23A-106 (6) 09/19/2000 13:02 14135274441 ZAKS CONSTR PAGE 02
Greg D 'Unger 07/1' '2OOU 01 :43: 33 PM P. 1
Thank you for your proposal of June 23 which included
two plans for paving our driveway - a full length and
a short length ptan. We have reconsidered-what we would
like and I am including a third option that ends in two
parking spaces.
Please send a revised proposal with just the third
}
option. We are also interested in having our current garage
(1Q' by 18') removed and building a walkway from
the end of the proposed driveway to the front steps. If
you can do this work as well - or can recommend someone -
I would appreciate an estimate -of recommendation.
Thank You,
Greg-D' ger and Dana Tracy, 141 s. Main St., Florence
586-6197
Area of Long is 167 77 sq.yds
Area of Short is 120 sq yds
1
h.
i _ I
Area c` 1hortDoubie . • 22 sq yds
0
n/19/2000 13:02 14135274441 ZAKS CONSTR PAGE 1
Greg D 'Unger 09/09/2000 03 :22 : 14 PM P. 1
PROPOSAL
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' DEPARTMENT OP BUILDING INSPECTIONS 4 _`_I i=
212 Main Street • Municipal Building =yV
Northampton, Mass. 01060 s
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
c pC,ctt7 T._ 7 tle-)Z z etv5 A.)
(licensee/permittee)
with a principal place of business/residence at:
5 iPP ii l7TUV94- 1-" (, Y Ei5f9 .1-)-0J1'/ /`(/�,olv-i) (phone/0 5 7-4 4 H U
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
Q I am an employer providing the following worker's compensation coverage for my
employees working on this job:
411eitiwv 17,-/b 1Ni , cvv a1CLI 7.7fY3( /9z)i1o.U0)
(Insurance Company) (Policy Number) (Expiry on Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnecexury to include inforntatioa pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ person:to do ma mtcmanc,,construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are not generally 000sidered to be
e mployera under the worker's compensation Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer wader the Wei-Imes Compensation Act.
I understand that a copy of this statement may be forwarded to the Department of Industrial Accident,'Oboe of Insurance for the
coverage vexificatioe and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work order and a
fine of 5100.00 a day against me.
For departmental use only
pLiccnsei Permit Number
Map# Lot#
Sine. .rr o e/Permittee Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
•
Name of License Holder : 02-c6"3 ,7 7yw12zett/y/) Off-q 741 `l
License umb r
Addre s /f Expiration ate
Signa re Telephone
I E`.` Not APPlioable ❑
7,0 ItL tee la.) a 35
Company Name Registr tion Number
1)vpu Tfitt p9nP 1Y M bieLLY y fffs 0
Address /� Expira ion ate
Telephone C a 7-1l y 40
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 eI No ❑
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
$ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ DemolitionX New Signs [ ] Decks [ ]
Siding[ ] Other [ ]
Brief Description of Proposed Work: 1)etioLoN 1 trove p$1W u7)L it1e7
a JILT h LiVi t
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
atAtiVietalieltil
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. Mascheck 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
6pc6oty T• , as ewn-mr/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.
GD1 eoi.qty J' 2_,ip2 z ewy it-
Print N. e f
lg 7 ell 1 c>v
Signatur of • ner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) _
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 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 DON'T KNOW
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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
•
D �; ii.f
Northampton Bing Department 4 g 2000 . ��� � �
�� 21• Main Street � J
'oom 100
f r,11dSP T ti
DEF[T(�of13t11� e, art . . pton, MA 01060
lv� l I L
• • e 3 587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Dit, 511p e a 3YOo . ' .
SECTION1-SITE INFORMATION
'This secti o r to be m leted by Fe .
1.1 Property Address: �
, ,�%LOIZellc h4• 0tUbaZ Zone ' '' y,i.< ;
t
��
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
GRc b u /c Cg- t O4V4 t cY /t1 l S i /111' f�- pw t c'�c n.1• v�t,�t
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
z.9�.5 cvu,tn+r,r!oN 3 c-1Cvl<<i i 1C /Iv1Ii191i2i.9C �' Kxw e-pz/J9�I'Ic'i /7i
Name,(P int)fro Current Mailing Address: O/i,,7
��'0�" 5'�Z 7-�4 IfL�
Signature Telephone
SECTI N 3•- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(G)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 + 3 +4 +5) Check Number ff� "-
This Section For official Use Only
Building Permit Number:
?it 3V Date Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2001-0300
APPLICANT/CONTACT PERSON Zaks Construction
ADDRESS/PHONE 41 Avis Circle (413)584-2118
PROPERTY LOCATION 141 SOUTH MAIN ST
MAP 23A PARCEL 106 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid (/tO
Typeof Construction: DEMOLISH&REMOVE 10 X 18 GARAGE(NO UTILITIES)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 054749
3 sets of Plans/Plot Plan
THE F9LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
pproved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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
Signature of Build'! Officia 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.
141 SOUTH MAIN ST BP-2001-0300
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A- 106 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:demolition BUILDING PERMIT
Permit# BP-2001-0300
Project# JS-2001-0479
Est.Cost:$1600.00
Fee: $10.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Zaks Construction 054749
Lot Size(sq.ft.): 5052.96 Owner: D'UNGER GREGORY R&
Zoning: URB Applicant: Zaks Construction
AT: 141 SOUTH MAIN ST
Applicant Address: Phone: Insurance:
41 Avis Circle (413) 584-2118 Workers
Compensation
FLORENCEMA01062 ISSUED ON:9/22/00 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH & REMOVE 10 X 18 GARAGE (NO
UTILITIES)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/22/00 0:00:00 5986 $10.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo