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23D-151 (10) 147 HINCKLEY ST BP-2003-0347 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 151 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2003-0347 Project# JS-2003-0578 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SARA NORTHRUP 049951 Lot Size(sq. ft.): 18513.00 Owner: GIBBS PATRICIA CANDEE& Zoning: URB Applicant: SARA NORTHRUP AT: 147 HINCKLEY ST Applicant Address: Phone: Insurance: 147 HINCKLEY ST (413) 586-0787 FLORENCEMA01062 ISSUED ON:10/9/02 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE SUPPORT PIERS ON ENCL PORCH & RELOCATE BATHROOM 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 10/9/02 0:00:00 914 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2003-0347 APPLICANT/CONTACT PERSON SARA NORTHRUP ADDRESS/PHONE 147 HINCKLEY ST (413)586-0787 PROPERTY LOCATION 147 HINCKLEY ST MAP 23D PARCEL 151 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid ‘9t/jL , 5d Typeof Construction: REPLACE SUPPORT PIERS ON ENCL PORCH&RELOCATE BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 049951 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved _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 .ssion ld y z�L-- 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. �> epartmer,�use only � '�, Q 1 of Northampton Status of PF m t E i ng Department Curb Cut/`Driveway Permit _ _ _ OCT - 2002 2 Main Street Sewer/Septic Availability "' Room 100 'vVate.r/T/„IIAvailability _ _-. _ N thanpton, MA 01060 Two S::ts of Structural Plan DEPT OF BUIIDIr�G�INSPECjJQ NORtM?iPi,�+�t165AA587-1240 Fax 413-587-1272 Plot/Ste 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 11 7 Hike �f(e S� �J7 Map D Lot 1 � Unit / Zone Overlay District r�l Dve o. G2 _ Gl Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:/ / M fii�./r, ia. Ci<i c/ee �7 i 645 /Ie4t pa vi1 /N (y �c-i K� fey .'r N me(Pr Current Mailing Addres : je 586-a7,, '✓ Telephone Si nature 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 oZ G'0 (a) Building Permit Fee 2. Electrical Trp (b) Estimated Total Cost of Construction from (6) 3. Plumbing 0 e' v Building Permit Fee 4. Mechanical (HVAC) 5-ro 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �QC0 Check Number ?if 066) — This Section For Official Use Only Building Permit Number: • 0,3 -g l 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 ^ /l' C7 CA et e Building Department Lot Size `f Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus 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?X 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 / C 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 IF YES, describe size, type and location: SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House El Addition ❑ Replacement Windows Alteration(s) f Roofing El Doors El \\ Accessory Bldg. ❑ DemolitionK New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: Re fIa(e SK//oderiaie%f 'KKer- enclose,,to perix I "love ba*h+- 0 " Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative❑ Renovating unfinished basement Yes X No Plans Attached Roll 0 • Sheet❑ 6a, IfINeW house "alia br ddition to''ezisting=housing;.complete thel olMOW 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 �• Ca" deg' '6 GS , as Owner of the subject property hereby authorize fec`' /v r-1-4 to act on m alf in all matters relative to work authorized tSy this building permit application. Signature . ner ate Sa✓nc /��' , as Owner/Authorized Agent hereby declare that the statements an 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 Name .251 o� Signature of Owner/A ent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : Sa"'''� _ " �7 rK/O 0/ fg5T1 / License Number I y7 keede7 sT f/dam-ice/ � v/©62 /5—/ce,i-t Address Expiration Dat 5 g.-07( 7 Signature Telephone g s e e ��provem`ent Contractor: ,;, °' 4. w �;1 Not Applicable 0 ra /4;1.4fr"..-70 /3 3 a 0 7 Company Name Registration Number Address Expiration !Ate 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 No 0 11:""-, nit-O`ritr + xemp 1°on 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 4.�ttA fp e (gli xt la1 Ntn1Iia ll #utt 1 -* 9 1ili~_ (i 6 J1asaachnsetta' `=' _ R W y '=— DEPARTMENT OF BUILDING INSPECTIONS TIT- `= 212 Main Street • Municipal Building Northampton, Mass. 01060 `0.. WORKER'S COMPENSATION INSURANCE A ywAVTT ,a►-cam /v --rif 7 t 2 / (licensce/permittee) with a principal place of business/residence at: I117 H,i-tc/-ley S7: f(af-' c —Mil v/O6s(phone#) (bb.cet/city/sutra/np) 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 wolfing 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 Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addditioaal skeet if'on,-, ry to include information pertaining to all ooutradors) AI am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plc lx aware that while homeowners who employ persons to do ma irifrn,ran- constructioo or repair work on a dwelling of not morn than throe units in which the homeowner resides or on the grounds appurtenant thereto arc not gen.ally considered to be employers under the ware ration Act(GL152,s 1(5)),application by a homeowner for a license or permit may evidence the legal atxh s of an employer under the Worker's Compomation Act. I understand that a copy of this rtatcm.+t may be forwarded to the Departmcot of Industrial Atcidents'Oflioo of Imtusnce for the coverage vcrif cslioe and that failure to yzure coverage under section 25A of MOL 152 can lead to the imposition of criminal penatt'et consisting of a Sne of up to S 1,500.00 and/or imptisormxu2 of up to one year and civil penalties in the form of a Stop Work Orda-and a fine of S 100.00 a day against me. 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