR 088335
Lot Size(sq. ft.): 46173.60 Owner: NORRIS LAURA
Zoning:URB Applicant: ROBERT BENOIT JR
,.T: 22 N!nF JQTi;C'< ST
Applicant Address: Phone: Insurance:
P 0 BOX 701 (413) 247-9927 () Workers
Compensation
HATFIELDMA01038 ISSUED ON:11/4/04 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE CHIMNEY, POUR BASEMENT FLOOR &
RELOCATE WASHER/DRYER
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: I A ou h:rye I� jar House# Foundation:
1gr1 w iii1y/0 eriveway Final:
Final: 0,_i 7 e1 Final: i , /
u / < sit,--/ Rough Frame:i4R'r(4 y Uk
11-97.a
Gas: Fire Department Fireplace/Chimney:
Rough: !r-,p-(]-T i. Oil: Insulation:
Final:/r t ��ki Smoke: eilt: Z-7 et Final:Q K /'� .a9q. d47 -'A
�Tl�
THIS PERMIT MAY BE REVOKEi
BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. "
-,—:,' ,,,e'../7_,
Certificate of Occupancy 7 Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 11/4/04 0:00:00 103 $140.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2005-0549
APPLICANT/CONTACT PERSON ROBERT BENOIT JR
ADDRESS/PHONE (413)625-0288
PROPERTY LOCATION 22 NONOTUCK ST
MAP 23D PARCEL 150 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �f —Fee Paid M e
Typeof Construction: REMOVE CHI EY,POUR BASEMENT FLOOR&RELOCATE WASHER/DRYER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 049917
3 sets of Plans/Plot Plan
THEJ�OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN)�ORMATION PRESENTED:
1// 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 Co ' 'on
,, t4e ,V,--ieeZ---- //di/24'19Y
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.
X_____0±-1 Department use only
,� t,yt of Northampton Status of Permit:
— lil ing Department Curb Cut/Driveway Permit
,'; Nov _ 2 203 2 Main Street Sewer/Septic Availability
u nOr Room 100 Water/Well Availability
orth pton, MA 01060 Two Sets of Structural Plans
OEPT Of BUONO `' -O�'513-58 1240 Fax 413-587-1272 Plot/Site Plans
NORIHAMP1ON, ��r.
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
1.2_ No, , f n-,-K- Si-. Map Lot Unit
-77o✓yn.GG2 Alec 0<0 b Z Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Za-b-►--z D eri (1 1 elfaa�t' (Jf ay F tia�.,-(1„,44A0Ind;
CjCurrent Mailing Address:
Lw 6J z�✓ TelephoneL7ye
-
2.2 Authorized Agent:
to .74 7?19. £x 9o/
Name(Prin 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
/0, _;2
2. Electrical -,� (b) Estimated Total Cost of
,,�/ (��(,. Construction from (6)
3. Plumbing /2p67 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection l(//
6. Total = (1 +2 + 3 +4 + 5) 2-7/ Z 6 0 -- Check Number /d 3 1
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot SizeLo
/o A
Frontage
Setbacks Front
Side Lill z R: I� '' L R:
Rear / •
Building Height zf!
Bldg. Square Footage 41 d0
Open Space Footage /f'+�/{,p,'
(Lot area minus bldg&paved 1�'. 0
parking) ++++ ���, L!
#of Parking Spaces �-
Fill: (/�
(volume&Location) j"
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 41 YES 0
IF YES, date issued:'.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO 4)
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0:1
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) Roofing ri
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [I Siding [O] Other[O]
Brief D.r4cription of Proposed /►
Work: fCetnoYQ-c.Wtnna�j peu�✓ ' 00)/ /in b‘.se;wait nel4o1404, re/o o e hl.f), at le A dee•i 54-A-0/gag
Alteration of existing bedroom Yes x No Adding new bedroom Yes )C No/
Attached Narrative Renovating unfinished basement Yes �_ No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing,`complete the following:
a. . - of building : One Family Two Family Other
b. Number o r.. in each family unit: Number of Bathrooms
c. Is there a garage attached.
d. Proposed Square footage of new constru '-.. B. ensions '
e. Number of stories?
f. Method of heating? Fireplac-- • Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energ ..mpliance form attached?
h. Type of construction
i. Is construction within 100 •.of wetlands? _Yes No. Is construction within 100 yr. floo.. •in Yes No
j. Depth of basem-• or cellar floor below finished grade
k. Will buil.' g conform to the Building and Zoning regulations? Yes No.
I. -ptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED,WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
GI, G eV .'��j'7�,,_)
, C � '`
(::;?/y
w� (-A�,1e'v`tiG✓c( ,007f.e., as Owner of the subject
hereby authorize
to t on m behalf, in al tters relative to work auto rized by thuilding permit application;
z )
ature of Owner Date
I, ,g, , ?, A. ;,,' ,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.
Signnder the p • s and penalties of perjury.
,CJ�2,Q .U1 n a, /l
Print Name
\Z.,,e._ Li/ _-----e /0 A IA i
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction• ervisor: � ,,�� ���' Not Applicablepab El
Name of License Holder: 1 / , %a ejd -V -I068 3,5-----
License Nu ber
/D ,g—i 1.6 5f 41 f''c li d io 72. 26 2c9o9-
Address �/ Expirati n Date
5,--- .11-/". 9.,2 9-
Signature Telephone
9.Re . ered Home Im ovement Contractor: Not Applicable 0
tr- t.� �, �, CA.�►— 2124009
C mpany Name Ragistrat n Nu ber
/0 IF—/Z5y_ 6-7L-i 7944-,Pe,•4/ At9- all:3'6 It X6 2cre-6
Address Expir tion ate
TelephoneW KZ 2
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 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
4t riAH pi,
4,o oy
C 7rtU LTt NirtI am thTt • =*
� �`f�tv
.I �aiancflnsctts'
,e0ice =�} 1_
.___=_
- DEPARTMENT OF BUILDING INSPECTIONS ! i=
212 Main Street ' Municipal Building `
Northampton, Mass. 01060 tt•'
WORKER'S COMPENSATION INSURANCE Ab'N'LUAVTT
I, --go', (aer c i f-
(li 'e./pe:mi tt.ee)
with a principal place of business/residence at:
•
l 0 : 15c S$., Isle -Int.id , I l A Q to30 (phone#) / 7- - O. 7-
(Li=t/c-ity/s-tat'zip)
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)
4.6 I am a sole proprietor general contractor r homeowner (circle one) and have hired
the contractors listed below w o ve e ollowing worker's compensation policies:
S Eleoi rat, d Mps 6-7-1,g) _ - b lo
(Name of Contractor) (Insurance CompanyPolicy Number) (Expiration Date)
- no ,4y 1 L NiQ.50,,vy ,, o,.,4,16.4 c. /A S® s— z q a �-
(Name of Contractor) (Insurance Coanv/Policy Number) (Exptra on Date)
i i{li f 4 i,714•_ t/A;IIGited (, P Y 6 7-3 /v
(Name at-Contractor) (Insurance Co /Policy Number) (E. i 'on Date)
•
/itD/ rf41,,,,i- 2A-tivil5 it • D
(Name of Contractor) (Insurance Company/Policy Number) ' tion Date)
(attach additional sheet ifneoesary to inch information pertaining to all contractors)
J 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 whilo homeowners who employ pc-am to do rm.ic.r,n,,,n construction or repair work on a dwelling of
not more than throe units in which the homeowner wide or on the group ,appurtenant thereto are not generally considered to be
mploycn under the wod cr a ocsapGuatian Act(GL152.ss 1(5)),a£plieafion by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act
I understand that a copy of this cts1 axt may be forwarded to the Dot of Industrial Academe'Office of Ii.auaoce for the
coverage verification and that failure to scatre cover ago under section 25A of MOL 152 can lead to the imposition of criminal penalties
comistiag of a fine of up to S 1.500.00 andlor i mprisosmocat of up to one year and civil pcsalties in the form of a Stop Work Order and a
fine of S 10o.00 a day against the
For dcpartmn3l LLfe only
Permit Number
LC %- y map4 Lot#
A Signature of Lic;usce/Pe mittce - Late
�� y
lU D r7 �o 4„
09/15/2004 20:36 4132537826
SAWICKI REAL ESTATE PAGE 07
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