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23D-124 (3) .ti t .v! SAo en - 999z of 1 B.6 �c m 8909 5 yj '1 tu go m ® n 990 999t C ry �B99r m y B90E a a s�vV soOl�4 2 sanSS o �.�.'nv�sIf SECTION 8-CONSTRUCTION SERVICES 8.1 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. Signed 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) Roofing Or Doors ou D'u' Accessory Bldg. Demolitio w 4 wg New Signs [ ] Decks [ ] Siding[ ] Other[ ) Brief Description of Proposed n Work: Cnna Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Ye No Plans Attached Roll -Sheet a. Use of building:One Family�_ Two Family Other b. Number of rooms in each family unit: 7 Number of Bathrooms Z c. Is there a garage attached? ND d. Proposed Square footage of new construction. Dimensions e. Number of stories? Z-- f. Method of heating? v i E;A A& - i�_X)$T(W C- Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction N i0a uj i. Is construction within 100 ft.of wetlands? Yes ko. is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 7, k. Will building conform to the Building and Zoning regulations? Yes No. 1. 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 1, & �� as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit ppli tion.ILI Signature of Owner Date 1, 9�PM kA AJ b Iv C O KS71 UC7-10 as Owner/Authorized Agent hereby declare that he 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 Nam Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Informtion Existing Proposed Required by Zoning This column to be filled in by Building D"bpartment Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height 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 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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: E. Will the construction activity disturb(clearing,grading,excavation,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. rr� P- [;� 6 v [P nn L= ity of Northampton OCT 16 2014 uiiding Department 212 Main Street Electric,Plumbing&Gas InspsawN Room 100 Northampton,MA 011 rthampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 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 /–7&_ �� c� 7— Map Lot Unit zone Overlay District — El SL Dlstrlct CB DisMct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AN Nil+ ftb7,-f-/Z „ lnzmy 1-76 fj; FKi '57- f L6ALC - _ Name(Print) urrent Ma iliing Address: /c 4:2 % /2 72-j ( Telephone Signature re 2.2 Authorized Ascent: N 'P- 1 A NamPrint) Current Mailing Address: yt 5;32---I�1J Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building O6 ASo (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing cs=�) Building Permit Fee / 4. Mechanical(HVAC) 6 �� 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 File# BP-2015-0440 APPLICANT/CONTACT PERSON JAMES O'SULLIVAN ADDRESS/PHONE 264 BUCK POND RD WESTFIELD (413)532-1312 PROPERTY LOCATION 176 FEDERAL ST MAP 23D PARCEL 124 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Z ZIP, Fee Paid Typeof Construction: REMODEL 2ND FLR, RELOCATE BATH, LAUNDRY New Construction Non Structural interior renovations Addition to Existin Accessory Structure Building Plans Included• Owner/Statement or License 66335 3 sets of Plans/Plot Plan THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I FO ATION PRESENTED: 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 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 D I y Ao/1) Signature of Building bffici al 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. 176 FEDERAL ST BP-2015-0440 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 124 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-2015-0440 Project# JS-2015-000806 Est. Cost: $33000.00 Fee: $198.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES O'SULLIVAN 66335 Lot Size(sq. ft.): 20952.36 Owner: TRINIDADE BRUNO Zoning. URB(100) Applicant: JAMES O'SULLIVAN AT. 176 FEDERAL ST Applicant Address: Phone: Insurance: 264 BUCK POND RD (413) 532-1312 WESTFIELDMA01085 ISSUED ON.1011612014 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL 2ND FLR, RELOCATE BATH, LAUNDRY 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 10/16/2014 0:00:00 $198.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner