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30C-051 I 0'4_6�. Vs -r (� .15 A p i € S is c � � �c ii ' �`_ A3 iI cry A r ..-- 5 0 c ,1 O c r / I y.� 'i; D Q ,-T,,, l......" it, c Ste - .� c _ ,, �: - M rr 0 - - ' aillt \hi. 40P• _�- _ _ - w Cr ___...'!'&..,./ 4.0 .._) il a cl! r 4 D i 'tii ; — ; I.! C■ r v., -qD, L. 1 , c, ko j * � -, 2, T', ,,, -b.e-c........ ...1— 4 , 0" r (.-., ( ._ a } CFP Cr- vi Z.L\ -r 11'11 elk ) P 1 1 1141/46-" t‘ 4 • -1,iz • ,1-11.1its!Aciiits.c113 1-t = =•• ‘ ..11 EPARTMEITF OF OtJIWING INSPECTIONS • =--= = 212 Main Street Municipal Building Northampton, Mass. 01060 -- WORKER'S COMPErsTiSA'llON INSURANCE AFFIDAVIT • I e ti a rr? HT)n !) principal place of busuaessires*ilenci:' 3 Ecio-e-hOir)p101)- r)-74 (s_phonci ) _110 (a) C,t0e.,Rri //3 6617—07e,,3 do cc:7fy, und:-21- thc.., 1-)alns ;Ind an employer provirl",7)1 the folloc,,,.11y.:, coinpcnsation cover.m.y.: tor ny C■1:,,)10yCe,S WOrkill2, on this job- , n suran ei Co caparn,:) Crl'c cy N.c..:711)c r) ( iJoe Dale) ( ) Lai a sole prourictor, r2entral hen-tf:owne:- (ciicle one) and have hired the contranors hs1 Delow v,.ho comnens,3:.:orl (1'.1 arc e of Cont---7,-_Lctr) (Tix:::-nt:ott Date) c,Name of Contrac-tot) ilas-drance Ntl_mb.or; (Ext:Imtio: Date) OC Contr,acter) Dat,2) (-Name of Contractor) anai cz CC 1117-1flY o cy Numl-y2s iExt-:.:7,:;307: Date) 1:1.(3 h.ol-nc a'11. toe l';071:- c,--.54 t ot thaf. - 3.1c C:np t-hrx cot ::••••`ir:Z • nhcic o O<CC -11y ii (G1_1 7.;-?1•:itticii 1,7' far t 10501 c-taluz of on e.2ploy or under thn Wco1coo' O - coc000 .ca I u_ned t.dad the-o Oa n of.11f ,3 c to for,Art.14,3 to tt I i,,,toloozi of irrc Aciri,!...otn'off.-of rdnd thltt to ii‘t..nic-n !).A. Ci 52 car, tl.Impasuio.-1 of„fin,of up to 21000.00 of ori- ?:-.;cvii on.atjco in tic: of ISru ..";!OK:LOU 3.thy 1;2•11.-.1 F C. D,Cs] C.C1 y Permit —--- _ (); • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: et-1- l-f me/fir) 07Lfa?94.4 License Number Addre-- ) � ©'(:).)-47 Expiration Date O d H 13 — -64-(6,3 gnatur= Telephone o9a eQisfer'e 4omn liibF iremer ontra oc ,' f Not Applicable ❑ 1 b 4 Dal l 1 t1 h 1CL/-�-)i1 eLc,� . 3 ttt/der" Cc i-ruefc Company Namej� Registration Num Or 3 trirt4„ti 1-.mar . _ Address Expiration Date y/3 (1-1(03t; ^ 14•-13 C Jf/- )- per.}-r) jV/74 Telephone 11/3 5S17--O 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 ❑ ii t lom .O I rte. nitbon 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 be/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 r SECTION 5-DESCRIPTION OF.PROPOSED WORK(check all applicable) New House ❑ Addition ❑ ,: Replacement Windows Alteration(s) n Roofing n Or Doors D Accessory Bldg. El Demolition El New Signs [0] Decks aejl Siding[0] Other[0] Brief Description of Proposed Work: Tg1SP_ pi2�*! �x 1 S�119 Deck te.(�w‘t I Ae�1 %A) S'kefte v � � Alteration of existing bedroom Yes n No Adding new bedroom Yes No t7o c Attached Narrative, Renovating unfinished basement Yes No Plans Attached RoH 01% -- sa If�ew house antl r�add.tioa#o exis inct o�s n�q'-comp to th DoT aw,nq: a. Use of building:One Family Two Family Other b. Number bf 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, Mre-ke-I1cA4Ke4.5Qi ,as Owner of the subject property )) ,( hereby authorize [,<-I+W1 qM t (4 0A to act on my behalf,in all matters relative to work authorized by this building permit application. �j, 1 1y - ignatur of Owner Date R404, to ,as Owner/Authorized Agent he y 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. Pri• ame f '-1— 15 -/3 gnature of 0 - gent Date Section 4. ZONING All Informatibh Must Be Completed.Permit Can Be Denied Due To Incomplete Infornhatiorr Existing Proposed Required by Zoning• This colum to n to be filled in by SR I 1111k Building Department Lot Size s - ' { E — I Frontage i Setbacks Front Side L:' R: ? L R: - ' Rear I Building Height ; . _ . Bldg. Square Footage i 1 % 1 i 1 I z Open Space Footage % (Lot area minus bldg&paved 1 j I 1 1 i parking) . #of Parking Spaces Fill: , :—_ (volume*Location) 1 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:, I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book ! Page; and/or Document#;`� B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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 0 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 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 r NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • F. RECEIVED �Dep ttrer �ifse6`lX : ' City of Northampton ® � Building Department ,' ra" Itii*se 212 Main Street r e , ��� ' X4 „4 Room 100 • Northampton, MA 0411036_5087-1272 ,'v� r ral - , - ��.�` , .OF BuILDING INSPEC11014 � � q; _ NDR1 AMPTON.MAOto60 rf3DnQ 413-587-1240 Fax fo 1# �'...4 ,g mn -°,4 k n APPLICATION 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: ���� 6/1VA1 qtr lllllap, Lot Untt • Q A44. O obi— zone overlay District '''.,1E11111 St District :` CB Aistrict SECTION 2-`PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: , i c .e.t (e M-1 , on 6 P tq-E �nvM,�> s l o� �ja, Name(Print) Current Mailing Address: O r �I t � Telephone 'i'(3 c 'i 9. 190 Signature 2.2 Authorized Agent: • t e.1--h /la. Il 3 . � n f1 .me(Print Current Mailing Address: .nature ©�7 Telephone SECTION 3 ESTIMATED CONSTRUCTION'.COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1L, �, (a)Building Permit 2. Electrical (b)Estimated Total of 3. Plumbing Construction from(6) Building Permit Fee Cost 4. Mechanical(HVAC) 5 Fire Protection . 6. Total=(1 +2+ 3+ 4+5) Check Number g/6 g This`Section For Official Use Only Date Building Permit Number. Issued: Signature: 1 Building Commissioner/Inspector of Buildings Date File#BP-2013-0977 APPLICANT/CONTACT PERSON KEITH HAMILTON ADDRESS/PHONE 3 LORD ST EASTHAMPTON (413)587-0763 0 PROPERTY LOCATION 36 PLATINUM CIR MAP 30C PARCEL 051 001 ZONE SR(100)/WSP(85)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid L, 7 o r O 12f Typeof Construction: REPLACE EXISTING DECK(SAME FOOTPRINT) Mob (<1;11- f"`C , r New Construction iS(1 Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 074129 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 //4- -22 Signature of Building Official Date 7 ' f I3 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. 36 PLATINUM CIR BP-2013-0977 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C-051 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Deck BUILDING PERMIT Permit# BP-2013-0977 Project# JS-2013-001624 Est. Cost: $14000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH HAMILTON 074129 Lot Size(sq. ft.): 40641.48 Owner: ATKINSON THOMAS H&MICHELE N Zoning: SR(100)/WSP(85)/ Applicant: KEITH HAMILTON AT: 36 PLATINUM CIR Applicant Address: Phone: Insurance: 3 LORD ST (413) 587-0763 0 EASTHAMPTONMAO1027 ISSUED ON:4/25/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE EXISTING DECK (SAME FOOTPRINT) 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 4/25/2013 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner