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32C-217 (2) 11/29/2006 21:24 FAX 4135844806 First Response [4]001 FIRST RESPONSE RESTORATION Fire and eRestorall011 Oil Spill Cleai3 1 FAX iRANSMISSTt�N COVER tJi _ — jo13/CLAIM NO: _ -- - DATE: ,,-_._ ------ — FAX NO - 5-,-6 -7 :�.�. f NUM6ER OF PAGES INCLUDING C.OVER__�.._— PLEASE DELIVER TO : ATTN: __ _ — ---- FROM: MESSAGE : i�f'^149v r I'tpr' 13+4 T" S i✓K- TV�A ttwr- 1'Grlt�rG 9 art tw cs x cpmr-� wa k rt c w 7j h�...t Fl oar' X45711 I R n. BOX 166 EASTHAMPTON,MASSACHUS1.TT5 01027 413-584-6519 > ~ . lz \ to © 0 2 - Cl) : c E 2 f E . ° z I J a » C) -Jw< . in f C)W oiw � �/\ • 1 °D . Xo Q i m N r � O w z O vc n b,--4' �-q• co p iDmtnM U3 w 1 °� ru r A CX] .� �� /ZZ► W V+ L71 LA a ti r r 03 ,� m m vi r N= ru =3 w 0 Gy z -�--- V Z I i t i I r � CA I� 00 6 C,1,.jr2,jpr P.t7j �t'wit Pri,r Effeive Dats: F.Popr, MA V'-I OR ct Applic Expiration Date: Cvpt:-;tcIi-r or Date pmces:;ed: (PLEASE REVD BOTH PAGES CAREFU'LUO 1. 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DEPARTMEhrT OP BUILDf\1G INSPECTIONS 212 Alain Strcet - ASunicip.al Building Norlhamplon, Mass. 010GO i - «`OI2ICCIZ'S COINIfPENSATIO.N G SURANCE All=- :.VIT a,S`r4 WiLh a principal place of business residence at: -- y -;�� �lr � c'���1� -����•v /l?1 (fhonc') (st�.t/a t•J lszatc�a p) jdo hereby cerdi.-, under tic.pains and penzties of perms, h�I I ( ) I an an employer providing the following!%vorl-ces cornpcnsc:]on coverage for In etnplovec:s worlorig on tuns job: (lnsu-m-n=Com=:.m,) (Potic:Nu-ter) D2=) I - ( ) I am a sole proprietor, general consacLor or homeow-Oer (c cie one) and have hired one coouactors listed below wbo lLave- the `olloWziQ worker's coLoen_tation pe!icies: i (i+31Be of Co_'tm or) Onsurdnc Cornpxi1 '/hoUcj- NuSILC:) (r`:�111 Q?Datc) (Nzmc of Coauzmor) (lnsuran= COMOax,-Pour. Lt>nc--r) (Ex-piruon Dale) (Name of Coaaact ) (La U-az= C.ompani/pOUC- Numb:.r) (-xpimdoo Dalc) i i . (Namc of Contactor) (Insurance Comrzay/PoUCY Numlxr) tExpirtion Datc) __-- (aC1Cb�-s,:ocil�cC.ifnccc,_-}w e�cu�aaforta,�oa pcue.i�sas to.!I we-sn:a) -I I am'a sale pFOprietor and Isave no ooe wor'dng for me. { } I am,a home owutr perior=g all the work myscJf. NOTE:plese be zw-arc tts-t 1c bcra a very wbo c=play p=-ors eo cLz c='=,ao c rgaa •oric of Got mace t!: t qtr in Leh the bomoo-resit or oa the avtrcra-7pur e tbe--o ooc c--=-DY or= d_-ai w be eirploycz u the=--A: -,:cc A=(GUI 52-=1(5)�=pplia?on b-f a bomco -oa fc c lid_- Y or pe-'mit r✓y C`-r&CD=th I-P1 c--^•'of M=Ploys uodor dro Work e.C.oc=p.am+lioa Act I I un4 -,ad dva a oopy of tni.cmz—od e y b.for--e-d io tb.Dop.� Offs.or i=-ror tb, oovexo•-c vciresion=ad th1 L-ik=to L ure tov= -cock==ioa 23 A of),(01-152 an fCtd to the i P=x boa of ei�penalva 00m1:isg of a fine or up IDS I}00.00 anycr i=pr6O====of up to ooe y-_-eat ci N-a p=.i-i=is zt�-f-,,n of,Slop W orE Ord---ad 11=oCSI0o.0o a(!--y e&Xi=t>x onty I - PCTiD.7i I`It1IDlXS �'S1f'SL1fltmnf? ..•.�.�..../D�.�...rr�� E� �'(.�n. -- tAl SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: E�.�.i; ✓ i c (` �'t!, ��'-�C� jLicense Number r/ ��4��, Sir �'� �;..�t1�-, �'�1� � �o`7_S C;C /�,�Zct;�-�� A Expiration Date Signature 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,§25C(8)) 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 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors 1711 Accessory Bldg. ❑ Demolition ❑ New Signs [a Decks [Q Siding[p] Other[O] Brief Description of Proposed > Work: R+ �t°S Y S cG� .e S � �GC� p i'Cr 2ry��� r ,(C / j Lip.-C lam;l,:rcc At! Pik 1'✓s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet sa,If New house and or addition to existing housing, complete the following: a. Use of building :One Family x 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. 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 . 1. 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 I 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. (0 C-f- 41 ) � � rF,�✓ Print Name /�— 7— e) Signature of Owner/Agent Date Section 4. ZONING All Information 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 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 Q DONT KNOW 0 YES Q IF YES, date issued:% IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book I Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 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 Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. „ 010 . City of Northamptonta '� � Building Department `Y '' 212 Main Street � I1t�1 UZ Room 100 at�lif;+kaii#�t - Northampton, MA 01060 U001,4,Of ur pho�ie 413587-1240 Fax 413-587-1272 I wt sIto 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 :Map Lot Unit Zone: Overlay District )_ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: C � Telephone Signature 2.2 Authorized Agent: /17 ! 4^.5- Name(Print) j Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by per it applicant 1. Building 3 ! (a)Building Permit Fee 2. Electrical fj 7 (b)Estimated Total Cost of Construction from 6 3. Plumbing I��j 1, Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection l 6. Total=(1 +2+3+4+5) c, C Y Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0600 APPLICANT/CONTACT PERSON FIRST RESPONSE RESTORATION ADDRESS/PHONE P O BOX 165 EASTHAMPTON (413)584-6519 PROPERTY LOCATION 27 HOLYOKE ST MAP 32C PARCEL 217 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinjz Permit Filled out _ Fee Paid Typeof Construction: REMODEL BATHROOM STRIP&SHINGLE WEST SIDE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 036374 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Stre mmission 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. � k i f 17� `R c_ I -f �' ciJ 27 HOLYOKE ST BP-2007-0600 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-217 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0600 Project# JS-2007-000886 Est. Cost: $9867.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FIRST RESPONSE RESTORATION036374 Lot Size(sq. ft.): 9496.08 Owner: KIELBOWICZ ROBERT Zoning.URC Applicant: FIRST RESPONSE RESTORATION Applicant Address: Phone: Insurance: P O BOX 165 (413) 584-6519 EASTHAMPTONMA01027 ISSUED ON:121112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM, STRIP & SHINGLE WEST SIDE ROOF 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: 11 I l� f'j Rough: fs� �i y House# Foundation: f i •y�-'�J Driveway Final: \ Final: Final: y� / Rough Frame: �/ � ( ��p"� Gas: Fire Department Fireplace/Chimney: e..,,,. rR�• Insulation: Final: Smoke: Final: `� 7-07 THIS PERMIT MAY BE REVOKED BY THVITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATI Certificate of Occu anc Si nature: FeeTYpe: Date Paid: Amount: Building 12/1/2006 0:00:00 $50.005197 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo � . 0 . c A Q § � - r « Cl) § \ CD w , ƒ 2 � $ 2 rM / Q � 6 f �_co § 3 tkƒ CD J \ ¥ m C * d/ § f « : CL _ N + � ®, f co ! . 0 1 / °0) \ \, , . , , k IZ4 s \2 ƒ ) i f o A IN El 11 # , j ® . & ] i { 2 . 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