18D-053 (2) 7 }
80 DAMON RD#2205 BP-2000-0891
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-053 CITY OF NORTHAMPTON
Lot:-043
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2000-0891
Project# JS-2000-1653
Est.Cost: $4000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CDT CONSTRUCTION 003666
Lot Size(sq. ft.): Owner: HANDY MARCIA A
Zoning: GI/WP Applicant: CDT CONSTRUCTION
AT: 80 DAMON RD #2205
Applicant Address: Phone: Insurance:
158 NORTH MAPLE ST (413) 585-8677
FLORENCEMA01 062 ISSUED ON:4/18/00 0:00:00
TO PERFORM THE FOLLOWING WORK:BATHROOM RENOVATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: 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 4/18/00 0:00:00 1844 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2000-0891
APPLICANT/CONTACT PERSON CDT CONSTRUCTION
ADDRESS/PHONE 158 NORTH MAPLE ST (413)585-8677
PROPERTY LOCATION 80 DAMON RD#2205
MAP 18D PARCEL 053 ZONE GI/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid / Yj-v
Typeof Construction:_BATHROOM RENOVATION
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included:
Owner/Statement or License 003666
3 sets of Plans/Plot Plan
THE,POLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
1/Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Li-/$'-OD
Signature of Building icial 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.
f tar 1?_. 00 1 O: 38a
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APR � 4 "3Gity of Northampton
B.lilding Department
OEPT OF BUILDING INSPECTIONS \212 Main Street as
NORTH►,MiTC`l MA 01060 Room 100
Northampton, MA 01060 I. i
phone 413 587 1240 Fax 413 587 1272 t4
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
r i yc �4��� td 6e t Iifed by o t! s s
1.1 Property Address: , , 5° ` ' w ,it '';. �° ,ta
wk h a llC,q C), ' ------rili tie r-Wvik) moviedd,+ � !��+p 1. y
,< k „giv t i p
D/`3//Y_ll�/l) Wc- /V i(� l t4- i T0,0 iZs< ,r1y DEstrict ii�. ,5.
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id
S:E,CTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
M l--Re Cii- -/7 J ln4J oa l,5- fi-re(PeKi Ic It Wol Ere e crAdol//1,4
-1-Name(Print) ( Current Mailing Ad s �� /L
1 lu - � Lc H-77 �<y <1
A.c✓ o,te., .,4 E124/toty Telephone R,� 8UA)-,3"8-y-/ 0 72
Signat re
2 A thorized Agent:
1-5V A
Na tint) Current Mailing Ad ress:
"Signature Telephone
4 1.0.;,iit 7;11VIfi }Cd l u 19:0 S, , .
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 Fhb
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3+ 4 + 5) �(f��p Ch icrUUmber (J
This Section For Official•U'se Onfy
�-- Buit g.,F'Perrn t,Nur► e:r: ,._ v -( / - - Date Issued:_
Signatu :: _
l44.1ttnr3sipr0-nspettor of 6uiftltns_ Date
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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 Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot arca minus bldg&paved
parking) F
#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: —_
R,fpr 1?. 00 10: 41a
p. 5
z Fl l ti#lfi N OF PR® kt"ED A"t, ,= check alt.applkcable)
New House 0 Addition ❑ Replacement Windows Alteration(s) Roofing 0
Or Doors LI
Accessory Bldg. 0 DemolitionD New Signs [ 1 Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: Q�p` �h d���r�t� e � )I'�9 'A:SWh
fob Giot y)kv w Pip s
Alteration of existing bedroom Yes ' No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D - Sheet Q
�..�f d t S�s.la e. .§ 'ijn. xFfdir h� doF >:" 9 b�� c e s YL yi..,,.
..:a�:�ti1.'�11_. "�..�rs._�b 13v... ..'L:_..ScL. �,+ �. .. .3 .�` _. ._� ,9 .t/�_. 'Li," -.�.�.,._a.�•,._f�_._��� ,,�;
a. Use of building : One Family Two Family Other \ .011k tge""Ckr. 'Ck)\
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? N 6
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. fioodplain 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_
a a 4) A�#it T ileMZ-{G'TON- SNP ,
' WHEN
OlithteRS;AGa£Nt OR CoN`rRAc1 OR APPPE4gt o - L d PEIRMIT
, 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.
`--,14a4 C _A-Pict.4icte
Signature of Owner Date
, 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 Name -�
VOA_ C4t14/
Fpr, 1 CO 10: 41a
p. 6
I-SECT:0,N 8'-CONSTRUCTION SERVICES
. .1 Licensed Construction Supervisor:'� Not
ic �
Applicable ❑
Name of License Holder : � \c ,� —�"�a \ Lice scTlumL r
161 Gig -- 0\
Ad r s Expiration Date
Signature Telephone
•,r.��.i`,r'ar. '��'' I i? .a r r�Fi ii�� i+ �� ?aAIyE�a "• a M Not Applicable ❑
130152-
Company a e Registration Number
• \5� twptsk.., S_ o ► — J i --M oa ) -
Addre Expiration Date
Telephone tl "tLi 1
SECTION 19-WORKERS' OOMPEN.S,ATION tNS'U.RM4C.E 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 per it.
' signed Affidavit Attached Yes 0 No
ti4 1. 3 it T. ,.�•r Y r .. r..,.u1 •kh'�'-Rr! ti lE
v N;L T.rdS 5 t i7 �i m. I ,
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 Officials 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_
Rtipr. 12. 00 10: 42a p. 7
oa-t pTo
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• t' (,2 1 3l NortIiainpfon Q. --
f�af ''��•6 atasaacEtnsrttst_
DEPARTMENT OP BUILDING INSPECTIONS
• 212 Main Street ' Municipal Building `L -
Northampton, Mass. 01060 \�
WORKER'S COMPENSATION INS CE AFPIDAVTT
I, 0_, A,_____esbns _
i.,-,6,Acvry.j.,_
(peen ccipermittee)
with a principal place of business/residen at:
1.100,11A.C4N_(p 11 o nei0, 1S-ILL-1. /.-A
(btr licit)•/sta crop)
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:
(Insuran= Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general coon-actor or homeowner (circle one) and have leered
the contractors listed below who have the following worker's cotnpensation,policies:
(Name of Contactor) (lnsuran=ColrmanyPolicy Number) ()=.»tr:uon Date)
(Name of Contractor) (insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Compam•/Policy Number) (Expir3nou Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(aturh addi ioml Mice irnoc awv to include information pcta:ninb to all 000trattora)
(1�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 tint while bomcowner wbo employ pcsom to otatmeasztec,coo;racoon or repair work OO a dv clltab:,(
not more trim throe twits in vcbicb the bomoouva rondos or on the pounsb apptutcsant thatto arc Dot gctarally 000aidacd to be
croPloYors under the woricc -u+ion Act(GL152,n l(S)).applieasoo by a bomcowva for a Lica=or permit mny evidesxu tlx
legal status of an employee under the Worker's Compensation Aar_
I uaderwtsd that a Dopy of this satcmrm ta,y bo forontistiel to the Lkpartmced of 3,hisrial Aoodcate Office of lmucwoo for the
eova>t ge vai5tntioo sad that failure to seauc wvcrago ttada scctioo 25 A of MQL 152 can lcsd to the ia>pmifion of mminal penalties
comianTg of a fine of up to S 1.5OO.00 and/or ireg isn�of up to ow year and civil penalties in the forts of a Stop Work Order end e
fine Of 3100.00 a day s.gaka mc.
— —
For scpatroco al use only