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Q) 10 11 0) 10 10 a) -H F N a �o a U H `� ,a) a x D ca ca tr)m v<r-C E v- U E ---, 4 >a o ?� U wEv s, aro v Q) q>, H o m W N a a H O Sl S4 r-I r.4 a z o E a z o •• •• •• rt m o C ro v k a ro m ro ro o m •• a h � .. .. .. o Q m0 0.1 x x-1 v s, >," k s, z H q O F Xvv U F -�,z ..b k.'~.;r1 v�, > wla icn vC7H HAJ F H x w o m� aJ aJ-H s, w H Q a oz F w aU ortrt qv z x cxw M16 0M av F: [l vin??v a a Q rt 11 H •• v x x x m .,.,'C) .ci v }4 U r F 1)Q H q W w q W I mro a v >.0 ES,C Cam, m E CiH I � ] H U x lf1 x bbb a� W Q S, v v I C Id-1 v 0 rt-0�'r r-Ib x v Cl) oo vvv u a w >,O M W-0 w O iJ C W W iJ rt rt v rt C F ow v (o 4 3 "i'a rt0 0 7rov10 XCs4 0-Hrt10 vvv � 70 Q �x a U U Hw qqq a CO Q m cn W xD 0 F w x w aU of 0 RUG 1 5 20M L SPFC31Ch�, MAI 01060 L L �7 7f,�� fai too r L� , mod ' { ��twr pT O _ F{ tiiE CrI I of po tII&IIIPtoll - _— t — gE �1c3%Rchncrtta _ DEPARTNIE14T OP BUILDfN'G INSPECrt01.'S 212 Main Strcct Municipal Building Northampton, Mass. 01060 «'O RICER'S CO 1TP ENS A TI O N M S URA_N CE A ' A NT17' (li ccnxxJpctmi flee) \I.rlth a principal place of business/residence at: (stTC�tici ty/stal�f2j p) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the followim-, worker's cotnoensn don cove mge for Illy etuplovees working on 0115 job. # (Iasur-n Coo=y) Tee c: Nu--airr) ----- (t=:-pij-,on Date) (�J I am a sole proprietor, general contractor r homeowner ucie one) and have hired the contractors listed below who have the following worker's compen-,.,-tjon policies: +c (-Name o- Contractor) (lnsrmfcr. Coinpa iyiPouc, Number) (EXplr'ahon Date) (Name of Contractor) -- Ras-ttrancc Comoazv/Poky Nuctccr) Date) (blame of Coamctor) Om uranc: CompanyfPot cy Numb,-r) (Expiraon Date) (Flame of Contractor) (Iasuranc-- Company/PoUcy Numbs) (L-xPird ion Datc) . (e(lar,�addi�ocal c'xd if ucc�s�n to a-!ucL inform•^oo P-I inns to.JJ O I am a sole propnetor and have no one working for me. ( ) I am.a home owner performing all the work myself. NOTE:plcs be ewut ttu 1 Jc th�_ca-l�co-���-v�c-r3 ubo cmpioy pciom to o r „ -c�x� rya.fork oa.d..cll��of arx n1arC th•n ( L-IY1 in wbh Ltx L'Crr OU'MY rcaid0 a Oa LbC V'ptIDF)Z'-?uTtCn,ar=ibc,-.D'T ooe C, rr .Uy ooc3i6�c to be cnglloy—tlndc Lbc amp-nz:l�on Aye afvbza6co by a homoowvcr for:lip,cc po-ma r>_:y c idDo«tLc Iegil etaIIu of en-a2ployor under dI Workoe.Comp000llion AeL I uDdrrn rid tha a Dopy of lh i cxatcmcat m.y bo Coe x rdnd to tba pcpartu�cm of ltix i.l ADOdmt� ofL oe of trs—for Lhe coven se vrri c--boa and th_t LiJ—to Linder Ioctioa 25A of MGL 151 an kad to the i Position of aiming!pcaatt CS oomiring of a rrne of up to S I}Oo.00 wwcx-jjn� of up to Doc yc,r end aviJ PcmLt o.LSc form of.Stop Worse Order and. firm of 5100.00.d:y rptnst me / For dc�arux m Uc—T r only ✓/// Pc=t Nutrm G°'� 1�4-3p:; _ Lot SIGD lrr of LiccnsccAIcRiuttcc — D3 te SE '�IC1N#�•CQNSTRU�TIQN�S1=RIIIC�5. I'Licensed Construction Supervisor: Not Applicable [ Name of License Holder License Number Address Expiration Date Signature Telephone ,,;�i', " �i U . i` Not Applicable Company Name Registration Number Address Expiration Date Telephone $ECTI©N 1Q-W©RI ERS'COMPENSATJQN.INSURANCE AFFIDAVIT(MA.Ly 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. igned 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 buildine 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 �✓' y. �''.�;R PT P� 0 c ck all applicahl New House :91 Addition !:JRe placement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. Demolition❑ New Signs [ ] Decks [ ] Siding( ] Other[ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ maim- 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 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 C71QN ,ER AIJtH01 IL47�QN BE,COMPLETED WHEN °OWNERS:A�ENT 09 CONTRAC 0 :'Ai�PU'r r F R.I�UIlk:D1NG 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 wner Date 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 r Signature oy wn rTAgent 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 Building Department Lot Size Id, v �' 77 D �bj ,a Ll f Frontage Setbacks Front Side L: R: L: 7 R: _ Rear Building Height Bldg. Square Footage 2 % Open Space Footage V % (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 1, 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: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Arejhere any proposed changes to or additions of signs intended for the property ?YES _ No // IF YES, describe size, type and location: N orthampton Bui" Department AUG 1 5202 a i n Street Ro m 100 r Mp on, MA 01060 _Ph 0 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 ,SITE;INEORMATItN 1.1 Property Address: S"EdtfON, PROPERTY Q"ERSHIP AUTHQRIZEn AGENT 2.1 Owner of Record: ame(Print) Current Mailing Address- Telephone Signature / V 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone ` ICI ESQ ITC N5TR CTi !QN"COSTS Item Estimated Cost(Dollars)to be Otcaai Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from S 3. Plumbing eftltdtiili g Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5), 4 A&O Check# umber T;h". '.Sactiow For.Gfffcial Us�-bm t undin Permit Number: � Cate Issued: igneture wilding CtrrnMis�aner/Insp6dtor of,bull4i Data e File#BP-2001-0168 APPLICANT/CONTACT PERSON CHANDLER JOYCE B ADDRESS/PHONE 1105 BURTS PIT RD (413)586-1776() PROPERTY LOCATION 1105 BURTS PIT RD MAP 36 PARCEL 023 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid I-? _ Typeof Construction: ERECT 8 X 10 SHED 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 LOWING 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 Comm' Permit from CB Architecture Committee oe Signature of Building icial 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. 1105 BURTS P1T RD BP-2001-0168 GIS#: COMMONWEALTH OF MASSACHUSETTS ✓wBlock: 36-023 CITY OF NORTHAMPTON Lot:-001 Permit: Building Categor}�shed BUILDING PERMIT Permit# BP-2001-0168 Project# JS-2001-0279 Est.Cost: $1200.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq.ft.): 12458.16 Owner: CHANDLER JOYCE B Zoning.URA Applicant: CHANDLER JOYCE B AT. 1 105 BURTS PIT RD Applicant Address: Phone: Insurance: 1105 BURTS PIT RD (413) 586-1776 O FLORENCEMA01062 ISSUED ON.8/17/00 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 8 X 10 S E D 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 8/17/00 0:00:00 2917 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo .. . . _ �; K �� y sr. 1105 BURTS PIT RD BP-2001-0168 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-023 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:she BUILDING PERMIT Permit# BP-2001-016$ Project# JS-2001-0279 Est.Cost:$1200.00 Fee:$25,00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: Lot Size(sc.ft.) 12458.16 Owner CHANDLER JOYCE B Zoning.URA Applicant: CHANDLER JOYCE B AT: 1105 BURTS PIT RD AnplicantAddressr Phone: Insurance: 1105 BURTS PIT RD (413) 586-1776 (� FLORENCEMA01062 ISSUED ON:8117100 0:00:00 TO PERFORM THE FOLLOWING WORK:ERECT 8 X 10 SHED 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: Fina1:0K 1,0-4 _ao THIS PERMIT MAY BE REVOKED BY THE CITY O ORTHAMPTON UPON VIOLATIO OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occugancy i nature: Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 8/17/00 0:00:00 2917 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo