24B-080 (12) 56 BRADFORD ST BP-2002-0307
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24B-080 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:ADDITION BUILDING PERMIT
Permit# BP-2002-0307
Project# JS-2002-0464
Est.Cost: $5750.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MANCHESTER HOME IMPROVEMENT 047828
Lot Size(sq.ft.): 10149.48 Owner: LARGEY MEG&
Zoning:GI Applicant: MANCHESTER HOME IMPROVEMENT
AT: 56 BRADFORD ST
Applicant Address: Phone: Insurance:
209 ROGERS AVE (413) 733-4689 Workers
Compensation
WEST SPRINGFIELDMA01089 ISSUED ON:9/20/01 0:00:00
TO PERFORM THE FOLLOWING WORK:CO N STR U CT RAMP
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: ii0L.67
Rough: Rough: House# Foundation:
Driveway Final:
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 9/20/01 0:00:00 1146 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0307
APPLICANT/CONTACT PERSON MANCHESTER HOME IMPROVEMENT
ADDRESS/PHONE 209 ROGERS AVE (413)733-4689
PROPERTY LOCATION 56 BRADFORD ST
MAP 24B PARCEL 080 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ��////
Fee Paid /AZ
Typeof Construction: CONSTRUCT RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 047828
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 Commi
./„.V 2.0 2rDO
Signature of Building Official Dat
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.
E C O �Vf�n orthampton Department use only
Status of Permit:
Bui Department Curb Cut/Driveway Permit
SEP 1 8 2001 2i ain Street Sewer/Septic Availability
Ro m 100 Water/Well Availability______.
mpt n, MA 01060 Two Sets of Structural Plans
P
DE9TDF1 E I 7-12 0 Fax 413-587-1272 ,P' of/Site Plans
NOR1� —__
;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
CAllit..,; 'TEMPI WC) 4 M� f GE� Map Lot �� Unit
570 il? sect Zone lT Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner-of Record:
C Aq-b}fr 1 NF 'SEEN nr 1 Li 6 S "A- NA-Q L. go' <6 (3 M w-1) S t -)
Name(Print) Current Mailing
Address:
.)/2.. 1c
Telephone
Signature
2.2 Authorized Agent:
�►�M-�-,� I`^,.kc Nu STPL4c 2-6G w P J en o s'9
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
5—)7 fl)
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) S) "7 g-1) , Check Number //
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 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 rA"J" Ak
re
C 416 4(,
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 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 V
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No V
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing 0
Or Doors 0
Accessory Bldg. 0 Demolition❑ New Signs [ I Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: kURh) Pct./ (K-e--'s iiiN- 'P(wa'a-t> A P Res
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes ✓No
Attached Narrative❑ Renovating unfinished basement Yes t✓ No
Plans Attached Roll ❑ - Sheet❑
6a. If New h"ouse:and..oraddition 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
/71 L.ar'cJ. , as Owner of the subject property
hereby authorize •` u1/4 ' ( to act on
m .-half, in.matters relative to work authorized by this building permit application.
Signatwe o Date
, 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.
Print Name
Signature of Owner/Agent Date
, •
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:peviis Not Applicableli 0
Name of License Holder : e "" / t4�/4` — D 1.�
License Number
'Le c( 0-4 61 -S A- . 3/ Y o 2-
Address Expiration bate
Signature Telephone
3 3 (
9. Registered 1-1 e Improvement'Contractor „ Not Applicable 0
i 6'5 (,c ?—
Company Name Registration Number
o (1-0 6 i -S tcve,. l q/ a 2'
Address Expiration date
&4 , Telephone `(c3-7 33 C(G T
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 IY No 0
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 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 X
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TI pi,
01-e
9 :8 �x1 of Narilla11Yptan =tk*=• 1�
9 i�t �'�6 4
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DEPARTMENT OP BUILDITIG INSPECTIONS 4 _
212 Main Street ' Municipal Building
.
Northampton, Mass. 01060 �
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, a -9 j"NW1.t+ktE SPA& DOty M a r es 00^-€- .J te/Low
(licenseeipermittee)
with a principal place of business/residence at:
•
20/ (1):3G-F-ems #1'L. w .5012/4-6.COVA -WI 0(0fl(p11one#) '((3 —733 `('`
(blicx t/city/stale/&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:
('li es('.c vrA g?s)s'?I( Lk3 G/ 4/0 z'
•
- (Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietoL,eneral coiln:acr_ei'or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
( - t-kvi-Af_WW Atli (. s '116 7 it (jr, 6 I ci ((l--
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
,r
(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)
(&Hach additional abed if ne-if nerwreary to include information portaiuing to all contractors)
( ) 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 employ persons to do nyinmsne, udio°or repair work on a dwelling of
not more than throe units is which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be
cmployera under the worker's compensation Act(GL152,ss I(5)),application by a homeowner for a license or permit may evidence the
legal rtatna of an employer under the Woriror's Compensation Act.
I',*+.stand that a copy of this cratcment may be forwarded to the Department of Industrial Accidents'Oflioe of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition at-criminal penalties
coosuting aflame of up to S 1,500.00 andrar imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fir of S100.00 a day against me.
For dqurtmoct-+1 rase only
Permit Number
0 Map;{ Lot# _
signature o icc at( i�a isce/Permittee t o
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SEP 1 8 2001
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General Notes Q
a) P-
i . Contractor shall:
A. Verify all dimensions in the field. 0 g Q
E. Obtain and pay for all required permits. Q
C.
Do all work in compliance with state and local --
building codes and authorities having jurisdiction. m
Ape' D. Provide insurance for the protection of employees, O
they work and the public. U
Grab bars to be installed in existing bathroom. E. Guarantee work against defects for one year from
A new ramp wraps about house from kitchen door to parking area at front. frcm the date of its acceptance and that he/she will
A section of bituminous or concrete ramp assures a smooth transition from ramp to new restore, at his/her expence, any work which becomes
landing area defective during this period. Scale: 3/16"=1'
Steps from rear ramp decking connect to back yard. F. Sct- edule for rapid completion.
2. New work is to be finished to match existing. Page 1 of 2
3. Upon completion the site is to swept and all debris
removed. Site is to be left neat after each workday. 02.28.01
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General Notes Q
a�
1 . Contractor shall: O
A. Verify all dimensions in the field. `Q E
E. Ob':ain and pay for all required permits. •E
Do all work in compliance with state and local
cu building codes and authorities having jurisdiction. m i
-0pe: D. Provide insurance for the protection of employees, 0
co
the work and the public. �j '-
Grab bars to be installed in existing bathroom. E. Guarantee work against defects for one year from
A new ramp wraps about house from kitchen door to parking area at front. from the date of its acceptance and that he/she will
A section of bituminous or concrete ramp assures a smooth transition from romp to new restore, at his/her expence, any work which becomes
landing area defective during this period. SCa e: 3/16"=1'
F. Schedule for rapid completion.
Steps from rear ramp decking connect to back yard. 2. New work is to be finished to match existing. Pace 1 Of 2
3. Upon completion the site is to swept and all debris
removed. Site is to be left neat after each workday. 02.28.01