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34-029 (4)
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ILA to ON ❑ sa® :JeNueIaaleM 40 I uea /' sleolwa ; r ".... auo1S ,t/£ ON ❑ sah C :�(a4 6ulouad G�''� :papnioul ION W t i 1 f let- _ SSSSrrrr ..• _. i. Z4� _ - - .{ I j , - — - <- F t - - - - _ _ I 1 t , ._I - _ z I i > ._ ----- - t T :N011diucma so :NOI1VO01/3WVN sor 31Va C-bib H :3NOHd � Ol r pt r :4jLvlxlZS:4 ,LS03 MHOM Vulxal WdS I S100d VV30 A(3(33JL "Aml woo-sloodjeaqAppaj-MMM £Z88-865 (£ xe3 O ad38-t,55 (oos) :lOrow 999Z-b69 (£lb) 4 DEPT Of BUILGlNC INSPECTILXS .�- U E85 gri�l`Oi�'I Pad_ '/ OZOLO VVI `aadom40 g # 'luo Iuawanoidwl 9WOH 10 �� laaJiS Ise3 Hv L99 0Z 0 ano 6881 L l # 'luo0 juawanoadwl awoH yW � '�NI `S�OOd a`d38, J.4031 v Grff� Of XDlrt4allrpf a t s � ,�1:saxcllasctta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Iicenser/permittee} with a principal place of business/residence at: (phone#) (stmeucity/swdzip) do hereby certify, under the pains and penalties of perjury, that: t, '� ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) I am a sole proprietor, general contractor or omeowrier circle one) and have hired the contractors listed below who have the follo s compensation policies: fYM In rac Ctor) (Insurance Company/Policy N Wr"tioa Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml shoes ifz&oc=ary to inciode information pertaining to all ooatradors) ( ) 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 awaro that while homewwnera who employ przsom to do mail tca nrr oonstution or repair worts on a dwelling of not more than throe units in which the homeowner resides or on the groin appurtennni therdo art nat ger7eraily oow0cr d to be employers under the vmrloa'a o=pcns4ca Act(GL152,ms 1(5)),application by a homeowner for a license or permit may evideaoe the legal status of an employer under the Woriceds Compomatioa Acs_ I understand that a Dopy of this statement maybe forwarded to the Deputmmi of rodwix iel Aoc:ideots'OlEoe of Insuranoa for the coverage verificatioa and that ad we to aoatre coverage under section 25A of MGL 152 an lead to the impo oa of criminal P=Wcs oom.isfiug of a fine of up to S1,500.00 and/or imprbo=c:A of up to one year and civil penalties is the form of a Stop Work Order and a fine of 5100.00 a day agninu tnc. For-dcpa total use only Permit Number Map#—Lot# Signahue of Licensee/Permittce ECTION".S-CONSTRUCTION SERVICES .1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 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. gned 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 ,�C�Y ho (c ck appligable New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: //16P-nCt /Jb PC o C_- r-)Q fl- Alteration of existing bedroom Yes V No Adding new bedroom Yes `� No Attached Narrative 11 Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet, u. ,,, 1,;.. ,,. ter, ., � .�. ,2 #. t 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? Type of construction n/ 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 S �TION 7f '-'OWNER AUTHORIZATION-TO BE COMPLETED WHEN OW IERS'AGENT 04'CONTRACTOR APPLIES FOR'BUILDING PERMIT as Owner of the subject property hereby authorize fiQ_ Q_N V ©Q�$ i .� to act on my behalf, in all matters relative td work authorized by this building permit application. (4�vt' M � ( �11(0 1 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. igned under the pains and penalties of perjury. Print Name 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 n Building Department Lot Size 4 ` '*P Frontage G 2J5 Setbacks Front rl�� a Side L: R: UA R: �j 'CP / 0 Rear lot /O Building Height a 0 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 # i contain a brook body of water or wetlands? NO V DON'T KNOW B. Does the site y 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 IF YES, describe size, type and location: 09010 vw'Noid f Nor hampton SN011o3dSN19N1011(1 g D'' artment APR 17 2W11 R a reet Do 00 Northam , MA 01060 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTI0,4-1 :SITE tNFORMATION 1.1 Property Address: This sec#i+an� cin�ete � e ttn 5t IistrtctEt;p&trlct ;- s PROPERTY;OWNERSHIP/AUT ORIZED AGENT 2.1 Owner of Record: ame(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone T T I Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) 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) a- .i)ip Check Number This Section''For Official Use Only Biriiding Permit Number; p �` Date Issued: Signature:' 6uliding Commissioner/Inspector of Buildings Date- File#BP-2001-0805 APPLICANT/CONTACT PERSON BELL ANDRE ADDRESS/PHONE 120 TURKEY HILL RD (413)585-9035 Q PROPERTY LOCATION 120 TURKEY HILL RD MAP 34 PARCEL 029 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid a Typeof Construction: CONSTRUCT 20 X 40 INGROUND POOL 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 OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § —w/ZONING BOARD OF APPEALS 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 Commi ' n Permit from CB Architecture Committee 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. BP-2001-0805 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Buildinq Category: Inground Pool BUILDING PERMIT Permit# BP-2001-0805 Project# JS-2001-1512 Est.Cost: $29393.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size sg.ft.): Owner: BELL ANDRE Zoning: RR Applicant: BELL A N D R E AT. 120 TURKEY HILL RD Applicant Address: Phone: Insurance: 120 TURKEY HILL RD (413) 585-9035 () FLORENCEMA01062 ISSUED ON:4119101 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 40 INGROUND POOL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 4/19/010:00:00 2387 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo