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23D-005 (6) 68 NONOTUCK ST BP-2003-0210 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-005 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# . BP-2003-0210 Project# JS-2003-0381 ' Est. Cost: $6500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Gale Home Improvement 060020 Lot Size(sq. ft.): 14069.88 Owner: LABATO PAUL J&MARCELLA Zoning: URB Applicant: Gale Home Improvement AT: 68 NOI\IOTUCK ST Applicant Address: Phone: Insurance: 319 Pine St (413) 549-5951 AMHERSTMA01002 ISSUED ON:8/30/02 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM 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: ��� z �� Rough: '�/���' L"Z,fib}._ House# Foundation: Driveway Final: Final:le:/� Final: y/ �� j Rough Frame: 5 W �'/(. 630 _ Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK !O_/7.0 _y THIS PERMIT MAY BE REVOKED BY THE CIT OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupanc / - ,/., , signature• Fee Type: Receipt No: Date Paid: Check No: Amount: Building 8/30/02 0:00:00 1600 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ci7 f ..tO� I� �� G�'/J A 114'4iV File#BP-2003-0210 APPLICANT/CONTACT PERSON Gale Home Improvement ADDRESS/PHONE 319 Pine St (413)549-5951 PROPERTY LOCATION 68 NONOTUCK ST MAP 23D PARCEL 005 001 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 /6D� , ! b Typeof Construction: REMODEL BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 060020 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF pRMATION 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 Y/1014 ?..c9q•O; Signature of Buildin 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. r - a 0 j'fiv i t p4r, ,,�' 1,. % 1 S of Northampton � ��� `-���,��t �, •mg Department � � �°�'kGt��® �(R� .� �; , ,, k2 Main Street �� ' � t i.QI- •OOm 100 � f�� � v 0° N tha pton, MA 01060 = (� : t v ' 587- 240 Fax 413-587.1272 - " - � � � .. ..,. .� > are 71 0 6 N,ta.R, e ts 90 „ �`; . . f` --,.., •TION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This sectio ;t b,e completed l .office 1 1.1 Property Address: 1111?-';''',":',:0, h 2 ' / 4 Loth`= I �� Unit �468 NanoloGk S F map, � � , ,t- ,.- N` { -11 �//J Zone r , Overlay Districts o: n�«^p(-0,1 "'4/T olcs(.c= j Elm"St."District" P " .CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: MARY (Y1 0‘,/-q,,�rdA. ►:� bK tie-np ck' 57 l` '1(.ci- Name(Print) , urrent Mailing Address: _ / , 'r./ ,,f elephone ignature 2.2 Authorized Agent: I<CL.);v1 6 41..6 3I1 P;'„ S'! A.iliers. N(&• Name(Print) Current Mailing Address: >4I.z-, -�7�- sy7- Sts► 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 3 ©o0. - 2. Electrical (b) Estimated Total Cost of SO©, Construction from (6) 3. Plumbing Building Permit Fee 3000. 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total = (1 + 2 + 3 + 4 + 5) (v:6b a. Check Number / 7O 0 —' r This Section For Official Use Only Building Permit Number: /,� 3 c2 1 V Date Issued: Signature: _ Building Commissioner/Inspector of Buildings 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 V 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 V 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: SECTIONS"DESCRIPTION OF PROPOSED WORK(checkkall applicable) New House ❑ Addition ❑ Replacement / ment Windows Alteration(s) E� Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ II New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: �QM,cr�e1 6,ill rra.ti. Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes ✓ No Plans Attached Roll ❑ • Sheet❑ sa IftNewArdu'se d d oar `"ddition td eXistrng housing, complete1the�folloWin : 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 I, .t/\J 4/141i,..,44(01 , as Owner of the subject property hereby authorize /J i+�✓. G<: t< P on 6.,(4._ (-4"mot .Co./5 to act on my behalf, in all matters relative to work authorized by this building permit application. qiDom" 2. 2401. gnature of Owner Da I, /<'e '. ' 64-4.6 004 Ch (< /4.,c ..1. , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing applicatrn are true and accurate, to the best of my- knowledge and belief. Signed under the pains and penalties of perjury. 14o..A GAc..L Print Name j /4J .../Z.3__ J Signature of ir/Agent Date .-T- SECTION:8-;CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 0�e4..) �1 G,1 i C S o4,062.0 License Number 3i ? Ric 5 ��, �ca�" a�vvZ- 9- 28- 02_ Address � Expiration Date 4-41e1-S1 ) Signatur Telephone iR 'x 4 ir7Ve e" 'r . �., . k 1 1Ke . Not Applicable ❑ 6/4i- 7 p/r� :�v+C C it 3 2 8 q Company Name / Registration Number 3) 1 P 5f 44-4=f-.54 6-/ - c=,3 Address Expiration Date Telephone S'`'-S1S.") 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 ❑ The current exemption for"homeowners"was extended to include Owner-occu.jed-Dwellings of one(1) or two(2)families d to allow such homeowner to engage an individual for hire who does not p. sess a license,provided that the owner acts ass ervisor. CMR 780, Sixth Edition Section 108.3.5.1. DefinitiI of Homeowner:Person(s)who own a parcel of land on w.'eh he/she resides or intends to reside,on which there is,or is inten.-•d to be,a one or two family dwelling, attached or .' ached structures accessory to such use and/or farm structures. A pe on who constructs more than one home in : two-year period shall not be considered a homeowner. Such"homeowner hall submit to the Building Official, o' a form acceptable to the Building Official,that he/she shall be responsible for all s h work performed under the • ilding permit. As acting Construction u Iervisor your presenc- .n the job site will be required from time to time, during and upon completion of the work fo which this permit i 'ssued. Also be advised that with re • ence to Cha• er 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resu'ltirg in .eath)of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you •a this permit. The undersigned"homeowner" ertifies assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, : ate and Local Zo • g Laws and State of Massachusetts General Laws Annotated. Jlomeowner Sign. " re 1-11'`M4 Pib �� ��° ixt cif 1 =*°'b' 9 ae>, r.•16 filissachnsetta Mae-V � i�°='� DEPARTMENT OP BUILDING INSPECTIONS 4 ^^_i'i- 212 Main Street • Municipal Building ' —_ Northampton, Mass. 01060 ' IMO"�� WORKER'S COMPENSATION INSURANCE A '1 mA.VIT I, I<"cQ:,.1 6'4C (licensefJpermittee) with a principal place of businesslresidence at: 3i G( p fie Si. A,,,., berg"rt , x'11 4 (phone-4) 5(it?-.5-`)s/ (street/city/state/rip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: - (Insurance Company) (Policy Number) (Expiration 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) e. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiooat sheet if necessary to include information pertaining to all contractors) r am a sole proprietor and have no one wonting for me. I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ persons to do maiutcaance;construction or repair work on a dwelling of not more than throe units in which the homeowner resides or oo the grounds appurtenant thereto arc not generally considered to be employers under the worker's compensation Act(GL152,sa 1(5)),application by a homoowncr for a license or permit may evidence the legitl status of an employer under the Worker's Compomation Ad I understand that a copy of this rtatema:A may be foswerdad to the Depatmcnt of Industrial Accidents'Oftoe of Inwrancu for the coverage verification and that failure to srxure coverago under section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a•fine of up to S 1,500.00 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 toe. 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