Loading...
23D-164 (4) 117 MAPLEWOOD TERR BP-2003-0708 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 164 CITY OF NORTHAMPTON Lot: -001 Permit: Buildinci Category: BUILDING PERMIT Permit# BP-2003-0708 Project# JS-2003-1148 Est. Cost: $19250.00 Fee: $96.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ACTION FIRE RESTORATION 074416 Lot Size(sq.ft.): 24001.56 Owner: SWIDLER MARK A Zoning: URB Applicant: ACTION FIRE RESTORATION AT: 117 MAPi,EW^ n TFPf1 Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 594-7800 Workers Compensation CHICOPEEMA01020 ISSUED ON:2/27/03 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR FIRE DAMAGED FLOOR JOIST 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: A seek--4' cal( 5/240 3 Mf See.- 6JrGfr 1/!/A �1U 3 )L4ir; Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: DK - �� O 3 .� ° THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF ANY OF ITS RULES AND REGULATIONS. .4yZfee Certificate of Occupancy - - Signature: FeeTvpe: Receipt No: Date Paid: Check No: Amount: Building 2/27/03 0:00:00 51474 $96.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo t File#BP-2003-0708 APPLICANT/CONTACT PERSON ACTION FIRE RESTORATION ADDRESS/PHONE 30 HAYES CIRC (413) 594-7800 PROPERTY LOCATION 117 MAPLEWOOD TERR MAP 23D PARCEL 164 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /L ,, Fee Paid 5/4/7( �" `. Typeof Construction: REPAIR FIRE DAMAGED FLOOR JOIST New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 074416 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: 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 ssion ....../. .7:-:-.---409, e' 24. 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. ILL 1J CUUJ 1J• 1 I J11'Wi1 r-IVJI-1 1rll- C` • City of Northampton ... t`A �x4r ' `�: �', •s ;1 - —. IIn Depart n�ent ti 4 aFlv r L _ -�" • %''iF `r .,', �LIIII p f ". *T� .-.4s:,, ..•.•^,. r �fr. 1'.7 `lil �SSy III ..--,212 'Main Street 1^n '\ S -�•� .,.,.c.., ,I. Room 100 • 4,-1 ,' w-. , , = • * .�fi, 2r'kj orthamptori, MA 01060 ',4,;."c FE—p�o`he t113.587-1240 Fax 413.587-127P ,•)e •� ri211 :-:l �• . ..L-i ^rfti ,1r�.-,.;?r,--, ra -.tiIr; APPLICATION TO CONSTRUCT-ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE {NFORMATION - .. .r,-.This 10 t lire.' rt'id,li?Y`'Pj1ic0 1.1 PrO re rerty A dg s�, 1 r� r!,.r;';` ' • //11��//j_'[ /"� r✓ �r• Zon•c �" ,. V r; ,�r.i !strict .4,' �.,. iti rim.It, bistrict. ••1- `"a'' , -(';ga D7iiiisL..._ _. SECTION 2 - PROPERT-Y•OWNERSHIP/AUTHORIZED AGENT'- ( _ • .--_-.. w 2!1 O ,i r of RecQ_rd_ • t Ai• S wiiNk ) - P el Si�etr 19r. (�+, yia t Nene LL4 ( _J:ea\ i,i Addrob• • t. 2,�ur� - /31l - 144-34it ORdi ) '-- 2.2 Authwmed_Agent, _ i'brJ h're., �r 0 3a N vier C . _e 1,., ,-op. •. /mow- rJa;r,P t 'irrT) r'I.'r;nt Mai!iri€kinr;as 5- ,Ifnoture _ . . feleph,inr•. SECTION 3 - E-STIMATED CONSTRUcT1ON COSTS • --Item - Estirrate Cost (Dollars) to t'P ` Official Use Only _^ ---_ COrr',p.,etec by perrni ur1:Irsri 1 - '.. et;Itdiri r ,5�/� ��� I (a) Eiuil�lir,g P�rml>: Fee - 2 Eleclr1C.11 • ; (Li.) stmiatac Total Cost Of --� o _ _.. ` Construciion from (( ) ,- .._ ,i. Plumbing gel apt' Building Permit Fee —1 'I 1,4rihiiiliCa}I (1(VAC' "ao . g rirt 11rmectinn — —.., -- n, Total - (1 + 2 t ' 4 t 5) f 9. a?,�d T,. — 1 (hCck Nut br r _ �I�77'_ ..(� ••--- This Section For Official Use Only __ Suildirig Permit Number: _U Po — 76 ok.te ls:,ued:___ _� _ __.� , Signatuie . . ._._ .,___ . ._ 6►litdirlb CbinnoissionerJlrmiecter of Ruildirigs q:,te _, P'.a lc'JFA9APtaIF,:nI 208L b6S 2Tb 1 S ?kd1SNI SdI. NOI,Dd:WOdd GO:60 2002-6T-SB4 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 (0 Bldg. Square Footage izeo0 Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces 2- Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO V 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"G13-17—C✓Jl`JJ 1J•10 n 1NH1 I'1U51•'1 I HL 1Z1t'Jb17'J(.S.( .v ' '' "l dROP05Di%YV fC. chklal.ab�Iic�aBl' x: '„ ' ;10P-� `.,r.; ..,;p..:.:! •SV.• _ •MM'�.cl - — New House D Addition D Replacement Windows Alteration(s) 0 Roofing 0 Or Doors Accessory Bldg. D Demolition0 New Signs [ 1 DeckS ( j Siding[ ] Other j 1 a.Sc:sz 'bye —Co -r;0-'e- Z r, +if r��nl-^ Yna-k�+mac s za.S C Brief Description of Proposed Work: — Alteration of existing bedroom Yes X NO Adding new bedroom YeS , No Attached Narrative C) Renovating unfinished basement YeS .. _NO Plans Attached Roll 0• Sheet Ufri - _ — -- r titdartat 7ci.sttn fi n '.ra re E tieeenli 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. ,w,•, • Maschech Energy Compliance form attached? .. . h. Type of construction i, Is construction within 100 ft. of wetlands? Yes No, 15 construction within 100 yr. tl000plein_.__,_Yes Na I. 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 we l City water Supply •"S;�C`IG Q'��,§+ ' NA�; O 1Z1� ION •''T+7BE'�t]_tYil?�EFED.,�-�'!f�,�-._:::"-� .'vVyt4 gsVE j4ww07.;{rTAppWg$FOR-BUl1 Qt �i-PtRMI;Tr ,I /41 2 S W b ens Owner of the subject prncerty hcroby aUthor'ze Ac k v_l I '1•r to iCl Or my behalf, in -ll I atter relale to w• . /r J=uthorized by thishbu ding ermit applicatiotl. __“.. Sigr,ature • Owner Date , • • A-c-ion .30544rrrrer/Authorized Aptnt hereby declare that the statements and information on the foregoing application are true and accurate, to the brst of my knowledge and belief_ Signed under the pains and penalties of perjury. .�- G A,g. edi Print Narrre -— •- 348nature of A+wteY/Agent pate L2LE0982T2TE:Ol 208L b6S ETO Y S i=id1SNI 3ZIId NOIOWW0eJ SO:60 E002-61-83J TOTAL P.03 • SECTION 8- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ I Name of License Holder : &A(9 SQ�%d1,G(L GS 0-1 'Li 16 License Number tki-"-44M\vv- ' — itAftNC- cSTV lit (-r• 91 t 81 a q Address Expiration Date 4 /3/2.-/ti'O?36, Signature Telephone Rei$terecfxHamemprovement'Co tin actor. , _ 'm .,, Not Applicable 0 --fr.G `ie isro-24riot I 2'g 12. Company Name Registration Number 30 44%1...° Ca+a- CLw CO ( — KiPt- 4(vi (o 3 Address Expiration Date Telephone +I'31 5 c)c) 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 I. ®ome wner xe mp o 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 arid/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 l (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 • "—`- 3 The Commonwealth of Massachusetts . ek... Department of Industrial Accidents r r==_ -- O�ceof/nres!Igat/ons 600 Washington Street?'� Boston, Mass. 02111 -` i Workers' Compensation Insurance Affidavit sa4i1( :ois+.)i�(t}.��! 1°CfJif.: _ ..". 4 ;:r'; :,4:t v fp)`;7 name: j/1 . !JF ► i'i t < )e,►t 7-11—G : A,DJ3ri 4Ao± 1)►1 /'. 2 f fiE5'l/2--4'1-i C;Lt location: t< U is/14, /r t.5 ( , c.[ E. city l —L1 L�lS F )(1'19 U 1 U r.0 phone,/ 9/.3- c% ii "7 P a O I am a homeowner performing all work myself. O I am a sole proprietor and have no one working in any capacity piz I am an employer providing workers' compensation for my employees working on this job. „.,___. company name: rn.�f.w..�45 ' -I- k © .A.- Lue. _ (� � 1 CjYy at F S r :'c' address: t ( 7`tr�v Pt eS l �►Y -,. 01 D city' P..,_./ e_ f E_ phone# < \ l Jam`/c/ — insurance co. F�f v►+.-e. i.t.ply.� /?rl' / f . lii.► i policy# ` 1.� - C / ,.t� "- 1 O I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address; city: phone# insurance co. policy# company name: address: pity: phone#: ;nsarance co, policy if y5 .( ''StiItitq in')1.1 Lr,it .,_/:):, Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under theth painsns and penalties of perjury that the information provided above is true and correct. ` Signature � ) /'.�-er--- / � -, Date ' I �\ . Zlyi 0 Print name L5-u 4.t ! 14 )-i4 / / Phone# t/f 3 ' �/ 7 re o official use only do not write in this area to be completed by city or town official A i city or town: permit/license# (Building Department Licensing Board • 0 check if immediate response is required DSelectmen's Office t 0Ilealth Department ,r. contact person: phone#; 0Otlicr (revised 3/95 P/A) • ✓e m w a/t% a/' A e oT ' l— Board of Building Regulations and Standards License or registration valid for individul use only _- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' � Registration: 112812 BoardBuilding g of Regulations and Standards = Expiration: 04/27/2003 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Supplement Card • ACTION FIRE RESTORATION ' Gary Brunelle 30 HAYNES CIR Liµ CHICOPEE,MA 01020 Administrator Not V. tEi without signature ✓/e Vanvmanwea/!la a/✓HzaaaclubseeZ BOARD OF BUILDING REGULATIONS F 1: • License: CONSTRUCTION SUPERVISOR . Number: CS 074416 Birthdate: 09/18/1956 Expires: 09/18/2004 Tr.no: 900 Restricted: 00 GARY W BRUNELLE 47 TANNER ST MANCHESTER, CT 06040 Administrator