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17A-083 �tKAAf ClftT ii�I F?I Z i2t ,+Zr"tT DEPf.RTIv ENT OF BUILDDtG INSPECTIONS Street ® uilding :INSPI =CTOR 2I2 Main Sweet Norttamptcm, ILA 01060 s LOCATION SQUARE FOOTAGE AMOUNT BASEMENT @ .20 I FLOOR @.50 2 FLR @ 30 FLOORS, FINISH ATTIC, GARAGE @.20 DECK/PORCFIES @ .20 TOTAL.. U 2' 12 S L = TVLA' C-1060 A \-,A I I C1, 0— — EDC-E - ,N/fENT A-; -LE UXrN, The State ofMassachuser allows the homeowner the Fight under 780C 108.3- t o act az hisil Aier construction sur,e. o r. T"-. state darines "Homeo a- " Person(s) who o a parcel on which he/slhe resides or 'intends to be, a ore or twofa;7dzy dw-- a=ached or de:ached strucn-zes accessory to such use and/or f=,-. strucnLires. A person who Constructs More than one home in a two -year Period shall not be considered a home owner." Th e bt d. epaitm- ent for the C ity of Northampton - 7-,-,-ntS any per SOII(S) who seek to use lie home Ov"Mer exemption, to act as their Own to be a that by do so y become responsible for compliance with state building codes and re- The inspe-c-tion process requires that the builldig, depa=ent be called to inspect work at vanous which include foundation/footings (before backfAI). so-notube holes (before Dour). a roush buRdinz insnectiont (before work is carwezje�. ills-ulatdo-h- 4nsz3ectian (if recuired) a--cLa-Emal--huRdin--.i=e--ti.on. The budldinS deparz:ment rc—quires these inspections before the work is concealed, failure to secure these insvections can result in failure to obtain 'a cerdBcatedoccu until the-w-o � -cam-be-insutc-ted- Ethe homeovvaer hires other trades to perform work (electrical, plumbing & gas) the homeowner wEl be r--sjonMA e to make sure that the trades hired sec" re their Proper- Permits in conjunction to the building pe=.U'- issued, and that they get their required inspections_ Failure of the indi trades to serge the permits and inzpecctions as requ— can DEMA Y the prC)j Ctuntil such time as the proper permits anL--' inspections are made 11rderstand the above. (Home PV mer,lresident's signature requesting exemption) I will ca .11 to schedule all required building inspections necessary for the buildi ZZ Pe,=t ISSL:ed to me. Daze Address- woik --- location Office of Incest goons 600 ff izshitr -1 on Street Boston, 11 � 021.11 www.lnass.a ovIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A l)olicant information Please Print Legibly Name ( Business /OrgaiiizationillldiVldLlal): \kqr \V %—a A 4,4 : _3 (o City /State /Zip: r3( Phone : 4,3 J "S V ( e - Are you an employe: ? Check the appropriate box: Type of project (required): I am a employer'with ❑ I am a general contractor and I employees (f ha hired the sub - contractors 6. ❑ New construction ull and /or part - time).`" 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have g. ❑ Demolition working for me in any ca acit . employees and have workers' p y 9. ❑ Building addition I + [No i ❑ We are a workers' comp. insurance comp. insurance. corporation and its 10. Electrical repairs or additions requred.] �. � ❑ officers have exercised their 1 I . Plumbing repairs or additions I am a homeowner doing all work ❑ myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] ' c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below snowing their workers' compensation policy information. Ho meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub- contractors have employees, they must provide their workers' comp. policy number. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: Policy # or Self -ins. Lic. Lc- $��Cp � a2>a /� Qb� Expiration Date: I O sk Job Site Address: 19 Qs_ 5 i\ocg Nc e F City/State /Zip: \N\SX 0 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Inve of the DI_A for insur coverage v 1 do her -ehy terrify- cr-jrder-tlie- Barns -rrntl penalties- erjt that-the information provided abo a is true and correct. op " Signature: Date: Phone Fc = � � — _u se_on L y yDc�_cr.oLrvute�nllzis__area, to_ be completed cit or tow�zoffzciaL - � Town: Permit[ # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cis (Town Cler:: 4. Electrical Inspector 55. Plumbing Inspector 11 6. Other Contact Person: Phone SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor i` Not Applicable ❑ Name of License Holder : s, (�� Licens tuber C,L J '�` t Address t, Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration, Nu ber 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....... No...... ❑ 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 -vear 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable New House Addition Replacement Windows [Alteration(s) Roofing Or Doors ❑ Accessory Bldg. Demoli ' n New Si ns [p] Decks [ Siding [l�] Other [p] Brief Description of Proposed Work: Q I131, 4 T Alteration of existing bedroom ,Yes No Adding new bedroom Yes No Attached Narrative �F Renovating unfinished basement Yes No Plans Attached Roll 6a. if New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other �C> b. Number of rooms in each family unit: Number of Bathrooms VA- c. Is there a garage attached? �N r- I S4 c�pi� rt yfl d. Proposed Square footage of new construction. o? 3 Dimensions e. Number of stories? c � `1 © f. Method of heating? � p, Fireplaces or Woodstoves " 4 Number of each d g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction W 1 '- 1 @&> 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 �a k. Will building conform to the Building and Zoning regulations? X 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 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, �y�, \� �, `� 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 lief. Signed under the ains and penalties of perjury. -- C-i Print Name Signature of OwnerlAgent Date w Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by '4 Building Department Lot Size.. t Frontage Setbacks Front �^ Side L: R: L: R .S'-* 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 0 DONT KNOW 0 YES IF YES, date issued: '7 D - 3 fc.._, IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO (S� DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 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 Q NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Build ding Department Curb Cut/Driveway Permit Main Street Sewer /Septic Availability OOm 100 WaterMell Availability Northampton, MA 01060 Two Sets of Structural Plans Q 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 Map Lot Unit © I - A'n s fyi O' Zone Overlay District 1 b Elm St District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record ` �r e.. \0 ��d c� c.� � Ct Co+c a��V �1 . � � Q� ��C�' y 'NCB • 4 �0 Name (Print) Current I�ailingS ddr� e s:��� \12 w Telepho Signature 2.2 Authorized Agent: Name (Print) 00 Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building ' S ' 4, .--) b sz) (a) Building Permit Fee 2. Electrical �p o ® (b) Estimated Total Cost of Q� Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) R 5. Fire Protection i � 6. Total = (1 + 2 + 3 + 4 Check Number D This Section For Official Use Onl Date Building Permit Number: Issued: Signature: Build i ingCommissioner /inspector ofBud rags °- -- Date Sheetrock 1/2 "gypsum board applied to the new walls and ceiling, fastened with 11/4" screws, taped, coated (3) applications and sanded to a paint ready surface. (Price domes not include garage sheetrock.) Interior Painting & Staining: (Allowguce of $1000) All new walls and ceilings to be painted (1) coat primer, (2) coats finish. All interior trim to be painted with (2) coats finish. One skylight window trim to be stained to match existing. Interior trim: All door, window and base trim to match existing. Casing to be primed and fingered jointed pine. Window sills to be Ix primed and fingered jointed pine. Baseboards to be primed and fingered jointed pine. Skylight extension jamb and casing to be clear pine material F grin : dr m: Install %" ULC underlayment, install Ceramic the and grout. (Tile by Owner) Study: Install ULC underlayment, carpet and pad. Bedroom: install new carpet and pad. We propose to furnish the material and labor necessary for the completion of the above stated work for the sum of: Fifty Four Thousand Nine Hundred & Forty Dollars $54.940.00 Payment as follows: $10,000.00 after foundation backfilled. $10,000.00 upon completion of garage water tight shell (shingled). $20,000.00 upon completion of addition water tight shell (shingled). $5,000.00 upon completion of Siding. $5,000.00 upon completion of rough inspections. $4,940.00 upon completion of Proposal. (Certificate of occupancy) All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra cost will be executed only upon written orders in the form of a change order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire tornado and other necessary insurance. Our workers are covered with workman's compensation insurance. Certificate of liability insurance will be sent to the above address upon signing. Note: This proposal may be withdrawn by Harlow Builders if not a e d by within 60 days. Respectfully Submitted by f Harlow Builders. ACCEPTANCE OF PROPOSAL I accept the above stated prices, specifications and conditions. You are hereby authorized to do the work as specified. Payment will be made as outlined. Date �� ��/ Signature Harlow Builders Page 3 Waldoch Addition Framing;, Install three big foot concrete bases and 10 filled with concrete, used for the addition foundation. 2 "x 6" pressure treated sill, bolted to top of the concrete piers. 2 "x 10" kds material used for first fl. floor joist and header material. 2 "x 4" studs 16 "O.C. used for the exterior wall framing. 2 "x B" kds material, used for second Fl. floor joist, placed 16 "O.C. 2 "x 6" kds material used for second floor ceiling joist. 2 "x 8" kds material, used for roof rafters, Placed 16 "O.C. cdx 4 ply wall sheathing and V? cdx 5 ply roof sheathing. EXTEWOR Ron: We will install a white aluminum drip edge around perimeter of roof. Apply ice and water barrier to the eaves and the low slope roof area's. Apply 15 lb. felt over remaining roof surface. A 30 year architectural shingles applied over entire roof surface. (Shingle to match existing) Install a continuous ridge vent (roll vent). All roof & pipe fleshings as needed to complete. Windows: (Material Allowance of $1,050) Paradigm new construction vinyl windows with 1/2 screen, Low E glass and argon gas. Includes 4 -9/16" painted pine interior jambs. (1) PDH3648, (1) PDH3236, (1) C2436 -2 Exterior Doors: Material Allowance of $450) (1) 3068 #C- 681CL, right hand in swing, 9- lite steel door unit with 4 9/16" primed jambs, brick mould casing, single bore. Installed to new addition. (1) 3068 #C- 681CL, Left hand out swing, 9- lite steel door unit with 4 9116" primed jambs, brick mould casing, single bore. Installed to new Garage. Install (2) schlage entry knobs to the new doors, keyed to match the existing house key. (1) 8' x 7' Buildmark SI overhead garage door installed to the new garage. Sidin : Tyvek house wrap on all new exterior walls. vinyl siding, on all new exterior walls. Wood trim soffit and facia will be covered in aluminum coil stock material. Any caulking that needs to be done will be done with silicone caulking. We will install vinyl light blocks behind light fixtures where needed We will nail all siding at least 16" O.C... (Vinyl siding And trim to match exjging) Install wall vents to the garage and house gable ends Gutters: Not included in this nrogosal NTERI R Electrical: (Allowance of $700) Using existing electrical service and main circuit breaker panel in basement. Install all switches and outlets as per code. To the new addition and the garage area's (Owner to supply decorative fixtures.) eatin : Includes, cutting and installing (2) floor registers to the proposed second floor area. Price does not include any duct work. Insulation: (Allowance of $1,300) Install closed cell polyurethane to exterior envelope of new addition. Install R -38 insulation with poly vapor barrier to the Ceiling of the main house area. Price does not include garage insulation) Harlow Builders Page 2 Waldoch PROPOSAL Harlow Builders 336 Coles Meadow Rd. Northampton, Ma 01060 (413) 586 -0465 Submitted to: TereZ Waldoch 19 Carolyn St. Florence, Ma. 01062 (413) 5844160, C -441 -7830 Page 1 of 3 August 14, 2010 The scope of this project is to build an 11' x 21' one car garage with attic storage and a two story addition to the side of the existing house. We hereby submit specifications and estimates for the work to be performed. All materials and labor to complete. All permits obtained by Harlow Builders. All debris caused by construction removed by Harlow Builders. See attached drawings for details on framing and placement of fixtures. Drawings by Chuck Witham Dated June 7 2010 Demolition: Remove existing chain link fence. Remove Existing one car garage and foundation. Remove partial roofing, siding, exterior trim,l skylight to be reused, interior finishes and framing. All necessary Demolition as per plans to complete the proposed work. S ilt A orl: Remove and dispose of existing garage foundation, Excavate for a new garage foundation as per drawings Dig for a 4' frost wall foundation. Backfdl the foundation to a rough grade. Spread 1' of processed gravel inside foundation area and compact for concrete slab. (Price does not include loam, raking or seeding.) Dig for (3) Piers for addition foundation. Dig and install underground electrical conduit from the house to the new garage. Concrete: Footing : will be 8 "g 16"x 64' of 3,000 psi poured concrete. Walls : will be 8 "x 5 x 64' of 3,000 psi poured concrete with anchor bolts Slab floor : 231 sq. ft. of 4" slab using 3,000 psi poured concrete with mesh. Garage Framing: Sill seal applied to top of concrete wall, 2"x 6" pressure treated sill, bolted to top of concrete wall. 2 "x 4" studs 16 "O.C. used for the exterior wall framing. 2 "x 10" kds material used for window and door header material. 2 "x 8" kds material used for garage ceiling and attic floor Exterior wall sheathing to be %" cdx 4 ply wall sheathing. (fastened with ring shank nails) Roof sheathing to be 1 /2" cdx 5 ply shething. We will build and install double doors to front gable end area of garage All necessary framing as per plans for a complete job. Harlow Builders Page 1 Waldoch File # MP- 2011 -0004 APPLICANT /CONTACT PERSON WALDOCK TEREZ ADDRESS/PHONE 19 CAROLYN ST (413) 584 -4160 () S� (3ACK k Ct/k12l��i C` PROPERTY LOCATION 19 CAROLYN ST i-� (T E -kAka -, MAP 17A PARCEL 083 001 ZONE URA(I00) //RI/WSP o` O T PERMIT APPLICATION CHECKLIST : �, Q ' ENCLOSED REQUIRED DATE ONING FO FILLED OUT Fee Pai Buildin Permit Filled out I "@ Fee Paid T3Meof Construction: ZPA - ADDITION GARAGE & DORMER New Construction Non Structural interior renovations _ Addition to Existing Accesso1y 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 INFO ATION PRESENTED: App 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 Permit DPW Storm Water Management �. ��� /► 23 i Signa 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 the Office of Planning & Development for more information. File # BP- 2011 -0163 APPLICANT /CONTACT PERSON HARLOW BUILDERS ADDRESS/PHONE 336 COLES MEADOW RD NORTHAMPTON (413) 586- 0465 O v PROPERTY LOCATION 19 CAROLYN ST ( !� fkA1 G ' Lti MAP 17A PARCEL 083 001 ZONE URA(100) //RI /WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid T_ypeof Construction: CONSTRUCT 2 STORY ADDITION(1 ST FLR MUDROOM,2ND FLR STUDY, DEMO GARAGE REBUILD 11 X 21 DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 052460 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF_ gRMATION 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 Permit DPW Storm Water Management Demolition Delay Signature of uilding 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. r 19 C AROLYN ST � BP-2011-0163 GIs #: COMMONWEALTH OF MASSACHUSETTS MayBloc t7A = 083 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2011 -0163 Project# JS- 2011 - 000086 Est. Cost: $55000.00 Fee: $91.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group HARLOW BUILDERS 052460 Lot Size(sq. ft.): 10846.44 Owner: WALDOCK TEREZ Zoning URA(100) //RI/WSP Applicant HARLOW BUILDERS AT. 19 CAROLYN ST Applicant Address: Phone: Insurance: 336 COLES MEADOW RD (413) 586 -0465 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON :813112010 0:00:00 TO PERFORM THE FOLLOWING WORK .- CONSTRUCT 2 STORY ADDITION(1 ST FLR MUDROOM,2ND FLR STUDY, DEMO GARAGE, REBUILD 11 X 21 DET GARAGE 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: 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 Si FeeType: Date Paid: Amount: Building 8/31/2010 0:00:00 $91.20 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner City of Northampton Massachusetts. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building y Northampton, MA 01060 INSPECTOR ANTHONY PATILLO BUILDING COMMISSIONER THIS FORM MAY BE FAXED TO: 413 - 587 -1272 REQUEST FOR PERMISSION TO VIEW RECORDS OR HAVE COPIES OF I3OCUMENTS`MADE *PLEASE KEEP THESE DOCUMENTS IN CHRONOLOGICAL ORDER.* DATE: - C� = ✓� MAP: �/ BLOCK: FILE ADDRESS: NAME: ADDRESS: - 6k 7 PHONE #: MASSACHUSETTS GENERAL LAWS GRANT US TEN (10) WORKING DAYS OF THE ABOVE LISTED DATE TO MEET THIS REQUEST. ., _� ` +� �. ''�...�. ,' t �--