23D-164 (5) 117 MAPLEWOOD TERR BP 2001 0421
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 164 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2001-0421
Project# JS-2001-0715
Est. Cost: $2000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Andrew Church 104480
Lot Size(sq. ft.): 24001 .56 Owner: SWIDLER MARK A
Zoning: URB Applicant: Andrew Church
AT: 117 MAPLEWOOD TERR
Applicant Address: Phone: Insurance:
174 Spring St (413) 586-0918
FLORENCEMA01 062 ISSUED ON:10/20/00 0:00:00
TO PERFORM THE FOLLOWING WORK:LINE CHIMNEY SUPRFLU CAST IN PLACE
LINER
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: Q aK
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 10/20/00 0:00:00 1751 $25.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
r
• - . r
City of Northampton
Bui(ding_Department
a12_Main Street
Room.100
Northampton, MA 01062_ .
piton 413>587.1240 Fax 413,587.1272
APPLICATION TO CONSTRUCT,ALTER;REPAIR;RENOVATE-OR-DENOtISN A ONE OR TWO FANtLY DWELLING
1.1 Proper Advil: A i i3' sT =.+� _ 1 n : :1- 01 I "4 elTm
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Name(Pri ) Current Mailing Address:
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Name(Print) ry Current ltat ng s:V -
f1l 'u,1 ,. , S'�G vvc
Signature Telephone
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Item ' Estimated Cost(Dollars)to be 010idlsl.lkrlet4 1
_• ;a
I. Btn d F(.i# g PerOrit Ribil
y � am I. 5 t7
2. Beet/ikat #�/'�y+ y y -d
1`
3. Plumbing .; ?k�lpikrest' -
5_Fire Protection __- -
6_ Total=g +2+3+4`+5)j C E+iltck l nttaar
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, ..ce. _,Y �_ is -issue _
,
1004 ilssi4 litaii !'JM1r 10 ..,, 11111i..: .. • -
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 eye
(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 K. 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 PC 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 K
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:
New House ❑ Addition ❑ Replacement Windows Alteration(s)0 Roofing 0
Dr Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Othe4
Brief Description of Proposed Work: /.cie. J ,s 4 ex..... ( ,y,y f/ /i.4r .
Alteration of existing bedroom Yes oC No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes k No
Plans Attached Roll b-Sheet CJ
`'
a. Use of building:One Family_ V 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 welt City water Supply
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SE ION 7 O Al HORI T 41+TO M rtl l WHEN
off� AGENT f.T 'iA ?F;APPt1E9 F '1 Rmrr
1 Tvt S !D L , as Owner of the subject property
hereby authorize d�O N u to act on
my behalf, i al matters r lative trip ork • rii . by this bu:tding permit application.
Signature of ner a Date 249
I, C,444/"C' " —/ , as Owner/Authorized Agent
hereby eclare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed underJere L1L
ans ofury.
Print N179...,
j(arty�
!�/ . G fp o'tv '—‘1713
Signature of Owner/Agent Date
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• •
- licensed a Construction Supervisor: { Not Applicable ❑
barns of L►cense Holder:.__Andrew Church DBA Chimney Saver _114094.3
License Number
174 Spring St Florence Ma 01062
Address Expiretior.Date
413-5.86 09fi8-
Signe. Telephone
. �-
_ �........_ � c . � .�.,-�.F--Not RpptrosEste D
Andrew Church DBA Chimney Saver 104480
c0 ppai site i _ . Registration Number
174 Spring-St Florence-Ma 01062 7-1-2002
Address FitpiratiorrOate
-Tam_ 413-586.0918
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 tic Na B.
T _ ,
The current exemption for"homeowners"was extended to include Owner-orcumied Dwellin to of one(I) 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 Sectionl0$3.3.1.
Definition of Homeowner:Person(s)who own a parcel of land on which heishe 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 ggrsan who constructs more than one home in two-vear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that belske shall be
responsible for all such work performed under the buildinn permit.
As acting Construction Supervisor your presence on the job site wilt 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)ofthe Massachusetts General Laws Annotated,you may be liable for person(s)
you him 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__._
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FS ttAH
(riff of orfliarnpfo11
9=��i� : raj B assacansette
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF'FIDAVTI'
I Andrew Chirch
(he n5a'l)�rwities)
with a principal place of business/residence at:
174 Spring St Florence Ma 01062 (phone.) 413-586-0918
(streUci tv/state hip)
do hereby certify, under the pains and penahies of perjury, that
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job.
(insurance Company) (Policy Numlrr) (Expiration Date)
i ( ) 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 CompanyrPoticy Numbe) (F�.-piration Date)
(Name of Contractor) (tnsuran=CompanYPolicy Ntrrneer)— (Expiration Date)
(Name of Conractor) (Insurance CotnpanyfPol;cy Number) (Expiration Date)
(Name of Contracror) (Insurance Company/Policy Nomhrr) (Expiration Date)
(mast,additiomr sheet ifr.w..•ry to mein&ioformattoo perwaiag to all O eAon)
(X) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
!NOTE.:ptcaac be aware that whim botncowocra who aaploy pcsom to do mean.•o oomtrvctiaa or repay work on a dwttling of
not more than throe emits in which the homeowac reside or on the trouads a.ppurtenam tbcdn are trot gcoc ally comidesed to be
cnptoyoa under the wodcta'a ootnpeasntioo Act(GLI S2.I(5)),application by a hotornwac far a tiornx oc permit may evidrme the
legal status of an employer under the Worker's.Corepoouiia@ Aa.
• I understand that a copy of Chia rartmaem may be fo e'a.ded to the Dapertmem of leetosrial Accidence OlLoe of Ioaru.oca for the
coverage ec it'scstioo and that feiltuc to secure enwrap uceder section 25A of MOL 152 an kart to the imposition of et-aiaal prattles
000atstiog of a foe of up to 11.300,00 axrtor emprisoa®eed of up to one year and civil pcoaia io the form of a Slop Work Order ma a
fit or S 100.00 a day against sac
pc."ecquurbcceil us only -.-----
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• Permit Number
Maps _—_ Lot rt
ignaturc of Liccnsce/Pcnnitiee