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V�.15 X< Z�Z> 3< LLJ ca x x Z3:1 -`:;- 91. > m o zw — LAJ a0-2 LLJ tn 0 O—z' in Q m-w mzzz LAJ z zz z < zvvww o 0 I < Z CX 0 z 0 YE x M x LLJ Z kj-J 11-Z ui kno M: LLJ :x Z I I �11 'zz L'i cz . t� w F, <0 =)-< m I.- @1- 2. z E2 n Z'Li =C� .. - Z.�Na V) Dx x A Ln z 5 a as 5.9- 0- za zom z Z' I. -.'q�' 6 , - - m 6)� MEO 13t F- 3- LL Z kn Z- C) SIM. Zo z 10 wa MQ x>l< oz 06/28/2005 TUE 2##Q6 FAX 5088363690 USA DECK BOSTON 001/001 -c c T o, ctu) JUN 2 9 2005 P005f- Y�Z-C) 14C r-- Appa* 10 ),-, S 7 !S 70 SCL cc),j 0i cc Ps So -7 C) 1 000 of A f tW-�b 6 p P vt 617 - )\75- 8 � 13 -3 6,� -3),579 Client#: 2072 USADECK1 DATE ACORDT. CERTIFICATE OF LIABILITY INSURANCE 10105/2004YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wachovia Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1753 Pinnacle Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Eighth Floor,VA2005 Mc Lean,VA 22102-4099 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Cincinnati Insurance Company 10677 USA Deck, Inc. INSURER B: Cincinnati Indemnity Co 10677 1041 Cannons Court INSURER c: Hartford Casualty Insuran 29424 Woodbridge,VA 22191-1434 INSURER D: Fax#: 703-497-1559 IN E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I R DD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/ IYY DATE M DD Y A GENERAL LIABILITY CPP0738119 10/01/04 10101/05 EACH OCCURRENCE $1 OOO OOO DAMAGE RENTED $100000 X COMMERCIAL GENERAL LIAB S 1 ILITY r � CLAIMS MADE FX1 OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1 j OOO 1 000 GENERAL AGGREGATE $N/A GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 PRO-PRO LOC A AUTOMOBILE LIABILITY CPP0738119 10/01/04 10/01105 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY CCC4962238 10/01/04 10101/05 EACH OCCURRENCE $5 000 OOO X OCCUR ❑CLAIMS MADE AGGREGATE s5,000,000 DEDUCTIBLE X RETENTION $O $ WC STATU- OTH- C WORKERS COMPENSATION AND 42WEK14063 10/01/04 10/01/05 X EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SAMPLE CERTIFICATE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV FOR WIS BY: ACORD 25(2001/08)1 of 2 #S316674/M253366 LSA01 © ACORD CORPORATION 1988 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �t ' r s., ('_ Address:_ 45' City/State/Zip: WP M t� D [ �'� t Phone#:_ ( �- ('36- 3 11 1 r Are yqu an employer? Check the-appropriate box: , Type of project(required): 1. I am a employer with +/_ 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- Listed on the attached sheet. I � ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working or me in an capacity. workers' comp. insurance. g Y P h'• 9. E] Building addition (No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.) 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.F-1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' � ther ' f> ; comp. insurance required.] 13. O ! I "Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Jo�c G ��S Policy#or Self-ins. Lic. #: "I oN �y� \� Q 9 Expiration Date: �©�G�1 &q Job Site Address: 1� f y� City/State/Zip: / ld ��j ,�CC C IC�� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb er the pains saa�nd penalties of perjury that the information provided above is true and correct Si afore: �/- E ''�' Date: g&C G Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Boar A Building Regulat bi d One Astiburton Place, - Room 'A Boston. Massaclusetits Boyne hinp-3.0-vtmeni". J P� F C E 1'6 ! UISI/1", DE:C'K.. ill"iL FAR—MELL [)ANNEL 10,4' G A 14 1 t 011 ; , i. WOODE R I DGI E \."A. '22 S, F C'L fc.r C�L i--, LC DPS-CA.', Q 50h',D4'04-G1,C',2)E Reg"40ivus cud �f cojv fvM,_0Vjj''EI,'T coh'TRAC7041 If kulad bokrd of I'mildifig 0 r.e S 1.1 b t'r i e F--P hn t t R V33 13 04 r-r:.Pukfiw I'-16i-2cloc gfCrt,Ni.,,02101 Type.: suppicro'u-"t cti-�. USA DECK,INC, H,�RRELL DANIEL 10,41 C-1 A Nt I'll,0 IN, %rV CC)DE-R,ID C-I--,VA'L2*1 Net N",fid r' ihovl sil nl tVfl- BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 070960 Birthdate: 0912511965 Expires:0912512005 TT.no: 6425.0 Restricted- 00 DANIEL H FARRELL 101 POPLAR ST TEWKSBURY, MA 01876 Administrator r i MORTGAGE LOAN INSPE C . ION 31, S ' ''LOT 52" " LDr 5/ 39 LoT 50 " ;2 J -Y WIF 8 w # o - yDUs� [03 q V cc� IDD. DD'-'- t ,eESTwE w DP-1vE �lar� t s /-14 C/c"16 2 r> Home • • Decks Customer's Last Name,First Name Store No. Order No. 1~ ✓ Service Address Io�n'�c ifri� l�iD6.2 City State Zip i Billing/Mailing Address(If a dress) City Oh State Zip 13 -D�ov 3 - - ooar 0 3 Custo er's Daytime Tel.No. Gust er's Evening Tel:N . Customer's Driver's License No.or State Identification No. CUSTOMERS INITIALS: BY INITIALING,YOU AGREES THAT SYtYOUR SIGNATURE BELOW,HOME DEPOT,ITS AFFILIATES,OR AN AUTHORIZED REPRESENTATIVE MAY CONTACT YOU BY PHONE,FAX OR E-MAIL ABOUT OTHER SERVICES THAT MAY BE OF INTEREST TO YOU.YOU MAY ALWAYS CHANGE YOUR MIND LATER;JUST LET US KNOW. Primary Payment Method: ❑ChecklMoney Order coome Depot Card/Home Improvement Loan [—]AMEX ❑Discover ❑MasterCard ❑VISA Primary Account Number: Expiration: / Secondary Payment Method:❑Check/Money Order ❑Home Depot'Card/Home Improvement Loan ❑AMEX ❑Discover ❑MasterCard ❑VISA Secondary Account Number: Expiration: / Payment Schedule: You agree Your payments will become due on the dates indicated below and,if You are paying other than by check or money order,may be automatically charged or debited{as applicable)to Your designated account(s)when due. Down Payment: $ _� Due immediately.Your down payment is NOT an installment payment under this Agreement. Final Payment: $ r 4P Due on finish date(see below)of installation. Sales Tax: $ If applicable. Total Amount of Sale: $ , Includes all applicable discounts,rebates,and taxes.Excludes finance charges.' *Any interest payments or other finance charges will be determined by your separate cardholder or loan agreement,to which Home Depot is NOT a party.Please see this Agreement's General Terms and Conditions for more details as to other charges that may apply. Anticipated Installation Schedule Please note that neither Home Depot nor Installation Professional are responsible for delays resulting from events beyond Start Date: / of tar- their control including,but not limited to,Change Orders,incorrect information You provide,legal encumbrances on Your property or its nonconformance with building code or zoning requirements,Your credit/financing,acts of nature,government Finish Date: j/a� or any third parties,labor strife,hidden/unforeseen physical/hazardous conditions,including,but not limited to,environmental _/� hazards such as mold,asbestos and lead paint,or Your noncompliance with this Agreement. Definitions:"You"P'Your"means the customer identified above."Installation"means the installation services specified in this Agreement."Installation Professional"or"Professional"means an independent contractor authorized by Home Depot(licensed and insured as required by Home Depot and applicable law)and the contractor's employees,agents and subcontractors."Agreement"means this Special Services/Home Improvement Agreement between You and Home Depot U.S.A.,Inc.(interchangeably referred to as"Home Depot"or"EXPO Design Center"),which includes this page,the General Terms and Conditions following this page,the State Supplement,the Invoice or Specifications and any other documents expressly made a part of this Agreement.Please see this Agreement's General Terms and Conditions for additional definitions. Acceptance and Authorization:By signing below,You authorize Home Depot to(a)arrange for Installation Professional to perform Installation and/ or(b)order and arrange for the delivery of special order merchandise,including special order merchandise that may be custom made,as specified in this Agreement.You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Home Depot(or by Installation Professional or its authorized representative on Home Depot's behalf)and You.This Agreement expressly supersedes all prior written or verbal agreements or representations made by Home Depot,Installation Professional,You,or anyone else.Except as set forth in this Agreement,You agree there are no oral or written representations or inducements,express or implied,in any way conditioning this Agreement,and You expressly disclaim their existence.Do not sign if blank or incomplete.(Installation Professional's/ permitting information may need to be provided to You later.) By signing, You acknowledge that You have read, understand, and accept this Agreement in its entirety.You further acknowledge receiving a complete copy.Keep it to protect Your legal rights. Accepted by: ez-&.Lo Professional's Full Business/i'rade Name,Address and License No.orNos.as"icaMe: X Customer's Signature Daf Customer's Initials: BY INITIALING,YOU AUTHORIZE DELIVERY OF MERCHANDISE TO SERVICE AD SS PROVIDED ABOVE WITHOUT OBTAINING DELIVERY AGENT'S SIGNATURE AND AGREE TO INDEMNIFY AND HOLD HOME DEPOT HARMLESS FROM ANY RESULTING CLAIMS. 1��� MIT I S 0 nowns 0 ubmitted by: ❑ Home Depot Associate X Za Prole irpnallAuth ized Representative on Home Depot's Behalf Associafe's/P i ars/A epresentative's Full Signature Date Z---j ' Associa epre to ve: ase PRINT Your Salesperson's License No.if Applicable ` O�Y�� H E DEPOT'S LICENSURE INFO:SEE ANNEX t As ielRep nta Ve.Please PRINT Your Name in Full and Check Applicable Box Above BUYER' RIGHT TO CANCER-SEE GENERAL TERMS/CONDITIONS NS-750(11/03) DISTRIBUTION:White—Home Depot Copy Yellow—Customer Copy Pink—Installation Professional Copy ¢•(11AMp�, , $ (1 �1'ilassac}tusetts ` DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR '212 Main Street • Municipal Building Nordi•unpton, MA 01060 - HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to v act as i:is/her construction sup<::- :sor. The state defines "Homeowner" as, " Person(s) a who owns a parcel on which he/she resides or intends lobe, a one or two f -ITy- 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 home owner." The building department for the City of Northampton wants.any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and fegulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour) a rough building inspection(before work is concealed), insulation inspection (if required) and a final building inspection.:The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location r a e a I l* �3io-A 4Ztw•tnT �.. - _ 0 0 - Z U '� - F Cris ofjn� fllaiil}�foll - _— _ o DEPnRTMEI-fT OP DUILDD-,'C INSPECTION'S i — 212 Alain Strcet Municipal Building j Northampton, Mass. 01060 4 WorucER'S COit/LPENSA770N MSURA_N CE AFM, A.x'IT SA Dc( �L �a:-u:-••rJ��crm�tCcc) � d %I,rl h a principal place of businessfresidenee at: /�' �JcaJU o� G� CtJ t (phone:=)�"� —� i ( city/statcta p) do hereby cerdi ;, under thc.p?_ins and penalties of perjury:, -Lh?i ( VI an an employer providing the following!�Vorkcr's co(nocasabon cove��e for Iny etllplaVCCS wot�ang on Liu's job. 0 S�— (lnsu.az=COE, sti) (Polic,tau-aixr) (r:-pirdon D21--) ( ) I am a sole proorietor, general conn-actor or homeoUrner (ci:cie one) and Dave hired the coasat tors listed below wbo have the follow' 9 workees coo:)ta5.aaon pakies: (i+1n]C Oi contnaon (Insuranc:, Co(noan)-i'obc; Ntrmr<:) (E�:Jtrauon bale) (Nzmc of Couazuur) (1nsJrancc ComoaativPo!ie \uncrr) (x-Dirilon Dait) (i i me of Conuacro;) (Lasuran= Compass)-RoUcy Numbu) (Expiraen Datc) (Nt_Mc of Contractor). Jnsurmcc Comeauy/PoUcy Number) (Expiration Date)- (attac3 adait:ocal�cC,ilnccc-ia.v to mdv�ufbrau ioa pctn-inias { ) I am 'a sole proprietor and have no one working for me. ( ) I am.-a home owner performing all the work lf ork myse . NOTE:pl=3c be ewzrt u——Ljo 6caxrn+acn who emPl%p---:.a=tq do cr rc,un'work of ant meet tb_n tsr_tmru in wt idr lb bor oa rcede or cc the a ouDC r` zppurten•}"the ao r z Dot Cx-.By oecr:d..vi w be citploye unr--the cry---,•on Act(GUI 52=1(5) =ppliobao bf a bomaoava fa_lice_or Pcr.na cr_y nidca=the IcIP]n--s or as eaPloyx under dao Wockce,Coaepom+lio,n Act_ o [asadezt�d th,a a Dopy of t>,i.mtem+�m m,.y be for+.nrdad to ttw p.cpa,uneo3 of Ind+sriJ Accd+m�Offroo of(+a+r<n°°for the Bova- &c v=-iGc3Iioa and(h:t f:ilLre to soa=`cowmV .dcr&-Mioa 23A of MOL 152 aw Ind to the i=pozi ioa ofaimios peaallics �l:r o of a fine orup to S 1 X00.00 and/or of up to cac yur rid aril pavhia in tSc roan of a Stop Wort ordcs Lod fim 0(S 100.00 a d_y c fp.ia-A ttx For u, 0`34 - Pcrmit Numbcl Lot" Date Signacurc of L,c=LSccfPcMIiucr_ � SECTION 8-CONSTRUCTION SERVICES r 8.1 Licensed Construction Su ervisor:/' `n i Not Applicable ❑/; Name of license Holder License Number G I, ao D"—Je C �C9l Address Expiration Date Signature Telephone PP Not Applicable ❑ ��Reausire`�tfo'me�inarar�er�rie'�i'"�G�t�aEtor�-, , `�" = 0 sec m J V c Company Name Registration um er 06"/00 0je 6 lklest- C)/,c Address Expiration Date Telephone -A�Y31 if SECTION 10-WORKERS'COMPENSATION INSURANCE,AFFIDAVkT(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-occupied Dwellings ofone(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,a7 one or two family dwelling,attached or detached structures accessory tq 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 perforrh 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 r l n a SECTION 5--DESCRIPTION OF-PROPOSED WORK(check•all applicable) New House ❑ Addition F-1, Replacement Windows Alteration(s) Q Roofing E] Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [02-- Siding [O] Other[C7] Brief Description of Proposed �-1� Work: )�I�(A CX vecrL �K �7� Co G)IA�j� �10/66,w-i C/"'J Alteration of existing bedroom Yes L,-'No Adding new bedroom Yes C No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet _ h a�sa If Af6usea g: d 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?/Uo d. Proposed Square footage of new construction. Dimensions iv 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? V Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATIO.N TQ BE COMPLETED WHEN I OWNERS-AGENTORCONTRAGTOR=APPLIES;`FOR BGIEDING�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 at)i ��f ` l `�� � 1 /Z :It C_ as Owner/Authorized Agent hereby declare that the statements and infofmation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Pr' ame g . nature o Owner/Agent Date Section 4. ZONING All Informatibri Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building`Department Lot Size - �'= r) Frontage Setbacks Front Side L: R: L: `r�' R:i � Rear t- F t Z© Building Height - Bldg.Square Footage % ti Open Space Footage __� % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume-&Location) ' ;V A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:? IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW YES 0 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 Q Obtained Date Issued: s C. Do any signs exist on the property? YES 0 NO 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 IF YES, describe size, type and location: 11 c 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 Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. m m C f Northampton Qi�g,Department a cap' 1'� fain Street r 7 ���} \ 60 100 o �-Wortha�rnptoMA 01060 e so �`'vhone 413-587'1240 Fax 413-587-1272 Y' PtoStt a€ �� �: PPLI dQW1 TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1'-SITE INFORMATION 1.1 Property Address: This secttort to be completedl�goffice cf v-S i-U P e' 1J �� Map Loth ''unit r � Zone werfay;Dtstnct� EIm St D,sfr�ct CB DGStFict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Aa+klQ,A) ,/���`�►� rsAJ Qr. . fbCeXce, A4 b 16 Name(Print) Current Mailing Address: �/3 Telephone Signature 2.2 Authorized Agent: vu, �l�es t-hvfci Oj?� d� 'I me(Print Current Mailing Address: ignature Telephone SECTION'3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 71 Y5 de, )Building Permit Fee 2. Electrical (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) 7 , &T/r— I Check Number , This Section Fo'r Official Use Only Date Building Permit Number. ' Issued; Signature: i Building Comm issionedinspectorof Buildings Date File#BP-2005-1279 APPLICANT/CONTACT PERSON USA DECK,INC ADDRESS/PHONE 125 FLANDERS RD WESTBORO (508) 836-3111 PROPERTY LOCATION 63 CRESTVIEW R MAP 29 PARCEL 460 001 ZONE URA/N E' THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 7 O D '73 S Typeof Construction: CONSTRUCT 12 X 16 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070960 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF94MATION 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 Comm iss' n Pwo 001e / /-ta/O 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. ri RF.S71VMW DR BP-2005-1279 COMMO WAAV OF"MASSACHUSETTS :Block 29-460 • G OF NORTHAMPTON Lot-001 Pets ir. .: - Bulldtnq Category L/ lJJ��►1r11T _ Permit# 13P-2005=1279 "' x Project# ` 'JS-2005-1708 Est.Cost:$7598.00 s, Fee:$50.00 SSf0NLV HEREBY GRANTED TO: �*Const.Cuss: Contractor. ` Zicese: s Lot size S :t : 10018.80 TUS�4 DECK; INC 070960 i 1 Owner: MICRON CHERYL A'&ANT-TONY W zonin�.71tA t>ica;a:-- L Cfr.`lilt � . AT:`63 CRES'fVI EWDR . Applicant Address: " Phone: Insurance: 125 FLANDERS RD (508)836-3111 WC" WEMOROMA01581 ISSUED ON::6/_i0/05 0:00:00 TO PERFO"TD'EFOLLOWfNG WORK:CONSMUCT 12 X 16 DECK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wirimg .� D.P.W. Building Inspector Underground—- -.Service: Meter: - Footin s. Rough. ;Rough - -- - House.# Foundateon: Driveway Final• '`x Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimneys Rough: 'Oily Insulation: Final: Smoke: Final: --2-C,6 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF ANY OF ITS RULES AND REGULATIONS s Certificate of Occupan Si nature. FeeType:_.. Date Paid: Amount: ;. Building 6/30/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo