24A-018 (7) 119 PROSPECT AVE BP 2000 1034
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-018 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-1034
Project# JS-2000-1866
Est. Cost: $8600.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD DENNO 066189
Lot Size(sq. ft.): 1 1238.48 Owner: HALL ADAM
Zoning:URB An�nlicant_ RICHARD DENNO
AT: 119 PROSPECT AVE
Applicant Address: Phone: Insurance:
551 FLORENCE RD (413) 584-0852
FLORENCEMA01062 ISSUED ON:5/19/00 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE PANTRY IN LIVING RM & REPLACE
W/DRYWALL, ENLARGE 1ST FLR BATHROOM,REMOVE 3 KITCHEN CABINETS
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:
�T� � # Footings:
E/ t Rough: gp' Rough: c�,aty(f�,+,,t/ j House# Foundation:
5e
Final: )jK*'4' 17r /06' Final: laa/O1 ° 2
Rough Frame: ok
Gas o fi Fire Department Fireplace/Chimney:
Rough: ---- Oil: Insulation:
Final:4lf'lj 4/9�4) Smoke: Final: ;'_!3K- 6 -,0 - 'd•-1"a
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy. > Signature:
' 4(2‘./1
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/19/00 0:00:00 1139 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
" y. Plumbing ❑ Building ❑ Electrical ❑
%%y*111 City of Northampton
2tir ""BUILDING INSPECTION LABEL
APP — OVED
Inspector t F
Date •
119 PROSPECT AVE BP-2000-1034
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-018 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-1034
Project# JS-2000-1 866
Est.Cost: $8600.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICHARD DENNO 066189
Lot Size(sq. ft.): 1 1238.48 Owner: HALL ADAM
Zoning:URB Applicant: RICHARD DENNO
AT: 1 19 PROSPECT AVE
Applicant Address: Phone: Insurance:
551 FLORENCE RD (413) 584-0852
FLORENCEMA01 062 ISSUED ON:5/19/00 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE PANTRY IN LIVING RM & REPLACE
W/DRYWALL, ENLARGE 1ST FLR BATHROOM,REMOVE 3 KITCHEN CABINETS
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:
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 5/19/00 0:00:00 1139 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2000-1034
APPLICANT/CONTACT PERSON RICHARD DENNO
ADDRESS/PHONE 551 FLORENCE RD (413)584-0852
PROPERTY LOCATION 119 PROSPECT AVE
MAP 24A PARCEL 018 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid I/3J —
Typeof Construction: REMOVE PANTRY IN LIVING RM&REPLACE W/DRYWALL,ENLARGE 1ST FLR
BATHROOM,REMOVE 3 KITCHEN CABINETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 066189
3 sets of Plans/Plot Plan
TH,FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation ission Permit from CB Architecture Committee
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
7,". "..."' ""..
? I/
--......__7 h Department use only
1.1 MAY 16 2 II/City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
DEPT OF$(flP�f IN$^�--�3 Water/Well Availability
NORTH,MPTv.J i, Room 100
.,. 11116° ► +rthampton, 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
This section to be completed by office
1.1 Property Address:
Map ' Ziz Lot / Unit
r�� Zone _Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
°17411 Cl /4474 /19 'e r ' c f 14 IV-c
Name j(4(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
/ ✓ t
Name(Print) i Current Mailing Address:
4
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) 8eco CO Check Number Ni? 0.56
This Section For Official Use Only
Building Permit Number: 73yo-v1oj Date Issued:
Signature: 7„if,e �� S /�� or,o
Building Commissioner spector of Buildings Date l
•
1
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 V YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW t/ 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 t/
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
NoX
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Altteratiop(s) V Roofing ❑
Or Doors ❑ e3glik
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
BrieffDgscri tion of Pro osed Wo �'Ja r 17ve/m1 /*1 L�� r,..)> ''boo ` 4./ Zip 4,�.. 4 '�Z/VW'
41 p t7 edmi i F'0al R0fIffii1 aj+ ✓S.f0ah,; �tA.sUc 3 /cIr4c4vPi 461'1-cir
qI t
Alteration o existing bedroom Yes X No Adding new bedroom Yes No
Attached Narrative IIRenovating unfinished basement Yes A 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
I, 7O,41`1 /4rt1.G_ , as Owner of the subject property
hereby authorize fti Ct'1 - --xi A 0 to act on
my behalf, in all ers r atjve to work au orized by this building permit application.
r oS rf/o ,:7
Signature of 0 er Da
I, AM , as Owner/Authorized Agent
hereby declare h t the stateme t and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the ins and penalte of perjury.
Print Name
O /d' 'O 3
Signature o Owner/ nt Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Spervisor: Not Applicable/ ❑
Name of License Holder : 44.fG ZQio/ �c h/( r 06�j/iff9
License Number
i? l ,a/2.0/1 ao/
Address Expiration Date
/v 'T,-, G'i c
Signature Telephone
4-17411titirdarriiniffaVelitintildriffittoilaP. Not Applicable El
n ./ L ci 4o-C
Company Name Registration Number
Address Expiration Date
h //e c,g-/ Telephone S'7 4 C8 -
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 ❑
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 p-rmit.
The undersigned"homeowner"certifies and •ssumes re o ibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Loca • ing Law n tate of Massachusetts General Laws Annotated.
Homeowner Signature
F �;t ye�yti CriN of Northampton ►
DEPARTMENT OP BUILDI>\C INSPECTIONS 9-11
t=
212 Main Street ' Municipal Building
Northampton, Mass. 01060 r
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
z hh. v
(liccnsedpermittcc)
with a principal place of business/residence at:
3 t/ i Ze J-7 r-e 2J (phone#) 48.5" Z
(strcet/ci ty/stale ri p)
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 working on this job:
(Insurance Company) (Polio Number) (Expiration Date)
( ) 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 Cont.-actor) (Insurance Company/Policy Number) (Expiration 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)
(ankh additiocal sheet ifnoocaary to include info[maaoa pertaining to all conrueors)
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 while homeowners who cmploy persons to do ma irar,,r cowruction or repair work on a dwelling of
not more than throe units in which the bomoowncr resides or oo the grounds appurtenant tbceto arc cot generally coosidcrt d to be
employers under the worker's eompcats atim Act(GL152„5n 1(5)),application by a homeowner far a license or permit may evidence the
legal ctaaaa of an employer under the Workda Compensation Ad
I understand that a Dopy of-this ctatemra t may be forwarded to the Depertmczrt of todut!rial Aoadomo(Office of lnwnooe for the
coverage verification and that failure to secure coverage under soction 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S 1.500.00 and/or imprisoj of up to one year and civil penstties in the form of a Stop Work Order and a
fins o(S 100 A0 a day against ttx
For dcpatmereai use only
G/ Permit Number
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