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32C-226 (12) _ zr f = - '\ uc?"?i v'"Fi G L' Dine IN ?ECTio1.`� =_ ?-7? hi--:r. St.-pct 07060 =- Square An,oun[ 2nd Floor r ,z-10 l `� 0 . ?/; Floors. Deco:', Porches 'IEE3 -r.2008'— 3:a4PM I .AYT0N II`��'URANC:E — �Cl. T1 �"P�M1F4nMtCpIYYYY) .bcQ. CERTI. ICATE OF LIABILITY INSURANCE �1 ozj27j2006 PIt pu Bz B 3 - 874 THIS CIERT�IFICATE IS ISSUED AS A MATTIER OF INFORMATION Martin 7, Clayton Insurance Agency. Inc. ONLY AM CONFERS NORICHTS UPON THE CERTIFICATE HOLDR THIS CERTI ICATIW 10003 NOT AMEND,EXTEND OR 1649 North4mpton Street C ORDER,'HE POLICIES EELCW P. 0. Box 989 Holyoke, MA 01042-0989 INSUREDS AFFORDING COVERAOE :NA 1C 0 INSURED Cedar F-Alls Construction INBURVIRAI S, . Smith A ICo n , Inc. P. U. Box 204 iNS[JRSRB; Safet Ilsuveanri t;Cb pn _ ,0014 Chicopee, NIA 01021 INVJRERC. INSURER D, _'QYERAGE8 THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 18SUIED TO THE INRUREC NAMED ABOVE FOR THE POLICY PERIOD INDIOAT'ED.N0TvyFI48TANDINQ ANY REOUIREMEN",TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REBPEOT TO WHICH"HIS OEPI7I1PIDATI MAY BE ISSUED OR MA-PERTAIN,THE INSURANCE.AFFORDED BY THE POLICIES I.1E CRISED HEREIN IS SUBJECT TO ALL THE TERMS,E=.U4IONS AND CONDITIONS OF SUCH FOLIC IES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY?AID CLAIM& ➢3 TYPROPIHSURANCE POLICY NUMBER n UNITS 0, ROL LIABILITY 0146 j EACH OCCI RMNCI I 1 000 00 . Z S0Q 4Q C4NIMIePCIAI GENERAL LIABILITY RENTED 3 CLAIMS MADE :]OCCUR; MID RXP 001y one aanom) $ 5100 A I PER54NAL!G ADV WJRY S --1,000,00 BENERAL&HREGATE 3 L000.00 0EN'LACiGREGATE LIMT APPLIES PEP; ` i PRODUCTS-COt'IPICP AGO S ;Lq 0 j8t5 PO _' AUTOMOVILC LIABILITY 6201759 11%05%20#5 �7j03jx006 oowlal�IX4 4104F LIMIT $ I AW AJTG Ila aco dkMt. ! ALL OWNED AldTO8 900%%INJURY 6 B X sWyEDUL�o Au res i ;Fmr person 250 00 I KRED,AUTOS 1 ; I 600P,Y INILIRY NON-OWNED AUTO$ I ! (PIKAaCiq�i x 500,013 PpOFARTY pAkwE I° 1 (Pef0 bow fI) i iao oa GARAGE6!ADIWTY i + AUTO ONLY-EA ACCIDENT i ANY ALTO y I V AUT4aWLYi BAAaa S AGO IECC$11WiJMHRGLLAU4BILITY EACH 0004L S OCCUR QLAIME MA05 A66REGATE I i DIEDLCTIBLE MRTENTION 4'JORKCRSCOMy6NfsATION AND EMPLOYERS'LIAMUTY S.L.4ACM R==ANT Q ANY PROPR Tip ARTNE f"a%ECI176VE OFFICERMA SXMV 07 k,L,0I81£AS1•r6A EMPLOYE $ i` es tleeetip�unt4t ". SIkFE AL,PRRMGIONR maw ., �w F.L.DISEA8'EPOLICY LIMIT 5 I OTHER I I '7ESOMPTION OP OPERA'90NS/LOCAnONS I VENICLU I VXCLUSIONS ADDED ttY 8NO0R$9MCNTf SPCOIAL PRCV18II3Na I 9IRT-1119hit 34OULD ANY OF THE ABOVE PEOrNO D POLOW NE CANCELLED BAPORR THE EXPIRATION PATE THEREOF,TNp ISOU140INSU*IRR ft1 ONPRAVORTO MAIL _Ii RAYS WRITTEN NOTICE TO THE CERTIpICATF NOWER NAMED TO TIDE LEFT, j Mary Beth Somorgi an SLUT PAILURN TIC MAIL SUCH NOTICE UALL IMPUic ND ONLIGATION OR U18C.PM' 67 Hawley Street OF ANY KIND UPON THE INSUN*4!TS AGENTS OR REFRCSENTATIVEQ, j Northampton, MA 01060 AUTHCIR26D REP Rk& aTlu� ACORD 25(2007108) OACORD CORPORATION X003 - \ .:' 1� 1 �a'y1• e=1� Ol f ,'j��^ �-1�' �� a�awS�OY t::} � fir✓ ' :SPC-CTG-P . Savare FP�� Fsnaunt 70 ��c r`��ccO -L L!Ly 7r yU 1-12 Fl=rs. A[t_C. rarace ;,q Deck-, porches �= T00 UZTLBSETfi XVI tZ:9T &OOZ/LZ/ZO 40 : ,., wffl File#BP-2008-073 � t � APPLICANT/CON7 = P l S` '/ ADDRESS/PHONE - s� � PROPERTY LOCA1 � �'�.��` ��SO MAP 32C PARCEL AV tee° LONINCJ FORM FILi - 317WI, Fee Paid �ra ' _ Building Permit Filled ' Fee Paid = e' Tvpeof Construction: *` C New Construction Non Structural interior renovations Addition to EYistinv- accessory Structure - -- Building Plans Included: Owner/Statement or License 080106 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 Permit DPW Storm Water Management Demolition Delay S_�,_,nature of Building Officia Date I 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. Cedar Construction Supervisors LiC#CSL 080106 FOUS MA Home Improvement ® Contractor#148489 Construction Service,LLC Cedar Falls Construction 209 Prospect Street•Chicopee,MA 01013 Founded upon the principles Tel 413 536-8544 • Fax 413 536-8627 • Cell 413 885-2852 of honesty, reliability and Email: builtrite01013 @yahoo.COm superior craftsmanship from frame to finish. f'efxea i'25, 2008 Built-ng Coi2?t—n1SSi CneL `VIV'r of N ort1°.atri to_3 z'£Aiairnn g to i � aiYle1 �6iCEb_ As +le Building Depar ri:cra is aware the fort 'ter Gwe.1intg at v� 1-E a,,� v� Street aS �e��. 3iDOVId and only tit undat:on t ernains. This foi - utio ' � ? - •, ��' r r�-•"'✓�C� �'".i. :4 .t :il"2:+1_ a.t'.2e�S�"vr.� ii ./ v A � S t t f:4?iT1 the paea'iAiSeS a:3"iC's .�l.S;C?,>,..C1 of. /�i�e'+'4 foundation a{3£'1. fGf;-:;+£, .z:s.., IJ tia..e.tsa ,,u a-`�C;: ra« i" r1 �'/`. # ?j. Tlhh, hooting shal.i rest.upon '✓`.r .'rk soaa Vv . 10 s.iis�"+k- '`vr; )1r.a �Ii.it i2 !�. LLr rE z �... stepne corn a ted as ti base i r the footing. Walls Sall be 110 loch s think. st rc.forf--e)-lent. Ali corls�ruct?on shall be aS per Mass codlt- l e '`�.Sla.to beak g o?�'a' as soon as peer 'z-.ts inay be rssiced. Please SeL supplied house plans an-3 site F=l:z's iep2r—, v}' 1=aro]d E.11on arc associates. Thank You A r x'fy�� e(� - �- "Building on American Values" Specializing in new home construction,additions,roofs, decks,siding,garages and fire restoration. r_ i 3 OR CD ee I p 100 O O un cc �}� ..a c_- I I I Gad ❑ � O CC 'V L `'� U3 V U C3 C. C5 j 'C2 CD _ m + j Q x i + ' �' yr ❑ { v. P.1 'C r•-q C3 C9 q cr. ❑ �+ ° a Zs a cd cd Ca e3 0-+ cn i od bA . :W` ch r W O z o _ co LU No. c� C LLI °x� 00 C)� me a G [YKc) 0 LU C� 0:c) a s alp�� .1Ijl V�lj��i N Ilj. x a 11 ' G. rs Ltiri7T J S 7: 2 }5cJ� •s.B�ESSaci� se'+s `_f,. ,_r' D_°PA T2vi_tiT OF EUI DDrl G 2,TS?F=0NS -� Z 12!Main S[rett • Munkipal Building N S p E i CT C R Nortba,pton,MA 0I 060 11VA1L r'%:17X' D V_PN4_3TJf)7V A('itNOWT,FD(�`T'MENT e S tate ofMassachuserts allows the homeowner the right under 780CMZ 108.3.4 to to a; his/her construction sup-: :`Sor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dweUing, 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 per sons)who seek to use the hole owner exemption, to act as their own consu ucucn sspe:z:so; to be aware that by doing so you become responsible for compliance with state building codes and regulations_ The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before bacltiilI). sonotube holes (before oour). a rou4h building inspection (before work is can-cealed).i-n$nlatio-n.insuecti.on (if rea aired)antia-rm Lbu;ldiva.insnectio.n. 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 occupanev ulAhe-w-o�-ran Ile-insziected.- 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 understand the above. (Home owner/resident's signature requesting exemption) I wHI call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work Iocation 77ie CommonweaLk of / -A_,rr_ssach_,sez7s De pa,-,m enz of InZasrrial A cede<<s s 600ashir. on Street Z!, Boston,M-4 02111 W",.Mass -ovldza Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele-Irricians/?Iumber s ADDliCaDt Information I Please Print LeO- y -NaMe(3siness!Orzaizaton/ladividual': r T.dl ( 1� 0,1 r 7 C ev Address:_ 0.6 , 0 0 --'Lre vou in e ployer?Check the 2-pprOP-Late box: M1 . Type of project(required) I I=a e=luer with 4. ❑ 1 am a general contractor and 1 6. C?_New cons coon employees (fal-I and/orpa:tti=ae.)_ have hired the rib-contractors T '1 -1 Remodtlimg 2� I am a sole--oprTiezor or partner- hsTad on the attached shetiL shit 2-1 have no lo-ees These sub-zon=ctors have 8- Demolito working for me many capacity- e=ploveees and have workers' 9- Ettilding addition /cornp.=,=ance.� I I W01kcrs,con 2p.=' =Mce * 7 repairs or L7 We are I O-L7 Elec—tical r" ' or additions required.] a corporaaon and its officers have exercised their J, 3� am a homeowner doing all-work I I D Plumbing r--pairs CT additions zays elf L--N'o work_-s'co=. right of exemption Per MGL 1 12.E]Roof r--pairs ins=ance required-]t c. 152, §1(4),and we have no employees. [-No workers' 13.❑ Other ;onip-mince requirred-] -----�Tny-app ricmf mat==32 5oxrT=s1=o ED out me s.. non be-owsHowmi,th=-wari-.--s'comp==on.pony infm-n=m Hon=wnen'who subrizir this affidavit indicating they are doing all work and:h=hire outside coa=z_-.o=tnust subrit a new affidavit indicating,suciL :Contr=rors that cacck this box must--shed an additional shec*showffiz the n=e of the sub-contactors and state Wilether or not those entities hive er,nplovees- If the s-dD-cor=actors.hzve c:np!oy=,trey must provide their work=s'co= - poncy number. I am an employer that isproiiAng-workers contp ej'ZS4=On insurance for my employees Below is the policy and job size -information. Insizance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: city/state/zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and ei?iration date). Failure to se--=e coverage as required=der Section 25A of MGL c. 152 can lead to the ittzoosition of criminal penalties of a tine up to S1,500-00 and/or one-year=opmsonznent; as well as civil penalties in the form of a STOP WORK 0_RD_k and a fne of up to S-250-00 a day against the violator. Be advised that a copy of this statement=y be forwarded to the Offic.e of Investigations of the DLk for ins-grance coven e verifcation- I do hereby cerd der the pains gild penalties ofperjztiy zhi=the=fermazionp provided is true correct p ro d co Date: 70 Phone UffLc=Lts.-owy. Do nor wrzte Ln azis area,to be curnpLezed by city or town official{ 3 or To- t ---City or Town: If-rzaitUcense M 0 wn C Authority Issuing Authority(circle one): Issuing 1.Board of Health 2.Building Department 3. Cim'Town Clerk 4-Dec-tical Inspector S.Flurnbina Inspector 6.LZth Other Contact Phone contac!Persoln:_ SECTION 8-CONSTRUCTION SERVICES s , 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9.Registered Home lmpro�ernent%Contractor. Not Applicable ❑ Companv Name Registration Number Address Expiration Date Telephone 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...... ❑ 11. = Home O�rier Egemp#i�in 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-vear 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 Slate 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 O Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[] Siding[❑] Other[[D] Brief Description of Proposed Work: CL,,1-7-T 4 NP c,./ ,2 F.4rilIL LO � �+ nti � N �+� Oj_ r � Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative y P 5 Renovating unfinished basement Yes No �7I ►'n Plans Attached Roll -Sheet 'J'(( U sa. If New'h"6, se and ar add-tion,to existing housiaa, corn q[ete the fodtowing: a. Use of building :One Family Two Family '/ Other b. Number of rooms in each family unit: Number of Bathrooms Z c. Is there a garage attached? N O d. Proposed Square footage of new construction. Dimensions e. Number of stories?_ f. Method of heating? F 14 /A Fireplaces or Woodstoves /t.� /� Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? E=C7 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 W A K O i i U x3 ►^°d C tj k. Will building conform to the Building and Zoning regulations? Z Yes No I. Septic Tank City Sewer_ Private well City water Supply 1 SECTION 7a-OWNER AUTHORIZATION—TO BE COMPLETED WHEN OWNERS AGENT OR;CONTRACTOR APPLIES FOR BUILDING PERMIT r as Owner of the subject property hereby a thorize C a rd Rlua to act o my be alf, in all matters relative to work authorized by this building permit application. Sign ture of Ow er Date c _Jf TJ I IJ to ( 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. 5igne rider th pains ana penalties of pejury. Print Na �� charip Qiye !-,3 '1 Signature of Owner/Agent Date Section 4. ZONING I 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:,__.5.._ L: _ R Rear Building Height - 11k1.;L,Q Pao Bldg,Square Footage 1 % Open Space Footage o° ,_..__ .�.. .,.. (Lot area minus bldg&paved narking) - — #ofParking Spaces ---' - --_ - Fill: (volume&Location) _....._ _ _. ..__, _....__,___ __. _ ._.__.._. _ _ ,.. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the p it recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book ' Page_._ .__ �_..._ ._. _.,w.._. ._.. ... and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ey--'DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q 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 0 NO G� — 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'l YES NO IF YES, then a Northamptdn Sform Water Management Permit from the DPW is required. i Department use only City of Northampto `�' L� L attkof e�it- Building Departm_t Curb Cut! rt sway Permit 212 Main Streef .a v. ailabilfty Room 100 FD E h erll � ailability Northampton, MA;01069 Two Se of ct Str ural Plans phone 413-587-1240 FaX 413- 7-1,272 Pill t Pla>1s APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 7 H�9�/ S 7"k'Q E'i` Map Lot Unit f\j (-1 A M e v(,N A) Zone! Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �y . S(� l�t> f ►'h_d f, ,�.!r 1^7�1Ct `�cal lfi'� Name nnt) J Current M 'in g,Add rss j Telephone Sig ure 2.2 Authorized Anent: n � (� ` tC �nGY'CM to 1/2l U c 1 •�� i1 �? \�.yYPC 1,r t-1 Name(Print) Current Mailing Address: Signature Telephone 5 Lj d r. F( C C SECTION 3-ESTIMATED CONSTRUCTION!COSTS' Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building _ (a)Building Permit Fee vbu 2. Electrical (b)Estimated Total Cost of U . v U 0 Construction from 6' 3. Plumbing 0 Building Permit Fee �' v 4. Mechanical(HVAC) /,!-. vO 6 / 5. Fire Protection isle Udell 1/ 6. Total=(1 +2+3+4+5) 7 -'/P1'12' Check Number �61 10 This Section For Official Use Only Date Building Permit Number Issued: Signature: Building--CommissioneriInspectorofBw mgs Date 1!; 271 11ILLZI SL=_ 0 "I/f uz-f-:L-all E U-4'. NL k-I ER I- allows th-- homeow::er Le under 7SOC-21"ER 108.3.-,Ir to -Tomeov"uer"af, ac-,-az coas---7-7c-Con sup�-- (:;4tfzes 11 a per CeI on which he/sEe resides or L-q-t.-zd-:to be, a one or r de: S=C,T_ef ECC, tC _e and/or 5--=Structures<. A . aChed SaCh U_ person W--, ,c cons,-ucts More one home M' , a Fef:cd sLaJI not be considered a Lorne O-IVTI-ef. T-he =e e E ome- fvr tlHe CIV;ofNor-,L,-=pzcr W = who setL to e=ptior, t5 as -L tLzn,by cc;- SO you become re-spor-sible for compIL-m-ce with state buEding codes and TL.i=e,-moL:prcce--s-req,Tres tEat-the buLding- cep zr=ent be cal-le-j to lzsrect woex Z-�-=Icus WLch Cbefore bacl-TUD. 2anotubt holes (before uour)- 2 rough ba-Rdinz'ir=ection-(before work is re-,T=res these=,ec-tior's before the-work is ccnc--Jed fitilure to secure these Lasrections can result in failure to obtain a certfficate ofoccunancy es.czLer L-ades to perform worn pIL-T---,bir z- Has) tLe re tLeir Prot-,dr- I be re:Spor-mble to --e rbat&-e trades I1 re Se---T Per= Issued 7 19 r --nz Lz cCr- "on-"on to tLe buLldi=- pe and that they get their re uired j=Pe4CtjoUS_FaL11:re of rae mcr,(-Id, 'a-'ades to severe:Le pet-=its and in-7zdccdcr�s as ,T-'-7red caz DAL,,-'%. tLe prcji-✓ u---L-7 sacL ti-,--t as the proper Per! �T - and i=PeCtons af,�- =ad- } the above- (11=.,Owner/resid=Cs suture requestin-7 exemption) I wz7-T CaE to SC!jedjZje all re..z.::red build imspe,-. szry for the buLdizz ptr=:,t to me. Date c-dd:ess- OffzCe of In vestigations 600 Wizshington Street - Boston, MA 02111 wyvri.mrzss.;ov/dia Workers' Compensation Insurance AffiLavit: builders/Contractors/Electricians/Plumbers o1ic::rat InforMation Please Print LeEibly f,( Name (Business/Organizaton/Individual): ' `l Tie �U Aaaro��• �tf (3 — Cil y/State/Zip: c.-\c• MA Phone #: Are Vou an employer? Check the a;prop --- Type of t(required): 1.❑ I am a employer with eral contractor and I ernpio,iees (full and/or part-tame). the sub--contractors 6. New construction 2.❑ l am a sole proprietor or partner- listed e attached sheet. 7. 0 R;einodeliniz ship and have no employees have g. ❑ Demohtion wor1ina- for me in any capacity. emplo es and have workers' 9. (� Building addition [No workers' comp. insurance P insurance-z reeuired.� 5. e e are a ccrportion and its 10.L7 Electrical repairs or additions 3.17 I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself. [No woi-Icers' comp. right of exemption per NIGL 12.❑ Roof repairs insurance required.] ; c. 152, §1(4), and we have no employees. [No workers' 13.[1 Other comp. insurance required.j Any applicant that the lcs box F�I must also fill out the section below showing their workers'compensation policy information. . Ho meowners who submit this afffdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ �o:tractors J-,at cheek this box must ataclied an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have emp loyees,they must provide their workers'comp.policy number. I am an employer dzat is providing workers'compensation insurance for my employees. Below is tnepoliey and job site information. Insurance Company Name: Policy=or Self-ins. Lic. : _Expiration Date: Job Site Address: City/State,Zip: Attach a cagy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a Ere uP to S 1,500.00 and/or one-year=, .,pnsonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against tlae violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI-A for insurance coveraa-e verification. I do hereby cerr. nrf lre rrl rr d ,�fperjz": A t-the information provided above 7e e and co rect S:anature Date-: G7 IP1,.one= --- - -1 - f'zcinl_'z-��'--'��zL'•�-.�?u_�zrzr tv�t�zlhis_arerz tome comDlered by city or[own o cial City or Town: BerinitLicease Issain:_�uthoriiti (d! e one): ,. Board o F Health _. BLiiLla'7 T-, rt�cnt 3. Lit,'To-,,u �le'li �. 'LieCi_a11 lIlS tL't.;r _. P:L_n✓3i'� II �. (JtL°f SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: y Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone t- V 3.Registered Home Irtsarayernertt GQnfiaactor „ A_ Not Applicable ❑ Company Name Registration -Number Address Expiration Date Telephone 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...... ❑ e>i>r��x�r�>l 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-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building'Otficial,on a for;n acceptable to the Building Official.that he/she shall be responsible for all such work performed'dnd'er`tl etuildinahermit 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 � e New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 177 Accessory Bldg. ❑ Demolition ❑ New Signs [tom] Decks [E] Siding[C:3] Other[01 Brief Description of Proposed Work: P r?h 7 6LV cr 4 lye kl/ /Vu Ire O/1 G ie 11, k Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If"New house and`' addi- a existin Itousirl corn Iete t ie fo[toiniin a Use of building: One Family Two Family L-,-" 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. D 2 6 Dimensions e. Number of stories? f. Method of heating? /Y /f/2 Fireplaces or Woodstoves /VC? Number of each g. Energy Conservation Compliance. y `7 Masscheck Energy Compliance form attached? h. Type of construction Lu Ct O `} 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? es No . I. Septic Tank City Sewer_,Z1 Private well City water Supply SECTION 7a-OWNER AUTHORIZATION;—TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i at as Owner of the subject pro erty hereby authorize X' �,\c S8,4 v LA 1 r I to act on m behalf, in I matters relative to work authcrizea 6y this b ilding permit application. Signature of Owner Date V, ' 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 der the pains and penalties of perju rC�j C Print Name Sign re of Cw er/Agent Date �e 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 _..a Setbacks Front Side Rear Building Height t t °" Bldg. Square Footage _. ._ . % __. Open Space Footage (Lot area minus bldg&paved Darkini�) #of Parkirxg Spaces . -- - - -- Fill: (volume&Location) _ �` .,_:. __ a "may; A. Has a SpePermit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:, IF YES: Was th ermit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO A21"** DONT KNOW () YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued 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 Q NO 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 0 NO IF YES, then a Northampton Storm Wafer Management-Permit from the DPW is required. t� De artm t use only City of Northampton status ofPer—mit Building Department r Cum CutlDrveway P6i.Tn 1 F 212 Main Street SesnedSeptic' vaiTab�tity Room 100 tt(ater/,WeII.,Auaiiabifity Northampton, MA 01060 Two`SetsafStructtialFlans phone 413-587-1240 Fax 413-587-T2Z2__ n APPLICATION TO CONSTRUCT,ALTER,REPAIRj`ENOVATE OR DEMOLISH A 6NIE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION J 4` APO 2 9 2008 1.1 Property Address: .. _ This-section tol be completed by office 6 7 F/•4W/P( S7—ree "map r _--��' Unit Zone Overlay District Elrri St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Recor . PV7 A— D -p6o ' ' S7e Ly. G „ �t /Vag-►�.,� Name()Wt) C n-ent actin Addre�; /Y1 SSet— � � X �< � 5 �� 1 A.k Te phone Sign Lure 2.2 Authorized Agent: Name(Print) Currbnt Mailing Address: (p ( n `L Sign r Telephone CTION 3-ESTIMATED CONSTRUCTION COSTS` Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building / ��U (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of o1u Construction from (6) 3. Plumbing a Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) O d G' Check Number This Section For Official'Use.Only . - Building Permit Number Date:Issued: Signature: Building Commissioner/Inspector.-o ui mgs- - Date File#BP-2008-0732 APPLICANT/CONTACT PERSON RICHARD RIVET t ADDRESS/PHONE 209 PROSPECT ST CHICOPEE (413) 536-8544 PROPERTY LOCATION 67 HAWLEY ST MAP 32C PARCEL 226 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out f Fee Paid T_ypeof Construction: CONSTRUCT 2 STORY 2 FAMILY HOUSE IN PLACE OF FIRE DAMAGE New Construction Non Structural interior renovations _ Addition to Existing Acccssory Structure Building Plans Included• __Owner/Statement or License 080106 3 sets of Plans/Plot Plan - THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN`F ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ — —_ Intennediate 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 Permit DPW Storm Water Management Demolition Delay Signature of Building Officia 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. ��v 5 C�G�,uA �iz T,.v�— o� — �,� f _ /y/,�� Al 1774 e,li e.1S 041v� 0 40 A, r / T-(7 O)q 5 dry -X �OV-L�Gl 4p cyo/.! 67 HAWLEY ST 3P-2008-0732 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma L lock: 32C-226 CITY OF NORTHAMPTON Lot:-001 Pl i•{ _ :'. GivTRACTING WITH UNREGISTERED CONTRAC'T'ORS Pemut Building DO NOT HAVE ACCESS 1'0 THE GUARANTY FUND (MGL c.142A) Categorv:FIRE RESTORATION BUILDING PE I , Permit� BP-2008-0732 Project P JS-2008-000687 Est. Cost: $178000.00 Fez: $2978.25 PERMISSION IS HEREBY GRANTED TO: Const. Class: 513 Contractor: License: Use Group: R4 RICHARD RIVET_- 080106 Lot Size(sn.ft.): 6'I 85.52 wlwner: SEMERBA_N AMY Zonini�: URC(100)/ Applicant, RIVET .1'r- 67 HA\/1JLEY �"T ApJJlicant Address: P11011e: Insurance: 209 PROSPECT ST (413_) 536-8544 CHICOPEEMA01013 ISSUED_ON:4 12912008 0:00:00 TO PERFORM THE FOLLOWING fVORK.CONSTRUCT 2 STORY 2 FAMILY HOUSE IN PLACE OF FIRE DAMAGE � Q oK POST THIS CARD SO IT IS VISff:_LE FROM THE STREET Inspector of Plumbing Inspector of'Xiring D.P.W. Building Inspector �3��k �p SEA(?re�-�'I Sc�(`�✓� nK' Underground: Service: '�� Meter: Footings: Rough: _f i�==, ,,',{ ought house# Foundation: F!1(ct� 1 i Driveway Final: Final: .! f4_ Fin:l.: Rough Frame:01KVC { LfR t Gas: Fire Deoat-:mr__ Fireplace/Chimney: Oil. J� Insulation: Rough:j u j x_.17"� Wes- !`t l jj G Final: Final: _� gyp;` awoke: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUI ATIONS. i / > Certificate of Occupancy - _ Signature: FeeTyue• Date aid: Amount: Building 4/29/2008 0:00:00 S2978.251356 i 212 Main Street, Phony:(413)587-1240,Fax: (413)587-1272 Building Conim ssiuner-Anthony Patillo f'