17A-290 (2) SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ' - Not Applicable ❑ <
Name of License Holder: Qj&. — V-. 0A yxJ� CS 4-7 05
License Number
L; i le, jai li�
Ad ess Expiration Date
k — `Z L
Signature Telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
����1 i1 11��2TUN VW 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...... (7 CP%v
11. - Hahne Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied DweHines 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 Alterations) Ff Roofing
Or Doors E3
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [M Siding[❑] Other[❑]
Brief Description of Proposed P
Work:�Tl# `Q jt it �P �$ �)L1V qk_5 1 S fmv �:k-e�1�r'�t ZQ��t.1A�&_ S 1� >t Z` Tt
Alteration of existing bedroom Yes No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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. Dimensio
e. Number of stories?
f. Method of heating? F' places 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 ands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement liar floor below finished grade
k. Will buildi onform to the Building and Zoning regulations? Yes No .
I. ptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l L-:,/ 1P i(a, as Owner of the subject
property
hereby authorize
to act on my beha in all matters rel tive to work authorized by this building perm it application.
/
Signature of DKner I Date
P�p �/�/�P•�, ,1'j 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.
'W g"
Print Name
�-
Signature of Owner/Agent Date
t �
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Xfilleby
This column to Building Depart
Lot Size
Frontage
Setbacks Front
v �
Side L: R: L:
Rear
Building Height lc
Bldg. Square FootageP/o
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parkin S s
Fill:
ume&Location
A. Has a Speci ermit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES 0
IF YES, date issued:"
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 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 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , 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:
E. Will the construction activity disturb(clearing,grading, ex ation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
S `
Department use only.
I � City of Northampton Status of Permit,
Building Department Garb Cutlbrive ayPerrnit
r ��i4 212 Main Street Availabil
r-.1 Room 100 WaterlWoll Availability.
Northampton, MA 01060 Two Sets of Structural Plans
� h 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
l,p VAA AV tz y t)U Z Zone Overlay District
Elm St.District ` CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
L,-(Diet 5Aiz1i-t` L f C) iQ "\L_iC'2V"-' �� �V� F{ .t-r "c 1i1fl °%mz
Name(P Current Mailing Address:
n Telephone
Signature
2.2 Authorized Acient:
1�-vC�Pi VV �i ,2 �� SCR-��'►c�r C �Tt-�aN
AIA
Name(Print Current Mailing Address:
4.13 - S64 -
I ZZ d
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �& ` Y6 (a)Building Permit Fee
2. Electrical 4T (b)Estimated Total Cost of
Construction from 6
3. Plumbing ,1 i Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) U Check Number
This Section For Official Use Onl
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
oil
File#BP-2014-0982
APPLICANT/CONTACT PERSON ROBERT WALKER
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413) 584-1224
PROPERTY LOCATION 68 HILLCREST DR
MAP 17A PARCEL 290 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: REMODEL BATHROOM&REPLACE SKYLIGHT
New Construction
Non Structural interior renovations
Addition to Existing
Accessoa Structure
Building Plans Included:
Owner/Statement or License 034783
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
_—,,PCfproved 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
8De
4sire 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.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
68 HILLCREST DR BP-2014-0982
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-290 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2014-0982
Project# JS-2014-001704
Est. Cost: $19500.00
Fee: $117.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT WALKER 034783
Lot Size(sq. ft.): 31929.48 Owner: SARRO LYDIA&JOSEPH F BARTOLOMEO
Zoning:URA(100)/ Applicant: ROBERT WALKER
AT. 68 HILLCREST DR
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:312712014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM & REPLACE SKYLIGHT
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: Rough: House# Foundation:
Driveway Final:
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:
FeeType: Date Paid: Amount:
Building 3/27/2014 0:00:00 $117.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner