17D-058 \ \ _.
•
, ,
YL _ >
rr
. . T T ------ . ----. 1
5 D
3q o 145
( 12 8 1 Q 8 ,,..5.r.
1 6 10
EFL � ��
0 6 4
111111 -
f 4 2_,' °
162
a 42 2Fr /B
o 1020 _
�� -
11 �1� - a
1 Fr /B
17 12 1 - 2 ,, 15- Sfie-PS
4 B6 f
8
n., 0,r,
Basement
1 iiiilD , i
i
1
14
1
17'
C i
t 9s, 8:31 >
GaC - cick A C.
Ivdk Sal \e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
, • • • • - • • - • 'roc ess requires that th building departme be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour). a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure ..these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
- permits -in conjunctionto thebuildingpermitissued ,. and _that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Address of work
location
The Commonwealth of Massachusetts
- -- Department of Industrial Accidents
T =tsir ' Office of Investigations
s,l=1
600 Washington Street
e..=1 .,.. t . 7 . _ a Boston, MA 02111
www. mass gov /dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly (�
Name ( Business /Organization/Individual): k , 411n -k- .. c �v / i hA 4�o t
Address: Z`1 1lC .or k J.
Pac k Ails. 111
City /State /Zip: 0 \06Z Phone. #: Cf' C a o
Are you an employer? Check the appropriate bog: Type of project (required): i'
1. ❑ I am a employer with 4.. ❑ I am a general contractor and I
employees (full and/or part- time).*
have hired the sub- contractors 6. ❑New constriction
2.I am a sole proprietor or partner-
listed on the attached sheet. 7. El Remodeling
ship and have n .. �loyees These sub - contractors have g. ❑ Demolition
for me in any capacity. employees and have workers'
working
Y P ty. 9. ❑ Building addition
[No workeis' comp. insurance _ comp. .instrrance. -
required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a heme of�r ?ve xe .cised their__ ? 1- ❑- .?umbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof rep
insurance required.] t c. 152, § 1(4), and we have no
13.
employees. [No workers' j Other /fit "5 0-(
comp. insurance required.}
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. .
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_
xContractors 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Naive: -
Policy # or Self -ins. Lic. #: ' Expiration Date: -
Job Site Address: City/State/Zip:"
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 $1,.500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a frnp
of up to $250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of
Investieations of the DIA for insurance coverage verification
I do hereby _certify under the pains and penalties of perjury that the information provided_above_is_true_and _correct.___ __
d, f .. . _ ate; �0 C
i gnature: J p
Phone #:
- - O ffi c i a l u s e o n l y . D o n o t w r i t e i n t h i s a r e a , t o be c o m p l e t e d by city or town ofic izL
_ City or Town: Permit/License #
Issuing Authority (circle one):
1. -Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _
6. Other ,.
Contact Person: Phone #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : on ' q
License um r
Address � Expire on Date
Lri
Signature ,; Telephone
9.. Register Homeimproverrient.Contractor .._ ... N... ° ,... ... Not Ap ❑
Q.3 i? r; /5 ? ?
Company Name I p Regis ratio Number
• Address ExpiFation ate
6 1,
C.7 ' r ` V •A C Telephone c •C I S�a ,
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 ❑
$ ors-;
The_current_exemption for "homeowners" was extended to include Owner 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 1083.5.1.
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
•mpton *romances, a • � s- Cenral- LawsAnnotated.
Homeowner Signature
•
•
` a
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks IC] Siding [D] Other]]
Brief Descript n of Proposed n
Work:_ 2 ' 4? ( OQ� /
Alteration of existing bedroom Yes No No Adding new bedroom Yes 0( No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa T h F ouse :anti di a ditio ta eidstir a housing, = camolete - tote followind:
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. Masscheck 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
I, 5Ae, , as Owner of the subject
proprtrty
hereby authorize , -CA4A 1YAA
to act on a' :If, in all elative to work authorized by this building permit application.
Sig' . ure of 0, Date
r"`
I,
de M • V , as Owner /Authorized
Agent hereby clare 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 enalties of perjury.
Pnnt Name p -
ignature of OwyfAgent Date
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
Building Department
Lot Size , __...�
Frontage
Setbacks Front
Side L c R:1_ �,. L : _...._.. R t ..'' --7--c
___/ ,-..-
Rea . ._ 2
Building Height
Bldg. Square Footage f k --- % .. _
Open Space Footage , /
parking) ��_
m
(Lot area minus bldg & paved 4. C ��
� m� . �....., �..� _.
# of Parking Spaces - -
Fill:
(volume & Location) _ ._ ______ — —
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW ti, YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW (, /� YES 0
1 g
IF YES: enter Book , Page' ? and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 4r DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued
C. Do any signs exist on the property? YES 0 NO 011
IF YES, describe size, type and location:
__ ._y_. —___ - "D: AF t e - e - " ro `osed`c an es to or a.:rtions o sf �ns Tien ed oh
r - te Property YES 0 NO 0
YP P g g � - �P P Y?
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 0 NO rj��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
.
p of Northampton S ,. � 4
k
U� Buildiri9 Department "t
� 212 in Street Se � . e k u .e . ` , es
'S i V oom 100 ` & i i l�i .4 ` M i l
)\‘.) '`, Northampton, MA 01060 „`w° ., S "� i ` � "
phone 4'(3- 587 -1240 Fax 413- 587 -1272 �4� si W ill f0ii.*F l
�" o°? „�, off, , _9 _
' amt u
APPLIC 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: .
/‘ Gar f tad ( Q ° + Map Lot Unit
n ote-46-e- /fns 0I° L .Zo Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Ow er of Record: s
N aAct p, .s- _ _H”- "-'"-`! ... - --J V ie 1_,� _ aCl 1Jl(t{�
Na . /� /— Current Mailin. Address:
., /5 CGc!` "(l Ae
Telephone 4, , 72z a c-e.,�G fvt c,, ujOG 2
S •nat���'
2.2 Authorized Agent:
�j LA (0 es Chn 2 i /.1 r. 4-- 1Jor4 Lil f✓�I6(
Name rint) Current Mailing Address':
� Signat Telephone
SECTION .3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ci'e.`' -r + (}", (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) " COO.,, (x) Check Number ?'/ �✓ "'
This Section For . ciat Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings__ Date
l
I
File # BP -2010 -0461
APPLICANT /CONTACT PERSON JAMES FINN
ADDRESS /PHONE 21 HENRY ST NORTHAMPTON (413) 584 -3272 O
PROPERTY LOCATION 15 GARFIELD AVE
MAP 17D PARCEL 058 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin 2 Permit Filled out
Fee Paid v'
Typeof Construction: CONSTRUCT 2ND EGRESS FOR 2ND FLR APARTMENT
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 FfJLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F MATION 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 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.
4
BP-2010-0461
GIS #: COMMONWEALTH OF MASSACHUSETTS
V CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Peinr;t: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
category: BUILDING PERMIT
Permit # BP- 2010 -0461
Project # JS- 2010 - 000634
Est. Cost: $5000.00
1 cc. 555.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
t =,e Gr oup: JAMES FINN
Lot Size(sq. ft.): 11717.64 Owner: SHERMAN RICHARD K & KATHLEEN T & RANDY R SHERMAN
TRUSTEE
Zoning. URB(100)/ Applicant: JAMES FINN
AT: 15 GARFIELD AVE
Applicant Address: Phone: Insurance:
2 HENRY ST (413) 584 -3272 0
NORTHAMPTONMA01060 ISSUED ON:11/5/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2ND EGRESS FOR 2ND FLR
APARTMENT
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 Signature:
FeeType: Date Paid: Amount:
Building 11/5/2009 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
•
„ .
:..___„,,,.......,
Roofing
6 Line St. Estimate Date
Southampton. Mu. 01073 5/ 1 h /2t)1 1
Phone i41.1, 527 -477
fax (41 3);27_s..160
Name / Address Job Location
Kathy Sherman 15 Garfield, Ave.
15 Garfield Ave. Florence_ Ma. 01062
Florencc, Ma. 01062
(41 3) 586 -2176
Terms Rep
Estimate valid for 30 days Days
Description Total
Remove c,x ititic1 rook. 4.100.00
Furnish & install aluminum drip edge. pipe flashings. chimney rlashim:s and step flashings.
Furnish & install new lead counter !lashings.
Furnish & install CertainTeed Winterl.auard ice & water barrier al„ng rave..
Furnish and in .rnihrtic underlay 11 111 ever existing deck.
Furnish and install 3)) rear C'crtaut Eeed Wno,l.ticapc time. shingle.
1= urnish and install Ccrtaint ced approved ridge vent.
All exterior reeling related dehris to he removed by R.C.1. Roofing.
All work v -vill he perforated according to manufacturers specirications.
3)) year Ccrtain'Ceed material warranty included.
All related permits will he obtained by R.C.I. Roofing.
Add h2.50 per sq. 11. for wood flecking replacement if needed.
WE LOOK FOR\VARD"IO DOING BUSINESS WITH YOU
Total .$4.100.00
TERMS 00 PAYMENT j �'! • ')
s'/ Deposit 1;' A
Customer Signature i - / 77.
Balance alma c�tiinplrtii ��
Registration t4 120235
Construction License # (174334 ` —_/ / -/1
Date
Insured by lianas & Fickert Ins.
(413)527-2700
1
SE 3 • ONST,R'UCTION SERVICES
License:! :onstruclion Supervisor: Not Applicable 0
J K2 . 1) E l [ s I
License Number
0 • ct . •
S
Expiration Dale
elttnhone-
ugistcr:: Home Improvement Contractor: Not Applicable ❑
ozi 126235
+'' 0 Registration Number
5 -ate
— — Expiration Dale
��QS.11Ji.3171 Qn. J_a_L_01_ 7 3 1elephone(11i3) C 5
SECTION IG WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
,crs Asa :.o . , ns:ranc.e affidavit must be completed and submitted with this application Failure to provide this affidavit will result
tfi, !ne. issuance of the building permit
,aerie;, `r'e_> v"3 No E
l 1. - 110111c Owner ExemptioI1
... "1' e:',Ttion for honwoAv-nCrs was CA1efded to include OWn4r- Occupied DwellinES of one (1) or two(2) families
homeowner to engage an individual for hire who does not possess a license, yrQYidcd thAt tht onnt( A$1
.ullcrvisor. ('AMR 780, Sixth Edition Section 108.3.5.1.
'.)..flnitinn of 1lomeowncr: I'crson (s) who oven a parcel of and on which he/she resides or intends to reside, on which there
ntcnded to he, a one or two lankly dwelling„ attached or detached structures acccssoty to such use and/ or farm
A person who constructs more than one home in a two -year period shall not t)4 CQnsl{tcred a hOnatior. ecr.
shall submit to the 1uilding Official, on a forth acceptable to the Building Official th #t Wshc shall bt
11,-.ponsible for all such work performed under the builctinp permit.
,ictinti, Construction Supervisor your presence on the job site will be rcyuired from time to time, during and upon
, , of the work for which this permit is is
he advised thus v with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
(n; injuries not resulting in Death) oldie Massachusetts General Laws Annotated. yQQ WAY tot ltAbly, for person(s)
;•)ero:rn work for sou under this permit.
"ihuncovvrCr certifies and assumes responsibility tor compliance with the State Building Code., City of
l cs, Matc n of Local %,onint ws and State of Massachusetts General Laws Annotated.
urco„ncr Signature .L .3 -C,I le -
ra.4* ,
1
4
1)1 (_,,1)1i/i1))1 k 811J1 j
1/11110r1.(11 /ICC/de/11S
OJJit 0 In ve.slititic)ris
6,
ir
600 11 lshillgti)11 ,treet
ll()st()11, 41,1 02111
oi-J..cr Compensation In surance litlilders/Contractors/Electriciatis/Plumbers
\iiidic,w _1 ft)rina(jon Print Leiiblv
C.,)
I ) 1) () t 1 C ■'; - 1
(...110,:k the appropriate box:
Type of project (required):
ritti cicrd Cl■ffirik:tor and
ha\ c Hired the stil)-,:ontractors LonmnatIon
parl_t •
' Ilt
listed on the attached sheet. j Remodeling
,
empio.e.es These sub-contractors have ti. Demolition
employees ami have ■vorkers'
(,) Building addition
c.c.)mp, insurance.:
,
H \\ e are a corporation its I F_Jectrical repairs or addition .
:L.c.n. •
orricers have exerk.:Ised their
, doliq,..! all .ork I i J lumbing repairs or additk,n
ri12, empon p
ht oreNtier
2.[2 repairs
c. 152, § I (4 ), and \,■,e have no
emplo,s, ces. iNu .'ork.ers' ()Met
comp. itirance required. j
;■■,;;; rth 4? mg their ■■(irliscrs' eurripeririariori (111i
.11■1■Iii■ 41444441,i aii arh; thcn Ht( mitsidc corittrictor, trtrriiit 4 I4 an ittLlictsti such
-; • Nbeei \ (Ng name o! thc. itit Ins1 slide “hether 41 ((444 Iht/Ar havc
CHIph We1 MILS( 4)4)44 )d their , ...trfASCIM il)(1144 'ih)4 /Cy nUlllt
pr,) vtriin;. compensation insurance /ur Iffy CIII,Ol(Tee.r. iCelOW L thc aridjiit) site
n
5'3 0 35 L.xpiration Date: - -
15 owe__
;;;;,.1, the workers' compensation policy declaration page (showing the policy number and expiration date).
required under Section 25..\ 01 M(;[. c. I 52 can lead to the imposition olcriminal penalties (i:
,..• ,ind or one imprisonment, as \veil as cl \,i1 penalties in the loon tit S1 WORK ORDliR nd it
ilt.1,1141St the \ lie advised that a ,.,op\ of this st.ttemeni :nay he forNvarcicci to the Oft o1
rt)l.:\ :or :nstirance coverage elltIcja(1011
'1(vc/4; , (1 rI,Icr thcyains and penalties 01 perjury that the ilyorrnation provided above i.s• true and correct.
1.2311Ci St
5; 4))4 not ■crtte in this itrea, 10 he kw/rip/ere(' hI' city or 1() 'fl
.
.
______
'[ P T\�N� � |l� YCR)PT)ONOC PROPOSED WORK [k U[a
/8L��U��Oh\H` �----- `'_r�~. |
—__—___-___ _ ___ /
__ , _____—
�/�Hoos, ' � Addihon | ! R�p|�comcn�VVindo�x Alteration(s) -- R � '��
�—� � v» nQ [Vl
Or Li � ' i
[
— Doors __ __-_� |
.
�_
2.c�.,u� :,.. .`: DrmnUtioc �-_J New Sig |[]) Decks ![] Siding (1:3] Other [01' '
-__ __'---_
- - -_
� __'_ ^ ___—
vcl, No Adding new bedroom _ _______ Yes ______wo
.ftaos`c :/"../'," Renovating unfinished basement __ Yes No
q/�» : 3o/� Sxco�
---
:;~ If New|}DuSe and or addition to existirq housinq, complete the following:
' u/co/xr*'.0 One Family Two Family Other . . .
, �."`u" ."'uon``.v each family unit Nurnber of Bathrooms ^ .
� cso' H`/n,;,o*mcd"% .
� '`r�o^.„: :c..^.c /anmOr of xe*cons:vo*n Dimensions
Fireplaces or Number each __'_ _
`o`` — ',~.,^^v :',o'^ masuchoc* Energy Compliance form attached?
'r�x:.. .�� ',7,0 : of wetlands'? ___Ycn No |n construction within 100 y Vocdp|uin Yes No
3con .! �ucrwm or cellar 000, below on/shed grade _
v/'x�c., ,. �on/Gnm/utnc Building and Zoning regulations? Yes No
Septic -^: -, _ City Sewer P^vaoe°eo ___ �uy.a»:r3uvP|y __
___
---'-------
SECTION 73 DWNER AUTHORIZATION 'TO BE COMPLETED WHEN
ov■wERS AG/ NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
______ /
e8u4_6_ __--__' ______ ______ .ouO*mm/u/�ewubw°�
`�pmy --...1 ,
`,'co' o"��'', _ ` ~� - ---
^' ` �, ` r / �� ao �n xr� � ,�oovc to m's�u/�mg permit application.
|
^� — -. °
„5z1I -- — —_
-\
[ �� au lL . as � —�—^"� `--~�~�^ ������ and information foregoing xn�ligation are true and accurate, to the be�o{my hnov�wdq^
.gr:`nc,r' '""`` =—' �' ^'`^'~''~�— -"
..::uo|/er `
signed unu,:,: c pains and penalties o! pequry |
NA~ ■_ -T-\ / ^ ' \
___ �
, .
,,, -.,,,: .: 2,:,,N1,., ,‘,; H■.7,,i71,1;10p, muy, ,.',e ,,' .-,)(7,,,,. Permr, Can Be Denied Due To Incomplete Inrormation
istIcig Propised Required by Zoning
1 l'his column to bc fillni in by
liolkimg Department
I .
1 ,
. ,
. + .
-t- .
i
'..:.1‘;■.• I.. k. 1 . R .
■
; ! !
!■.,,c„li
! i
— 1!
7 ' 7., • ,777777' i 7)0t,tp.' I !
— ---
:•; 7 77,7)',;■■,;(: 7 o 7
7 !
, . —77.7 77.7 7, 7)7,7,7 , 7 1 !
, .
---1— I
I
7 , 1
.", Hctl■ a Speciat Permit/Variance/Finding ever been issued for/on the site?
,•;(0 0 DONT KNOW 0 YES 0
.f: YES, date issued:
1 ' T LS: 'Vs the permit recorded at the Registry of Deeds?
..;L.) 0 DON'T KNOW 0 YES 0
-iori. Pagel nd/or Document #
'‘he i,ito contain a broo, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, bas a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: ,
aly signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
Are bee any proposed changes to or additions of signs intended for the property? YES 0 NO 0
H YES, describe size, type and location:
;r,e ;,cnstr„ction, activity orsturt(crearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
!!'7 A.771 .:Is:urt over 1 acre' YES 0 NO 0
t
i; Pit 1,
41 9ti. 1 4 ' y o orlhampton StittA or I
44 41... .
, ,,s . e i■ ,a, 1 t . . 4 ,1 . , . . ' 0
ouil Department
. '1 ,1 - . i 1 4 . 4 ...,... ■ *I* • r , i
46 7CP C 4C) va 4. I 2 Main Street ,
SOW i
r ckv
.,H, ,`P :`;'..• • . ' - ' ' ,
' .
Room 100 Oltr,r A '', .., : ' .
Northampton, MA 01060 Tte. '''..$ .•.1- ' ' - ' -.
_
phone. 413 Fax 413-587-1272 PlOtl:', • Oh :fi!, eit '-••,-,••.i0,,,,:, .;'• , ' •, . ' . 0
? Sp (...„(: ..• 1 „,u7ror+ir-,11-c.v°,.# O. - V.,N ' ri , ,'
Other od '1- 0° Y4 4 -4 *, •44;,„4 4,4 ,• -
,...-4 .4:,....4- 4 . , 4■Vh4..t.:*1 , . , 0... 0 %..,.. ,t2
. '
A PP. C AT ION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
S ECTION 1 , - , TE INFORMATION i
. .— -------.__ ------------
This section to be compieted by office
15 G10,..cCIt_. ck.:)e- . Map • Lot Unit
zone Overlay District
•
EIm St. District _ C� District
-'• EC 1.0N i.' - -ROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 CAvner ot '-'corri:
YNO..\ ----SX'e rcr‘.0-0 15 C c.._ \ A 0,4 e . PL oi oteZ__.
's
'am( ':-Anrit) --a Current Mailing Address:
1j3 :581., -Z A
.,:attia(2 il t.c.. Telephone _
SIgnaturo
- -
: 2 Authorize • Agent:
..........._ . _ .. • . a •
',Arne nfl , Current lting -ddress:
( 4115
, _ t
TThip,phone#
i
SECT iON 3 - i•"•STIMATED CONSTRUCTION CO$T$
1 ----r- —
..,,•:-. Estimated Cost (Dollars) to be I Official Use Only
completed by permit applicant i 1
— .
• • ''---- (a) Building Permit Fee I
._)ui,.:Ing ! .4 ck k c)(.. 0 ,
2 Elect:1(7a: (b) Estimated Total Cost of
Construction from (6) -J
3 P(umbin; Building Permit Fee
----- — -
4. "viechanico. HVAC)
i
5. Fire Prole() . j
Check Number /
5 74 3 --- rr — t —'3-5-'
This Section For °filets! Use Only --i
Date
5Oild■hg Pe, — . :',#i..);,e.i-'_., ___________ is$ued'
--- --I
:.;Ignaturt;
. .
____
f i
15 GARFIELD AVE BP- 2011 -1019
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D - 058 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP-2011-101g
Project # JS -2011- 001650
Est. Cost: $4100.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 11717.64 Owner: SHERMAN RICHARD K & KATHLEEN T & RANDY R SHERMAN
TRUSTEE
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 15 GARFIELD AVE
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:6/7/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: STRIP & SHINGLE ROOF
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 Signature:
FeeType: Date Paid: Amount:
Building 6/7/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner