24A-039 (3) -1
48 BLACKBERRY LANE BP-2001-0251
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-039 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: vinyl siding BUILDING PERMIT
Permit# BP-2001-0251
Project# JS-2001-0423
Est. Cost: $5800.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: B & R Siding 100465
Lot Size(sq.ft.): 10410.84 Owner: CALLANDER ROBERT A
Zoning: URB Applicant: B & R Siding
AT: 48 BLACKBERRY LANE
Applicant Address: Phone: Insurance:
781 Bridge Rd. (413) 586-4167 Workers
Compensation
FLORENCEMA01062 ISSUED ON:9/11/00 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
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 9/11/00 0:00:00 17236 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
.�s
Department use only
City of Northampton rtatus Permit:
Building Department /Driveway Permit - _212 Main Street eptic Availability
Room 100 IWater/Well Availability
Northampton, MA 01060 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:
la 5 4J9 o/G 4eit1x 44 ,J i Map Lot Unit
/o1214
11,63 AI Q d 6O Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Pc, r;Ak /f uc - ROAly
/A -e ,r�
Name(Print) Current�I�Yail yi r, 7'6 /s pot, )61‘ O
Telephone 5i at re ' 6 y
2.2'Authorized Agent: Efl4U.N t as4kv l 4640 log)147-pv
efyt , ..svevati6 sffk,
Name(Print) Current Mailing Address:
*/6 2
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ,S—E500 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing ✓ Building Permit Fee
4. Mechanical (HVAC) g �'
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number /-70936
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 E
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 KN
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:
ECTION 5- DESCRIPTION OF PROPOSED'WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roof i 0
Or Doors ❑
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding Other[ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
: Ne bQ.I.Wse.;ate 4 tiditio f't ►e'l'Ci ' t'1 'h J tgi g ft 1 e `..., +4 foilowiiir
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?
. 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, TZ6.43227. C,�//40 8`e- , as Owner of the subject property
hereby authorize i`(/) 0 Z- /iz 4Y 5-i ix.4-- to act on
my b half, in all matters relative to work authorized y this building permit application.
_„ a , - / 00
Sign t re of Owner Dat
I 6ev, 0 /9,4 , as<f r/Authorized Agent
hereby declare that the statements an 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.
EZGO, A) L #6')6 .01
Print Name
....ff:-,244-4.--e 04-- legtp....-erf 1. C7 (:)
Signature of Owner/Agent to
I SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: n Not Applicable 0
Name of License Holder: ER/w?P4 "✓ icy Q a t g 4�
License Number
7�l �624'aite /2O4O 0) ack,
Address Expiration Date
12-7-/{ h-, 73 MA-
Signature Telephone
Not Applicable 0
13'4/d la) SAO /tier 5/rye_ ...z")3 /00
Company Name Registration Number
7 l . 8e, 4 -Pc /j/012--JA41/R3& M '✓ o�
Address Expiration Date
Telephone 6TS- Y
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 f 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 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
•
•
• . E �iip of o flla)1tpfon •
(er AI w.„. r ' • - It 43artf1p1Grtt4
DEPARTMENT OP BUILDING INSPECTIONS — =,
212 Main Street ' Municipal Building
Northampton, Mass. 01060
«'ORIQ,IZ'S COMPENSATION INSURANCE AFFIWAV1T
(li ccuscdpermi ttec)
with a principal place of business/residence at:
1/6/2-4
(st citylgtateap)
do hereby certify, under the pails and penalties of perjury, :hat
am an employer providing the following workers compensation coverage for my
employees worlatig on tins job.
LI Zery 0004/ ,v S wG %34s-10, /79/—0/6 ds..' raocl
(Lasluacc Company) • (Polk:: Nu ni cr) (Lipirtion 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 Co_^.t:acto") (In.urance Coinoanyi?ol1:i Number) (t:x)1rduon Date)
(Name of Contractor) (Insurance ComoaawPo!ic-y Numccr) (Ex-pir,:tion Date)
(Name of Contractor) (Insurance Company/Policy Number) (Exairado❑ Date)
•
(Name.of Cont-ncior) • (Insura= Con IIy/Poiicy Number) (I.xpirarion Date)
(etti a klitiocal ry to cidu&inforca,:ioe pctte;ning to•11 co�r.�Ors) -
•
( ) 1 am a sole proprietor and have no one worldng for me.
( ) I am a home owner performing all the work myself.
NOTE:pros l e ew-are ttle w•t,�)c rxm v_n who employ pezoei w da r-•f--+.-a,"r• rrsair work m.d..cll=g of
pot mocc th c ttsa: ,r in u•bida ttx lurnocnvne roidz«oa the gra_tnrti apllftCblrt thCC.n LT DJ(L`C34-.T.:11y C,Cn(S.:-rd to b
ctplaycs ui d tts:t.o i a:m' -;co Act(G L152.rm l(S)),:_pplicatioo by a bomoowocr for liozax or p uit tong cvidaaoc the
Icpl at..ou of en oxployoc uoC<r 1130 Wor4.ol.Co0.Lr Ad
•
I undrnt,rid thot x copy of(hi.aztem w m.y bo fowled to tbo Depanmerst of In ux riel Aoodoor,'Offioo of Inw•uoo for trse
oovm.se vmjetioo and that f_iltro to sccu c covcrnge tmdcr soatioa 25A of MOL I52 an Icsd to the i ilica of criminal pcasltio
coccir...hig of►floc of up to S 1.300.00 ardor of up to am year rod civil poaaltio is t o form of a Stop Work Ordcr end a
tiro of 5100.00 a thy ttiin t me
For dctrartru—1 u.c ooiy
Permit Number —--
Signature of Licc.n_a•Jpermit cc e