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Project: Kaculis
Date: 11/14/00
Proposed Work:
Install 2 x 4 @ 16"o.c. framing at interior surface of existing concrete/
cinder block walls; re-route heat ducts @ ceiling and box-in; install furring
over existing ceiling surface; construct new exterior wall (2 x 4 @ 16"o.c.)
to accomodate new 32" exterior door and (2)joined 2' x 5' double-hung
windows (Andersen or equal); construct 3' x 8' bracketed overhang; apply
exterior trim and siding (wood) to match details of existing structure; repair
existing stairs, add riser boards and reinforce stair trusses; apply
furring/framing to lower stairwell walls; install electrical outlets, smoke
detector(s) and lighting as required by code (NEC); Install R-13 fiberglass
insulation and 6-mil poly vapor barrier at all exterior walls and walls
common to unconditioned adjoining interior spaces; install and finish 1/2"
drywall at walls and ceilings; install ceramic tile floor at existing concrete
floor; install wood door/window casings and sills at new and existi
door/window openings within room and stairwell; install baseboards; install
misc. other trim as needed.
OS`YNJW PLO ("'se–\-
9 e �aSfACI(Itftilf —
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFFIDAVIT
(liccn-urJpem�ittee)
with a principal place of business/residence at:
(Phone#)
(strtxs/ciry/statrJap)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Innuanrr_CnrnPatrv) (Policy Number) (E)cpiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contrnctor) (Insurance Company/Policy?dumber) (Expiration Date)
(Name of Contractor) (Insuran(e;Company/Policy Nnrn)u) (Expiration Date)
(Name of Contactor) (Insurance Company/Policy Number) (Expiration Date)
(etlach additic"c`xc(if ncccnary tc;ii d irforznation paxtaiaing to all ooa'sadon)
( j I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plesx be aware that while hoaica a who employ pct-w=to do oaaintc mnsw too or repair work on a dwelling of
not mo"then[ties units in which the homeowner rni cs or ou the gousxis appurtenant thereto arc not generally w¢s0cred to be
ernpioyera under the worker's oration Art(GL152,ss t(5)�application by a homeowou for a Eccase or permit may evidence the
legal rtatua of an employer undertba Worirees Compemat Act
I unde stead thst a copy of this cratemcm may be forwarded to the Dcparancna of lnduaUiel As &.&Offioe of lnoxxoce for the
coverage wxifiCejoo and that failUM to soaue coverage smdes soetion 25A of MOL 152 cxn lad to the ltmpwition of criminal penalties
comisting of a floe of up to S 1,500.00 and/or imprisonment of up to one year and civil peaL ies is the form of a Stop Wort Order and a
fine of S 100.00 a day against me.
For deps7tNumbexr xY
' t permil of
� �_
r -
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: � Not Applicable ❑'/
Name of License Holder: �l _[�SH j�F� �.f'�- 0 7 9 15 7r"6
License Number
Address f sz Expirati n Date
�. y ._ o ��i
Signature Telephone
9 Reg[,rtre�i`Noiltei �b eit Cs3� Not Applicable ❑
EGA .— ,moo t/ a�lS /C � Z-a
Company Nam— Number
Address Expiration Date
Telephone _52/1-07V I
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§2SC(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...... ❑
mem
IN &OW
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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
ss 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 ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes
--,g -No Adding new bedroom Yes _ /No
Attached Narrative D Renovating unfinished basement Yes i�No
Plans Attached Roll D. Sheet
6a. lf.New mouse and,,ar�addifi'ron ta-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. Dimensions —
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 Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L as Owner of the subject property
hereby authorize T�'A--v/ A-,�D�/k�C _to act on
my behalf, in all matters relative to work authorized by this building permit application.
r, c — %
Signature of Owner ' 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_
Signed under the pains and penalties of perjury.
Print Name r
,s
Signature of Owner Agent Dat
. ^
'
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning
Thi�column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&pavcd
of Parking Spaces
(volume&Location)
A. Has Special Pormit/Vahanoe/Findin8exer been issued for/on the site?
N0 DON'T KNOW ��` YES__________
IF YES, date issued:
IF YES: Was the permit recorded at the Registry/fDeeds?
NO DON'T KNOW P"" YES
IF YES: enter Book PaQo and/or Doounoont #
^�
B. Does the site contain a brooh, body of water orwetlands? NO DON'T KNOW
YES _--__-
IF YES, has o permit been or need to bn obtained from the Conservation Commission?
Needs to be obtained Obtained . Date Issued:
C. Dn 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
|F YES, describe size, type and location:
3
Q �
t..
D thampton
Build partment t,
21 i Street /
JAN 30
100
Northa pto , MA 01060
DEPT OpWM0156%124 Fax 413.587-1272
NORTHAMPTON,MA 01060 ft r S i 3
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address This section,4o,be complete_d by office-
g
Map or�_ Lot� i� Unit -
_z Zone Overlay District
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 OwnerlI of Record:
Name(Print) 7 CurreUWailing Address:
f J S Q
^z Telephone
Signature
2.2 Authorized Agent:
Name int) Current Mailing Address:
Sz-�? -a7LI/
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building j Z+ (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =G + 2 + 3+4+5) 50 0 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2001-0664
APPLICANT/CONTACT PERSON David Gardner
ADDRESS/PHONE 13 Plain St (413)529-0741
PROPERTY LOCATION 16 HAROLD ST
MAP 12C PARCEL 056 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
Typeof Construction: CONVERT EXISTING GARAGE TO FAMILY ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 059846
3 sets of Plans/Plot Plan
THEf,MLOWING 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 Commission Permit from CB Architecture Committee
,J,J��u =,A 1- 31- 01
Signature ofBuildinW6ihciaI 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.
16 HAROLD ST BP-2001-0664
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-056 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:renovation BUILDING PERMIT
Permit# BP-2001-0664
Project# JS-2001-1196
Est.Cost: $13500.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: David Gardner 059846
Lot Size(sq.8.): 10802.88 Owner: ZORN MARTHA W&NICHOLAS J KAC
Zoning: URA Applicant: David Gardner
AT. 16 HAROLD ST
Applicant Address: Phone: Insurance:
13 Plain St (413) 529-0741
EASTHAMPTONMA01027 ISSUED ON:1131101 0:00:00
TOPERFORM THE FOLLOWING WORK:CONVERT EXISTING GARAGE TO FAMILY
ROOM
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:`]j4)e f ;�/� House# Foundation:
Final: Final:
Rough Frame:Ojk
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
�
Final: 7-1,?-al
Final: Smoke: /'C'
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc Si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/31/010:00:00 1466 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo