31B-027 File#BP-2003-0335
APPLICANT/CONTACT PERSON WIJNHOVEN ROBERT
ADDRESS/PHONE 1 ALDRICH ST (413)585-5812 0
PROPERTY LOCATION 1 ALDRICH ST
11111.1100 PARCEL 027 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid di1'C2 V'/ ) '
Typeof Construction: DEMOLISH GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved 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 Commission
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.
Department use only
- •ty of Northampton Status of Permit:
Lg ilding Department Curb Cut/Driveway Permit
1\-D
1 �C, U '12 Main Street Sewer/Septic Availability_1 Room 100 Water/Well Availability
_ 1}� . h:mpton, MA 01060 Two Sets of Structural Plans
S" p2h0one 4 3-5:I-1240 Fax 413-587-1272 Plot/Site Plans
• S
' DE' •11NATION , - u T,ALTER, REPAIR, RENOVATE R DEMOLISH bebNE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map 2113 Lot 42 7 Unit
A[vgc,k\ viowl I vimo1>Jb3 Zone late„,/ Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
��� LV�► ;v viva;�., i I�t—�1?ZC�-1 s ` r--1, 11 _ tivvyk
—
Name((P Current Mailin Addres : J�--- aobc)
Telephone
=---------
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
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) Check Number o9�i�0 ip 16--
This Section For Official Use Only
Date
Building Permit Number: 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 E ev (4 \
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size Szcoo Sc -,'C 51"`^e-
Frontage lu 1L siomA
Setbacks Front 1d its" '.{,fttk
Side L: ` R: L: R:
Rear
Building Height (i - k n
Bldg. Square Footage bo u
Open Space Footage
(Lot arca minus bldg&paved / O
parking) b
#of Parking Spaces -111
Fill: N
(volume&Location) 'v
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:_ 14 16
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
—)L
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 X
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 El Addition ❑ Replacement Windows Alteration(s) 0 Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolitions New Signs [ ] Decks [ ] Siding [ ] Other[
Brief: X.)k ption of Pro ed ME. �1,11�V1 Work: �J���J�^�v1N�C Cu� tk�VwX c7 c ol Cl l A,k
Alteration of existing bedroom___Yes_�_No Adding new bedroom___ Yes _— S°No
Attached Narrative Renovating unfinished basement __.__Yes _i( _—No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following: N 1
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 1 �
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT E " " '
1, r\Uevk
,as Owner of the subject
property
hereby authorize _—_ ` S(t
to act on my ' all matters relative to work authorized by this building permit applica ion.
Signature of Owner Date
I, 1'.1klenek t�hk'W eM ,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.
r
- ------- -------
Print Name
4240
Signature of Owner/Agent 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: Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone_
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 *l
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 buildin2 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
�S1tMfp 1 �V'
'•°r c•• )t', 7:7 2 5 2002 Ifs of (Noy-thcil)lpton I ---
• E: / ek fitatendilncrlle•
-,N MSPECIArnitT ENT OP BuiLorNc INSPECTIONS
212 Train Street • Municipal Buildinc
Northampton, Macs. 01060
«'ORI.Q.R'S(COMPENSATION INSURANCE Al 17TD 1V17.'
(li crust c/permittcc)
with a principal place of business/residence at:
A1k4h S�rt ._� ��t� h (J;honc J) $9'S-S0I .
(str=/city/statcfap)
do hereby certify, under the pains and penalties of perjury, .hat
•
( ) I am an employer providing the following worker's colnnensauon coverage for my
employees «'ot ng on this job.
(Insure Company) (Policy Nu_rair_r) (;--pir Lion Date)
( ) I am a sole proprietor, general contractor or homeowner ctrcie one)
) and have his. el'
the contractors hsted below who have the following worker's camoen 2don policies:
(Name of Contractor) (InR nnce.. Compallyi?oUn- Num!'(:) (f-_ pi rfton Date)
(Name of Contractor) (1ns rancc Company/Polic, Nwn cr) (Exrir.-tion Dame
•
(Name of Coturae-tor) (Insufaricc Company/Policy Number) (Expiration Date
(Name of Contractor) (Insura.ncc Compairy/Policy Numb-r) (Expiration Date
(attach:hditiocal c'icc:ifoce .y to include infort oo pctiiaiog to al )
( ) I am a sole proprietor and have no one world.ng for me
(X) I am a home owner performing all the work myself.
NOTE:ply be ew'are that kWc bcc, wn wbo cmplpy pe�ont W d;r <as�ti cam- c m e rtpoir.Voris on I d••elL of
ooe mom tt-to t vre taats in which the boroxr.rvcr rctida or o0 the gro.tod,1ppurtctLr_the.c.o, ex(<r :llY o c,d_rcti to to
cxtployca uo th Is ttcem o ctico Act(GLl52. I(S)),cppticatioo by•bom000,per fc:be d pc,mit ri y c.idcooc
legal rta.n..of en ca:4,loyor uodcr Cleo Woe Cocopocoutioa Act
I uadcrwad that a.copy of thie mtccoc t m„y be coe-wo.re.3.4 to the Dcputa.ocv of Ind.IsriJ Arodmt,'OfLoo of Iruir.aon for tb.
coverage t'mf ettoa and t1Lt f_t1tun to some bovern e undue section 25 A of A(OL 152 can led to the imposition of crimiosl • • a
oodnisuing of a ftac of up to S 1_300,00 and/or ixapri.loarnc%of up to one ytor cad atiJ r xi uct i)the forth of a Slop Work Order •. e
fur,o(S 100.00&thy.pwasi coc
For dcp.runr.al teed only
9)I4joL
ktio /`tap:: Lot
ht
Signart of Liocnscc/Pcnyuucc