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212 Alain Street ' Alumcipal Buddiq� 0
Northampton, AWR 01060
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SECTION 8 -,CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Addr4ss Expir tion ate
S e tune Telephone
�9 Reglrster'ed Honeslmprovement Con'fractorti; r,; '{„k„ Not Applicable ❑
Ieveh 11 L���l�l� - -- --_091 C6 —_
Company Narne Pe�istr,3tion Dumber
Address
Da'c
_Telephone_Ski- 0i-__-__-
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted ` u ;pp _;tior. failure to provide thl, a;f:ca,,,it
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
1�1 :6mei fwnerl emq
The current exemption for"homeowners” was extended to include Owner-occupied Dwellings of one(1) or two(2) .anii:ies
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor-. CNIR 780. Sixth Edition Section 108.3.5.1.
Definition of I lomeoNvner: Pcrson (s) who own a parcel of land on v0iiclt he she resides or intends to reside, on which there
is, or is intended to bc, a one or t>>.o family dwelling, attached or detachu d 11 uctures icccssoi v to such use and/or farm
structures A Person who constructs more than one home in a two-yeal Period shall not he considered a homeowner.
Such "homeowner'' shall submit to the Building Official, on a form to the Official, that he/she shall be
responsible fur all such Nvorl: performed under the building permit.
As actino Construction_Supervisor your presence on the job site will he ilollr time to t'me, during and upon
completion of the work f( which this permit is issued.
Also he to Chapter 1?? abilit% of Employers
Employees i<)r injuries not resulting in Death) of tite Massacltuselts Gen:
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all apalicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. Demolition❑ New Signs [ ] ec s ] Sidin'g [ ] Other [r]
Brief Description of Proposed Work: _ � -{4e61C o-"
Alteration of existing bedroom Yes X_ No Adding new bedroom Yes 'C No
Attached Narrative ❑ Renovating unfinished basement Yes _ -_-_-No
Plans Attached Roll ❑ - Sheet,
sa if Newr;Fiouse and 'or:'addition to e_xistiDg h"ousin , complete fie.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?__ - e � ` 11
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?
In. Type of construction
i. Is construction within 100 ft. of wetlands? Yes _ No. Is construction within 100 yr floodplain -_--Yes ___ No
I. Depth of basement or cellar floor be!ow 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
I, _—� YYt✓IC� — _ _ as �,=r c c subject propert\
7
hereby authorize �� ,iIL'�1 C�.v<d, r° _- to ac: on
my behalf, in all matters relative h�� �: j ;� th nuildirg permit ar,phcation
Signature of Owner Date
hereby declare that the statements and infonmati�. on the foregoing application are true and accu .it( to the best c` nay
knowledge and belief.
Signed under the pains and penalties of perjury
r
Print Name
Signa,KuYe of Owner/Agen 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 re.
Frontage
Setbacks Front , �-
,�G.Ivt�?-
Side 1_: 1 R: ;ti'0_ L: �R:
Rear '
Building Height , r
Bldg. Square Footage 3 6 %
J
Open Space Footage
(Lot area minus bldg&paved
parking) J
#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 DCP"' I KNO`,V YES
IF YES: enter R( Page __- and/or Doi u� er:i it
13. Does the site contain a [;rook, L,o(iv of water or wetlands? NO J LIOT_f KNOW _
YES
IF YES, has a perm[! l,,en <,r reed to be obtained from the Conservation Cofw:iissic)W
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:_
Depalt erit"use fly <.:
City of Northampton SL dtus`o�fP rrprt
Building Department CuibCut/D '.veway
212 Main Street Sewer/SepJ6 arlab
Poom 100 Water`/Wel va l iff�
Northampton, MA 01060 Two Sets of�Strctural P arcs
phone X13 587 124 0 Fix 4 1 3
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 f'reperty Address.
This section to be completed by office
< Map -- ��e' Lot ! Unit
Zone
' — - -- _�------ ---- ---- —_- Zone Overlay. District
- --
Elm St. District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r
r, 4
,Vldress
2.2 Au_t-horizecl Agent
i n
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
----------------------------
E;uilcilnr Permit Fee
This Section For Otticial Use Only —_
R,,jildmg,, Permit Nurr -Jer:
-- -
mldm tili toner i i " � -
i I
File#BP-2003-0949
APPLICANT/CONTACT PERSON Steven Zucchino
ADDRESS/PHONE 70 Gleason Road (413)584-3878
PROPERTY LOCATION 44 ELIZABETH ST
MAP 25C PARCEL 133 001 ZONE URB
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: REBUILD DETACHED GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 021356
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PWENTED:
Approved VAdditional 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 Co 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.