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25C-060 (3) 1 tool k[ UTy~ R � � O w aI i w Nr IT 9 N T e� • G3 .tp Z)V �8 2"x G"TPUsS ac Ry"�`3• Rt/��.1..� tolt'�( LIGHT _ _ _ - - _ - �-�, r L.U, t-,4 10 I sty r cwt 21 Ia" X 2 7 tfa,u TIZi"",N 136' ST R-UC-lt'0 i�_e_ 2G 2.`i x 4'1 X8' 1 1u x-10"'X 10' 2 22 x t o" X 41 7 .31 Y 2 G" x6" ,t8' a . 2 G" x6"" x 1 o' G G'" R G" 2" - - 1 n j 1 � f } T+-t� Try O L �G-H �.t> H 0-T Y U GAT C—>"uc-, cr Fro® 2t� C, .-%; ,,;• _-•''" 'J EX t��1�tG, 'D®tom�. _a._ __,, 1 ! ..x t� a � ''i -'<•,+�sue. �€ t� I K�, F° � � � � ��� ©`�a k i i t I C �iZPN1l= I 2 S I ON t 4 i t z Rkc , 4 z !El L ��tWHp20 �O e� s 9 d �+cssncfitssrtta' 8 <n DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ' WOIUCER'S COMPENSATION INSURANCE AFFIDAVIT I, (liceusee/Permittec> with a principal place of business/residence at: (phone#) (streeUcity/scatrJap) do hereby certify, under the pains and penalties of perjury, that. O 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 o homeowner ircle one) and have hired the contractors listed below who have the followl�g -rker`s compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compau),/Policy Number) (Ex-pimtion Date) (Name of Contractor) (Insurance Comp*ry/Policy Number) (Expiration Date) (attach additiooal Lhcct if ntcCnAry to iachxlc pertaiuing to all coa racon) O I ain a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aw-.uc that v tj i c bc,( o,A ""who czaplay?a-10M to do mamtCaiacr,cc r 7uc on cr MPair work on a dWcll F,of not¢tote than thrre units in he noo«acr residcn oc on the Vc Lr appurtenant th, c arc oo(gully ooesidcrrd to be c`Ployct3 under the worxC " Act(GL152,=1(5)),application by e hortcoa,Yr for a uccwc or PC=it n:ay nidcncc the legal etahis of an employee under tho Wor cot'a compa)ft i n AcL I undera nd th t a copy of thi,etatcmcnt miy bo forwnrdad to tbo Dcpertmcnt of to&L-iUid Accidm&Offioo of Iffuranco for dh covaage verification and that failure to amore coverago'a&,- seetica 25A of?fGL 152 can Icad to thn imposition of u=i' l prn111:es oomisti of a Ene of up to S 1,300.00 andlor imm-uoamx of up to one year an i civil penariia in the form of a Step Wort Ordc and a find 0(5 100.00 a day tgainst tnc - For dcputn-;W—only Permit Number t S N fap;J Lot# rh,. ice of Li crtnittcc e NIL SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 19R°�*^�^ .�.imss^ a�,w�ra'-sa+a.-v�.,�u.�. - .,�•r,fn„-�s._a a S.+Lq m �9. �4u I egistered°Hom ImprovementzContr�ctor �� �� .. 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...... ❑ 4"y � x ., 11:- I3omeO.wnerEempton 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 L.Qcal Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature —t SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Lol Siding [ J Other [ ] Brief Description of Proposed Work: �w�c.�oS�a HoT T �3�7 _es —K s_ g t-k �> Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 5a,.If*,New.-,liduse and Or�a'dditicn tO�existing'h0'using completeAhe f6l7owihj a. Use of building : One Family Two Family Z Other b. Number of rooms in each family unit: 5 7 Number of Bathrooms c. Is there a garage attached? 0 0 d. Proposed Square footage of new construction. G Dimensions a ' X k L` X 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 l' Private well City water Supply l SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, _ as Owner of the subject property Hereby authorize to act o� my behalf, in all matters relative to work authorized by this buildinF, permit application. 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. Signed under the pains and penalties of perjury. Print Name Signature o Owner/ t Date x 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 Frontage Setbacks Front to Side L: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % D (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 # 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. Are there any proposed changes to or additions of signs intended for the property ?YES No ' IF YES, describe size, type and location: x City of Northampton Building Department G 212 Main Street ;S r Room 100 a Northampton, MA 01060 Tj es;o" phone 413-587.1240 Fax 413-587-1272 Plo �zote P a t s a' '' Otier�Speclfy-�� ,- ��, 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, L L I ►.3 Lca �� Map Lot Unit 1�}c�Z-i-rr'"A; C- ►" Zone Overlay"District Elm St. District CB District" SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ��:���t�..►`i N1 i�--V_���-t1� ` 1 ��tJ C.,G L.►J A. li� _ Name nt')-; Current Mailing Address: L C Telephone Signa e I '3 — 5 ?� - `7 L C' C 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Tctul Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building Permit Number: [Date Issued: Signature: Building Commissioner/Inspector of Buildings Date ZONING BOARD OF APPEALS FINDING APPLICATION FOR THE CITY OF NORTHAMPTON (Change of a Pre-Existing Non-Conforming Use or Structure) 1. Applicant's Name: 'i Address: it L-i&j ce t,-►.l NU E—. tJearr.r.a.vro>„ Telephone: 2. Property Owner's Name: ! N=cJ 5� lre e t am� s Address: t t ituc ee A vc� 6:) Telephone: s 6c- - '?GCS S- 3. Status of Applicant: Owner ,' Contract Purchaser_ Lessee Other(explain) 4. Parcel Identification: Zoning Map# 25G Parcel # 6-0 Zoning District(s) U�,�, Street Address: t� L-.o.�c--o�,&-= Po=- k3 aP--r WLt�6>J Property Recorded at the Registry of Deeds: County: HA-M Pas N,2�_ Book: Page:3i t 5. Finding is being requested under Zoning Ordinance: Section - 3 Page 1� - 6. Narrative Description of Proposed Work/Project: (use additional sheets if necessary) E►JGt�g�D Tc�oC_ St-11'7 C I+pT Tub p��t� 7. State How Work/Proposal Complies with the following Finding Criteria: (see also Section 9.2 ; for Signs Section 7.0). If the change, extension or alteration conforms to zoning in all respects, no Finding is required. *Explain why the existing building, lot or use is legally pre-existing non-conforming. (Buildings, lots or uses that are in existence at the time new zoning is enacted are protected under grandfathering rovisions) & 1 001 5 9 r *Does the change, extensi or alteration create a new violation of the zoning,,which wot d require a va iancc'? Yes No If Yes, explain how: P *Explain how the change, extension or alteration shall not be substantially more detrimental than the existing- nonconforming use to the t neighborhood: � �.k 0 UY _100 r+(0- oc 8. Attached Plans: Sketch Plan V/ Site Plan None Required 9. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. I(or the landowner, if I am not the landowner) grant the Zoning Board and Planning Board permission to enter the property to review this permit application. Date:_ Applicant's Signature: Date: Owner's Signature: (Owners�ignaterlfrom ner authorizing "" applicant to sign.) r 10. Do any signs ebst on the property? YES NO l' IF YES, describe size,type and location: Are there any proposed changes to or additions of signs intended for the property?YES NO IF YES,describe size,type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. this colIIma to be filled in by the Banding Department Required Existing Proposed By Zoning Lot size I a Frontage loo rn Setbacks - side L:66/ R:—'L L: &6+ R 9 i D - rear Building height Bldg Square footage 17 � Q %Open Space: f'�£n �' Lot area minus bldg 153 Q &paved parking) # of `Parking Spaces - f of Loading Docks Fill: (vol-u.me--& location) 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowle DATE: t Eau c�. Z APPLICANT'S SIGNATURE NOTE: Issuance of a zoning permit does not relieve an p cant's burd o oomply wltla_all zoning requirements and obtain all required permits fro the Board of Health, Conservestio Commission, Department of Publio Works and other applloable permit granting authoritiesn. FILE # k ail A)j — o i File No. 3 o) yal IN PERMIT APPLICATION (§10 . 2) TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: k( Telephone: 2. Owner of Property:__ Address: �� Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# c;T(2, Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property 2 J=A t4,%,t_-/ t-to r­4 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 7. Attached Plans: _�_Sketch Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. 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# 9. 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: (FORM CONTINUES ON OTHER SIDE) File#MP-2003-0021 APPLICANT/CONTACT PERSON ROGERS STEPHEN M&HARRIET ADDRESS/PHONE I I LINCOLN AVE (413) 586-7605 Q PROPERTY LOCATION 11 LINCOLN AVE MAP 25C PARCEL 060 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ONING FORM FILLED OUT ee C Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT DECK W/2ND STORY TOOL 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 FOLLOWING ACT19N HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRES TED: 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 t1 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 Commissio _ e Ica 7 ---- 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 the Office of Planning&Development for more information.