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24A-012 (2) 110 PROSPECT AVE BP-2004-0815 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-012 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0815 Project# 3S-2004-1205 Est.Cost: $8000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Paul McCutcheon 062544 Lot Size(sq. ft.): 46173.60 Owner: BARRETT J MICHAEL&SARAH C Zoning: URB Applicant: Paul McCutcheon AT: 110 PROS =ECI AVE Applicant Address: Phone: Insurance: 77 FOREST GLEN RD f413) 584-3352 FLORENCEMA01062 ISSUED ON:2/24/04 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL EXISTING BATH 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: Rough3 N 1 S n11Z Rough: /� House# Foundation: ` r Driveway Final: Fina1S4V—pN Final: // r /�4 Rough Frame: yl� s , l'E71.� -- 11 Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:C/K g 171� ✓ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 2/24/04 0:00:00 5819 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo , File#BP-2004-0815 APPLICANT/CONTACT PERSON Paul McCutcheon ADDRESS/PHONE 77 FOREST GLEN RD FLORENCE (413)584-3352 PROPERTY LOCATION 110 PROSPECT AVE MAP 24A PARCEL 012 001 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 (51/4 dif 0— Tvpeof Construction: REMODEL EXISTING BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 062544 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved _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 ' on alteg5#------ 2 cc-/-- 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. _ p Department use only ) (S lG li 0-1-City of Northampton Status of Permit: (.. ... Buddingl Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability FEB 2 3 Room 100 Water/Well Availability 413-587-2 40 Fax 413-587-1272 ets of Structural Plans Northam ton MA 01060 Two Gt.r phonePlot/Site Plans �. �°.:_ r 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 „C) /'`,43PC.).-V AU- Map 02V//ep /Lot o--- Unit �1''1/4./�AL i i nr�<�t'1.'\ Zone1iv Overlay District 1 SIC Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: jc trci-- . Name(Print) / Current Mailing Address: ' X_ 4../jri ", ,.� ; Telephone Signature 2.2 Aut orized Agent: CC., ,,T,' -71 R-t, 0 C-itv, -)A7 , Ploiko G2, Name (Print) / - Current Mailing Address: i i Z ifttt'‘ '. -- ',$ '11 - C--Z, J Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1•Tk"'''" "': 1. Building 4 4-Yyy CU (a) Building Permit Fee 2. Electrical /cCel I CO (b) Estimated Total Cost of Construction from (6) 3. Plumbing i . a. Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) f , co Check Number &I� —0 — This Section For Official Use Only Building Permit Number: fP0,7 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date • a 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 t LC, I€ Setbacks Front '3O �p Side L: it\ R: re.., L: R: 12.1—: Rear "� q Building Height .,LC Bldg. Square Footage LC( `1 % Li J, Open Space Footage _ o„ ..-- % , . " (Lot area minus bldg&paved " 4� _ 1� C'(S �' parkin) �) ,C_CCi ��;lt=Ci #of Parking Spaces Z- Fill: (volume&Location) i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? 1)(NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT 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. A e there any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: -'44 SECTIO: © fl PR OhSED ORK(checks �at ap'Uca, e) p 5: -,`�T ' .n_•,:J-^°.[,L`r.,�nf. xi ..a....::: .'ez ', ._":, tsJa .'•� -- " y New House 0 Addition 0 Replacement Windows Alteration(s) Roofing 0 { Or Doors 0 ,\\ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: LpinQ, �( . )'V5- .=,; Alteration of existin bedroom Yes XNo Adding new bedroom Yes X No \, Attached Narrative Renovating unfinished basement Yes k No Plans Attached Roll O• Sheet a EWM userand;or.a:dldition_.to d'x stinghousing complex e. tfdcio71owi it: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: 7 Number of Bathrooms 3 c. Is there a garage attached?N_ d. Proposed Square footage of new construction. bimensions e. Number of stories? I liz f. Method of heating? F, t-T . .t - Fireplaces or Woodstoves C Number of each Z 5,496Q. 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 Nc j. Depth of basement or cellar floor below finished grade V) k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer \l,.. - Private well City water Supply 7� fi". SECTIONW,-PWNER,Al7THORIZATION TO BE COMPLETED WHEN. OVfititiS A�GENIYoltit NTRWACTOR APPLIES, FOR BUILDING PERMIt I, �`�i /' *4 -Y4A-- , as Owner of the subject property hereby a thorize (PekFir C to act or my beh. f, in all matters relativ to work aut orized by this building permit application. .:: . i ,),,,i,,,ir () , (- , , .2. ___ I . -6' 1 Signatu , of Owner ifaate I, k t^^// &,,k,.„, --q--- , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledg and belief. Signe der $ pains and pr alti s ofqi rjur . Y ) )1.5 ,fre(Je--- . Print ame(-.1.i - (- _ , Signature of Owner/Agent Date I' SECTION 8 CONSTRUCTION SERVICES . 8.1 Licensed Construction Sup vis r: Not Applicable 0 Cy Name of License Holder : �' � � �>`., C � 0c)Z.<14� License Number c C�� ��� C VI c� 3�nip Address Expiration Date —7 - c� Signature Telephone PIReig stere ..Dine.mn ov_enTer n a e ® -:. _w�.a:�=A. ;i::. 40tA ..;�: 1 Not Applicable ❑ �V1 q,U .C' tcv. v\s-1,,kit ;cc (cc? j e Company Name Registration Number `77 �. s C, (c�,. 11-,s(,c Gil 7) c q Address Expiration Date r4Cf.,<-' Telephone '1 13CC SECTION 1D/WORKERS''COMPENSAT,ION INSURANCEAFFIDAVIT(M:G.Lrc. 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 ❑ ie� r ,teebon 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 • `�T1t O� xO: • Ole 1i of Northampton *--€1 � ri — $ s 6 ,&�aaachnsctls _fL : • • •-.- DEPARTMENT OF BUILDING INSPECTIONS 4 212 Main Street ' Municipal Building ` EEE--- Northampton, Mass. 01060 • tlw''s. WORT ,R'S COMPENSATION INSURANCE AF1111wAVIT 1, . \, \ 0___ R i_iu-L,I,vc.,, ____.. . . • (liccrs_Jp rrnittcc) with a principal place of business/residence at: 9 - -- --- �_l. �i— Q(ciiii �` (phone e'-1= '� (strcc tics ty/S"trat,.J7J 7) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's coinpcnsation coverage for my employees working on this job: - (Lnsuran=Campauy) (Policy Number) (Expirrnon Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed beiOw who have. the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) r • (Name of Contractor) _ (insurance Company/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Companyt?olicy Ntunber) (Exc.iradon Date) (Name of Contractor) (Insurance Comp:,y/Policy Number) (Expiration Date) (attach additional:::--et ifro-cn,r::n inel...-ie inrorms:ioc;:=.-.:int,t:all cx:.:aec,:-.) )}7I am a sole proprietor and have nO one working for nee. ( ) I am a hol7)e owner Iierxorming all the woi., myself. NOTE:plcae be aware that vii--iJc lxcrcowtm t,-ro c., ?Y ir_I s:. ta to it- :rtraanec,a:.:.. m c,2 nici era raif��,,;:_,-;a dwcili ;cf r not more than throe units in maid,the 1•..•-t+:,s re--id.=or on the gr.•_rvis a,.I..A.utcr-aril Ihccto ere not CcncrallY ccr:ii.1rol:o be employes under the worker.crr •=:aticn Act(GLI52,.s 1(5)),app lice tio3 by a homeowner for s lice tx a prrrnit:-. - ^.'.:r._e the. legal ctatiu of en employer under tiro Worlcrls Coroperr.-ation Act. 1 undersuad that a copy of this etata a ay be forwerded to the t)etiartaxrt of Industrial Accident?dire of 1:.:ur■noe for the coverage vcifictioo and that failtue to v:atre.covw•reg,ur4er:'Cake 25A of MOL 152 can lead to the imposition of criminal pc al;:u cocniating of a fine of up to S 1,500.00 ands r impris:rrnar of up to cn:)-zr r.r i civil pertaIli=in do form of a Sir,+Work Order tr..1 a Lr.4 0(5100.00 a day again al m:. For d4u+tm'ral use only CYcrmit Ntlulb r -_•- 2 'Z C� ?.Sap:• iot Sig.naturc Of!.icct:eJPcrmittct -1i. ,.' le�o o $ (City. of NortIantptott )Z =*_ ° /, $L$-::��in r:i Alassacttusetts = 1_ yam--i - = _ _ �=" DEPARTMENT OF BUILDING INSPECTIONS ^4 _'_.= 1 /;INSPECTOR 212 Main Street • Municipal Building 7`,,4 5,.,.. Northampton, MA 01060 . r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis/her construction super,• sor. 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), 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 I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location — SsoN'IP-A-" A - Ito Pve) eja - . FEB 2 3 2004 .. lN� PisEE tAckAt a0 16Ir'A. SUNY—ESF — SCHOOL OF LANDSCAPE ARCHITECTURE TITLE ENVIRONMENTAL STUDIES DATE SOURCE BY Aue- ___ ?L1A- - 0k7.. \\\.' / Z-G.1 ‘ 331 ! k 3\\ 5!),q w` • ,1 i \ l , i )(4---------- ia5-- so i SUNY-ESF - SCHOOL OF LANDSCAPE ARCHITECTURE 1 TITLE ENVIRONMENTAL STUDIES DATE SOURCE BY