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36-324 ( Q - 7-ioy) (4byq 7(/Aci ty / S 11 i i b/w_ 31')/v3cy07j (469 Mili / l' y --. i 1 i , 1 i -- '01 Ic I" \\\ ':, ■,1 1\ ao 0\ 71 ph'e 1 e sA 1 i _., v: I , - 01/6/7 ricv_/601Y-2,57Kod . _ I , • Cr f arf(iaillpt • 1 �� s f • �Zasaiac} — �o DEPARTMENT OP BUILDING INSPECTIONS 4 c> 212 Main Street Municipal Building Northampton, 01060 r , orlhnmpton, Mass. W'ORIC R'S COMTENSATTON INSURANCE AFFIDAVIT ___ A t{ d ate: - _4- (lice c dpermittect - with a principal place of business residence at: Ur • t- ti . � _ hone') 1 1/3 � J 5 0 sn t /cit-J /stafch do hereby certify, under the.pa.ins and penalties of perjury:, .hat • ( ) I am an employer providing the followJnt' worker's cotnnensaoon cove age for my • employees woJ'tlg on this job. • • (L:sur_n Comczay) (Policy Nu r) (ExpiratSon Date) ( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hued the cone ac ors listed below wbo have the followine worker's cotnpen_sation policies: • oNtone of Contrctor) (Insuranc Company/Policy Numec :) (Expirduon Date) (Name of Contractor) (Ins COMpaav /Policy Nunccr) (Expiration Date) � (Name of Conn (Insu ancc Company /Policy Nash r) (Expiration Data) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) . (anzrh rbecif ncccs.ary to 'netu& infor :La-ion pcta.iaias to ..11 noel - -cos) ( ) I am a sole proprietor and have no one working for me. (>4 I am.a home owner performing all the work myself. NOTE: plesc be ewarc th , .iJc bccocowocrs wbo employ pct.om r-• cs ruoo c (=pair ..•ork on a d..ci ioz, of not meet: th n tSo tata in ubith tbs botnaowoc rcaidea or co the c ouo6 appurtenr tb -do c"-c ooc c-me -41v ocx:d.�ni to be to the �P Y� xS:r -t: ITT- , • - - - Art (GL:! 523n l (5)). = PPliation by . 6omvoQaa fora c bey _ or perms ray e.-idmoc the ic-tpa n,^., of an cn, loyal under tbo Wortcda Coospomatioa Met I uadczttad that a copy of tbia cralceocat may ba fory vrd.d to tbo pcgavtmm! of J"-R •r•ial Acclenss otLoo o f trrur +oo. hoc t6. oovea veilcaioa and th.t L-ih - to aeetuc`eovcra.se uodC soctioo 23A of }.SQL 132 m lad to the imposition of aisnictx1 p"• Ilia corn ing of a fine or up to S I )00 and/or iape of up to ace yr.= end a ti] penal is is t .c form of a Stop Work Or and fin:: of 5100.00 a day aptintt me Q For dcp.rtal tae only - Permit Num es (... ■(ap: -_ Lot . ". !' Si rr of Li ucc L]3te - • ■ �l ` (44 o�� . r , ,. (z#p i f Northampton z / , �� � jtassxclluseffs 1...... c���,.. __ DEPARTMENT OF BUILDING INSPECTIONS , `� INSPECTOR 212 Main Street • Municipal Building W . Northampton, MA 01060 5 e y ei HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction super - ..sor. 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 any 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 tegulations. The inspection process requires that the building department 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 conjunction to the building permit issued, 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 •*e as the proper permits and inspections are made FI;'' ,� ,� i ) lti � ?CZ,d!- -04 understand the above. (Horn owner /resident's signature requesting exemption) I will cal to schedule all required building inspections necessary for the building permit issued to me. Date 2-1;? 5/-0 . Address of work 3 g a� ✓/ ki- 1 location r V. xii )9979 0/06 SECTION 8 - CONSTRUCTION SERVICES r• 8.1 Licensed Construction Supervisor: L ., Not Applicable ❑ Name of License Holder : .1+701'l.t h 4` Or-424r /) 1 License Number 142A--4---1 - C ((9 -37aicA) f ,aL Address Expiration Date Signature Telephone 9:':Regt stared -t me`lit pcairvelur aorta ra t , , " ' w 1 7 7 7 Not Applicable ❑ Company Name Registration Number _- Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G L c. 152, 125C(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 buil ing permit. Signed Affidavit Attached Yes.. ❑ No ❑ :4- 1 ', H o r �W n . ef t o 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 orthampton Ordinances, S . e and Local Zoning Laws and State of i fi achusetts General Laws Annotated. Homeowner Signat JP. .� /27),(LA G./a/ „o r , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House 0 Addition ❑ . Replacement Windows Alteration(s) I I Roofing n Or Doors D _ Accessory Bldg. ' 2K1 Demolition El New Signs [D] Decks [Cj Sidin [D Oth [D] S Jl .n N Brief Description of Proposed /Q K /h.„ tik2 L( �JrJ' u -L Bic. X i ∎Vi i C Ytp Work: ./?7-a Alteration of existing bedroom Yes L, "No Adding new bedroom Yes IV--No Attached Narrative Renovating unfinished basement Yes / No Plans Attached Roll - Sheet .. ,_ +�,., a"' n=om ^mT :'°� , s z taw.. � s �.,_ � � �- wm. � x � �.. ^ "'�:- '.,a;�';�. fi. if Ke lAia i'6 i iii ddlildii 64iiii i c ;:iii► sa cs 6i iiiiti itia laWinc : a. Use of building : One Family Two Family Other ��. (� �j " " `° '- '-'4el41 >� %y -22/ b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? N f i d. Proposed Square footage of constrt tion. / to x l � Dimensions /0 x l0 Z X IL / e. Number of stories? / / / f. Method of heating? N / 1 /9 Fireplaces or Woodstoves J/ Number of each g. Energy Conservation Compliance. 111// 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 L 'flIrA-..Q._ - k. Will building conf rm to the Building and Zoning regulations? A. Yes No . I. Septic Tank �/ 3 City Sewer AU Private well N `/ /City water Supply A SECTION Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /14 cc ICY l{ik +iSt- Eli P 4 : [ 4 ) L ,, _ .► , // _ J — L. 5 , as Owner of the subject prope y hereby authorize to act on my behalf, in all matters relative to wo : thorized by this building permit application. `, /..—I I • ' , s Art . ../ 7 — 0 O Signa ur= of Owner Date 1, , 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 4. ZONING All Informatibti Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing P,SFINd Required by Zoning This col um to be filled in by �5 # 0 40}(21-4•1/4.9gre4 Bui ldi Dn eparent Lot Size z;l: X- X- 7-- q Frontage — Setbacks Front JIB': `ern 1; fit 115 Side L: lI R: L:'' cei R:1 /0 ' ;_. Rear /O a `t) Building Height �! / 0 R it !g-a; " __._4 i Square i I WO Open Space Footage % (Lot area minus 41 & paved l parking) /tJ /Cj A l 1 ' / • # of Parking Spaces / ` Fill: , /J /Q — / 1 / � � (volume& Location) / ` _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO ', / DONT KNOW ig. , .� ,/� YES, 0 . IF YES, date issued: d /`-�- 9 /'tom"" `" : / 7 ) (_Za I c.0 -P-- /cAUL2 S1— IF YES: Was the p ermit recorded at the Registry of Deeds? P 9 ry NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page; s and /or Document # B. Does the site contain a brook, body of water or wetlands? NO CA DON'T KNOW Q 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 P 4 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0:4 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 Q r NO la '` l � ` 4 ' , w l/ IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ` (� ~, wDe , . ,c ` :441° - ;,` - , r l5 t : o rt � ?m pton `tus•:o P i : apartment � � i A. 21 I ii in Street Se wer s v t i l l �1 QS� 100 er ep �� , t-v:! , --= - 441&.,.: 29 or ha ' MA 01060 o�Se s Struct ra lanst " 4-.." -3 r � � fi ( phone 413-587j-124 Fax 413- 587 -1272 P t ot lS�te -P at A L.u._.< , H 41 . DEPT OF nl,ili7 °'VC ire a, � - u.. �. , � � �� ',� ,��.�,,, � � � �.�� C lvaS oth - 6:t eefiy � 1 � � _ . NoR,;_o IAA 01riitJ s �. �wK_ '. _ . , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: n This.section to be completed byoffcce &3E CARD //t/,' L �(.� �7 i Maur s+ Lot_ Unit J ?1 6 RENO C� »/9 0/06 r Zone Overlay Drsfrrct. . Efcir.S District C &.D , SECTION 2 - PROPERTYOWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 4. �) >Y7 l? Atia Na.. (Print) Current Mailing ddress: 4", , 0 /C,G4'j A. i Qmtii l,4- Telephone Y/ -. c 3 — 6 -', : --) ( 1 ) 1 / gn : ture 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone -y SECTION 3 - ESTIMATED'. CONSTRUCTION COSTS l / C e y r 14 (� i;2Al'Y — �/ gh /r�..0 -r1 C / . Item - Estimated Cost (Dollars to be Official Use 'Drily U �� � /0 )e a, c mpleted byo perm a pplicant 1. Building / o Z� (a) Building Permit Fee J 2. Electrical A,/ (b} Estimated Total Cost of Construction from (6) 3. Plumbing /` e. Building Permit Fee 4. Mechanical (HVAC) / / f 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 41 500 ' cr_) Check Number digit )6sra This Section For Official Use Only Date Building Permit Number. issued: Signature: r Building Commissioner /Inspector of Buildings Date Qie.rf CA Vol-f2 * aL/i /62i,24-0i (21242ta atzelie/ r 34 i / CO• -1-- / c7) //t--- Rif/ /7 (f41 i 9 ( t Zz ci.0-42. (4 d�� lam ( C°,„athli7 x /rya 6 , -Aat/a.,,..f,!_tu,„..,' ci.)0_,zi: 70‘//00 ,.....,‘" File # BP- 2006 -0125 APPLICANT /CONTACT PERSON MASAMITSU DIANNA & MICHAEL ADDRESS/PHONE 238 CARDINAL WAY FLORENCE (413) 586 -5504 O PROPERTY LOCATION 238 CARDINAL WAY MAP 36 PARCEL 324 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid dr& Typeof Construction: INSTALL 24' ABOVE GROUND POOL & 10 X 16 SHED 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 INFpRMATION 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 Stree ommission r/7, mss` 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. 238 CARDINAL WAY BP- 2006 -0125 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 324 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: Above ground pool BUILDING PERMIT Permit # BP- 2006 -0125 Project # JS- 2006 -0170 Est. Cost: $7900.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): Owner: MASAMITSU DIANNA & MICHAEL Zoning: SR Applicant: MASAMITSU DIANNA & MICHAEL AT: 238 CARDINAL WAY Applicant Address: Phone: Insurance: 238 CARDINAL WAY (413) 586 -5504 0 FLORENCEMA01062 ISSUED ON:8/9/05 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 24' ABOVE GROUND POOL & 10 X 16 SHED 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 8/9/05 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo '---- 0.7) oi Nartilampion t v ' •It - eli # elk, • 4.) ;* •4„ fer: ,— DEPAitrmiwi• OF il..iiii_DiNG iNspLurioNs '- .- , ..._F ,....... z 212 IvIttin Strer:t - MunicipAl Building - o.. '''-'. • •-• Nort,ituillptor., Ktiss 010O -t,' ,---- \N'On.r(ETZ'S COIYITENSATION rNSUTZANCE tU • I, . k-A . 1, - E - Ppv -e.. - (1..c:-_ witla a princlnal pe (.7 do hei eby cc.r :::::;••• tilt.; :-..,i ....:..0 1)7a:i.i..:-.; of pc-.ryi;) , .iii , .: - ( ) I an 2.n en)pio) ry th.::: foi.lo \ . .nkcrs coinpons:lvoo coverav; for my . en!ployet; woriang on this job, (Las Comp:Loy) ("Fv.!c No.: CE.XDirZti:D bait) ',!..C . )t!"2 ,.. i - j .- 710UleCr.Vots.; (CI,e ore) anc i'.1'...:: :air ed the centraciors listed 5eiovv -,- ::::0 ■:::•.,....,!. :11';.' fbUc.' woks comp.ensuon r.0!::: O Crwred, /4.6. Ca 7-/-455/ (,24e- of Conu.c.o) Ct.r.fu::::Ic.:::. Cc,. ?ot.ic., '.'‘ILLiTit-7. (77.N D2.tc) _ — -- ------ (Name of Col)(17.t..1(7) - .. ',JA-11J o:LIV/PCiiC,' NailiC.47) .... (); Y:,:': Daze) (Name of Coniractol (Da.7,! /2z,5-•?(-‘licy 1‘:-.;).ik,i) ;... Dat) ___.---- (Name of Cor.:rzczci) (IGEs:RrY,`,Z. Coni• Numi (E.-.10 n Dar..e.) 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S ' » i A 2 r�- rCw Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes X No Plans Attached Roll 0 • Sheet 0 6a., : "tl.eYlt; =ou • ® DY ' dilr�on Ic x s ing ousing a e e iiAt ow =i.ng: 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 Nc 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 fl aiftlt ORIZATION 1Y.=t�1 TO BE COMPLETED WHEN iO1E� E fl' CONTRACTOR PPLIES FOR BUIt0 10 PERMI f , as Owner of the subject property hereby authorize to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner 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 'S1 =CTON 8 Co.? SRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : q��0 a License Number Address y Expiration Date _ V3 s 7-3,5 Signature Telephone ° Re: •eree orn' `?.. ®: =ue.. e.r =G. o tractor` = s ..,._.. 4s 3�.,." Not Applicable ❑ Company Name Registration Number • Address Expiration Date Telephone iR3is. 4w1 § 1.. .T YVOR ERS' COMPENSATION IN 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 ❑ 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 thispermit. 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 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 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 DONT KNOW YES IF YES, date issued: 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 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: City of Northampton � .� , s q: � -- � � ' Building Department � � a ilr € , ,-� aZ , 212 Main Street i , . �0 , i, - ;,. FP r b � � � �,�e q � �Y,q -r �'S e�'�"S' � w'ks �1 � '� " " � `" Room 100 i a - , �. , • ` Northampton, MA 01060 , phone 413 - 587 -1240 Fax 413 - 587 -1272 i p t APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH;A (NE,OR TWO FAMILY 11A1ELLING I I- SECTION 1- SITE INFORMATION it.I, F EB 1 3 2004 II : - 3.�. 4 T w f o ,,,t tr '+.o m PIt b 'ic 1.1 Property Address: ,� � , 4 " ; ff iY € , k �+ �^�j a ' fix 1 . 4 �x _T s 4 t q � � '�� �$ Mx "�� ; '"'" , x #� 4� a " fi,- �` r •Z t O Oisbic ,.u'xu yf � '. � n� Mc, '�w �s.�rl+pf*i i x i -µ. � ll x � u 4 SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED'AGENT 2.1 Owner of Record: min '4 1, f'i aka ¢5r S7 f % 4.4g Name (Pri Current Mailin Addre 7• sir S — 3 . ..s' �z �, ", Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3— ;ESTIM CONSTRUCTION 'COST S 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 Numtien [� Q This Section: Official Us °Only Building Permit Number: t ( " 7 ` Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File # BP- 2004 -0799 APPLICANT /CONTACT PERSON DAVID LEPINE ADDRESS/PHONE 262 EAST STREET EASTHAMPTON (413) 527 -3975 PROPERTY LOCATION 238 CARDINAL WAY MAP 36 PARCEL 324 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 5 Typeof Construction: FINISH BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 044188 3 sets of Plans / Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION PRESENTED: A pproved 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 Co. ' 'ssion /!.. LOd 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. r 238 CARD '/AL WAY BP- 2004 -0799 Gls #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 324 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit # BP- 2004 -0799 Project # JS- 2004 -1186 Est. Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DAVID LEPINE 044188 Lot Size(sq. ft.): Owner: LEPINE DAVID M WILLIAM P WZOREK SR Zoning: SR Applicant: DAVID LEPINE AT: 238 CARDINAL WAY Applicant Address: Phone: Insurance: 262 EAST STREET (413) 527 -3975 Workers Compensation EASTHAM PTON MA01027 ISSUED ON:2/19/04 0:00:00 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT 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: Receipt No: Date Paid: Check No: Amount: Building 2/19/04 0:00:00 5 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo '110 313. * 0 3 ere )11/ ')/J NO S /V b/o), . ...N.,.rT4 • /III".. Ilk , I" tio -wr < • ...L. . vi,.., wus . / . ..ti 0 \ 0 co • s . i 1 _2. • f .....„• t t 0 •r :Cei. -''..11-ir€?:1614t,_ . \_ 9%3? i C 4{jS liglIt - •`''" ti31. 1. ' [ , eh *--.4> A, .4-,.... ' - Il l 6 , . \..... illP:z.., .. . - - - . imoki . -',, •,' 3 O.O3 -``.. 1 ``.. �,.. 1„..., i , •_. . . .... 14;59 w -s:-. , r v-- . . . / . . vg0 451 , 50 • • . / ... A.5•q(2 /4 9 013ts r Permit No. 1) o. --0 '7 Conditions: Driveway Permit In lieu of plan approved by City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: P • • ioner Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. cc: Building Inspector p • Permit No. D02 -04 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: July 14, 2003 FEE: $25.00 CHECK #: 5920 THE BOARD OF PUBLIC WORKS The undersigned respectfully petitions your honorable body for: Permission to install a driveway at 238 Cardinal Way. Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the existing roadway. Driveway surface to be paved as soon as possible if the grade of the proposed driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City of Northampton in the event of a washout of this driveway. By: Dave Lepine 262 East Street, Easthampt• , MA Telephone #: 413/527 -3975 Proposed Location Inspected By: ' / U 2 / / Gravel Base Grade Inspected By: Final Approval THE BOARD OF PUBLIC WORKS voted that petition be granted. George Andrikidis Director of Public Works (SUBJECT TO ATTACHED CONDITION 1 & 2) cc: Building Inspector MUNICIPAL SEWER AVAILABILITY Northampton Streets Department 125 Locust Street Northampton, MA 01060 587 -1570 Location: 238 Cardinal Way Lot II 20 Inquiry Made By: Dave Lepine Date of Inquiry: 7 -14 -03 Municipal Sewer Main in Front of Location: Yes g No Size of Sewer Main: 2 " Material: PVC Age: 2002 Depth of Sewer Main: 5' Size of Service Connection: 1 -$ PVC Comments: The City of Northampton has not accepted responsibility for the maintenance of the sewer main and service connections as of this date of inquiry_ A corresponding "sewer entrance fee" shall be paid prior to making any connection to the municipal sewer system. Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. Joseph homas, uperintendent Streets Department cc: Ned Huntley, Asst. City Engineer Anthony Patillo, Building Inspector . � � , , • s � /N3 1 07 0 �,. `> o0 . • / 4 to 0 I tll i, ID Ise -P. ...--- ',5 \ \ P . . ............ • . at Q , so N,„,, 40. ‘ 147 0 (A \ A Pp . 1 ' r ' FIC........._ z:ii 1 N' qs 6 4 PO ''',, \ %-,,Ii?, ...,. _ - g . .1 ' \,,, a38 t r O tit , o Ua 0 6 . LD3 C 'f , ----] 1 0 ..issi 1 30.X03s ‹,.. .,„ '�►.., \:....2.0>•,.. X 05 ' 00 7 4 59 00 n �`4`• • / . • L.1=451 .5O' • ` 74'59 00 . / MUNICIPAL WATER AVAILABILITY Northampton Water Department 237 Prospect St. Northampton, MA 01060 587 -1098 Location: 238 Cardinal Way Lot # 20 Inquiry Made By: Dave Lepine Date of Inquiry: 7/14/03 Municipal Water Main in Front of Location: Yes x No Size of Water Main: 12" Material: DI Age: 2002 Approximate Street Pressure: 72 PSI Size of Service Connection: 1" copper Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. The City of Northampton has not accepted responsibility for the maintenance of the water main and service connections as of this date of inquiry. A corresponding "water entrance fee" shall be paid prior to making any connection to the municipal water system. Arrangements of such installation shall be made with the Northampton Water Department with a minimum of 5 working days notification. All work shall conform to Northampton Water L De artment specifications. 1t ' . N W /Ilt Charles Borowski, Superintendent of Water cc: Ned Huntley, Ass(. City Engineer Anthony Patillo, Building Inspector Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non - Circulating Runouts Circulating Mains and Runouts Temperature (F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170 -180 0.5 1.0 1.5 2.0 140 -160 0.5 0.5 1.0 1.5 100 -130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range ( F) 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure /Temperature 201 -250 1.0 1.5 1.5 2.0 Low Temperature 120 -200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40 -55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R- values and glazing U- values must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities /spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on /off heater switch and require a cover unless over 20% of the heating energy is from non - depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 ° F or chilled fluids below 55 ° F must be insulated to the levels in Table 2. MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release la DATE: 07/14/03 TITLE: 238 Cardnal Way Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R -38.0 cavity insulation Comments: Above -Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R -19.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Wood Frame, Double Pane with Low -E, U- factor: 0.350 For windows without labeled U- factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: [ ] 1. Door 1: Solid, U- factor: 0.350 Comments: Floors: [ ] 1. Floor 1: All -Wood Joist /Truss, Over Unconditioned Space, R -19.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 78 AFUE or higher Make and Model Number [ ] 2. Air Conditioner 1: Electric Central Air, 10 SEER or higher Make and Model Number Air Leakage: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944 L /s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs /ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in- winter side of all non - vented framed ceilings, walls, and floors. w r , Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release 1a Checked By/Date TITLE: 238 Cardnal Way CITY: Northampton STATE: Massachusetts ---""1 HDD: 6404 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non- Electric Resistance) : DATE: 07/14/03 JUL 1 6 �C „3 DATE OF PLANS: 7 -14 -03 � G �N�T t.C(iO Cap PROJECT INFORMATION: , �� � , �R h r MOfiO Plantation At West Farms ._- ----- COMPANY INFORMATION: Dave Lepine Building Contractor COMPLIANCE: Passes Maximum UA = 488 Your Home = 402 17.6% Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U- Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1490 38.0 0.0 45 Wall 1: Wood Frame, 16” o.c. 3220 19.0 0.0 172 Window 1: Wood Frame, Double Pane with Low -E 292 0.350 102 Door 1: Solid 64 0.350 22 Floor 1: All -Wood Joist /Truss, Over Unconditioned Space 1290 19.0 0.0 61 Furnace 1: Forced Hot Air, 78 AFUE Air Conditioner 1: Electric Central Air, 10 SEER COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release 1 a. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% e design load as specified in Sections 780CMR 1310 and J4.4. /7 f,� Builder/Designer G �i/ Date 7 `7 "Z2 _? b. it . . • rcl, � tf. . , .$(4 ,/ N36 - 1. tA � t 6 _ \ ' • 41° liT)) '_L- (f [_. [i / t . 0 t. ,�' / At • !I Jp1.. 16 -fuel �J DL BUILDING .P NS w 29► N . . . e i,,,„ ,,, \ . ,,,,,„,,, , ,, , .., ! La 3a (N solo„ ' ��, iC R`d .� C O l�o� _ r *1 �oo •oo %., %., l i A . , i4 i t Gi ■N 45rN tea' . t • 9�. � . 3� \ - ms s ; - ---:. 1 \S \> . + i ..,..t ,,x. _ - . . s? z i 4' - - _.,11 6. ' } o .00' L30.03 rt ' 8,,.405 7 4 59 00 ' / ,..• 45.00 • L45.5' • • — -� P . = 74'59'00' Dz1. . T:7737 . ' ' 7 doP , , - •. VI: tv- ....,. 4.3114. C1- ‘ i 4, Ccitp of .7.-_, alp. • Altaim•tiliisell• 'II -"" •• I;li ' t=-1"7-1!"- •- S ;.. 7-:. i :::: DEPARTMENT OP BUILDING INSPECT!ONS r,t-il•2-L..-7-7 212 Main Street. ' Municipa! Buift::ng Northampton, is 0106C Square Fc..).:, Arnount Oaserre..-t @ .4g,- L5' f Rqo i f3, SID is Floor 0 4ger 50 I a ?(.) 6,5/5160 2nd Floor @ .& 30 1/2 Floors, AtLic , Garag,i ...1.E.6 74 #1, 75 Deck, Porches .10 *7 '7 575 , . . . „.. . , . . . 1 i 357, 75 TOTL . , • • . ./4';c1,1/2,16...7,...• .. . - , !.. . . . ° emit" + CEizf r of Xrrrilia ltpthn ► _ -t. _ it A ,,, ) P?il A - 1 ��� . ( /'t B Alassachnselta • • _.� w 4 ,� `J : ifs =s_ �� ________:„ '�.4,— DEPARTMENT OF BUILDING INSPECTIONS __' - 212 Main Street ' Municipal Building / Northampton, Mass. 01060 go ,.• . WORKER'S COMPENSATION INSURANCE AFMAVIT I, e--1 1-0(D IA )16.1A)- (licenstecerinlittee) with a principal place of business/residenc.e at. • c (to rS i Sr44I ' (,phone #) V,5-51,)7-3f7,..5 (stxeet/ci ty/state/ri p) do hereby certify, under the pains and penalties of penury, that ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: • (Insurance Company) (Policy Number) (Expiration Date) ( ) am . - - •roprietor, general contracoo ; or homeowner (circle one) and have hired the contractors listed below who have the allowing wor. er's compensation policies: • � Ce srace77au _ 40Maism 45770, a co 1 8- ale -03 (Name of Consactor) (Insurance Company/Policy Number) (Expiration, Date) . s Me ticA /-loge A SSv/ ce 0 LeovC4,CTe wcstpa/ 3 ay (a- • 05 - - eV (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ?t'�i( eo &5 Frio r7.0 �GI e4s P/11.r C45 Kv68 0 3 -1 (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ( i7?I c 6 /ec �r1 /G 1,)c L o 7 /' DV (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ( ` '1 /tf n to information pertaining w aL «xni-actnrs) 5 4 e k A' /U mar 5 co 6 f '2 Vt2 C!r ,Jv � — ao -oy (5 I am a sole proprietor and have no one working for me. ( ) I am a home owner performing / all the work myself � _ j _ kEZAA - +So..�� :4 (•tick, (A , "F ak) y9q os� y . NOTE: p1sa.ae be aware that while homsowvm who employ pcsoat to do toannensoce, ts?auvesioo or repair wade en a dwelling cf not tune than throe units in which the bamoowner resides or cc the grounds appurtenant thereto art not dally 000ridersd to be employers under the wen -keel eca casetioc Act (GLI52. i 1(5)), application by a botneovv er fora license or permit may evidence the legal status of an ecaployee coder the Workers Corpnusatioc Act I understand that a copy of this ctatemmt may be forwutdad to the Ieyurtmcos of Industtiel Academe Woo of Instusoce for the coverage veri&catioa sari that faihs c to secure coverage cod r section 15A of MOL 152 can lrsd to the imposition of criminal penalties oomi�ag oft fuse of up to S1 500.00 allot. imprisonment of up to ooc year and civil penalties in the form oft Stop Wit Order tad a fine of 5I00.Q0 a day tgtinst the. _ Ford er!weo°!y / / O3 t Nu Mardi mber I_Qt , '. . i ,,yy ♦ � of Lt - 4 • ernztttec I t o • SECTION ;$ 40,STRUCTION SERVICES 8.1_I Construction Supervisor: I Not Applicable C1 Name of License Holder : 4L O #t4 kV/4)'C License Number FAS r Sr .. 93-7, /4�d�� A44 ©ioa, D `� �S Address � / Expiration Date / 73" 3 3i7s Signature Telephone 1-i g- ,90o7 �1 aL.,r� xs " :'•s ' " .i(ti 'fin•. Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone _ ,• rJQN 10 WO COMPENSATION INSURANCE AFFIDAVIT (M.G c, 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavi' will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ,al No ❑ I;l {s� a��t�t;n��tlt j.Qca as"o 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 I erson who constructs more than one home in a two- ear . eriod 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( 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• pER1P'T�ON QF PROPOSED WORK (check all applicable) New House f Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors CJ Accessory Bldg. ❑ Demolition❑ New Signs j ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work : (st)577 x77v)? 6 ' 2 a : I. f e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll ❑ • Sheet 0 60f rtdfO i t1 Via' i �r'a to existiif g; :CO mplet rtt5e #oti u^i;n X a. Use of building : One Family Two Family - Other b. Number of rooms in each family unit: Number of Bathrooms 0.5 c. Is there a garage attached? d d. Proposed Square footage of new construction. acr Dimensions t4, 3 (.0 e. Number of stories? +f f . Method of heating? 9 4 5 - is 4i' " ) A Fireplaces or Woodstoves C A S 1 " ' Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? rS h. Type of construction 0A3 SIT' i. Is construction within 100 ft. of wetlands? _ -_ Yes j( No. Is construction within 100 yr. floodplain Yes ,C No j. Depth 01 basement or cellar floor below finished grade 40 _ k. Will building conform to the Building and Zoning regulations? x Yes No . I. Septic Tank City Sewer X Private well City water Supply X S N 7a R Q1�Y EIS AUTHORIZATION - TO BE COMPLETED WHEN OWI EI S A r 4G 1TRACTOR`APPLIES FOR BUILDING PERMIT I, as Owner of the subiect property hereby authorize to act on my behalf. in all matters relative to work authorized by this building permit application. Signature of Owner 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 Na . - _/ .._.. -- - -- 7 — /57-6 3 Signature of Owner /Age Date • • Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed } Required by Zoni This column to be fill i by Building Department i 4 Lot Size y /8", Cs, P. 5 P1, Frontage Setbacks Front Side ' L: (S _ R: / 5 L: a � , Rear as Co D-S Building Height 3a i Bldg. Square Footage SY P Open Space Footage � (Lot area minus bldg & paved / V3 d parking) # of Parking Spaces Fill: (volume & Location) 1 A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW YES x IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES )C IF YES: es - Book Page and /or Document # :. Does th: s.te ntain a brook, body of water or wetlands? NO x DON'T KNOW GL.►L F 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: City of Northampton e faii+iix= V r' I Building Department C ,.fs C ,0(���e)! a_i,9ii9 212 Main Street Se j 1:44 - C r�X ill'i D °, -0 Roca 100 Wa - eV = k -+i=' Northampton, MA 01060 1 ;w .7 ?rNiilt a1"45ii phone 413.587.1240 Fax 413587.1272 PIa;I eur9._. {,1;- i CthervSp-,aL r r r A PPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMO R sNIE 6 _� T+� U I' l NG '`` JUL 1 2003 _ i SECTION 1- SITE INFORMATION `I �r �� ffic,,e �fr�fd "h���t >r'� ° 1 1.1 Property Address: Thi seati � 4 � � I . Q t Y { t rp . h Y, & 3' CARavA�. A y 6,01- a �,) Map 4. fli L u . . :- Zone Oirerlay District. s :`: ,. Elm St. District ' c8 Dist?Ict' 1 SECTION 2 - PROPERTY OYYNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 1 Name (Pri Current N,ail Address: 1 / _ W 3 . 3r'5 Telephone Signature , 2.2 Authorized Agent: Name (Print) Current Mailing Address: I Signature Telephone SECTION 3 • ESTIMATED CONSTRUCTION COSTS Item f Estimated Cost (Dollars) to be 1 Official Use Only com•leted b •ermit a••l cant 1. Building / �O 00 0• C3C_7 I (a) Building Permit Fee (b) Estimated Total Cost of _ _ I Construction frbm (6) 1 4, Electrical 3. Plumbing /0. Q © , - a C Building Permit Fee , 4. Mechanical (i-iVAC; i If. 000_ v 0 (D —1 _ 5. Fire Protection 0��(7 0 , f.D 0 0 1 6. Total = (1 + 2 + 3 + 4 + 5) „,. ! . 0 y► vb , a 0, O l Check Number Pr / his ection For Official Use On! Building Permit Number: Date Issued:_ Signature: 1 Bu id+ng Commissioner /Inspector of Buildings Date { r File # BP- 2004 -0046 APPLICANT /CONTACT PERSON DAVID LEPINE ADDRESS/PHONE 262 EAST STREET (413) 527 -3975 PROPERTY LOCATION LOT #20 - 238 CARDINAL WAY MAP 36 PARCEL 324 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 6 0) 367' 7S Tvpeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE/DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 0441 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 1/ 4/o3 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. LO1'a #20 = 238. CARDINAL WAY BP- 2004 -0046 '.T Grs : COMMONWEALTH OF MASSACHUSETTS " g= Map Block: 36 X 324 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit # BP- 2004 -0046 Project # JS- 2004 -0082 Est. Cost: $174000.00 Fee: $1351.75 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor : License: Use Group: R4 DAVID LEPINE 044188 Lot Size(sq. ft.): Owner: LEPINE DAVID M WILLIAM P WZOREK SR Zoning: SR Applicant: DAVID LEPINE AT: LOT #20 - 238 CARDINAL WAY Applicant Address: Phone: Insurance: 262 EAST STREET (413) 527 -3975 Workers Compensation EASTHAMPTONMA01027 ISSUED ON: 7/22/03 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY SFH W /ATT GARAGE/ DECK POST THIS CArs13 SO IT 13 VISIBLE FROM THE STREET Or el: \ ` ✓ir;: _ :.'1. Buildii g Insy ect:.r V / y Urderg; :,u r1: Serv.c.: 1 1 1 J 0 �f t :; t '" �. ,. 1 / (7.'17 g 1i Fo undation: C/ 1 y V C�.... _A/ Rough: too L: )) 0 � #:.. it r i ✓r_1.h..y Final: Final: 1- 47 °p q ae Final: 9/ Rough Frame: 0 K )J - pQ - ©3, - ( Gas: Fire Department Fireplace /Chimney: 1 1-e53 Rough;. ; -o ri d �J LisuIatiQra f k `ol Final: g.-/ 7— ZP . Sm oke: Final• c �� �OY' - - - .:. THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS.. Certificate of Occupancy l Si gnature; FeeType: Receipt No: Date Paid: Check No: Amount: 2EMPO RARY `OCCUPANCY. - expires 4/28/04 L' ulding 7/22/03 0:00 :00 5927. $1351.75 212 Main Street, Phone (413) 587 -12 Fax: (413) 537 -1272 Ba.ilding Commissioner - Anthony Patillo