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32C-116 (17) .e- � - ' � � ` ^ ` - ^ � ^ '^� ^ ` . ` ` .4. . - (1.\ ) li,itil Ili ,..\'fluiii,zin-pi,, , J•11,a ssA ci,•,:t;ctt5 ■I-r ---silt-ii,---t--71_ z.ic1 / 11 OF 1q1111)1 10.)1 : , :i 10.';: '21'2 Main Street ' ?■1;:nicipa1 :1I'Ll11(lirli; Northainpto:1, :',1 r,...,-., 01 \\'()R1 i El:: (:0-:\r1I)ENSATI.()N INSUIA NCI,: APT'1):\V IT i. 5t-o 33 4,.. (..itst,.c.s 1........t..o .-- SI..S.:. kk.ZA"..e•i\•41 ,:':; '".'• C.- 'cl1/41 to s"-- .::;;) .:.,_.:H....-,:. — H H. H .- .: :::::s." pc:1:-,Itic.: ,,:.-,,,::,)1,::.-, H..: I ::: :,:1 ,,,,,,,-::,:::: : :::: ....:.::::::: th,..: :.H.10::::.,:: -.:, ,... .„): i-, ,-,.)::,,, ::. :. cip,r)1;:,..: ::: y,',)1.....),:,: —.1 :H.:: :.::, td.zr....4. ( ss.:1,G.ItZesz> 6.0•0Mkt ■ts‘u . 141114a3 (..-,,,..:_-.• ,.,-,,i--,-.:), ,::,,,,-.:).,.- :, :). ,,,,,,', ic ,.,:,..):.::,:,::, ,,:::2:a! ,:,.;:i1i-dc-i_e: :.- hi,i::: :.(r,,,-::v. c.i::,_;. 0:1'—',) •c-11,. 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"..'..,7,• ',1:.:.:.. .''.. _:: (--OVCXIKC VC:itiC.ntiCX1 rinfl ill21(t-.1`,.',;[7,10•,.17.11C COVCI r.;;--,Ill !-.7:5,C.C...1C.C1.2 5 A d 0(1!,1"2 can 1.•:0 to th.,...::::•,-,)•;:tio:-.,-f••:-..::•.•:--11•,,cr....:11t-til cor/tuting,of A fin,:of up to SI.!•C).1,(7'0:,:•'.'•r..,Irt.....y..-.••....- tt.•)ft:p t,),-:-..-}-7.-.,-,:-.1 c:',Ilp,,,I'..cl m•.`,,,-'.-,,,,L-f A■:t,,`V;',1 '$:-■'...,': n:-,-.1•.. full:c("SIO,J.0.0 s.,l_ly 14;:t.Irr.1 r.y.• • I Ft,dt-t„,,,,,,..:,..1,,,•,,i; : . , PC1 Mit l';tittiL•t_ti- Signature of I.iccuf,c-c/i.)-crottc. CV)("' ''t '' .. . .... . r .. SECTION 8 :CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: S "it? StRigh A4(` N ■••101111s, 0 C. at-{C, License Number Address O`d iZ Expiration Date / Signature Telephone ,:w�, .. _ ,, . ,r3P , .� "n, �. Not Applicable ❑ �R� e• E �m=� v men <. •n r.,c_.r���-�.� �._�, ..��� �,�, h " c-\ w Qv i\ \\ \ a Company Name Registration Number 3 c.42>l I Address Expiration Date Telephone CSZ G- c(-1G 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 e building permit. Signed Affidavit Attached Yes No ❑ 1gl. - H ome° wne ]ox mutton 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 4144. SECTION=DES(RIPTIONtOF PROPOSED WORK check alI a••licable � ,... New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition" New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: ' Q..vn■ v E. QV.St ,K' Va. k .0 ft Tom\ to , 4 . . w C444N Alteration of existing bedroom Yes C No Adding new bedroom Yes / No Attached Narrative l -' Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet 0 0,131f :MM s a "d of ard'dition>to exi`stiirk;ticTtit ti c iliVI te' ttt e fotr W:i g: a. Use of building : One Family Two Family Other ✓ 3—s b. Number of rooms in each family unit: V14,-\ Number of Bathrooms c. Is there a garage attached? (O 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 al matter relative t work authorized by this building permit application. Signatu e of caner Date I, S W��V 10-+4+4`., QQfi=5 or\tb.w %■13\Dlk-C S , 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. Print Name of/6/. Signature of Owner/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 IFYES, describe size, type and location: • . • ' . Ci�vT�fNnrtharnpton � ' ` �� Aul|dUnQDepar�rneni ` »� . ~ _ _ - -'- ' 212 Main Street :....,,,*,,,:z...„ti:,.,.,, ,i,; zijoptg :f:;-,,)7;r;--:::;7 -,:,,,..,:::jr'.:„.„..,4,:p..,...;*:,...,,,,,,:: R0onnlOO O "DR�m ' -�� , , �"~.nrthon?pton' ��AOlObD phone 413- Fax `` . \ ` ^ - �PPUCAT0N��OCONSTRoCT. ALT�R, REPA0. RENOVATE 0R DEMOLISH A ONE ORTVY0FA01|LYDYYELL\NG This SECTION ' 3!TE |NFOR MA|nOm 3 ^m,a,1.1 Pro pert Address: _.�S-4 _-- ' oo�����k wK° Elm St. District ^ ' �� ^ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ---_�_ r („ f°114 9�� ��� ~_=� «1� .Owner of 2.1 _5. *„ � .: ^2,..c � % w ~~ , mno xouess �� ~,a, mn, ` ~| w 2.2Avthoriz�d�yg�0: ! ��«~ ~°�� -�� k / C '��� WnUin3 Address: �� ���Name(Plint) ...004t4j. Signature -I SECTION 8_-_E SI M8_�IE D CONS TREUs�CTm(0a�tN e�d C�CO yoSsT�5( Dollars) to ic Item / � �)ic i a( Use Only / c2mp(ete'd bpermhanp|ican\ _ (a)' 1 Building Building / 2 Beo/icai Gui|di � Perm\t Fee b) �shmacd PeTromtal Cost of uost �mction from 3. Plumbing 1 _ *— / ----- ^� �r ---'—�--- This Sec For Official Use Only Boi�din� PermitNumber� / uY Date |ssued:__. Signature: m �ui|dinKC�mm�sinnmf|nspcc�,o|Buildings »n ' ` ■ a, File#BP-2003-0669 APPLICANT/CONTACT PERSON Harlow Builders ADDRESS/PHONE 336 COLES MEADOW RD (413)586-0465 PROPERTY LOCATION 33 CONZ ST MAP 32C PARCEL 116 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Peufflut Filled out ---Fee Paid Typeof Construction: REMOV PLASTER LATH,INSTALL INSULATION,SOUND BOARD,SHEETROCK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052460 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Stree ommission Z 20 a3 Signature of Building 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. i $ r , r BP-2003-0669 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0669 Project# JS-2003-1102 Est. Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Harlow Builders 052460 Lot Size(sq. ft.): 15986.52 Owner: SANSOM FRANK T& Zoning: URC Applicant: Harlow Builders AT: 33 CONZ ST Applicant Address: Phone: Insurance: 336 COLES MEADOW RD (413) 586-0465 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:2/11/03 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE PLASTER LATH, INSTALL INSULATION, SOUND BOARD,SHEETROCK 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 2/11/03 0:00:00 678 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo