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23D-195 (2) 22 WARNER ST BP-2003-1200 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 195 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-1200 Project# 3S-2003-1868 Est. Cost: $15200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 10236.60 Owner: O'NETL JOHN F&KATHLEEN B Zori oziT1RT1 A►+nrica.,:t:_(YNETI_ JOHN F 8,.KATHLEEN_B AT: 22 WARNER ST Applicant Address: Phone: Insurance: 22 WARNER ST (413) 584-3610 () FLORENCEMA01062 ISSUED ON:6/27/03 0:00:00 TO PERFORM THE FOLLOWING WORK:ENLARGE & ENCLOSE EXISTING DECK & INSTALL SIDING 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://,6 4,4 fl House# Foundation:I/OL. E S 4 ' Driveway Final: -G2'z 2 Final: Final:ki3/07 Rough Frame: K ,, ,Z in Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:0/C l 1—a a-O 9 41 17 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULAT S. Certificate of Occupan signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 6/26/03 0:00:00 171 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2003-1200 APPLICANT/CONTACT PERSON O'NEIL JOHN F&KATHLEEN B ADDRESS/PHONE 22 WARNER ST (413)584-3610 Q PROPERTY LOCATION 22 WARNER ST MAP 23D PARCEL 195 001 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 /7/ gt5'"O — Typeof Construction: ENLARGE&ENCLOSE EXISTING DECK&INSTALL SIDING New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INAMATION 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 ion v 4/43 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. 1I I ' IVV. _ Deem a e '.,l: k` City of Northampton Status of Perm ti r -�,�0° �x ��� rt Building Department Curt Cut/Dr.vewa per t -� `fig *,; r 212 Main Street 5e e kSepttc A attab 'ty . '..- "!.',..7:::,,,,f,ft', 1-i-lECEp 'oom 100 Water%WeillAvat b l y-" . �,,, w, h pton, MA 01060 Two Sets 0PS_tr cturalYpans 1 ,,•, JUN Zphone 41 , -1240 Fax 413.587-1272 Plot/-Site Plan '� .r��` ,� � `"�,,� as 4 . ' . fir,br 2��3 Other Specify �`-�_� ; i.�.,;, ti .a ., IM'r0 Ito :• • CO STRU T, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING RTHAMPTON,MA 01060 SECTION 1 - SITE INFORMATION 1.1 Property Address:' r This section to be completed by office G .? a 1�tgR/yE� S%. Map (� T) Lot f "u Unit _ /Veie7-/4,7�>V� "279, D /e Zone L�%/!/�' Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT -2.1 Owner of Record: oiaG �o , ?- . ha__'_ /< _s,20? /14#NE-r<.,, cr7 . GG.t'E '.,7.- _/7 , Name;Print) Current Mailing Address: ,t..e., C'—one..�&<v i4 Teleph Signature i 2.2 Authorized Agent: I 1 Name(Print) Current Mailing Address: ! Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars)to be Offic al Use Only comsleted by •ermit applicant 1. Building i; p OG , o p (a) Building Permit Fee E .."cal 401.00 , ©a (b) stimated Total Cost c= - Construction from (6) ___^_ 3. P' robing O Building Permit Fee d. f.' chanica! (HVAC) -- - - ----- 5. Fi-e Protection _ /2/ 1,3-, 6. T;tal =(1 + 2 + 3 + 4 + 5) ies-/ 02 00. D O Check Number his Section For Official Use Only � ,Uvgyp Building Permit Number: 03 / 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 Building Department Lot Size / , �nsy �� g t Frontage Yd Setbacks Front o26?"' (7,1c7 Side R: ,(S L: a/ R: / / S Rear P.? / g C7 Building Height Bldg. Square Footage Open Space Footage cyo (Lot area minus bldg&paved O�� �C) parking) 9 #of Parking Spaces p 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: SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition ❑ Replacement Windows Alteration(s)1 I Roofing 0 Or Doors ❑ Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks fyr Siding Other [ ] Brief Description of Proposed Work:#C,E►OGACCE V. 4kAr/7i5'6 SI4 1 fl. r Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No � Attached Narrative 0 Renovating unfinished basement Yes ✓ No Plans Attached Roll 0 - Sheet 0 6a. lf'New.heuse and or addition to existing housing, complete the following. 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 , 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. Signature of Owner Date d>t_e:c „c as Owner/Authorized Agent h re y declare that the statemen an. formatio on he oregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. >`rliF.F- 1 `B, O 'NE/Z_. 0 � �. O '//E/4 Print Name ignature of Owner/Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : License Number Address Expiration Date Signature Telephone ReiStered Homelmir"ovem'ent Contractor;-, :` � :.,. Not Applicable ❑ Company Name Registration Number Address Expiration Date 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 ❑ _ 11. = HomeTOwncr ExenWt 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 QG.L1 --81� _II%AHrT Ot — b€ (rztti Of artllalnptol _a -rrtB illassacllnsttla �imp,_Il �vt 4-:j• DEPARTMENT OF BUILDING INSPECTIONS -V.V.—M------===--- --- : • 212 Main Street Municipal Building Northampton, Mass. 01060 " WORKER'S COMPENSATION INSURANCE AHW)AVWT I, — — --- - (licensee/pen-ilium) — with a principal place of business/residence at: ---- (phone?:)-- -- (strcdt/ci ty/statc/o p) do hereby certify, under the pains and penalties of perjury, that: - ( ) I am an employer providing the followine, worker's compensation coverage for my employees working on this job: - (Insurance Company) (PoLici Number) (Expiration Date) ( ) I am a sole proprietor, general contractor o homeowner . de one) and have hired the contractors listed below who have the following wor e s compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expirati a Date) (Name of Contractor) (Insurance. Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) - (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (much Additional sbcct ifncocnsrr to inclu&i:fornu:ioc pertaining:o all c_c-.r^adx') ( ) 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 w',.ile beencowucrs who ctnplay, -sons to c:J maintenance,cores: to cr repair work on n dweth;of not more than three units in wt d,the homeowner rid or co the grounds appurtenant therdo ere not Generally considered:o be employes under the worker's circa satin Act(GLl52, 1(5))•e plicatien by a homrowtw for a Gccnic cc pa-nit ntey e. 'erne the legal status of an onnployet under the Worker's Codnpcosation Act I understand that a copy of this etatemdsat may be forwarded to the Department of industrial Attidatt1 Ottico of In.ar.000 for the coverage waif cation and that failure to i xure covcrago und:.r section 25A of MOL 152 can lead to tha imposition of crirnin.l persltics cornistiag of a fine of up to S 1,300.00 aM/or imprisonment of up to one year and civil penalties in the form of a Step Work Order and a , fins of S l00.00 a dry against me. For dcpartmerdal use only _ Permit Number ! - Ivfapti Lot n it..lture --j l —_— .., '` �..., o Licensee/Pa-mittce e • "5 6 -y.); ,41 (City of Nortllm.mtptom )7 `/ s =**=Y ` �• ftilassacttusttts =a��= w' � DEPARTMENT OF BUILDING INSPECTIONS , _`71-i= INSPECTOR 212 Main Street • Municipal Building r ,4 us 1`•`�. Northampton, MA 01060 e' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill)z sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made y 2eCIF:teeal. c e ge r understand the above. (Home owner/resident's si d ature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 6 -/7- Address of work location o?02 I) 9--/e--'/& • • -NOTE-- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. ,t Wo- 1 "0 y6o N 'rzZ TO: FLORENCE SAVINGS BANK & LAWYERS TITLE INSURANCE CORPORATION I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY ## 7 Q 1 h 7 SURVEYOR: r air C.• - L —NOTE— THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY �`iN or —MORTGAGE LOAN INSPECTION PLAT— DALL NORTHAMPTON, MASSACHUSETTS g UER PREPARED FOR #3502 JOHN F. & KATHLEEN B. O ' NEIL fi SCALE: 1 "=30 ' JANUARY 3 , 1996 IAN = HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS �• -1' 235 RUSSELL STREET — HADLEY — MASSACHUSETTS • -NOTE-- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND 1S NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. , -, ,t- 6� �N1 TO: FLORENCE SAVINGS BANK & LAWYERS TITLE INSURANCE CORPORATION I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. 1 FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # SURVEYOR: QA^- —NOTE— THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY -MGAGE PLAT— �F EuL o NORTHAMPTON, INSPECTION MASSACHUSETTS at-ERPREPAREDLOAN FOR 1,0 .3S032JOORTHN F. & KATHLEEN B. O' NEIL SCALE: 1 "=30 ' JANUARY 3 , 1996 14o=u HAROLD L. EATON AND ASSOCIATES, INC. 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