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24A-018 (8) 119 PROSPECT AVE BP-2001-0540 GIS#: COMMONWEALTH OF MASSACHUSETTS 4ap:Block:24A-018 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0540 Project# JS-2001-0939 Est.Cost: $7000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD DENNO 066189 Lot Size(sq.ft.): 1 1 238.48 Owner: HALL ADAM Zoning:URB Applicant: RICHARD DENNO AT: 119 PROSPECT AVE Applicant Address: Phone: Insurance: 551 FLORENCE RD (413) 584-0852 FLORENCEMA01 062 ISSUED ON:12/1/00 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN CABINETS & NEW CEILING, REPLACE DOOR W/WINDOW POST THIS CARD SO IT IS VISIBLE FROM THE STREET nspector 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 12/1/00 0:00:00 113 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo T � File#BP-2001-0540 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 ��� Typeof Construction: REPLACE KITCHEN CABINETS&NEW CEILING,REPLACE DOOR W/WINDOW 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 TH4OLLOWING 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 C fission Permit from CB Architecture Committee AL-i/D 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. • 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 161 -r.togre-z-r Irk Map Lot / 1 Unit /1/n41).- `lib,a f l A Uic)G� Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: /(// Kilt 01060 Telephone Signature �-13 CE6 27C 2.2 Authorized Agent: Name(Print) Current Mailing Address: Sign ture 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) 7®G14 Check Number /13 15- 6 ' This Section For Official Use Only Building Permit Number: L5V- 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 X 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 ->S' 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] :�cl,s, Cgdie c�r /t4 w Cei�i+ �e /oc.� a. ; Brief Description of Proposed Work: 1 Alteration of existing bedroom Yes N No Adding new bedroom Yes ' No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet n 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 C RACTOR APPLIES FOR BUILDING PERMIT • , as Owner of the subject property hereby authorize 'G� 17rj�j to act on my behalf, in all matters relative to work autho d by t is building permit application. / Il /C o 0 Signature of Owner Date I, , as Owner/Authorized Agent Y hereb declare that the t tements 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. Print Name /L o0 Signature of Owner/Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : �C/t'hi�✓ Jf 21.4 4 h ©(6 /15 License Number S,f' f71* !4 `-21 /044 /I.. oal Address Expiration Date /Ud/7 4-mf i) j2,4- ca s Signature Telephone 9:RiPtered/laiiiemo Not Applicable ❑ 27-7J'17v /Zado Company Name Registration Number S—ri A04,17 7,J/ .z/i/7,Qa Address Expiration Date /1) I J dJ- Telephone Sao Q 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 No 0 11. on a sOwner e imption 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 sec ttAN y. Crif� oaf Nord ampton ► -# f1 cssnchnsctte V �W = DEPARTMENT OP BUILDING INSPECTIONS _ 212 Main Street • Municipal Building Northampton, Mass. 01060 r"s WORKER'S COMPENSATION INSURANC)I AFFIDAVIT (lucensedpermittec) with a principal place of business/residence at: SS /r�✓0)j ✓Tt, A'Ic 016 (phoneif) 5-0*-G?AZ_ (suit/city/stalcirip) do hereby certify, under the pains and penalties of perju y, that: ( ) I am an employer providing the following worker's compensation coverage for lny employees working on this job: (Insurance Company) (Policy 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.ractor) (Insurancc 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) (attach additional sheet ifnoeceu y to include information pe taiaing to.n ommar..ors) (41I 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 employ persons to do sea m+err coostruaioo or repair work on►dwelling of not more than throe units in which the homeowner resides or cm the grounds appurtenant thccto are not generally ooa+idaed to be employers under the worker's compensation Act(GL152,5s 1(5)),application by a homeowner for a licence or permit may evidence the legs!status of an employer under the Worker's Compensation Act I understand that a Dopy of this mrcmmt may be forwarded to the Dopertnscat of Iodutriel Accident?Ofrioo of lawr.00e for the coverage verificstioa and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of aimin.sl penalties consisting of a fine of up to S I.500.00 andlor imprisonment of up to one ytar and civil peaahtia in the form of a Stop Work Order and a fins of S 100.00 a day against me_ For dial use only Permit Number //� Mapes Lot # —_ ___J, ._. 0 1 — 1 1 a 0 L AG_ L__ a' -r )a(-- cab)h-cks 5r c , , 1116 KITCHEN ./ ' / la C' bt) / [ RING AREA ,,,,,d 4' .. 248 sq ft