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24A-008 (7) 55 TERRACE LANE BP-2001-0344 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-008 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: windows replaced BUILDING PERMIT Permit# BP-2001-0344 Project# JS-2001-0558 Est. Cost: $4798.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. ft.): 16639.92 Owner: SUCHECKI CAROLINE A Zoning:URB Applicant: Ed Corbett Jr AT: 55 TERRACE LANE Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON:10/2/00 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS 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: ® /0" °_d U " THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA'` ION O ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy ��' �., � signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/2/00 0:00:00 1023 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo w r Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01062 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site 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 --eeeR :4-T- LA-Me_ Map Lot Unit Zone Overlay District_ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S474Af ci Svc)-1 6:c K .SA-- — Name(Print) Current Mailing Address: y y76 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: ���� $ - 77/ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 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 Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) LJ79g -- Check Number This Section For Official Use Only Building Permit Number: 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 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? 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 ❑ Replacemen}Windows Alteration(s) ❑ Roofing ❑ Or Doors l Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] I _ Brief Description of Proposed Work: l.�ntS- 11 14 Vi ! ia_f/4-ciAvArr P,n1UUuS W f G(7W-E (. J4S 5 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll Sheet 6a. If New house 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 I, ed 6/ n J/i , 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. £7 Lia Print Name ©cr .2 02906 Signature of Owner/A nt Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: —-_ License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor:� ��� - � �_ , , .xr�� .:' Not Applicable ❑ Co ke%1- ,) 049 Com an Name Registration Number e d si .5=-)5-oz Address `_ j ` // Expiration Date J%JO f A ,,&11 / Telephone✓g'7_/c7/ 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 fro LtY/ 11. — Home Owner Exemption 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 �(11Mf pi. ?. � 4'ic+ 'c c O O F t te �If�l of Northampton ► *= tLii h A �d• Alassarlinactta - "'"' 'L. DEPARTMENT OP BUILDING INSPECTIONS , 1 r _� 212 Main Street ' Municipal Building Northampton, Mass. 01060 r''. WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, fel/ 6, - J (1iccasee/permittee) with a principal place of business/residence at: ti Rea s- 1J `7v/J 7%1d- c/d (no (phoned) cgiq—6DS7) (st»t/city/st2i1 J2ip) 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 worming on this job: (Insurance Company) (Policy Number) (Expiration Dale) ( ) 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) (Insurancc Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Polcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attachadditioml aftoet ifnerY- .ry to mchrde information pc/taiaing to all oodroe.or) (144am a sole proprietor and have no one woridng for me. ( ) I am a home owner performing all the work myself. NOTE:plcsse be aware this wtrilo homwwocn wbo employ pasom to do teeirdre•nrr coosruction or repair work co a dwelling of not morn than three units in which tine botnoowncr resides or on the grounds appurtenant thceto are oot generally considered to be employers under tho worker's compensation Act(GL1S2ts 1(5)),application by a homeowner for a license or permit may cvidcooc the legal a area of an employer under the Wockco?a Compomation Ad I understand that a copy of this:saleroom may be forwarded to the Dopartmcot of Industrial Markot•1 OUloo of insert Doe for the Dover verification and that failure to toque coverage tmdcr suction 23A of MOL 152 can lad to the imposition of criminal penalties coos.istiag of a fine of up to 31.300.00 and/or imprisotrmcnd of up to one year and civil pew/ties in the form of a Stop Works Order and a fins of 5100.00 a day againat me. . For dcpartmexaal trsc only Permit Number i' -Z— D© Map# Lot4' -- Signature of LiccnscefPermittee Late