36-147 SECTION 5: CONSTRUCTION SERVICES
5 Licensed Construction Supervisor (CSL) I 2-1(,- 9 il 2.-// L ,
144A- Gil - Lei AA-Z License. Number Expiration Date
Name of C,SL- holder I List CSL Type (see below) _ e v (
A m . , Type Description
1 4 , U Unrestricted (up to 35,000 Cu. Ft.)
Signature R Restricted 1 &2 Family Dwelling
` i Masonry Only
L� f ` • RC Residential Roofing Covering
Telephone • WS Residential Window and Siding
SE Residential Solid Fuel Burning Applince Installation
D Residential Demolition
5.2 ,Registered Home Improvement actor (H
ompa ntr � i
t - 7� . P, , Icy 1
HIC n Name or HIC Registrant Nam Registration Number
�.. ..ine,��. Ro +. iAi ne,
.,n f2hk /
Addr¢ss J, Y f . !! `
,/( .La -u1 `t�3 . i l Fxpi lion Date
Signature - Teiepnone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit trust 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 ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILT ING PERMIT
1, O r', V 1 S , as Owner of the subject property hereby
authorize 11ro Qc4- C\ A VIC J` to act on my behalf, in all matters
relative to work. dthorized by this building permit application.
/ Cdr
S
ignature o D
\\ .. SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, nC.A- L-G.,..., 2 ---. , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf. •
. IDr :n,t 1'
Signature of Own Autnonz at Agent D
(Signed under th pains and alties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor (HIC) Program), wi1 i not have access to the arbitration
program or guaranty ftind under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 1 10.R5,•respectively.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) (including garage, finished basement/attics, decks or porch)
Gross living area (Sq. Ft.) Habitable room count _.
Number of fireplaces Number of bedrooms ',
Number off bathrooms Number of half/baths
Type of heating system Number of decks/ porches •
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted for "Total Project Cost"
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SECTION 5- DESCRIPTION OF PROPOSED WORK check all a • • licable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors EJ
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0]
Brief De cription of Pro lnsed �l
Work: �� h ` �YI_t� Q(` t‹. a - , ftB)tiee. Old 541rep
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. 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
, 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
, 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
RE Fl ty t,P�
D Department use only
RE ity of Northampton Status of Permit:
32012. :uildin g Department Curb Cut/Driveway Permit
,
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability "
INsP Et; TI ONs
tnu mA otos o ■ • Campton, MA 01060 Two Sets of Structural Plans
p one 413 - 587 -1240 Fax 413 - 587 -1272 Plot/SitePlans
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
37 L,,f,g .
t Zone Overlay District
"v r e � t Q' r Y� Elm St. District_ CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
L- a��� ► S . L„)r vi2w 7r' - (1 r,c.1C .
Name (Print) Current Mailing Ad ss: 3
Telephone
�)
Signature
2.2 Authorized Agent:
N \,c r �. L C T Z � y rnr Y, V1/4Pc-kii
Name Print) Current Mailirfg Address:
.
Sig ature Telephone
SECTION 3 - ESTIMATED ONSTRUCTION COSTS ail
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1 lg / 1 v C A. I6 � (a) Building Permit Fee
2. Electrical 1 (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) RfLa \O V Check Number 1/43
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0741
APPLICANT /CONTACT PERSON MARK LANTZ
ADDRESS /PHONE 74 LYMAN RD NORTHAMPTON (413) 320 -7611
PROPERTY LOCATION 37 LONGVIEW DR
MAP 36 PARCEL 147 001 ZONE URA(100) / /WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out I ,�� ,s� �"
Fee Paid V ` �Lfv
Typeof Construction: AIR SEAL,INSULATE ATTIC,REPLACE GABLE VENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102169
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved _ _ Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
•
C> l z l z3 A -�--
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.
37 LONGVIEW DR BP- 2012 -0741
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 -147 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit # BP- 2012 -0741
Project # JS- 2012- 001299
Est. Cost: $2100.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK LANTZ 102169
Lot Size(sq. ft.): 16291.44 Owner: DAVIS ROBERT E & LORI J
Zoning: URA(100) / /WSP Applicant: MARK LANTZ
AT: 37 LONGVIEW DR
Applicant Address: Phone: Insurance:
74 LYMAN RD (413) 320 - 7611 WC
NORTHAMPTONMAO1060 ISSUED ON:2/24/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:AIR SEAL,INSULATE ATTIC,REPLACE GABLE
VENT
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 2/24/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner