24D-274 e
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : A. 4—c-n A. f5r 7
License Number
34 rt. ; c de/K.4e c L
Address Ex P iratfon Date
V V7'C ", -t /j a D/04
Signature Telephone
y/3
'9. a lstered Home 1010r0vement.Contractor: Not Applicable ❑
53 L�A p , m ss — c„, - ,04 �a 4,71%, ,1a✓ /1 e r7
Com anv Name Registrati n Nu ber
?& c-c_ /24 r?cl S 1 ( / 1
Address Expir ion Dat
s /jA414.7 K ��''G' Telephone 51:5V "l e4y
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 ❑
Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
4
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [Mr
Brief Description of P po d 1
Work: �--L �tr4 i'L 7 ` i�IeJS�gI +'
Alteration of existing bedroom Yes `� No Adding new bedroom Yes
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 ne . construction. Dimensions
e. • mbe •f stories?
f. Method of eating? Fireplaces or Woodstoves Number of each
g. Energy Con - ation Compliance. Masscheck Energy Compliance form attached?
h. Type , constructio
i. Is construction within 100 ft. of we - •s? 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, 5t . -$4-&& 5 41 &S ' , as Owner of the subject
property 1
hereby authorize " '`- l • / dS 5
on my behalf, in II tt relative to work authorized by this building permit application.
POfi / ‘( 2.-Y7/
Signature of Owner Date
1 _ - p. �� , as Owner /Authorized
Agent here 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.
S •-GL.. 1). /aM
Print N e
atur of Owner /Agent D ate
f .,
/ ii,
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 . . R:- . L: ` R:
Rear
Building Height
Bldg. Squ. e 'ootage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding er been issued for /on the site?
NO 0 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Regi of Deeds?
NO 0 DON'T KNOW YES
IF YES: enter Book Page; and /or Document # -
B. Does the site contain a brook, body of water or wetlands? NO 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 Issu d:
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 G/
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exca • n, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department usa,orlly'
City of Northampton
Ota*t of P
Building Department --Ot.trb'CiltiRrievvay Permi
212 Main Street
490*
Room 100 I r� 4 r/W Aval s�tt ''
Northampton, MA 01060 Two Sets er'birti tur Plans
phone 413 - 587 - 1240 Fax 413 - 587 - 1272 io � l an �
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
Z ✓>nn LG ( iK Map Lot Unit
//� f /�/ / H Zone Overlay District /1-7
/ve d"{ � J' � Eire St. District CB District
SECTION 2 =- 'PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
g f i d )))h i'10`5 ce0,4"..t-
Na (Print) /(�� Current Mailing Address:
1N �!'ZT' / � � " �' Telephone
Signature
2.2 Authorized Agent:
� ->= .-� •-� b . f - a.Q sf 34 S".e.. ;c- t-C....,1 _.,..i i2
Current Mailing Address:
i/ - /A. 04, t i OA- /Y2.4 D 0
Signs a Telephone ,s"8- 2 2
y l h'
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building / r g (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) / 500, Check Number 3 3
This Section For Official Use Only
Permit Number: I
Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2010 -1189
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 Q
PROPERTY LOCATION 127 FRANKLIN ST
MAP 24D PARCEL 274 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid L5b3 4(15
Tvpeof Construction: RETRIM FRONT INTERIOR STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION PRESENTED:
i/ 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
G�- v-u.�%o l��✓ Z�. c /2s / (o
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.
127 FRANKLIN ST BP-2010-1189
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map Block: 24D - 274 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1189
Project # JS- 2010- 001724
Est. Cost: $1800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: •
Const. Class: Contractor: License:
Use Group: _ STEPHEN D ROSS 079160
Lot Size(sq. ft.): 16770.60 Owner: STEBBINS SUSAN
Zoning: URB(100)/ Applicant: STEPHEN D ROSS
AT: 127 i-Ftir:t'vKUN :3T
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 -1224 () WC
NORTHAMPTONMAO1060 ISSUED ON:6/28/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:RETRIM FRONT INTERIOR STAIRS
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:
0 k 17- - (6)
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG TI S
OtA4 Certificate of Occupancy signature:
q Y
AistuffAcie
°" S
FeeType: Date Paid: Amount:
Building 6/28/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo