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17A-298 1 S �. 15 ro cx LID P LA-+J u 9 Bach,Florence008.JPG 'U L - 3 2003 3 -"G Bach,Florence005.JPG Bach,Florence010.JPG +�04�11AMP�O � e Crz�r �# Paz#I�ttnt�f�tt t a a �ttasarlinstua DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKEWS COMPENSATION INSURANCE AFFIDAVIT L C 0 c-k S c\_(_0bS r (license&permittee) with a principal place of business/residence at: ')F� 01x6 Z-(phone#} - (str=Ucity/staW7ip) do hereby certify, under the pains and penalties of perjury, that: I" 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 proprieto , general con%ct or r homeowner (circle one) and have hired the contractors listed below.who ve ollowi ng worker's compensation policies: (Name of Contract r (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Po cy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (anach ad 60021 sheet ifneo-7 to inohsde kdbrmatioa patn;aing to all cod raotm) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homcowocra who employ perw=to do maiatt masuuctioa or repair work:on a dwelling of Wt more than throe units is Which the bomeowocr midi or on the grounds appurunwd thetcw are not Cawal1y ooasidcred to bo employara Under the workers comp=sation Act(GL152,m 1(5)),application by a homeowner for a license or permit may evidcnoe the legal eiatua of an employee under the Workeea Compematioe Amt I undmund that a copy of this ctat mxa may be forwarded to the Dtpwmce2 of Induatrid Acddcats Offioo of InwrRam for the coverage vc ficdicn cad that failure to aware covnuge under section 25A of MGL 15Z can lead to tha�imposition of aimmal peaaitiea consisting of a Sae of trp to 51,500.00 andtor imPViSOUMCUt of up to ace year and civil pesntties in the form of a Stop Wocit Orris and a 1 flue of 5100.00 a dry against For depr¢ftWW Use only P.cilaitNumber Map# Lot# Si Li ermi lk i ;aEDT�GN15 C 0.616 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: t \ ��° b C'S O 3� License Number Addre Expiration Date J Signature Telephone r ' Not Applicable ❑ n ,.,RIJN=„ t 00,Kd!1 Comp nv Name r� t11, Registration Number } Address Expiration Date q tir Telephone 1 SECTION lop iWORKERS°''CQIVIPENSATiON INSURANCE AFFIDAVIT(IVl G L 3c 3152,§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 E� SC T3 � USED WOR ec g e !.-""'4410 a ,,Wm h New House ❑ Addition Re lacement Windows Alteration(s) P� Or Doors ❑ t�,�� L&1 Roofing ❑ Accessory Bldg. ❑ Demolitiong )4'y-14 New Signs [ ] Decks [ ] Siding[ ] Other[ ] 'Decx Brief Description of Proposed Work: j?t--4lerkz' 14X1q, ye:161 4/671IVIXIV sc S.,. pa-91.,Alteration of of existing bedroom Yes__�L_No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes _X No Plans Attached Roll ❑ - Sheet a. Use of building : One Family 1— Two Family Other b. Number of rooms in each family unit: Number of Bathrooms_ c. Is there a garage attached? I� C;5<, / d. Proposed Square footage of new construction. It s.F Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. DJ Mascheck Energy Compliance form attached? Kw h. Type of construction i. Is construction within 100 ft. of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade N k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply _ 1E{�1T t N 7 „ OV� R 1 ..HCI ... -ION- 'O B �COtVIPL 7`b b WHEN OVIS AGNT OR C©NTRAC�"QR;APPLIES FOR BtJNtbMNGERNlNT f 1�A tt as Owner of the subject property hereby authorize �A M 0 �'�—o c- G-b to act on my behalf, all matters relative to work huthorized by this building permit a pli ation. Signature of 04eq 04e 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 a d penalti of perj ry. c=am Print Name _ - 2, Signature of Ow er/Agent Date Section 4. ALL INFORMATION MIDST 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 3� Frontage I I S I Setbacks Front Side L: ?2-' R: 157- 5 L: R: Rear , Building Heigh Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved �Ip� ' 7 , 5 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? NOi— 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 j`' IF YES, describe size, type and location: D. A there any proposed changes to or additions of signs intended for the property ?YES No Z IF YES, describe size, type and location: f Northampton B I ing Department Main Street I ;doom 100 + s';ii__ 3 %q10 rrjpton, MA 01060 hone 413- 87-11240 Fax 413.587.1272 CC.': TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING r SECTION"1-SITE INFORMATION This sects to be c pteted y offt e' 1.1 Property Address: �n � � � D vie— Lot it N� Zdn@ Over a D Clct x Elsa 5t`District SECTION 2-!PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 02:7—1 Telephone Signature 2.2 Authorized Agent: Cccl\ Scv-605 ? �/1 "•fi+�\k Name(Print) ; Current Mailing Address: Signature v Telephone ,SECTIO!N 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building G rQ (a) Building Permit Fee 2. Electrical ( `I (b) Estimated Total Cast of Construction from 6 3. Plumbing g�0 Building Permit Fee 4. Mechanical (HVAC) �ZfQ 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) Check Number r" Thk:Section"For Official Use"Onl Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2004-0015 APPLICANT/CONTACT PERSON Barron&Jacobs ADDRESS/PHONE 30 NORTH MAPLE ST (413)586-8998 PROPERTY LOCATION 148 HILLCREST DR MAP 17A PARCEL 298 001 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: REPLACE 14 X 14 DECK W/SCRREN PORCH&REMODEL KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• - Owner/Statement or License 030739 3 sets of Plans/Plot Plan THE F IL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 2� 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. , s = BP-2004-0015 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0015 Project# JS-2004-0025 Est.Cost: $88000.00 Fee: $376.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Barron & Jacobs 030739 Lot Size(sq.ft.): 20342.52 Owner: BACH NEIL D&JOAN E Zoning.URA Applicant: Barron &Jacobs AT. 148 HILLCREST DR Applicant Address: Phone: Insurance: 30 NORTH MAPLE ST (413) 586-8998 Workers Compensation FLORENCEMA01062-1367 ISSUED ON:7114103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 14 X 14 DECK W/SCREEN PORCH & REMODEL KITCHEN 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• Receipt No: Date Paid: Check No: Amount: Building 7/14/03 0:00:00 7887 $376.40 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo