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16B-001 (3) ... , i. •-ttc-,.A..0,..,4-1 ,ks:,0 ,.... ,‘„,. C--e-t L..vi,-)f,.. c7-L A-t„-- — . .,„ vi , - ,./: Lo — M------*-7-;-------.:.—" _—_, --77: I 1 ..,,,,,, . : , ",....145 -ra,,,, ; , .., 0 2.- 1 , co?E) , ; = i ' -1-------- 27(4- v- i i 1 i 1 -,,-- - : ,• I -4-- g47 C-,'sc, ?i'4',,,. L - 2. 5 . ; . i --,,, a 4 C-4 1 4t tk. c4ati i -r , 1 i © . I : i -.-."1-,7,,Z, O 1 ! t G ISEtiv, VINL- N . / - .,--, . ---------.1 ...___, r .., , SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ n'�— Name of License Holder: ���� J ����_ �S — 4. 763 License Number c r\uq ( u l t e, / 2-o l 3 Address Expiration Date f_,. �. �r '. "c84- \22 6.. Signa ure Telephone 9.Registered Home Improvement Contractor Not Applicable ❑ tf-J ..iss-LvAg 1 -1 2 ' L Company Name Registration Number c - 2 � �� 5� � Address (�t Expiration ate ,.�C6 N) ,/L„/V Telephone 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 ❑ 11. - 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 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 [El] Decks , Siding[El] Other[ICAO] Brief Description of Proposed i_ !7 Work: C-6I-1VOrr' 1S'�° ► UNCADs-+tS1, p >tw. Tb c-1 h- S4 'c? CV r- Alteration of existing bedroom Yes i,"--No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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. �` imens.- s e. Number of stories? f. Method of heating? _ eplaces 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 - .nds? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or - ar floor below finished grade k. Will buildin. •.nform to the Building and Zoning regulations? Yes No . I. Sep. ank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ' I, Q9 V 1 in 9 �6►V�1S , i �'� �� ' ..I as Owner of the subject property hereby authorize F'"�_� 1/ei V`- ‘-'Ne.- -C_ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, C7-0 &Z-Q " ki,,,,ps tAL-1'TA-z. , 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. (z-©?-ems- vs itN-LALiZ Print Name , Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incorplete Information Existing Proposed Res red by Zoning T• s column to be filled in by •uilding Department Lot Size Frontage Setbacks Front Side L: R: Rear (3)Sle" Building Height V 4Q1 Bldg. Square Footage Open Space Footage % (Lot area minus bldg&p. -d parking) #of Parki • ..paces • I: (volume&Location) A. Has a Special Permit/Variance/Finding r been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:'" IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 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 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 Cce7/ 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, ex vation,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 use only RECEIVED City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit, 212 et Al II 1 0 0 Room 100 Wa er/SNe Sewer/Septic Availability v Mail rthampton, MA 01060 Two Sets of Structural DEPT.OF BUILDING INSP OI 41 -587-1240 Fax 413-587-1272 1:101/Site Flans i NORTHAMPTON,MA 01060 Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION / 1.1 Property Address: -�cn./6'24 This section to be completed by office (o t_�.�1/eU-* l t./Ca4-' '1 • Map Lot Unit Cylkfi-Ak)CV_ A 1A Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r-►0 I( -v KV-1 iAkce tWk u t a(0 Nam rint) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: kx/lArt AC.fre -2 ;�v1 c, Cc t r&& ,e- Name(P•- ) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ..z 26 (a)Building Permit Fee 2. Electrical OD (b)Estimated Total Cost of Construction from(6) 3. Plumbing — Building Permit Fee 4. Mechanical(HVAC) CICt C 5. Fire Protection 6. Total=(1 +2+3+4+5) -11 t1.3 Check Number /6-e? /601 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-0930 APPLICANT/CONTACT PERSON ROBERT WALKER ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 16 MARK WARNER DR-20 BRIDGE RD MAP 16B PARCEL 001 001 ZONE SR/URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ,,,r Fee Paid 450.41 I jO Typeof Construction: CONSTRUCT FAMILY ROOM ABOVE GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 034783 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 PIan 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 be di •InDelay 1{-77 /5 Signature of Building Of icial 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. 16 MARK WARNER DR-20 BRIDGE RD BP-2013-0930 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16B-001 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2013-0930 Project# JS-2013-001577 Est. Cost: $17123.00 Fee: $102.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT WALKER, 034783 Lot Size(sq.ft.): 1296345.60 Owner: TOWNSEND CARL&KATHI Zoning: SR/URA/WSP Applicant: ROBERT WALKER AT: 16 MARK WARNER DR - 20 BRIDGE RD Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:4/11/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT FAMILY ROOM ABOVE GARAGE 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 4/11/2013 0:00:00 $102.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner