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I. i ,,,,..) -, .- k SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ F'C Name of License Holder: 'C A. W �"��-Y�tZ Cs— ' 3 4-7 8 License Number flj C [?&J %(--f 1-'-%-a t•--)C c1- t?rvw i1 r'4 1 0 � I g, / '2C; 13 Addressn Expiration Date 4 -- X27 - Signature Telephone 9.Registered Home Improvement Contractor Not Applicable ❑ 9 �, 1��"41,k)e.trit 17 L 0 (� Company Name Registration Number �() tf:. te...e efF • s l (4- t Address � Expiration Date Telephone 4(3 "- 'L4 12t 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 EV No ❑ o" G� t 11.• - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [0] Other[0] Brief Description of Proposed , Work: /kOC) A i c ..-,1 4, € mcrtoi� ` 1r1�tc,o -- It �t/Z/_-icet - L AA-Js�' Alteration of existing bedroom Yes V No Adding new bedroom Yes V No Xo Attached Narrative / Renovating unfinished basement Yes Plans Attached Roll -Sheet i/ 6a. If New house and or addition t 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 I /Z c. Is there a garage attached? NL d. Proposed Square footage of new construction. , ,@- ' Dimensions 4--., 3 x S ' e. Number of stories? f. Method of heating? ( A..i C-1"2-t( Fireplaces or Woodstoves 1444- Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction t )bcp 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 C(L-P4vL S Qt-4-0 l•-4" k. Will building conform to the Building and oning regulations? V Yes No . I. Septic Tank City Sewer Private well City water Supply p Y SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT G L.A-‘(Lq - c l- , as Owner of the subject property �(7 hereby authorize 1� v (A.`' L'i., to act on my behalf, in all mattersielative to work authorized by this building permit application. / all,641_ 77////....? Signature of Owner Date go QA',(j i1- , 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. Tic W' v..)V4,- '44- Print Name atP.A U 1-.__ 11 tA. 1 13 Signature of Owner/Agent Date RECEIVED , Departmentt seort�' City of Northampton Status of Permit JUL ' ' 2013 Building Department Curb Gutbrl?�eyvay Perrlt 212 Main Street ��Sewer/ DEFT.OF UILUING INSPECTIONS ROOM 100 VtraterlW ll Availability k�����i NORTHAMPTON,MA 01060 Vorthampton, MA 01 060 Two Sets of Structural Pena k ��� i t phone 413-587-1240 Fax 413-587-1272 Plot/Stte mans Other Specify F 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 c-ropp,Av.,0 .3TV - T- Map Lot Unit Ncy Qz cLk°Pnin.,r-R)(`-' VV1 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C L y( A-'1.1.-c Ot. :.ppp -a p cT• / we m4 Name(Print) �C�� /I� Current Mailing Address: `9 / Telephone Signature 2.2 Authorized Agent: n 'Kii)) , V�M��/1C C C' S 12-V N G; Name(Print) n Current Mailing Address: 3 f d-– 1—z 4— Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1 .L (a)Building Permit Fee 2. Electrical Ct 7 (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) t91 ZjW, — Check Number 1S7y This Section For Official Use Only Building Permit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date 9 STODDARD ST MP-2013-0085 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS#: 3924 a M H Ma p �t � 24D Block 057 -- -- -- , � I � ,I [u 4� ZONING PERMIT Lot 1001 __ WCPi Permit: (ZONING PERMIT APPLI T£RCENTEN APPLICATION PERMIT Category: (Zoning Permit Permit# MP-2013-0085 PERMISSION IS HEREBY GRANTED TO: Project# JS-2013-001360 Contractor: License: Est. Cost: Expires: Fee Charged:$15.00 Homeowner as Contractor 1< 1;nce Due'.$.00 Owner: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALLEN of Fixtures i _ Applicant: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALL DigSafe# __AT: 9 STODDARD ST UseGroup ConstClass ISSUED ON: 07-Mar-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: ZPA-ADDITION THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 14444,s. /7c'' cm Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Zoning Permit Application REC-2013-003549 04-Mar-13 6425 $15.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov (:eoTMS®2013 Des Lauriers Municipal Solutions,Inc. File#BP-2014-0038 APPLICANT/CONTACT PERSON ROBERT WALKER ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 9 STODDARD ST MAP 24D PARCEL 057 001 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 / / Vf//)1 9b Fee Paid Typeof Construction: CONSTRUCT 4 X 5 SHED ADDITION&REMODEL TO 1/2 BATH&LAUNDRY 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 I FO ION PRESENTED: 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 Commission _ Permit DPW Storm Water Management ; • • 'e Delay Signature o guild i g 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. 9 STODDARD ST BP-2014-0038 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-057 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-2014-0038 Project# JS-2013-001360 Est. Cost: $19300.00 Fee:$115.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sq.ft.): 3223.44 Owner: ALLEN CLAIRE P&R F CARRANCHO&C M DIEMAND&M D ALLEN Zoning:URB(100)/ Applicant: ROBERT WALKER AT: 9 STODDARD ST Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:7/19/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 4 X 5 SHED ADDITION & REMODEL TO 1/2 BATH & LAUNDRY 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 7/19/2013 0:00:00 $115.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner