Loading...
17A-017 (3) SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder ' A a cO L.0 ei A License Number pttI Lis Rs IPt_AL l o 4_y ,/A- CI- A-ddress a 3S Expiration Date S-ignature Telephone 9.Registered Home Improvement Contractor; Not Applicable ❑ Company Name Registration Number — Address Expiration Date Telephone • SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C46)) 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 hvo(21 families and to allow such homeowner to engage an mdivrdual for hire who does not possess a license,provided that the owner acts as supervisor.('MR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner Person is who owuu a parcel of land on which he;she resides or intends to reside.on winch there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use midi 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 w-il1 be required from time to tune,during and upon completion of the work for which this permit is isared 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 persoinsl 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 4. ZONING All Information Mist Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by I N6 yes Building Department Lot Size l k 30�j 44- 2--0 (4i,W'T t -2-43 Frontage Setbacks Front Side L. R: L R Rear Buikling Height Bldg. Square Footage °o Open Space Footage 00 (Lot area minus bldg&paved parking) of Parking Spaces Fill (volume&Location) A. Has a 4)ecial Permit/Variance/Finding ever been issued for/on the site? NO 0 DCNT KNOW ,St YES 0 IF YES, date issued: IF YE Wasthe permit recorded at the Registry of Deeds? NO 0 DCNT KNOW to YES 0 IF YES enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO ,4,,!I DCNT KNOW 0 YES 0 IF YES has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q . Date Issued: C. Do any signs exist on the property? YES Q NO tip' 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 10# 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 (3 NO ay4 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [J Addition ❑ Replac• • ,.♦'"'"\ ows Alterations) ❑ Roofing ED Or Doors PA Accessory Bldg. ❑ Demolition ❑ New Sign — Decks [C,] Siding[D] Other[DI Brief Description of Proposed S reacact9d w� /�w te(I-Led an c Q e �jP-. ZOt�-—©�S 9 Work: p -Awl" (SSS�cQ �g'�ck113 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 existin• housin' corn•let()the followin a. Use of building :One Family Two Family Other N©4ac<< 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. 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, . 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 cvlSet . as Owner/Authorized Agent hereby decl a that the statements and information on the foregoing application are true and accurate.to the best of my knowledge and belief. Signed under the p 'ns d pen ties of p L . �-- cUSAO Print Name 02gi3 Signature of Owner Agent Date Department use only E C L / �VI City of Northampton Status of Permit ? Building Department Curb Cut/Driveway Permit AUG 2 9 j 212 Main Street Sewer/Septic Availability 013 Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans •ctric, Plumbing&,�, worth„, . ,,., Gas r 13-587-1240 Fax 413-587-1272 Plot/Site Plans ,fir. 6160 Other Specify 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 / 90 cçort v7, 6r ' - Ode Map Lot Unit icrei CC/ 4('r 0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: gu Sav) 6 ems(als e ftT PR/2-€4-{r_ ad .w Name(Print) / Current Mailing Addrtss Telephone ` �,J L� Signature ae 1O 1" I 2.2 Authorized pent: Name(Print) 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 (a)Building Permit Fee c0r f-CSJ" 2. Electrical (b)Estimated Total Cost of 6�P Construction from (6) S40• (�'�- 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) �-�O . 0 rte- Check Number This Section For Official Use Only Date Building Permit Number: Issued:d: Signature: Building Commissioneriinspector of Buildings Date 190 SPRING GROVE AVE BP-2014-0194 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-017 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT BUILDING PERMIT Permit# BP-2014-0194 Project# JS-2014-000328 Est.Cost: $3500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES SOLDEGA 97091 Lot Size(sq. ft.): 19384.20 Owner: TIMBERLAKE SUSAN Zoning: RI(100)/URA(100)/ Applicant: JAMES SOLDEGA AT: 190 SPRING GROVE AVE Applicant Address: Phone: Insurance: 6 PHILLIPS PL HADLEYMA01035 ISSUED ON:8/19/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOW & DOORS 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 8/19/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner