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32C-277 (3) IX-2" 7 2'-11 T-9"------- 2,.6fr A/ 2'-0"x 6'-8" C( Z-O"x 8" C\I I C4 living room collar door CV) I- entry CO z 84 Williams St k Northampton, MA. oo 01060 00 7 kitchen k CO 3' 2ffi:':-- OR rM 00 n 2'-0' SC*-82-0"x 6-8" C 101 '09 -101 1Z-5" Cb 0: 6 x I-W-81-1 3"4 rear entry N 2'-0"x 6'--8" CO 2=0"x�,8" W living room cellar door entry 84 Williams St X .� Northampton, MA. 00 01060 , I 00 C4 kitchen ! o ha lCO CN N I � 2'-0"X 6'-ffl=0"x 82=0"X 6�-8" C 4-1 -8 Cb V �1 1 5„ existing bathroom 'V — _— pant .�aMOyS/9nl i MI-0-0 '09 =6' x 6=8" --- _ - ��- - 10-11 '=-T-3 , rear entry r 04-�L PTO a $ Gift laf wart fittllyfell B B :sartchttsrtla e DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WOR- ER'S COMPENSATION INSURANCE AFFIDAVIT A&' Ie� klerw�el,-_ (liceuserJpermittee} with a principal place of business/residence at: ZV119� ­7 (phone#) (streei/city"/state/ap) do hereby certify, under the pains and penalties of perjury, that. ( ) I am an employer providing the following ,,vorker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) O 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) ,. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insttran(-- Company/Policy Ntunber) (Expiration Date) (Name of Contractor) (Insurance Company/PaHcy Number) (Expiration Date) (attach additional slxci ifntc�u to include iafocmxEoa pertaining to all cccltracton) ( I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homcowven who cmplay pczons to 63 c.aintcnancr,ocrr ioa or repair wwk on a dwelliag of not mote than throo traits in which tie homoowvcr raid,=or oa the gcounriz appurtenant thereto arc not ccrr ly ooruidacd to be cmployrrs under the worker's c=rpe tioa Art(GL152,ss 1(5)),application by a homcowricr for a lieeme a plr'n may widen",the legal status of an employer under the Wockods Compomation Art_ I understand th,d a copy of this cutcmmt may be forwarded to tbo Dcp�of 1.&,,t6 l Aocidrnif Offioo of Inavaooa for the ooveagc vaificatioa and atat failure to secure oovccngo under section 25A of MOL 152 can Icad to the imposition of aiminal pcaaliies oonsisti of a fine of up to S!. 00.00 anNor imprisoanxtti of up to one year and civil pmaltia in the form of a stop Work Or'cie and a fins of 5100.00 a day For -�Yr Sig-ature o Li ermittee e 3 SECTION 8-,CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone o DIM Applicable ❑ �Re S grg �i m�arovement Contractor ;, a PP i JVr IZ Company Name Registration Number ('ivy Sfu^y .�i } /�jr 1.1131A r Address Expira ion Date 4 'u Telephone SJ 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-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 bESCRIPTION OFPROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition New Signs [ ] Decks [ ] Siding[[ ] Other [� t Brief Description of Proposed Work: 1.1 Era ry t r nr -a/tT,�—P - S'7ieYf e ew Alteration of existing bedroom Yes No Adding new bedroom Yes o Attached Narrative' Renovating unfinished basement Yes _ No Plans Attached Roll ❑ - Sheet 5a1f.N:ernrhou e�a "i�dr��tldition t6'�existinghous`in,�,�'corri"plete'tYiecfol"low�n� 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 1­4 (C t a `' ��� as Owner of the subject property hereby authorize _ to act on my behal , in all matters relative to work authorized by this building permit application. Signature of Owner Date I, fA- A /9 , 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. PA 's21 C Print Name Cj -�� -p�- Signature of Owner/Agent Date s , 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 ` t Lot Size / Frontage Setbacks Front Side R:_j L: _ R: l�_ Rear 36' Building Height Bldg. Square Footage % 'U G' Open Space Footage % (Lot area minus bldg&paved parking) }(J/� I l }/(/ I #of Parking Spaces V 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: f 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 IF YES, describe size, type and location: fi gCit of Northampton 5 a Department Cur ct.`I : in Street See t. i R m 100 a 6rtha r Dn, MA 01060 hone 413-58 p 413-581!7-12 0 Fax 413-587.1272 Pio sit eAl'y ys fi TnE Ti N Oterp>w ► f � APPLit�STFOf�� TER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section§to b,e,compI te,1d l off ce c4 W / LL► r'tS JI' Map + �'Lot� 1 R`, Zone 4O rerlay b►str►ct� Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f -i�fCl� G— �©5 �( 5-,j CJLIU �� Si Name t (Prin� G e ' rent Ma il�g Address: �5�,4 A4PTc-�',a-a 7e (4, 3) 50-7 � 2.2 Authorized Agent: y [ �' � i/ �•, i ��� f`Lf'i'_`�/'�1"7 ��-�i�L1���JC�.t�i ��i�� Name(Print) XI' Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION-COSTS Item Estimated Cost(Dollars) to be Official Use Only com leted by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing /Sc�'�'f,�, Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) C�4;��� Check Number Q� This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2003-0388 APPLICANT/CONTACT PERSON LACROSS PATRICIA � e ADDRESS/PHONE 52 OLIVER ST (413)527-2582 O �..�.�, 5a7 4 ass PROPERTY LOCATION 84 WILLIAMS ST MAP 32C PARCEL 277 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ENLARGE BATHROOM, SHEETROCK,NEW DOORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOWATION PRESENTED: to�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 C ssion 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. f n. of, s, 4 A" dX t y: i 84 WILLIAMS ST BP-2003.0388 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-277 CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate&M:Non structural inteMor rMowtiuns BUILDING PEMIT ermit# }.P-2Q03-0388 Project# .15-2003-Q§57 Est.Cost.$ ,75Q0 4 PERMISSION IS HEREBY GRANTED TO: Coast,Class: Contractor: License: Usc9LOW: FIVE STAR REMODELING_ Lot Size(sq.ft.): 10410.84 Owner: LACROSS PATRICIA zor nY' f _ 4r, _r A{pplicant:.LACROSS PATRICIA Ag&k"t Address: Phone: n ran„nce.- 52 OLIVER ST (413)52'7 2582 O EASfiHAMPTON MAO 1027 rsSrEDfIN:IP/XG/02O:OUTDO TOPERFORM TIE FOLLOWING WORK:ENLARGE BATHROOM,' SHEETROCK, IW DOORS POST THIS!CMW§Q IT IS XLS1_B.,Lg FR E Inspector of Plumbing Inspector of Wiring D.P.W.: Building Inspector Underground:, Semee: Meter:. q Footinv: Rough:141v o�.kr,..� ow# Found Ild"way Ftatd: Final: .� �� Finai: Rough Frame: t7� 10 , 34-a Eirl ,!'-won t FirepiaciOCl ney: , Aw s T 's� K� 41!,"m#o-T t ; g v 1 511- t r # } r ft r M1N , �- ."� . r.